Shoulder rotational profiles in young healthy elite female and male badminton players.

The aim of the present study was to profile shoulder passive range of motion (ROM) and isometric strength for external (ER) and internal (IR) rotation as part of a preseason screening in adolescent national badminton players. Passive external range of motion (EROM) and internal range of motion (IROM) were examined on the dominant and nondominant shoulder in 31 adolescent national badminton players (12 females and 19 males) with a standard goniometer. Muscle strength was examined with a hand-held dynamometer in ER and IR. Total range of motion (TROM = EROM+IROM) was lower on the dominant side compared with the nondominant side in both groups (P < 0.001). Males were generally stronger than females in all strength measurements except for IR on the dominant side (P < 0.01). In females, IR dominant side strength was greater compared with IR on the nondominant side (P < 0.05). TROM was reduced on the dominant side compared with the nondominant side in young elite badminton players, irrespective of gender. No rotational strength differences existed between the dominant and nondominant side in male players, but in female players a higher IR strength on the dominant side was not balanced by a higher ER strength.

K(ATP) channel openers in the trigeminovascular system.

BACKGROUND: The ATP-sensitive K(+) (K(ATP)) channel openers levcromakalim and pinacidil are vasodilators that induce headache in healthy people. The neuropeptide calcitonin gene-related peptide (CGRP) induces headache in healthy people and migraine in migraineurs, potentially through a mechanism that involves opening of vascular or neuronal K(ATP) channels and mast cell degranulation. Using rat as a model, we studied the molecular presence of K(ATP) channels in the trigeminovascular system. Furthermore, we examined whether K(ATP) channel openers stimulate the in vitro release of CGRP and whether they degranulate dural mast cells. METHODS: mRNA and protein expression of K(ATP) channel subunits were studied in the trigeminal ganglion (TG) and trigeminal nucleus caudalis (TNC) by qPCR and western blotting. In vitro CGRP release was studied after application of levcromakalim (1 µM) and diazoxide (10 µM) to freshly isolated rat dura mater, TG and TNC. Rat dural mast cells were challenged in situ with levcromakalim (10(-5) M) to study its potential degranulation effect. RESULTS: mRNA and protein of K(ATP) channel subunits Kir6.1, Kir6.2, SUR1 and SUR2B were identified in the TG and TNC. K(ATP) channel openers did not release or inhibit capsaicin-induced CGRP release from dura mater, TG or TNC. They did also not induce dural mast cell degranulation. CONCLUSIONS: K(ATP) channel openers do not interact with CGRP release or mast cell degranulation. Activation of these channels in the CNS is antinociceptive and therefore cannot explain the headache induced by K(ATP) channel openers. Thus, they are likely to induce headache by interaction with extracerebral K(ATP) channels, probably the SUR2B isoforms.

K(ATP) channel expression and pharmacological in vivo and in vitro studies of the K(ATP) channel blocker PNU-37883A in rat middle meningeal arteries.

BACKGROUND AND PURPOSE: Dilatation of cerebral and dural arteries causes a throbbing, migraine-like pain, indicating that these structures are involved in migraine. Clinical trials suggest that adenosine 5'-triphosphate-sensitive K(+) (K(ATP)) channel opening may cause migraine by dilatating intracranial arteries, including the middle meningeal artery (MMA). We studied the K(ATP) channel expression profile in rat MMA and examined the potential inhibitory effects of the K(ATP) channel blocker PNU-37883A on K(ATP) channel opener-induced relaxation of the rat MMA, using the three K(ATP) channel openers levcromakalim, pinacidil and P-1075. EXPERIMENTAL APPROACH: mRNA and protein expression of K(ATP) channel subunits in the rat MMA were studied by quantitative real-time PCR and western blotting, respectively. The in vivo and in vitro effects of the K(ATP) channel drugs on rat MMA were studied in the genuine closed cranial window model and in myograph baths, respectively. KEY RESULTS: Expression studies indicate that inwardly rectifying K(+) (Kir)6.1/sulphonylurea receptor (SUR)2B is the major K(ATP) channel complex in rat MMA. PNU-37883A (0.5 mg kg(-1)) significantly inhibited the in vivo dilatory effect of levcromakalim (0.025 mg kg(-1)), pinacidil (0.38 mg kg(-1)) and P-1075 (0.016 mg kg(-1)) in rat MMA. In vitro PNU-37883A significantly inhibited the dilatory responses of the three K(ATP) channel openers in rat MMA at 10(-7) and 3 x 10(-7) M. CONCLUSIONS AND IMPLICATIONS: We suggest that Kir6.1/SUR2B is the major functional K(ATP) channel complex in the rat MMA. Furthermore, we demonstrate the potent in vivo and in vitro blocking potentials of PNU-37883A on K(ATP) channel opener-induced relaxation of the rat MMA.

Metabolic bone disease in patients receiving home parenteral nutrition: a Canadian study and review.

BACKGROUND: Metabolic bone disease (MBD) is a significant complication in patients receiving long-term home parenteral nutrition (HPN). Pamidronate has been poorly studied in this population. We examine the prevalence and risk factors for MBD and examine changes in bone mineral density (BMD) after pamidronate administration. METHODS: First, a chart review of patients receiving HPN for >1 year was performed, and Pearson correlations were used to assess associations between MBD (defined as t score<-1) and risk factors. Second, the effect of IV pamidronate on BMD was studied prospectively in 11 HPN patients. Results were compared using a t-test. RESULTS: Charts were reviewed in 25 patients (15 F, 10 M): age, 56.9+/-3.1 years; body mass index (BMI), 21.2+/-0.57 kg/m2; months receiving HPN, 113.2+/-0.09; and days per week receiving HPN, 5.08+/-0.39. MBD was present in 33% of patients for the spine and hip and in 50% for the femoral neck; 24% had previous fractures. There was a significant negative correlation between the duration of HPN and BMD (r=-0.40) for all measurements. From those patients, 11 received IV pamidronate for a mean of 22.2+/-5.4 months. At baseline, their mean HPN treatment duration was 10.6+/-6.3 years. Overall, BMD results showed a trend toward improvement in the mean t score of the spine and hip postpamidronate therapy (pre, -3.1+/-0.75; post, -2.9+/-0.69; p=.07). After excluding 2 patients receiving corticosteroids, the mean t score of the spine showed significant improvement (prepamidronate -3.4+/-0.57 vs post-pamidronate -3.1+/-0.65, p=.036). CONCLUSIONS: In our HPN population, 76% had MBD and 24% had previous fractures. The results suggest that these patients may benefit from pamidronate. More studies are needed to assess the efficacy of pamidronate.

The effects of a companion animal on distress in children undergoing dental procedures.

The purpose of our pilot study was to evaluate the effects of a companion animal (dog) on physiologic arousal and behavioral distress among children undergoing a dental procedure. A repeated measures experimental design was used to study 40 children between the ages of 7 and 11 years who were undergoing procedures in a pediatric dental clinic. Half the children had the dog present during the procedure and half did not. Data were obtained before, during, and after the procedure. Behavioral distress was measured using the Observational Scale of Behavioral Distress; procedures were videotaped. Physiologic arousal was measured using a YSI telethermometer taped to the child's index finger. Student's t-test and repeated measures analysis of variance were used to answer the research question. No significant differences in behavioral distress or physiologic arousal were found between experimental and control groups. Further analysis revealed that for children who initially verbalized distress on arrival at the clinic, the presence of the dog decreased physiologic arousal during the time the child was on the dental table waiting for the dentist to arrive. Further research should be conducted to verify the effect of a companion animal on initial stress experienced by children for whom the visit to the dentist is most stressful.

The role of the pulmonary afferent receptors in producing hemodynamic changes during hyperinflation and endotracheal suctioning in an oleic acid-injured animal model of acute respiratory failure.

The purpose of this study was to examine the role of the pulmonary afferent receptors in producing hemodynamic changes during hyperinflation and endotracheal suctioning (ETS) in an oleic acid-injured animal model of acute respiratory failure. Previous investigations of hyperinflation as a method to prevent hypoxia-induced sequelae of ETS have demonstrated unrecognized hemodynamic consequences. In this within-subject, repeated-measures study, instrumented, oleic acid-injured dogs had continuous measurements of heart rate (HR), mean aortic blood pressure (MAP), left ventricular pressure (Plv), pulmonary artery pressure (Ppa), right ventricular afterload (Ppa(tm)), right atrial pressure (Pra), and right ventricular filling pressure (Pra(tm)) during hyperinflation and ETS when the vagi were intact and after the pulmonary branches of the vagus nerves had been severed. After severing the vagi, MAP and Plv were decreased and HR and Ppa were increased. With the vagi severed, there was less variation in MAP and Ppa but increased variation in HR. These findings suggest that vagally mediated reflexes from the lungs produce some, but not all, of the hemodynamic effects associated with hyperinflation and ETS. Continued research is necessary to discover a method of hyperoxygenation and suctioning that does not produce potentially harmful hemodynamic effects.

Using a therapy dog to alleviate the agitation and desocialization of people with Alzheimer's disease.

1. Short-term exposure to a therapy dog can reduce the number of agitation behaviors in institutionalized persons with Alzheimer's disease (AD), particularly during the period of agitation known as sundown syndrome. 2. The presence of a therapy dog can increase socialization behaviors among a group of persons with AD. 3. A therapy dog can be used as an adjunct to other calming interventions for persons with AD.

The effects of the presence of a companion animal on physiological arousal and behavioral distress in children during a physical examination.

The purpose of this study was to examine the effects of the presence of a companion animal on physiological arousal and behavioral distress exhibited by preschool children during a routine physical examination. A within-subject, time-series design was used to study 23 healthy children ages 3 years to 6 years during two physical examinations, with and without a dog. Statistically significant differences were found with greater reductions in subjects' systolic and mean arterial pressure, heart rate, and behavioral distress when the dog was present. Findings support the use of a companion animal in reducing stress experienced by children during a physical examination.

Avian companionship in alleviation of depression, loneliness, and low morale of older adults in skilled rehabilitation units.

To assess effects of a companion bird on the depression, morale, and loneliness of 40 older adults in a skilled rehabilitation unit, self-reported measures of depression, loneliness, and morale were completed on admission and 10 days later. With the presence of a companion bird the experimental group (n = 20) showed a significant decrease in depression but none in morale or loneliness from the control group (n = 20) who were without a bird. Use of a companion bird may lessen negative effects of change of residence for older adults.

Increasing patient control of family visiting in the coronary care unit.

BACKGROUND: Stress of coronary care unit admission and need for rest may contribute to a sense of helplessness, exacerbated by the unpredictability of visitor entry. Control over the environment, and particularly family visiting, could alleviate patient stress. OBJECTIVE: To determine if patient control of visit timing would minimize undesired psychophysiologic effects of coronary care unit visiting. METHODS: Data were collected at multiple points from 60 coronary care unit patients during the first 20 minutes of the evening visit and at visit end. Randomly assigned subjects used a visitor control device to communicate their wishes to potential visitors: red hallway light to restrict, and green to allow, visits. Dependent variables were heart rate and rhythm; premature ventricular contractions; systolic, diastolic, and mean arterial blood pressure; salivary cortisol; and finger temperature. Psychologic variables of visit stress versus comfort, perceived control of visits, and perceived rest between visits were measured by pre- and postvisit appraisals. RESULTS: Repeated measures analyses showed that over time, perceived control of visits and rest between visits were greater, and heart rate and diastolic blood pressure were lower for subjects with the visitor control device. Appraisal of visit stress increased slightly in this group. No statistically significant differences were found for possession of the visitor control device. Reaction to visitor entry was a short-term stress response, as indicated by increases in systolic, diastolic, and mean arterial blood pressure. CONCLUSIONS: Based on positive comments, increased perceived control over visiting, and decreased blood pressure, the visitor control device was beneficial.

The proposal-reality gap: the mechanics of implementing a funded research proposal.

In summary, planning is the key to smooth implementation of a newly funded study. Adequate planning reduces the time necessary to hire personnel, purchase equipment and supplies, acquire space, manage the budget, maintain agency contacts and provide for smooth agency orientation, and complete the pilot study. Moving smoothly into data collection ensures that the project will be on target by the end of the first year of funding and that the investigator will have an opportunity to demonstrate scholarly productivity. Pilot testing pieces of the research protocol during the period between submission of the proposal and notification of the funding decision will facilitate smooth transition either to data collection or to revision and improvement of the proposal for resubmission.

Effect of oxygen insufflation during endotracheal suctioning on arterial pressure and oxygenation in coronary artery bypass graft patients.

BACKGROUND Numerous studies have demonstrated the need for increased inspired oxygen with endotracheal suctioning to prevent hypoxemia; however, increased arterial pressure has been reported as a consequence of lung hyperinflation/inflation used to deliver hyperoxygenation. OBJECTIVES To compare insufflation during endotracheal suctioning with a standard procedure of hyperoxygenation using a ventilator on arterial pressure, pulmonary artery pressure, heart rate, arterial oxygen saturation, and blood gases in intubated, mechanically ventilated coronary artery bypass graft patients. METHODS A within-subjects, repeated-measures design was used to measure arterial pressure (systolic, diastolic, and mean), pulmonary artery pressure (systolic, diastolic, and mean), airway pressure, heart rate and rhythm, arterial oxygen tension, arterial carbon dioxide tension, pH, and arterial oxygen saturation during an oxygen insufflation protocol and a hyperoxygenation protocol via the ventilator. RESULTS Using analysis of variance for repeated measures, statistically significant time effects were found for all variables. Statistically significant differences between protocols over time were found for arterial pressure, arterial oxygen tension, and arterial oxygen saturation. CONCLUSIONS Oxygen insufflation resulted in less increase in arterial pressure than did the hyperoxygenation protocol. The hyperoxygenation protocol resulted in hyperoxia. Based on this study, oxygen insufflation is a safe alternative for providing oxygen during endotracheal suctioning.

Effects of lung hyperinflation and presence of positive end-expiratory pressure on arterial and tissue oxygenation during endotracheal suctioning.

PURPOSE: To explore the effects of endotracheal suctioning on mixed venous oxygen tension and other measures of arterial and tissue oxygenation, to determine if these would be clinically useful outcome measures of endotracheal suctioning. BACKGROUND: Measuring arterial oxygenation only as an outcome of endotracheal suctioning can be misleading in that it may appear adequate in the presence of marked decreases in mixed venous oxygen tension, a good indicator of the adequacy of tissue oxygenation. METHODS: Eighteen instrumented and oleic acid-injured animal models of acute respiratory failure undergoing closed-system endotracheal suctioning were studied according to a 2 x 2 factorial design to measure the effects of oxygen inflations at tidal volume or 135% of tidal volume either in the presence or absence of positive end-expiratory pressure. RESULTS: Using multivariate analysis of variance for repeated measures, protocol by time effects for mixed venous oxygen tension, arterial oxygen saturation, arterial oxygen tension, oxygen delivery and oxygen extraction ratio were statistically significant. Changes in mixed venous oxygen tension and arterial oxygen saturation were parallel. CONCLUSIONS: Continuous measurement of mixed venous oxygen tension allows the calculation of oxygen delivery and oxygen extraction ratio, which provide a better estimation of the effects of endotracheal suctioning on tissue oxygenation than arterial oxygen tension alone.

Endotracheal suctioning in adults with head injury.

The purpose of this study was to determine the method of endotracheal suctioning (ETS) that resulted in the least compromise to the cerebrovascular status of adult patients with severe head injuries. A two-group (two vs three ETS), two-protocol (100% tidal volume [VT] vs 135% VT) design was used. The dependent variables were mean intracranial pressure (MICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), heart rate (HR), and oxygen saturation (SaO2). By random assignment, 14 subjects were in the two-ETS group and 16 subjects were in the three-ETS group. Intracranial pressure response to ETS in these patients with head injury can be characterized as falling into three patterns: (1) a rise in baseline beginning with ETS and continuing throughout the ETS sequences; (2) intracranial pressure spiking during the suctioning component of the protocol; (3) a combination of both a rising baseline and spiking. There was a significant (p less than or equal to 0.001) increase from baseline for both two- and three-ETS groups with both hyperoxygenation protocols (100% VT vs 135% VT) for MICP, MAP, HR, and CPP. No significant difference was found for SaO2 for either of the protocols regardless of number of suction passes. No significant differences were found between two- and three-ETS groups for any of the dependent variables. All groups, however, regardless of number of suction passes, demonstrated a cumulative increase in MICP, MAP, and CPP with each consecutive suction sequence.(ABSTRACT TRUNCATED AT 250 WORDS)

Effectiveness of oxygen concentrations of less than 100% before and after endotracheal suction in patients with chronic obstructive pulmonary disease.

This within-subject study compared the effects of hyperinflations with 20% above maintenance oxygen (O2) level and 100% O2 hyperinflations before and after endotracheal suction in 11 acutely ill patients with chronic obstructive pulmonary disease. Four hyperinflations were delivered at 1.5 times the calculated tidal volume (10 ml/kg) with 100% O2 or 20% above maintenance O2 level via resuscitator bag, followed by 10 seconds of continuous endotracheal suctioning. This sequence was repeated three times. No statistically significant differences (p less than 0.05) were found between the two protocols for arterial oxygen saturation, blood pressure, or heart rate (analysis of variance for repeated measures). There was no change in heart rhythm for any of the subjects. The results of this study suggest that hyperinflation with 20% above maintenance O2 level can be used for oxygenation in patients with chronic obstructive pulmonary disease before and after endotracheal suctioning. Replication is needed before clinical implementation.