野外急救多功能气道防护屏的研制

研制一种适合野外急救使用的多功能气道防护屏,以解决气道相关操作时患者呼吸道分泌物喷溅的问题。多功能气道防护屏由一个底部为直角"目"型框架,两个体部为直角"∏"形不锈钢支架,一个双层开放气道体位调节垫和一个透明塑料罩组成,具有可拆卸、可折叠及视野清晰的多功能呼吸道防护装备;防护屏设计具有可调节头颈后仰卧位,能充分显露气道提高气管插管成功率,可提高医护人员安全性和满意度;在防护屏内建立人工气道、实施各种气道护理,可防止患者呼吸道分泌物喷溅,使周围环境处于相对安全状态,有效避免职业暴露及交叉感染。     

European consensus on patient contact shielding

Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.     

Five-year change scores in old age for six neuropsychological tests and normative data for the Useful Field of View (UFOV) test: The influence of physical health

Introduction: Neuropsychological assessment of cognitive change over time is often conducted in clinical settings, but whether neuropsychological change scores are influenced by physical health has, as far as we know, not been examined previously.

Method: In a sample of 153 older Swedish adults (age range, 72–86 years), we evaluated the influence of common age-related diseases, terminal decline pathology, age, education, and gender, to provide (a) preliminary test-specific regression weights and 90% confidence intervals to assess significant change in performance after five years on tests of visual scanning, mental shifting, visual spatial ability, memory, reaction time, and selective attention, and (b) normative data for the Useful Field of View test (UFOV) from a single testing occasion.

Results: Multiple regression analyses showed that test–retest changes were affected by physical health for mental shifting, visual spatial ability, memory, and reaction time, by age for mental shifting and visual reaction time, by education for visual spatial ability, and by Age × Education for auditory reaction time. Gender did not affect any of the change scores. The overall average of variance explained was 2.5%: up to 8.1% for physical health, 4.4% for age, and 3.6% for education. The UFOV scores were mostly influenced by age, but also by physical health and education.

Conclusions: The findings indicate that considering the influence of health on normative change scores in old age in addition to demographic factors leads to more accurate predictions of whether true change has occurred.     

Embracing nature’s complexity: Immunoparasitology in the wild

A wealth of research is dedicated to understanding how resistance against parasites is conferred and how parasite-driven pathology is regulated. This research is in part driven by the hope to better treatments for parasitic diseases of humans and livestock, and in part by immunologists who use parasitic infections as biomedical tools to evoke physiological immune responses. Much of the current mechanistic knowledge has been discovered in laboratory studies using model organisms, especially the laboratory mouse. However, wildlife are also hosts to a range of parasites. Through the study of host-parasite interactions in these non-laboratory systems we can gain a deeper understanding of parasite immunology in a more natural, complex environment. With a focus on helminth parasites, we here explore the insights gained into parasite-induced immune responses through (for immunologists) non-conventional experimental systems, and how current core findings from laboratory studies are reflected in these more natural conditions. The quality of the immune response is undoubtedly a central player in susceptibility versus resistance, as many laboratory studies have shown. Yet, in the wild, parasite infections tend to be chronic diseases. Whilst reading our review, we encourage the reader to consider the following questions which may (only) be answered by studying naturally occurring parasites in the wild: a) what type of immune responses are mounted against parasites in different hosts in the wild, and how do they vary within an individual over time, between individuals of the same species and between species? b) can we use wild or semi-wild study systems to understand the evolutionary drivers for tolerance versus resistance towards a parasite? c) what determines the ability of the host to cope with an infection and is there a link with the type of immune response mounted? d) can we modulate environmental factors to manipulate a wild animal’s immune response to parasitic infections, with translation potential for humans, wildlife, and livestock? and e) in context of this special issue, what lessons for Type 2 immunity can we glean from studying animals in their natural environments? Further, we aim to integrate some of the knowledge gained in semi-wild and wild settings with knowledge gained from traditional laboratory-based research, and to raise awareness for the opportunities (and challenges) that come with integrating a multitude of naturally-occurring variables into immunoparasitological research.     

Single-source dual energy CT to assess myocardial extracellular volume fraction in aortic stenosis before transcatheter aortic valve implantation (TAVI)

PurposeTo assess myocardial extracellular volume fraction (ECV) measurement provided by a single-source dual-energy computed tomography (SSDE-CT) acquisition added at the end of a routine CT examination before transcatether aortic valve implantation (TAVI) compared to cardiac magnetic resonance imaging (MRI).Materials and methodsTwenty-one patients (10 men, 11 women; mean age, 86 ± 4.9 years [SD]; age range: 71–92 years) with severe aortic stenosis underwent standard pre-TAVI CT with additional cardiac SSDE-CT acquisition 7 minutes after intravenous administration of iodinated contrast material and myocardial MRI including pre- and post-contrast T1-maps. Myocardial ECV and standard deviation (σECV) were calculated in the 16-segments model. ECV provided by SSDE-CT was compared to ECV provided by MRI, which served as the reference. Analyses were performed on a per-segment basis and on a per-patient involving the mean value of the 16-segments.ResultsECV was slightly overestimated by SSDE-CT (29.9 ± 4.6 [SD] %; range: 20.9%–48.3%) compared to MRI (29.1 ± 3.9 [SD] %; range: 22.0%–50.7%) (P < 0.0001) with a bias and limits of agreement of +2.3% (95%CI: −16.1%– + 20.6%) and +2.5% (95%CI: −2.1%– + 7.1%) for per-segment and per-patient-analyses, respectively. Good (r = 0.81 for per-segment-analysis) to excellent (r = 0.97 for per-patient-analysis) linear relationships (both P < 0.0001) were obtained. The σECV was significantly higher at SSDE-CT (P < 0.0001). Additional radiation dose from CT was 1.89 ± 0.38 (SD) mSv (range: 1.48–2.47 mSv).ConclusionA single additional SSDE-CT acquisition added at the end of a standard pre-TAVI CT protocol can provide ECV measurement with good to excellent linear relationship with MRI.     

Transcranial focused ultrasound induces sustained synaptic plasticity in rat hippocampus

Transcranial focused ultrasound (tFUS) neuromodulation provides a promising emerging non-invasive therapy for the treatment of neurological disorders. Many studies have demonstrated the ability of tFUS to elicit transient changes in neural responses. However, the ability of tFUS to induce sustained changes need to be carefully examined. In this study, we use the long-term potentiation/long term depression (LTP/LTD) model in the rat hippocampus, the medial perforant path (mPP) to dentate gyrus (DG) pathway, to explore whether tFUS is capable of encoding frequency specific information to induce plasticity. Single-element focused transducers were used for tFUS stimulation with ultrasound fundamental frequency of 0.5 MHz and nominal focal distance of 38 mm tFUS stimulation is directed to mPP. Measurement of synaptic connectivity is achieved through the slope of field excitatory post synaptic potentials (fEPSPs), which are elicited using bipolar electrical stimulation electrodes and recorded at DG using extracellular electrodes to quantify degree of plasticity. We applied pulsed tFUS stimulation with total duration of 5 min, with 5 levels of pulse repetition frequencies each administered at 50 Hz sonication frequency at the mPP. Baseline fEPSP is recorded 10 min prior, and 30+ minutes after tFUS administration. In N = 16 adult wildtype rats, we observed sustained depression of fEPSP slope after 5 min of tFUS focused at the presynaptic field mPP. Across all PRFs, no significant difference in maximum fEPSP slope change was observed, average tFUS induced depression level was observed at 19.6%. When compared to low frequency electrical stimulation (LFS) of 1 Hz delivered to the mPP, the sustained changes induced by tFUS stimulation show no statistical difference to LFS for up to 24 min after tFUS stimulation. When both the maximum depression effects and the duration of sustained effects are both taken into account, PRF 3 kHz can induce significantly larger effects than other PRFs tested. tFUS stimulation is measured with a spatial-peak pressure amplitude of 99 kPa, translating to an estimation of 0.43 °C temperature increase when assuming no loss of heat. The results suggest the ability of tFUS to encode sustained changes in synaptic connectivity through mechanism which are unlikely to involve thermal changes.     

Short-term neuronal effects of fumonisin B1 on neuronal activity in rodents

Fumonisin B1 (FB1) is a mycotoxin produced by microscopic fungi (mostly Fusarium species), which may infect our major crops. The toxin inhibits the development of these plants and may also have harmful effects on animals and humans consuming the infected crops.FB1 inhibits sphingolipid biosynthesis which leads to altered membrane characteristics and consequently, altered cellular functions. There are some indications that the toxin has inhibitory effects on neuronal activity in case of repeated consumption, presumably due to sphingolipid depletion. However, according to new literature data, FB1 may have acute excitatory neural effects, too, via different mechanisms of action. Therefore, in the present study, we addressed the neuronal network effects of FB1 following acute treatment, using different electrophysiological techniques in vitro and in vivo.Acute treatments with FB1 (10–100 μM) were carried out on brain slices, tissue cultures and live animals. After direct treatment of samples, electrically evoked or spontaneous field potentials were examined in the hippocampus and the neocortex of rat brain slices and in hippocampal cell cultures. In the hippocampus, a short-term increase in the excitability of neuronal networks and individual cells was observed in response to FB1 treatment. In some cases, the initially enhanced excitation was reversed presumably due to overactivation of neuronal networks. Normal spontaneous activity was found to be stimulated in hippocampal cell cultures. Seizure susceptibility was not affected in the neocortex of brain slices.For the verification of the results caused by direct treatment, effects of systemic administration of FB1 (7.5 mg/kg, i.p.) were also examined. Evoked field potentials recorded in vivo from the somatosensory cortex and cell activation measured by the c-fos technique in hippocampus and somatosensory cortex were analyzed. However, the hippocampal and cortical stimulatory effect detected in vitro could not be demonstrated by these in vivo assays.Altogether, the toxin enhanced the basic excitability of neurons and neuronal networks after direct treatment but there were no effects on the given brain areas after systemic treatment in vivo. Based on the observed in vitro FB1 effects and the lack of data on the penetration of FB1 across the blood-brain barrier, we assume that in vivo consequences of FB1 administration can be more prominent in case of perturbed blood-brain barrier functions.     

Test-retest reliability of upper-limb proprioception and balance tests in older nursing home residents

AimTo examine the test-retest reliability of two upper-limb proprioception tests (Weight Detection Test, or WDT, and Arm Ruler Positioning Test, or ARPT) and two balance tests (Functional Reach Test, or FRT, and Timed Up and Go test, or TUG) in older nursing home residents.MethodsFifty-three nursing home residents (85.9 ± 3.9 years) participated in this study. Outcome measures were assessed on two occasions, 10–14 days apart. The same rater administered all tests. The relative reliability was estimated using the intraclass correlation coefficients (ICCs) with a two-way mixed-effects model. The absolute reliability was analyzed using the standard error of the mean (SEM) to estimate the minimal detectable change (MDC) at the 95 % confidence level. Systematic bias was studied using the paired-samples t-test or the Wilcoxon signed-rank test.ResultsThe WDT (ICC = 0.84), ARPT (ICC = 0.87) and FRT (ICC = 0.85) had good relative reliability, and the TUG (ICC = 0.99) had excellent reliability. Our results suggest acceptable measurement precision: the SEMs were equal to 1.0 points, and 0.3 cm, 1.5 cm, and 0.5 s for the WDT, ARPT, FRT, and TUG, respectively. The mean difference between sessions was 0.3 points (1.4 %; w=-1.37, p = 0.17) in the WDT, 0.1 cm (-0.74 %; t = 0.41, p = 0.68) in the ARPT, 0.1 cm (0.45 %; w=-0.33, p = 0.74) in the FRT, and 0.2 s (1.37 %; w=-2.28, p = 0.02) in the TUG.ConclusionsThis study showed that the four field-usable motor tests had good to excellent test-retest reliability and had acceptable measurement precision in older nursing home residents. These tests could be valuable clinical tools for assessing proprioception and balance in nursing home residents.     

Restorative effects of urban green environments and the role of urban-nature orientedness and noise sensitivity: A field experiment

In this experiment we investigated how individual differences in orientation towards built vs. nature environment as well as noise sensitivity affect psychological and physiological restoration in a constructed urban park, urban woodland and city centre of Helsinki, Finland. The participants, 30–61-year-old healthy women (N = 83), visited each study site once. The experiment consisted of a 15-min viewing session, followed by a 30-min walking session in each environment. We measured restorative effects: perceived restorative outcomes, vitality, and blood pressure in these three environments. The data were analysed in SAS with a linear mixed model. We found significant differences between environments in psychological restorative effects, but not in blood pressure. The urban-nature orientedness, and to a lesser extent noise sensitivity, modified the effect of environment on restoration. In conclusion, individual characteristics affect psychological restoration provided by various urban environments. Varying needs of individuals should be taken into account in city planning.     

EBT3胶片和辐射荧光屏测量质子重离子放疗设备照射野剂量分布的对比研究

目的 对比离线分析的EBT3胶片和在线实时分析的辐射荧光屏对医用质子重离子加速器照射野剂量分布的质控测量差异,选择更适合的设备质控测量的探测器系统。方法 针对主动式点扫描医用质子重离子加速器,在布喇格峰展宽为3 cm,射程分别为7、16、29 cm条件下,通过放疗计划系统规划100 mm×100 mm的质子和碳离子照射野,分别利用EBT3胶片和辐射荧光屏探测器测量各种条件下的照射野大小,EBT3胶片图像获取在照射24小时后通过平板扫描仪获取,辐射荧光屏图像在束流照射过程中由相机实时拍照获取,通过照射野剂量分布曲线的半高宽进行对比分析。结果 三种质子和碳离子射程条件下,通过对比分析,不论物理意义方面还是统计学方面,两种探测器测量质子重离子照射野剂量分布,结果一致性好,精度相当,辐射荧光屏探测器在结果处理时间上更有效率。结论 两种探测器都满足质子重离子照射野剂量学参数测量要求,在照射野剂量分布的指标测量方面,能够在线实时测量分析的辐射荧光屏探测器比EBT3胶片更符合放疗质控发展要求。