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At least 145 records · Page 8

Seasonal variations in urinary risk factors among patients with nephrolithiasis

Twenty-four hour urine specimens from 5,677 stone-forming patients throughout the United States were analyzed for seasonal variations in urinary risk factors for nephrolithiasis. Determinations were performed for urine volume, pH, calcium, oxalate, phosphorus, sodium, magnesium, citrate, sulfate, uric acid, and the relative supersaturation (RS) of calcium oxalate, brushite, monosodium urate, and uric acid. Criteria for significant seasonal variation included a significant difference in monthly means of risk factors, seasonal grouping of the data by the Student-Newman-Keuls multiple range test, consistent year-to-year trends and a physiologically significant range. Minimum urine volume of 1.54 +/- 0.70 SD L/day occurred in October while a maximum urine volume of 1.76 +/- 0.78 SD L/day was observed during February. Minimum urine pH of 5.94 +/- 0.64 SD was observed during July and August while a maximum pH of 6.18 +/- 0.61 SD was observed during February. Daily urinary excretion of sodium was lowest during August, 158 +/- 74 SD mEq/day and highest during February 177 +/- 70 SD mEq/day. The RS of brushite and uric acid were found to display significant pH-dependent seasonal variation with a maximum RS of uric acid 2.26 +/- 1.98 SD in June and a low of 1.48 +/- 1.30 SD in February. Maximum RS of brushite 2.75 +/- 2.58 was observed during February. Minimum RS of brushite 1.93 +/- 1.70 SD was observed in June. Phosphorus excretion displayed seasonal variation about a spring-fall axis with a maximum value 1042 +/- 373 SD mg/day in April and a minimum value of 895 +/- 289 SD mg/day. Urine volume, sodium, and pH were significantly lower during the summer (June, July, August) than in the winter (December, January, February). The RS of uric acid was higher, but that of brushite and monosodium urate was lower in the summer than in the winter. The seasonal changes observed in urine volume, pH, sodium, and the RS of brushite and uric acid are consistent with summertime sweating and increased physical activity. Seasonal variations in phosphorus excretion are probably dietary in origin. The summertime was characterized by an increased propensity for the crystallization of uric acid but not of calcium oxalate or calcium phosphate.

NASA Discipline Regulatory Physiology↗

Orthostatic hypotension in patients, bed rest subjects, and astronauts

Orthostatic hypotension after even short space flights has affected a significant number of astronauts. Given the need for astronauts to function at a high level of efficiency during and after their return from space, the application of pharmacologic and other treatments is strongly indicated. This report addresses the clinical problem of orthostatic hypotension and its treatments to ascertain whether pharmacologic or physiologic treatment may be useful in the prevention of orthostatic hypotension associated with space flight. Treatment of orthostatic hypotension in patients now includes increasing intravascular volume with high sodium intake and mineralocorticoids, or increasing vascular resistance through the use of drugs to stimulate alpha or block beta vascular receptors. Earlier treatment used oral sympathomimetic ephedrine hydrochloride alone or with "head-up" bed rest. Then long-acting adrenocortical steroid desoxycorticosterone preparations with high-salt diets were used to expand volume. Fludrocortisone was shown to prevent the orthostatic drop in blood pressure. The combination of the sympathomimetic amine hydroxyamphetamine and a monoamine oxidase inhibitor tranylcypromine has been used, as has indomethacin alone. Davies et al. used mineralocorticoids at low doses concomitantly with alpha-agonists to increase vasoconstrictor action. Schirger et al used tranylcypromine and methylphenidate with or without a Jobst elastic leotard garment or the alpha-adrenergic agonist midodrine (which stimulates both arterial and venous systems without direct central nervous system or cardiac effects). Vernikos et al established that the combination of fludrocortisone, dextroamphetamine, and atropine exhibited a beneficial effect on orthostatic hypotension induced by 7-day 6 degrees head-down bed rest (a model used to simulate the weightlessness of space flight). Thus, there are numerous drugs that, in combination with mechanical techniques, including lower body negative pressure to elevate transmural pressure, could be studied to treat orthostatic hypotension after space flight.

Review↗

Space-Proven Medical Monitor: The Total Patient-Care Package

The primary objective of the Gemini Program was to develop techniques that would allow for advanced, long-duration space travel, a prerequisite of the ensuing Apollo Program that would put man safely on the Moon before the end of the decade. In order to carry out this objective, NASA worked with a variety of innovative companies to develop propulsion systems, onboard computers, and docking capabilities that were critical to the health of Gemini spacecraft, as well as life-support systems and physiological-monitoring devices that were critical to the health of Gemini astronauts. One of these companies was Spacelabs Medical, Inc., the pioneer of what is commonly known today as medical telemetry. Spacelabs Medical helped NASA better understand man s reaction to space through a series of bioinstrumentation devices that, for the first time ever, were capable of monitoring orbiting astronauts physical conditions in real time, from Earth. The company went on to further expand its knowledge of monitoring and maintaining health in space, and then brought it down to Earth, to dramatically change the course of patient monitoring in the field of health care.

Source record↗

Scripting Scenarios for the Human Patient Simulator

The Human Patient Simulator (HPS) is particularly useful in providing scenario-based learning which can be tailored to fit specific scenarios and which can be modified in realtime to enhance the teaching environment. Scripting these scenarios so as to maximize learning requires certain skills, in order to ensure that a change in student performance, understanding, critical thinking, and/or communication skills results. Methods: A "good" scenario can be defined in terms of applicability, learning opportunities, student interest, and clearly associated metrics. Obstacles to such a scenario include a lack of understanding of the applicable environment by the scenario author(s), a desire (common among novices) to cover too many topics, failure to define learning objectives, mutually exclusive or confusing learning objectives, unskilled instructors, poor preparation , disorganized approach, or an inappropriate teaching philosophy (such as "trial by fire" or education through humiliation). Results: Descriptions of several successful teaching programs, used in the military, civilian, and NASA medical environments , will be provided, along with sample scenarios. Discussion: Simulator-based lessons have proven to be a time- and cost-efficient manner by which to educate medical personnel. Particularly when training for medical care in austere environments (pre-hospital, aeromedical transport, International Space Station, military operations), the HPS can enhance the learning experience.

Bacal, Kira↗

Stress Induced Immune Dysregulation: A Continuum Spanning Antarctica Winterover, Spaceflight, and Terrestrial Patients

Spaceflight is a unique environment characterized by stress, microgravity, isolation, circadian misalignment, and radiation exposure and impacts immune health. Planned long duration missions to Mars are a top priority for NASA and mitigating the negative health consequences of spaceflight is particularly important. Terrestrial analogs are a vital aspect of spaceflight research since data from astronauts is limited and it is costly to receive samples from ISS. The most relevant ground analog would include station lifestyle, stress, disrupted circadian rhythms and isolation. This analysis compares various aspects of immune dysregulation in astronauts during long-duration orbital spaceflight to groundanalogs. Astronaut data were also compared to a clinical immunodeficiency population, shingles patients, to help interpret clinical risks during deep space missions. A comprehensive evaluation was performed across hypoxic interior Antarctica, normoxic coastal Antarctica, HERA, and astronauts which included plasma and mitogen stimulated cytokine profiles, T-cell function, and peripheral leukocyte distribution. A cross platform analysis was then performed to define in-flight immune alterations, determine analog appropriateness, and interpret clinical risk.

Krieger, Stephanie↗

Oxygen cocoon for patients under intensive care

Cocoon is made from Teflon film. It includes full-length, pressure zipper on top side and bottom part is rigid pad constructed of burn-resistant material. Cocoon includes oxygen supply port with exhaust port at opposite end.

Maas, J. W.↗

Treating the insomniac patient - General measures and psychological and pharmacological treatment

The general preliminary measures for treating insomnia include moderate physical exercise several hours before bedtime, and the relaxation of complex mental activity before bedtime. A case history concerning a woman with marital troubles is offered as evidence that insomnia may be caused by deeply rooted psychological and situational problems. Another case history illustrates how prior pharmacological treatment may complicate the process of clinically evaluating an insomniac.

Kales, A.↗

Early detection of disease: The correlation of the volatile organic profiles from patients with upper respiratory infections with subjects of normal profiles

A method is described whereby a transevaporator is used for sampling 60-100 microns of aqueous sample. Volatiles are stripped from the sample either by a stream of helium and collection on a porous polymer, Tenax, or by 0.8 ml of 2-chloropropane and collected on glass beads. The volatiles are thermally desorbed into a precolumn which is connected to a capillary gas chromatographic column for analysis. The technique is shown to be reproducible and suitable for determining chromatographic profiles for a wide variety of sample types. Using a transevaporator sampling technique, the volatile profiles from 70 microns of serum were obtained by capillary column gas chromatography. The complex chromatograms were interpreted by a combination of manual and computer techniques and a two peak ratio method devised for the classification of normal and virus infected sera. Using the K-Nearest Neighbor approach, 85.7 percent of the unknown samples were classified correctly. Some preliminary results indicate the possible use of the method for the assessment of virus susceptibility.

Zlatkis, A.↗

Vestibular reactions in patients during occlusion form of chorioependymitis

A change in intracranial pressure during chorioependymitis is discussed. The inflammatory process in the choroid plexi and walls of the cerebral ventricles is described. The otoneurological method, not having any significant contraindications, can be employed repeatedly, quaranteeing control in dynamics over the course of the disease and effectiveness of treatment.

Ladyzhenskaya, E. A.↗