Nursing care of acute stroke patients after receiving rt-PA therapy. The NINDS rt-PA Stroke Study Group

Treatment with tissue plasminogen activator (rt-PA) for acute stroke requires intensive care of the patient. The risk of thrombolytic therapy and the need for rapid interventions make it clear that the nursing role during this time is crucial. Nurses should be familiar with safe dosage and administration of rt-PA for stroke, which is clearly different than administration of rt-PA for myocardial infarction. Furthermore, thrombolytic stroke treatment must be accompanied by intensive neurological monitoring to observe for complications. Intracerebral hemorrhage is usually accompanied by an acute change in neurological status and vital sign instability. Intensive monitoring of neurologic condition, vital signs, cardiac status and other standard critical care practices must be initiated immediately to optimize patient outcome.     

A porous silicon-based optical interferometric biosensor

A biosensor has been developed based on induced wavelength shifts in the Fabry-Perot fringes in the visible-light reflection spectrum of appropriately derivatized thin films of porous silicon semiconductors. Binding of molecules induced changes in the refractive index of the porous silicon. The validity and sensitivity of the system are demonstrated for small organic molecules (biotin and digoxigenin), 16-nucleotide DNA oligomers, and proteins (streptavidin and antibodies) at pico- and femtomolar analyte concentrations. The sensor is also highly effective for detecting single and multilayered molecular assemblies.     

In vivo microdialysis of 2-deoxyglucose 6-phosphate into brain: a novel method for the measurement of interstitial pH using 31P-NMR

A unique method for simultaneously measuring interstitial (pHe) as well as intracellular (pHi) pH in the brains of lightly anesthetized rats is described. A 4-mm microdialysis probe was inserted acutely into the right frontal lobe in the center of the area sampled by a surface coil tuned for the collection of 31P-NMR spectra. 2-Deoxyglucose 6-phosphate (2-DG-6-P) was microdialyzed into the rat until a single NMR peak was detected in the phosphomonoester region of the 31P spectrum. pHe and pHi values were calculated from the chemical shift of 2-DG-6-P and inorganic phosphate, respectively, relative to the phosphocreatine peak. The average in vivo pHe was 7.24+/-0.01, whereas the average pHi was 7.05+/-0.01 (n = 7). The average pHe value and the average CSF bicarbonate value (23.5+/-0.1 mEq/L) were used to calculate an interstitial Pco2 of 55 mm Hg. Rats were then subjected to a 15-min period of either hypercapnia, by addition of CO2 (2.5, 5, or 10%) to the ventilator gases, or hypocapnia (PCO2 < 30 mm Hg), by increasing the ventilation rate and volume. pHe responded inversely to arterial Pco2 and was well described (r2 = 0.91) by the Henderson-Hasselbalch equation, assuming a pKa for the bicarbonate buffer system of 6.1 and a solubility coefficient for CO2 of 0.031. This confirms the view that the bicarbonate buffer system is dominant in the interstitial space. pHi responded inversely and linearly to arterial PCO2. The intracellular effect was muted as compared with pHe (slope = -0.0025, r2 = 0.60). pHe and pHi values were also monitored during the first 12 min of ischemia produced by cardiac arrest. pHe decreases more rapidly than pHi during the first 5 min of ischemia. After 12 min of ischemia, pHe and pHi values were not significantly different (6.44+/-0.02 and 6.44+/-0.03, respectively). The limitations, advantages, and future uses of the combined microdialysis/31P-NMR method for measurement of pHe and pHi are discussed.     

Code Stroke: rapid transport, triage and treatment using rt-PA therapy. The NINDS rt-PA Stroke Study Group

In view of the concern regarding the potential risks and benefits of sodium restriction, the effect on biochemical and orthostatic responses from a moderate reduction in sodium intake in elderly persons that is sufficient to lower systolic blood pressure (SBP) was examined. Seventeen hypertensive subjects aged 65-79 years entered a double-blind randomized placebo controlled cross-over trial of a low sodium diet plus placebo tablets vs a low sodium diet plus sodium tablets (80 mmols/day) each for 5 weeks. At the end of high and low sodium periods, two 24-h urine collections and venous blood samples were undertaken and supine and standing BPs were recorded. On the low compared to the high sodium phase (urinary sodium excretion 95 +/- 36 vs 174 +/- 40 mmols/24-h, respectively), clinic supine SBP fell by 8 mm Hg (95% CI: 1-15 mm Hg, P< 0.05) and diastolic BP (DBP) by 1 mm Hg (CI: -3 to 5 mm Hg); there was no change in total LDL- and HDL-cholesterol and triglyceride levels, serum calcium, phosphate, parathyroid hormone, glucose, creatinine clearance or urinary albumin excretion rate. Serum urate was significantly higher during the low compared to high sodium intake (304 +/- 56 vs 277 +/- 44 micromols/l). Orthostatic BP responses during the high and low sodium intakes were unchanged. In summary, after 5 weeks of moderate sodium restriction no adverse effects other than an increase in serum urate was seen in elderly hypertensive persons.     

The Effect of Surfactants on the Reactivity and Photophysics of Luminescent Nanocrystalline Porous Silicon

The effect of aqueous cationic and anionic surfactant solutions on the chemical stability and photoluminescence (PL) of n‐ and p‐type porous Si has been studied. Exposure of either n‐ or p‐type porous Si to aqueous solutions of the surfactants dodecyltrimethyl ammonium bromide (DTAB) or sodium dodecylsulfonate (SDSulfonate) at ≤ pH 3.0 results in quenching of the visible PL from this material via two distinct mechanisms. In the case of the cationic surfactant DTAB, irreversible quenching of the PL is accompanied by chemical corrosion of the porous Si sample, as determined by infrared spectroscopy. The enhanced corrosion rate is attributed to an increase in the reactivity of the hydrides present on the Si surface towards water, induced by adsorption of the cationic surfactant. Hydrogen evolution in this reaction was confirmed by gas chromatography. In contrast, the anionic surfactant SDSulfonate physisorbs to either n‐ or p‐type porous Si samples, and quenches PL without resulting in a significant amount of oxidation. The mechanism of quenching for the anionic surfactant is attributed to local dielectric effects that increase the non‐radiative decay rate in porous Si.     

Photoluminescence‐Based Sensing With Porous Silicon Films,Microparticles, and Nanoparticles

Here, chemical sensors made from porous Si are reviewed, with an emphasis on systems that harness photoluminescence and related energy‐ and charge‐transfer mechanisms available to porous Si‐derived nanocrystallites. Quenching of luminescence by molecular adsorbates involves the harvesting of energy from a delocalized nanostructure that can be much larger than the molecule being sensed, providing a means to amplify the sensory event. The interaction of chemical species on the surface of porous Si can exert a pronounced influence on this process, and examples of some of the key chemical reactions that modify either the surface or the bulk properties of porous Si are presented. Sensors based on micron‐scale and smaller porous Si particles are also discussed. Miniaturization to this size regime enables new applications, including imaging of cancerous tissues, indirect detection of reactive oxygen species (ROS), and controlled drug release. Examples of environmental and in vivo sensing systems enabled by porous Si are provided.