An on-line system for acquisition and processing of cerebral blood flow data

Regional cerebral blood flow is measured by monitoring the clearance from the brain of the gamma emitting radioisotope ¹³³Xe following an intracarotid artery bolus injection. On-line data analysis, which is performed on a PDP $\text{12}\text{30}$ digital computer, involves exponential stripping to isolate grey and white matter flows and integration of the clearance curves to infinity to enable the mean flow to be calculated. The data is displayed in real time and stored on the PDP 12 Linc tapes as a permanent record.     

Identification of parasite proteins in a membrane preparation enriched for the surface membrane of erythrocytes infected with Plasmodium knowlesi

A subcellular fraction enriched in erythrocyte membranes has been isolated from rhesus monkey erythrocytes infected with Plasmodium knowlesi. Infected cells were lysed by centrifugation through a zone of hypotonic buffer and membranes isolated by equilibrium density gradient centrifugation in the same tube. The purified membrane fraction was shown to include the erythrocyte surface membrane by several methods: electron microscopy, identification of Coomassie Blue stained erythrocyte membrane proteins, identification of band 3 with a monoclonal antibody, and identification of radioiodinated cell surface proteins. The resulting ghosts were shown to be specifically reactive with monkey sera against the variant surface antigens of P. knowlesi by indirect immunofluorescence and membrane agglutination. No reactivity was seen with a monoclonal antibody (13C11) against the intracellular schizont surface. A number of metabolically labelled parasite proteins were enriched in this membrane function, including peptides of 277, 208, 173, 153, 134, 109, 80, 60 and 48 kDa and the variant surface antigens of variable molecular mass (180-207 kDa). These proteins were distinct from the major parasite proteins of total infected erythrocytes and isolated merozoites. The major glucosamine labelled glycoprotein of the internal schizont (230 kDa) was not found in this fraction. Moreover, no fragment of this parasite glycoprotein was found in this membrane fraction, indicating that no part of this molecule is transported to the erythrocyte surface. In contrast, the variant antigen of P. knowlesi, known to be on the erythrocyte surface, could be readily identified as peptides unique to specific cloned parasite lines. We propose that the other nine parasite proteins found within this membrane fraction represent a starting point for the identification of other parasite proteins transported to the surface membrane of the infected erythrocyte.     

Patient distribution in a mass casualty event of an airplane crash

Introduction

Difficulties have been reported in the patient distribution during Mass Casualty Incidents. In this study we analysed the regional patient distribution protocol (PDP) and the actual patient distribution after the 2009 Turkish Airlines crash near Amsterdam.

Methods

Analysis of the patient distribution of 126 surviving casualties of the crash by collecting data on medical treatment capacity, number of patients received per hospital, triage classification, Injury Severity Score (ISS), secondary transfers, distance from the crash site, and the critical mortality rate.

Results

The PDP holds ambiguous definitions of medical treatment capacity and was not followed. There were 14 receiving hospitals (distance from crash: 5.8–53.5 km); four hospitals received 133–213% of their treatment capacity, and 5 hospitals received 1 patient. Three hospitals within 20 km of the crash did not receive any casualties. Level I trauma centres received 89% of the ‘critical’ casualties and 92% of the casualties with ISS ≥ 16. Only 3 casualties were secondarily transferred, and no casualties died in, or on the way to hospital (critical mortality rate = 0%).

Conclusion

Patient distribution worked out well after the crash as secondary transfers were low and critical mortality rate was zero. However, the regional PDP was not followed in this MCI and casualties were unevenly distributed among hospitals. The PDP is indistinctive, and should be updated in cooperation between Emergency Services, surrounding hospitals, and Schiphol International Airport as a high risk area.     

Effectiveness of Some Novel Ionic Liquids on Mild Steel Corrosion Protection in Acidic Environment: Experimental and Theoretical Inspections

Three ionic liquids (ILs)—1-butyl-1-methyl-pyrrolidinium Imidazolate (BMPyrIM), 1-butyl-3-methyl-imidazolium Imidazolate (BMImIM), and bis(1-butyl-3-methyl-imidazolium Imidazolate) (BBMImIM)—were synthesized and examined experimentally and theoretically as potential inhibitors for mild steel corrosion in HCl (1.0 M) solution. To our knowledge, two of the ILs successfully synthesized in our laboratory named BMPyrIM and BBMImIM are novel. Different electrochemical (potentiodynamic polarization (PDP), electrochemical impedance spectroscopy (EIS)), surface and structural (scanning electron microscopy (SEM), Energy-dispersive X-ray spectroscopy (EDS), Atomic force microscopy (AFM) and Fourier Transform Infrared Spectroscopy (FTIR)) and theoretical (Density functional theory (DFT)) techniques were utilized to confirm their use as efficient environmentally safe inhibitors. These ionic liquids were designed to study the cation effect (imidazolium and pyrrolidinium) and the dimeric effect of the imidazolium-based IL. A pronounced inhibiting effect was recorded using the optimum concentration (5 × 10⁻³ M) of BBMImIM with protection efficiency of 98.6% compared to 94.3% and 92.4% for BMImIM and BMPyrIM, respectively. The investigated ILs act as a mixed-type corrosion inhibitors and their protection obeys Langmuir adsorption isotherm. The results obtained by SEM, EDS and AFM confirmed the mild steel protection by the formation of protective film of the ILs on the steel surface resulted in less damaged surfaces compared with the blank solution. Furthermore, quantum chemical calculations illustrated the electronic structure of the investigated ILs and their optimized adsorptiοn configurations on mild steel surface. The findings from the different techniques helped to provide a supported interpretation of the inhibition mechanism.     

Computer analysis in the electron microscopic assessment of cellular injury.

Computer programs have been developed to characterize data obtained from the electron microscopic assessment of diverse types of cellular injury using cultured cell preparations.     

Changing the treatment paradigm for Parkinson’s disease psychosis with pimavanserin

ABSTRACT

Introduction: Parkinson’s disease psychosis (PDP) may affect up to 60% of patients with Parkinson’s disease over the course of their disease, and is associated with poor prognosis, including increased risks of mortality and nursing home placement. PDP treatments have been limited to off-label use of atypical antipsychotics, most of which pose risks of worsened motor symptoms and other potential adverse events (AEs) due to their dopamine receptor blockade and additional off-target receptor affinities. Pimavanserin is a highly selective 5-HT_2A inverse agonist and poses no known risks for worsening of parkinsonism or other off-target receptor AEs. Pimavanserin is the first and only medication approved for PDP treatment.

Areas covered: This review covers estimated prevalence, clinical characteristics, diagnostic criteria, and risk factors for PDP; the hypothetical progression of PDP; management of PDP including use of antipsychotics; pharmacology and clinical trial data on pimavanserin; and expert opinion on PDP treatment. The NLM/PubMed database was searched for papers using the search terms of "PDP" AND "treatment" AND "pimavanserin" for the last 10 years.

Expert opinion: The recent insights into PDP pathophysiology and approval of the only medication specifically to treat PDP are key advances that should improve the recognition, diagnosis, and management of PDP.     

Improvements in both psychosis and motor signs in Parkinson's disease, and changes in regional cerebral blood flow after electroconvulsive therapy

Purpose

Psychotic symptoms in Parkinson's disease (PD) are relatively common and, in addition to creating a disturbance in patients' daily lives, have consistently been shown to be associated with poor outcome. The use of anti-PD medications has been the most widely identified risk factor for PD psychosis (PDP). However, the pathophysiology of PDP remains unclear. Although the efficacy of electroconvulsive therapy (ECT) for PD had been pointed out, only one study has demonstrated the effectiveness of ECT on both psychotic symptoms and motor symptoms. The aim of this study was to examine the acute effectiveness of ECT on PD and to identify the brain areas associated with PDP.

Methods

The study was conducted at Juntendo University Hospital in Tokyo. Eight patients with L-DOPA- or dopamine (DA) agonist-induced PDP, who were resistant to quetiapine treatment, were enrolled. Severity of PD was evaluated using the Hoehn and Yahr stage. Psychotic symptoms were evaluated using multiple measures from the Scale for the Assessment of Positive Symptoms (SAPS). Technetium-99m ethyl cysteinate dimer single photon emission computed tomography (99mTc ECD SPECT) was used to assess regional cerebral blood flow (rCBF) before and after a course of ECT. A voxel-by-voxel group analysis was performed using Statistical Parametric Mapping (SPM5).

Results

Our study clearly demonstrated that PDP was significantly less severe after ECT than before ECT, as indicated by change in mean SAPS total domain score (t = 7.2, P = 0.0002). Furthermore, the patients showed significant improvement in Hoehn and Yahr stage after ECT (t = 11.7, P < 0.0001). A further notable observation was significant increase in rCBF in the right middle frontal gyrus after ECT.

Conclusion

We conclude that a course of ECT produced notable improvements not only in PDP but also in the severity of PD. The findings of change in rCBF suggest implications for dysfunction in the middle frontal region for patients with PDP.     

体外光动力学反应调节角质形成细胞分泌细胞因子的研究

目的探讨不同强度光动力学反应对角质形成细胞（HaCat）分泌某些细胞因子的影响。方法将0．O～12．8mol／L的5-氨基酮戊酸（AI。A）与HaCat细胞共同培养,检测胞内原卟啉IX（PpIX）含量;经632．8nrfl激光照射后测定细胞死亡率。依据细胞死亡率（0％～10％）确定ALA浓度区间（0．0～1．6mmol／L）,继而检测该区间内细胞（包括照射组与非照射组）上清液中白介素-1α（IL-1α）、IL-6、碱性成纤维细胞生长因子（bFGF）、内皮素一1（ET-1）和a肿瘤坏死因子（TNF—α）的水平。结果ALA浓度可调控胞内PpIX含量和光动力反应强度,在0．O～1．6mmol／L：区间与细胞死亡率（≤10％）呈线性正相关（rs=0．451,r2=0．606,P〈0．05）,且IL—1α、bFGF和TNF-α水平随着ALA浓度增加而逐渐升高（皆P〈0．05）,IL-6和ET-1水平则无显著变化（皆P〉0．05）。结论通过增强光动力反应可促进HaCat细胞分泌某些细胞因子,以提高对某些皮肤病的疗效。     

ABSTRACTS

The IMI National Guidelines have been prepared as baseline guides on specific aspects of medical illustration practice, and provide auditable standards for the future. They can be implemented in full, or may be amended according to individual requirements. The following, prepared by Mike Devlin, is the second in the series to be published in this Journal. This and the other guidelines can be read or downloaded at: www.imi.org.uk.     

患者PDP性格预评估对护理实习生床旁带教效果的影响

目的 为了提高临床护理实习生床旁带教效果，探索应用PDP评估表对患者进行性格预评估方法在护理实习生床旁带教中的影响。方法 选取2018年1月至2019年1月来常州市第二人民医院神经外科实习的同等学历、同一学校的护理实习生40人，随机分为试验组和对照组，每组20名护生。试验组带教前对患者进行PDP性格预评估，选出孔雀型和考拉型的患者作为临床带教对象；对照组由临床带教老师根据自身经验，主观选出临床带教的对象。带教结束后对两组的护生进行理论测试和操作考核，统计各组护生平均成绩，进行带教满意度测评，职业成就感测评，统计两组护患矛盾发生率，比较两组差异。 结果 试验组护生的理论测试和操作考核均高于对照组(P<005)；试验组护生的带教满意度和职业成就感高于对照组(P<005)；且试验组护生护患矛盾发生率小于对照组 (P<005)。结论 通过对患者进行PDP性格预评估，选出配合度高、情商高、易沟通、乐于接受护生的孔雀型和考拉型的患者作为床旁带教对象，能显著提高床旁带教效果，减少护患矛盾，有利于护理实习生成长，值得临床推广。