Advances in pulsed electric stimuli as a physical method for treating liquid foods

There is a need for alternative technologies that can deliver safe and nutritious foods at lower costs as compared to conventional processes. Pulsed electric field (PEF) technology has been utilised for a plethora of different applications in the life and physical sciences, such as gene/drug delivery in medicine and extraction of bioactive compounds in food science and technology. PEF technology for treating liquid foods involves engineering principles to develop the equipment, and quantitative biochemistry and microbiology techniques to validate the process. There are numerous challenges to address for its application in liquid foods such as the 5-log pathogen reduction target in food safety, maintaining the food quality, and scale up of this physical approach for industrial integration. Here, we present the engineering principles associated with pulsed electric fields, related inactivation models of microorganisms, electroporation and electropermeabilization theory, to increase the quality and safety of liquid foods; including water, milk, beer, wine, fruit juices, cider, and liquid eggs. Ultimately, we discuss the outlook of the field and emphasise research gaps.

A Correlation Between Electric Fields That Target the Cell Membrane Potential and Dividing HeLa Cancer Cell Growth Inhibition

OBJECTIVE

Clinical studies show that low intensity (single V/cm), intermediate-frequency (100 kHz-300 kHz) electric fields inhibit the growth of cancer cells, while the mechanism is not yet understood. We examine the hypothesis that electric fields modify the cell membrane potential of dividing cancer cells in a way that correlates with cells growth inhibition.

METHODS

A Schwan based mathematical model calculates the changes in HeLa cells membrane potential due to single V/cm electric fields and frequencies from 0.1 to 1 MHz. An experimental study examines the effect of these electric fields on the inhibition of HeLa cells growth in an incubator.

RESULTS

The theoretical calculation shows that the effects of these electric fields on cell membrane potential decrease with an increase in frequency. The HeLa cells experiments verified the inhibitory effect of these fields on cell growth. The inhibitory effect is decreasing with an increase in frequency, in a way that is similar to the frequency dependent effect of these fields on the cell membrane potential.

CONCLUSIONS

The superposition of the theoretical results and the experimental results suggest a correlation between the effect of these fields on the cell membrane potential and inhibition of cancer cell growth. It should be emphasized that correlations do not prove causality, however, they suggest an area for future research.

SIGNIFICANCE

These findings have value for the understanding of the mechanisms of cancer cells growth inhibition with electric fields and suggest an interesting area of research on the interaction between electromagnetic fields and cancer cells.

Short microsecond pulses achieve homogeneous electroporation of elongated biological cells irrespective of their orientation in electric field

In gene electrotransfer and cardiac ablation with irreversible electroporation, treated muscle cells are typically of elongated shape and their orientation may vary. Orientation of cells in electric field has been reported to affect electroporation, and hence electrodes placement and pulse parameters choice in treatments for achieving homogeneous effect in tissue is important. We investigated how cell orientation influences electroporation with respect to different pulse durations (ns to ms range), both experimentally and numerically. Experimentally detected electroporation (evaluated separately for cells parallel and perpendicular to electric field) via Ca²⁺ uptake in H9c2 and AC16 cardiomyocytes was numerically modeled using the asymptotic pore equation. Results showed that cell orientation affects electroporation extent: using short, nanosecond pulses, cells perpendicular to electric field are significantly more electroporated than parallel (up to 100-times more pores formed), and with long, millisecond pulses, cells parallel to electric field are more electroporated than perpendicular (up to 1000-times more pores formed). In the range of a few microseconds, cells of both orientations were electroporated to the same extent. Using pulses of a few microseconds lends itself as a new possible strategy in achieving homogeneous electroporation in tissue with elongated cells of different orientation (e.g. electroporation-based cardiac ablation).

Development of transmembrane potential in concentric spherical, confocal spheroidal, and bispherical vesicles subjected to nanosecond-pulse electric field

Electroporation of concentric compound spherical and confocal spheroidal as well as eccentric compound spherical vesicles, considered to be good models for corresponding nucleate cells, are investigated with an emphasis on their response to nanosecond pulse electric field (nsPEF). Analytical models are developed for the estimation of the transmembrane potential (TMP) across the bilayers of the inner and the outer vesicles and finite-element simulations are also carried out for the eccentric case. Our calculations show that with an increase in the aspect ratio, while the TMP decreases when nsPEF is used, it increases for confocal spheroids when the pulse width is greater than the membrane charging time, leading to fully charged vesicles. Bipolar pulses are shown to effectively control the TMP for a desired time period in the nsPEF regime, and a fast decay of the TMP to zero can be achieved by judicious use of pulse polarity. The external conductivity is found to significantly influence the TMP in nsPEF, unlike millisecond pulses where its effect is insignificant. Additionally the critical electric field required to induce a TMP of 1 V at the inner vesicle is presented for different pulse widths, rise time, as well as membrane capacitance, and the TMP of the outer vesicle is found to be within limits of reversible poration. It is found that the maximum TMP has a roughly linear dependence on the outer aspect ratio of the vesicle. We also introduce a new method to obtain the particular solution to the Laplace equation for bispherical system, and it is validated with finite-element simulations. Our study on nsPEF electroporation of bispherical vesicles shows that the north pole TMP is typically greater than the south pole, thereby suggesting the typical pathway a charged species might take inside an eccentric nucleate cell under electroporation.

Evaluation of a New Catheter for Simultaneous Intracranial Pressure Monitoring and Cerebral Spinal Fluid Drainage: A Pilot Study

OBJECTIVES

Intracranial pressure (ICP) monitoring is a common practice when treating intracranial pathology with risk of elevated ICP. External ventricular drain (EVD) insertion is a standard approach for both monitoring ICP and draining cerebrospinal fluid (CSF). However, the conventional EVD cannot serve these two purposes simultaneously because it cannot accurately measure ICP and its pulsatile waveform while the EVD is open to CSF drainage. A new Integra^® Camino^® FLEX Ventricular Catheter (Integra Lifesciences, County Offaly, Ireland) with a double-lumen construction has been recently introduced into the market, and it can monitor ICP waveforms even during CSF drainage. The aim of this study was to evaluate and validate this new FLEX catheter for ICP monitoring in a neurological intensive care unit.

METHODS

Six patients with 34 EVD open/close episodes were retrospectively analyzed. Continuous ICP was detected in two ways: through the FLEX sensor at the tip (ICP_f) and through a fluid-coupled manometer within the FLEX catheter, functioning as a conventional EVD (ICP_e). The morphologies of ICP_f and ICP_e pulses were extracted using Morphological Clustering and Analysis of ICP algorithm, an algorithm that has been validated in previous publications. The mean ICP and waveform shapes of ICP pulses detected through the two systems were compared. Bland-Altman plots were used to assess the agreement of the two systems.

RESULTS

A significant linear relationship existed between mean ICP_f and mean ICP_e, which can be described as: mICP_f = 0.81 × mICP_e + 1.67 (r = 0.79). The Bland-Altman plot revealed that no significant difference existed between the two ICPs (average of [ICP_e-ICP_f] was - 1.69 mmHg, 95% limits of agreement: - 7.94 to 4.56 mmHg). The amplitudes of the landmarks of ICP pulse waveforms from the two systems showed strong, linear relationship (r ranging from 0.89 to 0.94).

CONCLUSIONS

This study compared a new FLEX ventricular catheter with conventional fluid-coupled manometer for ICP waveform monitoring. Strong concordance in ICP value and waveform morphology between the two systems indicates that this catheter can be used for reliability for both clinical and research applications.

Cerebral Vascular Changes During Acute Intracranial Pressure Drop

OBJECTIVE

This study applied a new external ventricular catheter, which allows intracranial pressure (ICP) monitoring and cerebral spinal fluid (CSF) drainage simultaneously, to study cerebral vascular responses during acute CSF drainage.

METHODS

Six patients with 34 external ventricular drain (EVD) opening sessions were retrospectively analyzed. A published algorithm was used to extract morphological features of ICP recordings, and a template-matching algorithm was applied to calculate the likelihood of cerebral vasodilation index (VDI) and cerebral vasoconstriction index (VCI) based on the changes of ICP waveforms during CSF drainage. Power change (∆P) of ICP B-waves after EVD opening was also calculated. Cerebral autoregulation (CA) was assessed through phase difference between arterial blood pressure (ABP) and ICP using a previously published wavelet-based algorithm.

RESULTS

The result showed that acute CSF drainage reduced mean ICP (P = 0.016) increased VCI (P = 0.02) and reduced ICP B-wave power (P = 0.016) significantly. VCI reacted to ICP changes negatively when ICP was between 10 and 25 mmHg, and VCI remained unchanged when ICP was outside the 10-25 mmHg range. VCI negatively (r = - 0.44) and VDI positively (r = 0.82) correlated with ∆P of ICP B-waves, indicating that stronger vasoconstriction resulted in bigger power drop in ICP B-waves. Better CA prior to EVD opening triggered bigger drop in the power of ICP B-waves (r = - 0.612).

CONCLUSIONS

This study demonstrates that acute CSF drainage reduces mean ICP, and results in vasoconstriction which can be detected through an index, VCI. Cerebral vessels actively respond to ICP changes or cerebral perfusion pressure (CPP) changes in a certain range; beyond which, the vessels are insensitive to the changes in ICP and CPP.

Data-Augmented Modeling of Intracranial Pressure

Precise management of patients with cerebral diseases often requires intracranial pressure (ICP) monitoring, which is highly invasive and requires a specialized ICU setting. The ability to noninvasively estimate ICP is highly compelling as an alternative to, or screening for, invasive ICP measurement. Most existing approaches for noninvasive ICP estimation aim to build a regression function that maps noninvasive measurements to an ICP estimate using statistical learning techniques. These data-based approaches have met limited success, likely because the amount of training data needed is onerous for this complex applications. In this work, we discuss an alternative strategy that aims to better utilize noninvasive measurement data by leveraging mechanistic understanding of physiology. Specifically, we developed a Bayesian framework that combines a multiscale model of intracranial physiology with noninvasive measurements of cerebral blood flow using transcranial Doppler. Virtual experiments with synthetic data are conducted to verify and analyze the proposed framework. A preliminary clinical application study on two patients is also performed in which we demonstrate the ability of this method to improve ICP prediction.

Mechanism of E. coli Inactivation by Direct-in-liquid Electrical Discharge Plasma in Low Conductivity Solutions

This work investigates and reveals the main mechanism(s) responsible for inactivation of E. coli by in-liquid pulsed electrical discharge plasma in low conductivity solutions. Experiments were designed and performed to explore the effects of plasma-emitted UV light, oxidative radicals, and electric field on E. coli inactivation curves, rate of DNA leakage and visual appearance of the treated microorganisms. Results showed that electric field had the main role in inactivation; scanning electron microscopy images revealed that both plasma and the isolated electric field result in extensive cell wall disruptions. While this damage in the case of plasma treatment was extensive and distributed randomly along the envelope, the electric field-induced damage resulted in disruption primarily at the poles of the bacterial rods. Subsequent experiments conducted with an oxidative radical scavenger suggested that plasma-generated radicals do not contribute directly to the inactivation but assist in cell wall deterioration and extension of the ruptures first generated by the electric field.

Molecular Binding Contributes to Concentration Dependent Acrolein Deposition in Rat Upper Airways: CFD and Molecular Dynamics Analyses

Existing in vivo experiments show significantly decreased acrolein uptake in rats with increasing inhaled acrolein concentrations. Considering that high-polarity chemicals are prone to bond with each other, it is hypothesized that molecular binding between acrolein and water will contribute to the experimentally observed deposition decrease by decreasing the effective diffusivity. The objective of this study is to quantify the probability of molecular binding for acrolein, as well as its effects on acrolein deposition, using multiscale simulations. An image-based rat airway geometry was used to predict the transport and deposition of acrolein using the chemical species model. The low Reynolds number turbulence model was used to simulate the airflows. Molecular dynamic (MD) simulations were used to study the molecular binding of acrolein in different media and at different acrolein concentrations. MD results show that significant molecular binding can happen between acrolein and water molecules in human and rat airways. With 72 acrolein embedded in 800 water molecules, about 48% of acrolein compounds contain one hydrogen bond and 10% contain two hydrogen bonds, which agreed favorably with previous MD results. The percentage of hydrogen-bonded acrolein compounds is higher at higher acrolein concentrations or in a medium with higher polarity. Computational dosimetry results show that the size increase caused by the molecular binding reduces the effective diffusivity of acrolein and lowers the chemical deposition onto the airway surfaces. This result is consistent with the experimentally observed deposition decrease at higher concentrations. However, this size increase can only explain part of the concentration-dependent variation of the acrolein uptake and acts as a concurrent mechanism with the uptake-limiting tissue ration rate. Intermolecular interactions and associated variation in diffusivity should be considered in future dosimetry modeling of high-polarity chemicals such as acrolein.

Characterization of Shape Differences Among ICP Pulses Predicts Outcome of External Ventricular Drainage Weaning Trial

BACKGROUND

External ventricular drains (EVD) are widely used to manage intracranial pressure (ICP) and hydrocephalus for aneurysmal subarachnoid hemorrhage (aSAH) patients. After days of use, a decision is made to remove the EVD or replace it with a shunt, involving EVD weaning and CT imaging to observe ventricular size and clinical status. This practice may lead to prolonged hospital stay, extra radiation exposure, and neurological insult due to ICP elevation. This study aims to apply a validated morphological clustering analysis of ICP pulse (MOCAIP) algorithm to detect signatures from the pulse waveform to differentiate an intact CSF circulatory system from an abnormal one during EVD weaning.

METHODS

We performed a retrospective study with 50 aSAH patients with reported weaning trial admitted to our institution between 03/2013 and 08/2014. By reviewing clinical notes and pre/post-brain imaging results, 32 patients were determined as having passed the weaning trial and 18 patients as having failed the trial. MOCAIP algorithm was applied to ICP signals to form a series of artifact-free dominant pulses. Finally, pulses with similar mean ICP were identified, and amplitude, Euclidean, and geodesic inter-pulse distances were calculated in a 4-h moving window.

RESULTS

While the traditional measure of mean ICP failed to differentiate the two groups of patients, the proposed amplitude and morphological inter-pulse measures presented significant differences (p ≤ 0.004). Moreover, receiver operating characteristic (ROC) analyses showed their usability to predict the outcome of the EVD weaning trial (AUC 0.85, p < 0.001).

CONCLUSIONS

Patients with an impaired CSF system showed a larger mean and variability of inter-pulse distances, indicating frequent changes on the morphology of pulses. This technique may provide a method to rapidly determine if patients will need placement of a shunt or can simply have the EVD removed.

Relative Position of the Third Characteristic Peak of the Intracranial Pressure Pulse Waveform Morphology Differentiates Normal-Pressure Hydrocephalus Shunt Responders and Nonresponders

INTRODUCTION

The diversion of cerebrospinal fluid (CSF) remains the principal treatment option for patients with normal-pressure hydrocephalus (NPH). External lumbar drain (ELD) and overnight intracranial pressure (ICP) monitoring are popular prognostic tests for differentiating which patients will benefit from shunting. Using the morphological clustering and analysis of continuous intracranial pulse (MOCAIP) algorithm to extract morphological metrics from the overnight ICP signal, we hypothesize that changes in the third peak of the ICP pulse pressure waveform can be used to differentiate ELD responders and nonresponders.

MATERIALS AND METHODS

Our study involved 66 patients (72.2 ± 9.8 years) undergoing evaluation for possible NPH, which included overnight ICP monitoring and ELD. ELD outcome was based on clinical notes and divided into nonresponders and responders. MOCAIP was used to extract mean ICP, ICP wave amplitude (waveAmp), and a metric derived to study P3 elevation (P3ratio).

RESULTS

Of the 66 patients, 7 were classified as nonresponders and 25 as significant responders. The mean ICP and waveAmp did not vary significantly (p = 0.19 and p = 0.41) between the outcome groups; however, the P3ratio did show a significant difference (p = 0.04).

CONCLUSION

Initial results suggest that the P3ratio might be used as a prognostic indicator for ELD outcome.

The Influence of Vesicle Shape and Medium Conductivity on Possible Electrofusion under a Pulsed Electric Field

The effects of electric field on lipid membrane and cells have been extensively studied in the last decades. The phenomena of electroporation and electrofusion are of particular interest due to their wide use in cell biology and biotechnology. However, numerical studies on the electrofusion of cells (or vesicles) with different deformed shapes are still rare. Vesicle, being of cell size, can be treated as a simple model of cell to investigate the behaviors of cell in electric field. Based on the finite element method, we investigate the effect of vesicle shape on electrofusion of contact vesicles in various medium conditions. The transmembrane voltage (TMV) and pore density induced by a pulsed field are examined to analyze the possibility of vesicle fusion. In two different medium conditions, the prolate shape is observed to have selective electroporation at the contact area of vesicles when the exterior conductivity is smaller than the interior one; selective electroporation is more inclined to be found at the poles of the oblate vesicles when the exterior conductivity is larger than the interior one. Furthermore, we find that when the exterior conductivity is lower than the internal conductivity, the pulse can induce a selective electroporation at the contact area between two vesicles regardless of the vesicle shape. Both of these two findings have important practical applications in guiding electrofusion experiments.

Cerebral hemodynamic and metabolic effects of remote ischemic preconditioning in patients with subarachnoid hemorrhage

BACKGROUND

Remote ischemic preconditioning (RIPC) is a form of endogenous neuroprotection induced by transient, subcritical ischemia in a distant tissue. RIPC effects on cerebral hemodynamics and metabolism have not been explored in humans. This study evaluates hemodynamic and metabolic changes induced by RIPC in patients with aneurysmal subarachnoid hemorrhage (SAH).

METHODS

Patients underwent three or four RIPC sessions 2-12 days following SAH. Continuous vitals, intracranial pressure (ICP), and transcranial Doppler (TCD) data were collected. Brain microdialysis metabolic changes were monitored. ICP and TCD morphological clustering and analysis of intracranial pulse (MOCAIP) metrics were compared to positive and negative control groups for cerebral vasodilation.

RESULTS

Seven ICP and six TCD recordings from four patients demonstrated an increase in mean ICP (8-14.57 mmHg, p < 0.05). There was a reduction in middle cerebral artery (MCA) mean velocities (111-87 cm/s, p = 0.039). ICP and TCD MOCAIP metrics demonstrated variances consistent with vasodilation that returned to baseline following the RIPC. Over the duration of the RIPC, microdialysis showed reduction in the lactate/pyruvate (L/P) ratio (42.37-33.77, p = 0.005) and glycerol (174.04-126 μg/l, p < 0.005), which persisted for 25-54 h after the last RIPC.

CONCLUSIONS

This study demonstrated cerebrovascular effects induced by RIPC consistent with transient vasodilation. Cerebral metabolic effects suggest protection from ischemia and cell membrane preservation lasting up to 2 days following RIPC.

Association between ICP pulse waveform morphology and ICP B waves

The study aimed to investigate changes in the shape of ICP pulses associated with different patterns of the ICP slow waves (0.5-2.0 cycles/min) during ICP overnight monitoring in hydrocephalus. Four patterns of ICP slow waves were characterized in 44 overnight ICP recordings (no waves - NW, slow symmetrical waves - SW, slow asymmetrical waves - AS, slow waves with plateau phase - PW). The morphological clustering and analysis of ICP pulse (MOCAIP) algorithm was utilized to calculate a set of metrics describing ICP pulse morphology based on the location of three sub-peaks in an ICP pulse: systolic peak (P(1)), tidal peak (P(2)) and dicrotic peak (P(3)). Step-wise discriminant analysis was applied to select the most characteristic morphological features to distinguish between different ICP slow waves. Based on relative changes in variability of amplitudes of P(2) and P(3) we were able to distinguish between the combined groups NW + SW and AS + PW (p < 0.000001). The AS pattern can be differentiated from PW based on respective changes in the mean curvature of P(2) and P(3) (p < 0.000001); however, none of the MOCAIP feature separates between NW and SW. The investigation of ICP pulse morphology associated with different ICP B waves may provide additional information for analysing recordings of overnight ICP.