Acute effects of postural changes and lower body positive and negative pressure on the eye.

Introduction: Entry into weightlessness results in a fluid shift and a loss of hydrostatic gradients. These factors are believed to affect the eye and contribute to the ocular changes that occur in space. We measured eye parameters during fluid shifts produced by lower body negative pressure (LBNP) and lower body positive pressure (LBPP) and changes in hydrostatic gradient direction (supine-prone) in normal subjects to assess the relative effects of fluid shifts and hydrostatic gradient changes on the eye. Methods: Ocular parameters (intraocular pressure (IOP), ocular geometry, and optical coherence tomography measures) were measured in the seated, supine, and prone positions. To create a fluid shift in the supine and prone positions, the lower body chamber pressure ranged from -40 mmHg to +40 mmHg. Subjects maintained each posture and LBNP/LBPP combination for 15 min prior to data collection. A linear mixed-effects model was used to determine the effects of fluid shifts (as reflected by LBNP/LBPP) and hydrostatic gradient changes (as reflected by the change from seated to supine and from seated to prone) on eye parameters. Results: Chamber pressure was positively correlated with both increased choroidal thickness (ß = 0.11 , p = 0.01) and IOP (ß = 0.06 p < 0.001). The change in posture increased IOP compared to seated IOP (supine ß = 2.1, p = 0.01, prone ß = 9.5, p < 0.001 prone) but not choroidal thickness. IOP changes correlated with axial length (R = 0.72, p < 0.001). Discussion: The effects of hydrostatic gradients and fluids shifts on the eye were investigated by inducing a fluid shift in both the supine and prone postures. Both hydrostatic gradients (posture) and fluid shifts (chamber pressure) affected IOP, but only hydrostatic gradients affected axial length and aqueous depth. Changes in choroidal thickness were only significant for the fluid shifts. Changes in hydrostatic gradients can produce significant changes in both IOP and axial length. Fluid shifts are often cited as important factors in the pathophysiology of SANS, but the local loss of hydrostatic gradients in the head may also play an important role in these ocular findings.

Investigating Bénard-Marangoni migration at the air-water interface in the time domain using sum frequency generation (SFG) spectroscopy of palmitic acid monolayers.

Sum-frequency generation (SFG) spectroscopy is frequently used to investigate the structure of monolayer films of long-chain fatty acids at the air-water interface. Although labeled a non-invasive technique, introducing intense SFG lasers onto liquid interfaces has the potential to perturb them. In the present work, narrowband picosecond SFG is used to study the structural changes that occur in palmitic acid and per-deuterated palmitic acid monolayers at the air-water interface in response to the high field strengths inherent to SFG spectroscopy. In order to determine structural changes and identify measurement artifacts, the changes in specific resonance intensities were measured in real-time and over a broad range of surface concentrations from films spread onto a stationary Langmuir trough. Using narrowband instead of broadband SFG minimizes the overlap of the incident infrared beam in the lipid C-H stretching region with resonances from the water sub-phase. Nevertheless, narrowband SFG still generates a thermal gradient at the surface, which produces a significant decrease in local concentration in the area of the laser spot caused by Bérnard-Marangoni convection originating in the sub-phase. The decrease in concentration results in an increase in the conformational disorder and a decrease in the tilt angle of lipid tails. Crucially, it is shown that, even at the highest monolayer concentrations, this gives rise to a measurement effect, which manifests itself as a dependence on the spectral acquisition time. This effect should be taken into account when interpreting the structure of monolayer films on liquid surfaces deduced from their SFG spectra.

Chemically characterizing the cortical cell nano-structure of human hair using atomic force microscopy integrated with infrared spectroscopy (AFM-IR).

OBJECTIVE: The use of conventional microscopy and vibrational spectroscopy in the optical region to investigate the chemical nature of hair fibres on a nanometre scale is frustrated by the diffraction limit of light, prohibiting the spectral elucidation of nanoscale sub-structures that contribute to the bulk properties of hair. The aim of this work was to overcome this limitation and gain unprecedented chemical resolution of cortical cell nano-structure of hair. METHODS: The hybrid technique of AFM-IR, combining atomic force microscopy with an IR laser, circumvents the diffraction limit of light and achieves nanoscale chemical resolution down to the AFM tip radius. In this work, AFM-IR was employed on ultra-thin microtomed cross-sections of human hair fibres to spectrally distinguish and characterize the specific protein structures and environments within the nanoscale components of cortical cells. RESULTS: At first, a topographical and chemical distinction between the macrofibrils and the surrounding intermacrofibillar matrix was achieved based on 2.5 × 2.5 µm maps of cortical cell cross-sections. It was found that the intermacrofibrillar matrix has a large protein content and specific cysteine-related residues, whereas the macrofibrils showed bigger contributions from aliphatic amino acid residues and acidic-/ester-containing species (e.g. lipids). Localized spectra recorded at a spatial resolution of the order of the AFM tip radius enabled the chemical composition of each region to be determined following deconvolution of the Amide-I and Amide-II bands. This provided specific evidence for a greater proportion of α-helices in the macrofibrils and correspondingly larger contributions of ß-sheet secondary structures in the intermacrofibrillar matrix, as inferred in earlier studies. Analysis of the parallel and antiparallel ß-sheet structures, and of selected dominant amino acid residues, yielded further novel composition and conformation results for both regions. CONCLUSION: In this work, we overcome the diffraction limit of light using atomic force microscopy integrated with IR laser spectroscopy (AFM-IR) to characterize sub-micron features of the hair cortex at ultra-high spatial resolution. The resulting spectral analysis shows clear distinctions in the Amide bands in the macrofibrils and surrounding intermacrofibrillar matrix, yielding novel insight into the molecular structure and intermolecular stabilization interactions of the constituent proteins within each cortical component.

OBJECTIF: L'utilisation de la microscopie conventionnelle et de la spectroscopie vibratoire dans la région optique pour étudier la nature chimique des fibres capillaires à l'échelle nanométrique est limitée par la limite de diffraction de la lumière, interdisant l'élucidation spectrale des sous-structures à l'échelle nanométrique qui contribuent aux propriétés des cheveux en général. L'objectif de ce travail était de surmonter cette limitation et d'obtenir une résolution chimique sans précédent de la nanostructure cellulaire corticale des cheveux. MÉTHODES: La technique hybride de l'AFM-IR, combinant la microscopie à force atomique avec un laser IR, contourne la limite de diffraction de la lumière et permet d'obtenir une résolution chimique à l'échelle nanométrique jusqu'au rayon de l'extrémité de l'AFM. Dans ce travail, l'AFM-IR a été employée sur des coupes transversales microtomes ultrafines de fibres de cheveux humains pour distinguer et caractériser sur le plan spectral les structures et environnements protéiques spécifiques au sein des composants à l'échelle nanométrique des cellules corticales. RÉSULTATS: Tout d'abord, une distinction topographique et chimique entre les macrofibrilles et la matrice intermacrofibrillaire environnante a été obtenue à partir de cartes de 2,5 × 2,5 micromètres des coupes transversales des cellules corticales. Il a été constaté que la matrice intermacrofibrillaire avait une grande teneur en protéines et des résidus spécifiques liés à la cystéine, tandis que les macrofibrilles présentaient des contributions plus importantes provenant de résidus d'acides aminés aliphatiques et d'espèces acides/contenant des esters (p. ex. lipides). Les spectres localisés enregistrés à une résolution spatiale de l'ordre du rayon de l'extrémité AFM ont permis de déterminer la composition chimique de chaque région suite à la déconvolution des bandes Amide-I et Amide-II. Cela a apporté des preuves spécifiques pour une plus grande proportion des hélices alpha des macrofibrilles, de même que des contributions plus importantes des structures secondaires à feuillet bêta dans la matrice intermacrofibrillaire, déduites dans des études antérieures. L'analyse des structures parallèles et antiparallèles des feuillets bêta, et des résidus d'acides aminés dominants sélectionnés a donné des résultats inédits de composition et de conformation pour les deux régions. CONCLUSION: Dans ce travail, nous avons surmonté la limite de diffraction de la lumière en utilisant la microscopie à force atomique intégrée à la spectroscopie laser IR (IR-AFM) pour caractériser les caractéristiques submicroniques du cortex capillaire à une résolution spatiale ultra-élevée. L'analyse spectrale qui en résulte montre des distinctions nettes dans les bandes d'amide dans les macrofibrilles et la matrice intermacrofibrillaire environnante, ce qui apporte un éclairage nouveau sur la structure moléculaire et les interactions de stabilisation intermoléculaire des protéines constitutives dans chaque composant cortical.

Training programme in gasless laparoscopy for rural surgeons of India (TARGET study) - Observational feasibility study.

BACKGROUND: Benefits of laparoscopic surgery are well recognised but uptake in rural settings of low- and middle-income countries is limited due to implementation barriers. Gasless laparoscopy has been proposed as an alternative but requires a trained rural surgical workforce to upscale. This study evaluates a feasibility of implementing a structured laparoscopic training programme for rural surgeons of North-East India. METHODS: A 3-day training programme was held at Kolkata Medical College in March 2019. Laparoscopic knowledge and Fundamentals of Laparoscopic Skills (FLS) were assessed pre and post simulation training using multiple choice questions and the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS), respectively. Competency with an abdominal lift device was assessed using the Objective Structured Assessment of Technical Skills (OSATS) and live operating performance via the Global Operative Assessment of Laparoscopic Skills (GOALS) scores during live surgery. Costs of the training programme and qualitative feedback were evaluated. RESULTS: Seven rural surgeons participated. There was an improvement in knowledge acquisition (mean difference in MCQ score 5.57 (SD = 4.47)). The overall normalised mean MISTELS score for the FLS tasks improved from 386.02 (SD 110.52) pre-to 524.40 (SD 94.98) post-training (p = 0.09). Mean OSATS score was 22.4 out of 35 (SD 3.31) indicating competency with the abdominal lift device whilst a mean GOALS score of 16.42 out of 25 (SD 2.07) indicates proficiency in performing diagnostic laparoscopy using the gasless technique during live operating. Costs of the course were estimated at 354 USD for trainees and 461 USD for trainers. CONCLUSION: Structured training programme in gasless laparoscopy improves overall knowledge and skills acquisition in laparoscopic surgery for rural surgeons of North-East India. It is feasible to deliver a training programme in gasless laparoscopy for rural surgeons. Larger studies are needed to assess the benefits for wider adoption in a similar context.

Nanoscale adhesion profiling and membrane characterisation in sickle cell disease using hybrid atomic force microscopy-IR spectroscopy.

Sickle cell disease (SCD) presents a significant global health problem. At present there is no effective treatment, with most being supportive for its associated complications such as the vaso-occlusive crises that result from increased cell adhesion. Hypoxic sickle cells have previously shown greater phosphatidylserine (PS) exposure and oxidative damage, as well as being notably "stickier" suggesting that increased cell cohesion and adhesion to the blood vessel endothelium is a possible mechanism for vaso-occlusion. The present work uses the hybrid technique of atomic force microscopy nano-infrared spectroscopy (AFM-IR) to probe changes to the coefficient of friction and C-O IR intensity in SCD on a nanoscale for dried red blood cells (RBCs) fixed under conditions of hypoxia and correlates these observations with adhesive interactions at the membrane. Using functionalised AFM tips, it has been possible to probe adhesive interactions between hydrophilic and hydrophobic moieties exposed at the surface of the dried RBCs fixed under different oxygenation states and for different cell genotypes. The results are consistent with greater PS-exposure and oxidative damage in hypoxic sickle cells, as previously proposed, and also show strong correlation between localised oxidative damage and increased adhesion. A mechanistic explanation involving significant lipid tail disruption as a result of oxidative action, in combination with differing concentrations of externalised PS lipids, is proposed to explain the observed adhesion behaviour of each type of cell.

Detecting changes in distortion product otoacoustic emission maps using statistical parametric mapping and random field theory.

Distortion product otoacoustic emission (DPOAE) maps collect DPOAE emissions over a broad range of frequencies and ratios. One application of DPOAE mapping could be monitoring changes in intracranial pressure (ICP) in space, where non-invasive measures of ICP are an area of interest. Data were collected in two experiments to statistically assess changes in DPOAE maps. A repeatability study where four maps per subject were collected across four weeks to establish "normal" variability in DPOAE data, and a posture study where subjects were measured supine and prone with lower body negative pressure, lower body positive pressure (LBPP), and at atmospheric pressure. DPOAE amplitude maps were analyzed using statistical parametric mapping and random field theory. Postural changes produced regional changes in the maps, specifically in the range of 5-7.5 kHz and between primary tone ratios of 1.13-1.24. These regional changes were most pronounced in the prone LBPP condition, where amplitudes were lower from baseline for the Postural Cohort than the Repeatability Cohort. Statistical parametric mapping provided a sensitive measure of regional DPOAE map changes, which may be useful clinically to monitor ICP noninvasively in individuals or for research to identify differences within in cohorts of people.

A time domain study of surfactin penetrating a phospholipid monolayer at the air-water interface investigated using sum frequency generation spectroscopy, infrared reflection absorption spectroscopy, and AFM-nano infrared microscopy.

We have investigated the interaction of surfactin with a monolayer of 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) at the air-water interface as a function of time, following its injection into the sub-phase, using non-linear Sum Frequency Generation (SFG) vibrational spectroscopy and Infrared Reflection Absorption Spectroscopy (IRRAS). SFG resonances from the phospholipid and from the surfactin were distinguished from each other by using selective deuteration. The surface pressure at the interface was measured concurrently for up to 8 h. After an induction period, the spectra from the lipid diminished and those of surfactin gradually appeared whilst at the same time the surface pressure increased. However, eventually the surfactin signals disappeared and those of the lipid reappeared. Although the SFG spectra of the lipid disappeared at intermediate times, the IRRAS spectra of the lipid were always present at the interface. Variation in the temporal SFG behaviour was investigated as the pH of the sub-phase, the initial surface pressure of the lipid, and the surfactin concentration were changed. Samples of the surface film were transferred onto mica substrates at selected times along the temporal profile and imaged by Atomic Force Microscopy - nano Infrared Spectroscopy (nano-IR). A model is proposed to account for the results from the four different experimental techniques used.

Microbubbles are detected prior to larger bubbles following decompression.

Using dual-frequency ultrasound (DFU), microbubbles (<10 µm diameter) have been detected in tissue following decompression. It is not known if these microbubbles are the precursors for B-mode ultrasound-detectable venous gas emboli (bmdVGE). The purpose of this study was to determine if microbubbles could be detected intravascularly postdecompression and to investigate the temporal relationship between microbubbles and larger bmdVGE. Anesthetized swine (n = 15) were exposed to 4.0-4.5 ATA for 2 h, followed by decompression to 0.98 ATA. Microbubble presence and VGE grade were measured using DFU and B-mode ultrasound, respectively, before and for 1 h postdecompression, approximately every 4-5 min. Microbubbles appeared in the bloodstream postdecompression, both in the presence and absence of bmdVGE. In swine without bmdVGE, microbubbles remained elevated for the entire 60-min postdecompression period. In swine with bmdVGE, microbubble signals were detected initially but then returned to baseline. Microbubbles were not detected with the sham dive. Mean bmdVGE grade increased over the length of the postdecompression data collection period. Comparison of the two response curves revealed significant differences at 5 and 10 min postdecompression, indicating that microbubbles preceded bmdVGE. These findings indicate that decompression-induced microbubbles can 1) be detected intravascularly at multiple sites, 2) appear in the presence and absence of bmdVGE, and 3) occur before bmdVGE. This supports the hypothesis that microbubbles precede larger VGE bubbles. Microbubble presence may be an early marker of decompression stress. Since DFU is a low-power ultrasonic method, it may be useful for operational diving applications.

Post-transfusion hepatitis revisited.

OBJECTIVE: To evaluate the risk of post-transfusion and postoperative non-A non-B hepatitis in Australia immediately before the introduction of screening for hepatitis C. DESIGN: Retrospective testing of blood samples from a prospective study of cardiac surgery patients. Samples were taken from transfusion recipients and non-transfused controls at regular intervals for 12 months after surgery during 1987-1989. For all donor, recipient and control samples, alanine aminotransferase (ALT) levels were measured and tests for antibody to hepatitis B (anti-HBc, anti-HBs) and, when available, to hepatitis C (anti-HCV) were performed. SETTING: Cardiac surgery units. PARTICIPANTS: Participants were included if they lived in the metropolitan area, and had not had a transfusion in the past year. MAIN OUTCOME MEASURES: Post-transfusion hepatitis (two consecutive samples showing raised ALT levels, > 90 IU/L with no other known cause); hepatitis C infection and carriage (antibody to hepatitis C). RESULTS: Post-transfusion hepatitis occurred in 1.1% of 736 recipients of blood not screened for hepatitis C (i.e., two cases per 1000 unscreened units given). No hepatitis occurred in 514 controls. Seven of the eight patients with post-transfusion hepatitis seroconverted to hepatitis C virus infection. Seven of the 26 anti-HCV-positive donations transmitted hepatitis C, six of these were positive by recombinant immunoblot assay (RIBA) (one by second generation testing only) and one was RIBA indeterminate. Nineteen were RIBA non-reactive; one transmitted hepatitis but the recipient did not develop anti-HCV, although hepatitis C RNA was detected in the donation. Serum ALT was raised in four of the six infective donations. CONCLUSIONS: Hepatitis C virus infection accounted for almost all cases of non-A non-B post-transfusion hepatitis. First generation anti-HCV tests detected about 85% of infective donations. Surrogate testing of donations by ALT or anti-HBc offers no additional advantage.

Is an information booklet for patients leaving hospital helpful and useful?

OBJECTIVE: To determine whether a booklet given to patients being discharged from hospital giving details of their admission and treatment increased their knowledge and recall when reviewed in outpatient clinics. DESIGN: Patients alternately allocated to receive a booklet or to serve as controls. Assessment by a questionnaire at first attendance at outpatient clinic after discharge. Data were collected over nine months. SETTING: One general medical and cardiological ward in a large teaching hospital and associated outpatient clinics. PATIENTS: One hundred and thirty one patients discharged taking at least one drug and scheduled to return to clinic within 12 weeks. Patients stratified by age and by the number of weeks between discharge and outpatient appointment. INTERVENTION: A booklet was given to 65 patients at discharge from the ward; 66 patients served as controls. MAIN RESULTS: Of the patients who received the booklet, 56 (86%) knew the names of their drugs, 62 (95%) the frequency of the dose, and 55 (85%) the reasons for taking each drug. The numbers in the control group were 31 (47%), 38 (58%), and 28 (42%) respectively. These differences were highly significant (p less than 0.001). Twenty six (40%) who received the booklet brought all their drugs to clinic compared with 12 (18%) control patients. Appreciably more of the first group of patients than control patients knew the reason they had been in hospital, and more of the first group indicated that they would take the correct action when their prescribed drugs ran out. Most general practitioners thought that the booklet was a good idea, that it was helpful, and that it was better than the existing interim discharge letter. CONCLUSIONS: Giving patients an information booklet at discharge from hospital appreciably increased the accuracy and thoroughness of their recall of important medical details concerning their illness and its treatment. The booklet was shown to be feasible, helpful in the outpatient clinic, and preferred by most general practitioners.