Heterogeneous proteolytic specificity and activity of the house dust mite proteinase allergen Der p I

Background Exposure of the skin or respiratory tract to proteinases is frequently associated with allergic sensitization. This is of particular significance in the domestic indoor environment where the proteolytic activity of Der p I, the group I allergen of the house dust mite Dermatophagoides pteronyssinus, may influence the allergenicity of mites. Using class-specific proteinase inhibitors and active-site affinity chromatography, we have previously shown that Der p I exhibits a mixed cysteine-serine proteinase activity. Measurement of the amount of cleavage, however, did not determine whether the inhibitors used were targeting exactly the same proteolytic mechanism. Objective To resolve this issue, we have examined whether the cleavage specificity of the cysteine and serine proteinase activities of Der p I was the same. Methods HPLC and mass spectrometry were used to analyse and identify the products of a Der p I-digested peptide substrate and thus identify the peptide bonds cleaved. Results Der p I cleaves different peptide bonds, depending upon the class of proteolytic mechanism used. In the model peptide substrate insulin B chain, the cysteine and serine proteinase activities of Der p I showed preference for glutamic acid and arginine respectively in the P1 position. Conclusion These data suggest the existence of more than one mechanistic form of the allergen immunologically identified as Der p I. If proteolytic activity is indeed a function of allergenicity, this information may have important implications for the pathogenicity of Der p I and the ability of innate antiproteinase defences in the respiratory tract to prevent immune sensitization.     

DEFINING A STANDARD INTUBATING POSITION USING "ANGLE FINDER"

Study of patients who exhibit only limited morphological abnormalityyet present difficulty with direct laryngoscopy is facilitatedby a standard intubating position. The "Angle Finder" instrumentallows implementation of a simple reproducible geometric standardwhich is applied easily in formal research work and in clinicalpractice and teaching. The proposed standard relates to thecurved (Macintosh) laryngoscope blade and a supine patient.The lower neck flexion is 35° and extension of the planeof the face 15°, each angle measured relative to horizontal.Initially, the standard was derived from a review of the literature,then validated in a study of the intubating practices of 10senior anaesthetists. A more detailed study of 10 normal volunteersconfirmed reproducibility and, for nine patients with a historyof difficult direct laryngoscopy, the standard was shown tobe appropriate.     

Epitheliomas in patients receiving razoxane therapy for psoriasis

We report two cases in which cutaneous squamous cell carcinomata developed in patients with psoriasis on razoxane therapy. The relevance of razoxane as well as past treatment for psoriasis in the aetiology of these tumours is discussed.     

Speed of injection and spread of bupivacaine in the epidural space

Speed of injection of bupivacaine was assessed in 73 women who received epidural analgesia in labour. Rapid injection was shown to produce quicker onset of epidural block and more reliable perineal anaesthesia than slow injection, but there was no difference in the final extent of the block.     

DISPOSITION OF CERVICAL VERTEBRAE, ATLANTO--AXIAL JOINT, HYOID AND MANDIBLE DURING X-RAY LARYNGOSCOPY

Ten healthy volunteers underwent direct laryngoscopy using topicalanaesthesia and a curved Macintosh laryngoscope blade. A lateralx-ray was performed during laryngoscopy in a standard intubatingposition. In this position the lower neck was relatively straightand increasing curvature occurred from the mid cervical spineupwards. Extension at the atlanto—axial joint was probablynear maximum; this has implications for conditions associatedwith laxity of this joint. The position of the mandible wasinfluenced by the direction of pull on the laryngoscope handle.The hyoid was drawn forward and its body tilted downwards soas to lie halfway between the lower border of the mandible andthe glottis. The relative length of epiglottis projecting abovethe hyoid was variable.     

Reflection: an educational strategy to develop emotionally‐competent nurse leaders

Aim This paper explores educational strategies for nurses that focus on reflectivity and promote the development of self‐awareness, relationship and communication skills and ability to lead with presence and compassion in the midst of change. Background Today nurses move rapidly from carefully‐controlled educational experiences to a fast‐ paced clinical world of increasing patient complexity amid calls for improved quality of care. Making the transition to clinical competence and leadership in practice requires a strong sense of self and emotional intelligence. Evaluation Pedagogies that integrate theoretical and data‐based textbook learning with experiential learning and reflection are a foundation for the development of emotionally‐ and intellectually‐competent leaders and requires new ways of assessing learner outcomes. Key issues Reflection is a key instructional strategy for preparing transformational nurse leaders for interdisciplinary settings where they lead patient care management. The remarkable global spread of reflection in nursing education, practice and research follows an emphasis on developing self‐awareness as a leadership strategy for improving individual and organizational performance. Conclusions Empirical, experiential and anecdotal evidence suggests that reflection has the potential to prepare emotionally‐capable nurse leaders. Implications for Nursing Management As educators create more reflective and nurturing learning environments, they will promote the development of emotionally‐competent nurse leaders who will, in turn, inspire individual and organizational growth and positive change in society.