Elevated skull fractures: an institutional experience and individual participant data meta-analysis

Elevated skull fracture (ESF) is a rare but potentially life-threatening type of skull fracture. The literature on this topic is relatively sparse. Herein, we conducted a meta-analysis of all the patients reported in the literature with ESFs with respect to their clinical management to better inform practice. On 20th of January 2023, we conducted a systematic search of literature to find all published cases of ESF. We also conducted a retrospective review of ESF cases from our institution. The data collection and analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After screening, 28 studies met the inclusion criteria. A total of 104 individual patients were included in the meta-analysis, with a median age of 24 years and 85.7% of whom were males. 11 patients (11.2%) had an unfavorable outcome while 37 (35.2%) had one or more complications. We found that GCS on admission is an independent predictor of poor outcome in ESF (odds ratio (95% confidence interval) = 1.605 (1.110-2.315), p value = 0.012). Regarding complications, dural injury (odds ratio (95% confidence interval) = 66.667 (7.407-500.00), p value < 0.001) and multiple bone involvement (odds ratio (95% confidence interval) = 6.849 (2.127-22.222), p value = 0.001) were independent predictors of complication. ESFs represent a rare yet consequential form of cranial injury, carrying potentially life-threatening implications if not promptly addressed. In this study, we present the meta-analysis of outcomes and complications within this patient cohort, offering a comprehensive synthesis of existing literature on this pathology. However, further investigation is imperative to provide higher-quality evidence and address lingering uncertainties in the classification and management of ESFs.

Surgical outcomes of myelomeningocele repair: A 20-year experience from a single center in a middle-income country

BACKGROUND AND PURPOSE

Spina bifida is the second major cause of congenital disorders and the most common central nervous system congenital malformation compatible with life primarily. Herein, we describe the short-term outcome of post-natal Myelomeningocele (MMC) surgical management and predictors of its postoperative complications and mortality.

METHODS

This retrospective chart review studies the children who underwent post-natal surgical management for MMC in Namazi hospital, a tertiary referral center, in southern Iran from May 2001 to September 2020.

RESULTS

248 patients were included in this study. The mean age at the operation was 8.47 ± 8.69 days. The most common site of involvement of MMC was Lumbosacral (86%, n = 204). At the evaluation conducted prior to the operation, cerebrospinal fluid leak was observed in 7% (n=16) of the patients. Postoperatively, 5.7% of the patients expired in the 30-day follow-up after the operation (n = 14), while 24% needed readmission (n = 47). The most common complications leading to readmission were wound dehiscence (n = 10, 42%) and wound purulence (n = 6, 25%). Only the site of the lesion (p-value = 0.035) was associated with postoperative complication. After controlling for potential confounders, the site of the lesion (adjusted odds ratio = 0.146, 95% confidence interval = 0.035-0.610, p-value = 0.008) and age at surgery (adjusted odds ratio = 1.048, 95% confidence interval = 1.002-1.096, p-value = 0.041) were significantly associated with mortality CONCLUSIONS: The age of the patients at the surgery and the site of the lesion are the two factors that were associated with mortality. However, further investigations into preoperative interventions and risk factors to mitigate the risk of complications and mortality are highly encouraged.

Development of a Novel Neurological Score Combining GCS and FOUR Scales for Assessment of Neurosurgical Patients with Traumatic Brain Injury: GCS-FOUR Scale

BACKGROUND

Consciousness assessment is crucial for patients with traumatic brain injury. In this study, we developed a novel scoring system combining the Glasgow coma scale (GCS) and the full outline of unresponsiveness (FOUR) and evaluated its association with the intensive care unit (ICU) length of stay, mortality, and functional outcome.

METHODS

We retrospectively analyzed the data from patients with traumatic brain injury admitted to the neurosurgical ICU of our institution during a 2-year period. The eye and motor components of the GCS and the brainstem reflex component of the FOUR were used to compute the GCS-FOUR. We performed statistical analysis to demonstrate the association between the GCS, FOUR, and GCS-FOUR and the ICU length of stay, mortality, the development of a persistent vegetative state, and desirable recovery.

RESULTS

A total of 140 patients were included. The mean age was 30.6 years, and 89.3% were male. All 3 scores were associated with the ICU length of stay, mortality, a persistent vegetative state, and good recovery. In terms of predicting mortality, the GCS score exhibited a slight superiority compared with the other indexes, and the GCS-FOUR score showed a slight superiority over the other indexes in predicting for good recovery.

CONCLUSIONS

The GCS-FOUR is a novel scoring system comparable to the GCS and FOUR regarding its association with functional status after injury, ICU length of stay, and mortality. The GCS-FOUR score provides greater neurological detail than the GCS due to the inclusion of brainstem reflexes, in addition to using the experience of healthcare providers with the GCS score compared with the FOUR in most settings.

A Novel Skin Incision for Posterior Fossa Midline and Paramedian Lesions: A Technical Note and Case Series

Approaching posterior fossa pathologies is fairly challenging. Poor exposure, cerebrospinal fluid (CSF) leak following surgery, post-operative suboccipital and neck pain, as well as wound healing are all common complications following traditional suboccipital midline incision. Herein, we present a novel incision for approaching posterior fossa pathologies. The incision is shaped like a question mark and makes a musculofascial flap supplied by the occipital artery on top as well as a wide area for craniotomy. In our technique, the dura is also incised in a question mark-shaped manner. The new incision was used to operate on three patients who had masses in the posterior fossa. Following surgeries, none of the patients experienced any adverse events such as CSF leak, wound complications, severe suboccipital pain, and neck instability. This new incision not only facilitates approaching pathologies in the posterior fossa by providing wider exposure but also enables us to perform watertight dural closure, which reduces CSF leak. Furthermore, as the muscular incision provides a sufficient area for craniotomy, muscular retraction can be minimized to reduce post-operative pain. Moreover, unlike the midline avascular incision, the flap is well supplied by the occipital artery, which facilitates the healing procedure.

Design and performance of a double-solenoid magnetic bottle photoelectron spectrometer for attosecond metrology

The design and performance of an in-house developed double-solenoid magnetic bottle (MB) time-of-flight photoelectron spectrograph are presented. A combination of a strong permanent magnet (Sm₂Co₁₇) with a soft iron cone and a double-solenoid geometry is used to generate MB configuration. The first solenoid (length ∼150 mm) is placed inside the vacuum, and the second solenoid (length ∼1 m) is placed outside the vacuum. The double-solenoid geometry improves the effective conductance and reduces overall material outgassing. Due to this, an ultra-high vacuum (∼5 × 10^-8 mbar) desirable for the working of the spectrograph was achieved using a small capacity (300 lps) turbo-molecular pump. An optimization of solenoid current generates a smooth magnetic field variation in MB, which keeps the adiabaticity parameter ∼0.6 at ∼25 eV photoelectron energy. The double-solenoid geometry also provides high collection efficiency as well as high energy resolution of the spectrograph. The experimentally measured energy resolution (ΔE) of the spectrograph is better than ∼60 meV at ∼15 eV photoelectron energy. The collection efficiency is estimated to be ∼25% under optimum conditions as compared with ∼10^-4 in field-free configuration. The calibrated MB spectrograph is used for the characterization of the attosecond pulse train using a cross-correlation "RABBITT" technique. The attosecond pulse train is generated from 15th to 25th odd high-harmonic orders, in argon filled cell. Attosecond pulses of average duration ∼260 as (FWHM) have been measured. The proposed MB electron spectrograph design provides a compact experimental setup for attosecond metrology and pump-probe studies with a relaxed requirement on vacuum pump capacity.

Hypoxia-sensitive miRNA regulation via CRISPR/dCas9 loaded in hybrid exosomes: A novel strategy to improve embryo implantation and prevent placental insufficiency during pregnancy

Assisted reproductive techniques as a new regenerative medicine approach have significantly contributed to solving infertility problems that affect approximately 15% of couples worldwide. However, the success rate of an in vitro fertilization (IVF) cycle remains only about 20%-30%, and 75% of these losses are due to implantation failure (the crucial rate-limiting step of gestation). Implantation failure and abnormal placenta formation are mainly caused by defective adhesion, invasion, and angiogenesis. Placental insufficiency endangers both the mother's and the fetus's health. Therefore, we suggested a novel treatment strategy to improve endometrial receptivity and implantation success rate. In this strategy, regulating mir-30d expression as an upstream transcriptomic modifier of the embryo implantation results in modified expression of the involved genes in embryonic adhesion, invasion, and angiogenesis and consequently impedes implantation failure. For this purpose, "scaffold/matrix attachment regions (S/MARs)" are employed as non-viral episomal vectors, transfecting into trophoblasts by exosome-liposome hybrid carriers. These vectors comprise CRISPR/dCas9 with a guide RNA to exclusively induce miR-30d gene expression in hypoxic stress conditions. In order to avoid concerns about the fetus's genetic manipulation, our vector would be transfected specifically into the trophoblast layer of the blastocyst via binding to trophoblast Erb-B4 receptors without entering the inner cell mass. Additionally, S/MAR episomal vectors do not integrate with the original cell DNA. As an on/off regulatory switch, a hypoxia-sensitive promoter (HRE) is localized upstream of dCas9. The miR-30d expression increases before and during the implantation and placental insufficiency conditions and is extinguished after hypoxia elimination. This hypothesis emphasizes that improving the adhesion, invasion, and angiogenesis in the uterine microenvironment during pregnancy will result in increased implantation success and reduced placental insufficiency, as a new insight in translational medicine.

Frequency of Low Cardiac Output Syndrome Following on Pump Coronary Artery Bypass Grafting Surgery and it's Association with Degree of Pre-operative Left Ventricular Dysfunction

Background Low cardiac output syndrome (LCOS) is a serious complication after coronary artery bypass grafting (CABG) surgery. It is associated with 10 times to 17 times increase in mortality and markedly increase morbidity. Objective To find out the frequency of Low cardiac output syndrome following on pump coronary artery bypass grafting surgery, to determine the association of Low cardiac output syndrome with degree of pre-operative left ventricular dysfunction and to compare in hospital outcomes of coronary bypass surgery with and without low cardiac output syndrome. Method This prospective, descriptive study enrolled 200 patients who underwent on pump coronary artery bypass grafting surgery using antegrade St Thomas blood cardioplegia. Pre-operatively grouped into two groups consisting Group A of 100 patients with pre-operative left ventricular ejection fraction (LVEF) ≥ 40% and group B of 100 patients with pre-operative left ventricular ejection fraction (LVEF) < 40%. Post-operatively frequency of low cardiac output syndrome was compared between the groups and in-hospital outcomes were studied. Result The mean age of the patients in the study was 53.50±7.57 years. Male to female ratio was 1.8:1. Results showed overall frequency of low cardiac output syndrome was 21.5%. The frequency of LCOS was 15 vs 28% (p - 0.038) in patients with preoperative LV EF ≥ 40% and < 40% respectively. The outcomes of coronary artery bypass grafting surgery were stroke (3.82 vs. 30.23%, p - 0.001), acute kidney injury (5.09 vs. 23.25%, p - 0.001), respiratory failure (6.36 vs. 34.88%, p - 0.001), ICU stay days (4.75 ± 1.28 vs. 7.44 ± 4.66, p - 0.018), hospital stay days (9.56 ± 2.40 vs. 15.22 ± 3.89, p - 0.001) and mortality (4.45 vs. 32.55%, p - 0.001) in patients without and with low cardiac output syndrome respectively. Conclusion The frequency of low cardiac output syndrome following coronary artery bypass surgery is 21.5%. Left ventricular dysfunction pre-operatively is associated with high frequency of low cardiac output syndrome following surgery. There is significantly poor outcome of coronary artery bypass surgery with low cardiac output syndrome in terms of stroke, respiratory failure, acute kidney injury, mortality and significant ICU stay, hospital stay in compare to patients without low cardiac output syndrome.

Multiplexed microfluidic chip for cell co-culture

Paracrine signaling is challenging to study in vitro, as conventional culture tools dilute soluble factors and offer little to no spatiotemporal control over signaling. Microfluidic chips offer potential to address both of these issues. However, few solutions offer both control over onset and duration of cell-cell communication, and high throughput. We have developed a microfluidic chip designed to culture cells in adjacent chambers, separated by valves to selectively allow or prevent exchange of paracrine signals. The chip features 16 fluidic inputs and 128 individually-addressable chambers arranged in 32 sets of 4 chambers. Media can be continuously perfused or delivered by diffusion, which we model under different culture conditions to ensure normal cell viability. Immunocytochemistry assays can be performed in the chip, which we modeled and fine-tuned to reduce total assay time to 1 h. Finally, we validate the use of the chip for co-culture studies by showing that HEK293Ta cells respond to signals secreted by RAW 264.7 immune cells in adjacent chambers, only when the valve between the chambers is opened.

843 Improving Antibiotic Prophylaxis Prescribing in Arthroplasty Surgery Following Neck of Femur Fracture (NOF#): A Clinical Audit Revealing Multi-Factorial Influences on Prescribing Accuracy

Introduction

Post-op infection is a serious complication in surgery, particularly in arthroplasty. NICE guidelines advise antibiotic prophylaxis for all arthroplasty procedures to avoid this. This audit aimed to assess our concordance with our local guidelines and achieve improvements where we were deficient.

Method

Electronic prescribing records were analysed for 60 patients who underwent arthroplasty following NOF# across St. Richard's and Worthing Hospitals between 4/3/19 – 17/6/19. We presented these initial findings at our local orthopaedic clinical governance meeting to educate team members. We then collected a second cycle of data between 1/11/20 – 16/12/20.

Results

Patients receiving some form of antibiotic prophylaxis improved from 90% to 100%. Patients receiving the appropriate prophylaxis as per local guidelines increased from 78% to 83%. However, more patients were given incomplete prophylaxis in the second cycle: 5% of patients were on concurrent antibiotics for chest infection and were not given full prophylaxis, 5% of patients were under-dosed on gentamicin and 3% of patients were not given the full 24 hours’ worth of flucloxacillin. No patients developed joint infections post-op after following up for 6 months.

Conclusions

Although all patients were given prophylaxis in the second cycle, patients not receiving the full recommended course of antibiotics represents an avoidable risk in developing post-op infection. We identified that communication between orthopaedic surgeons, anaesthetists and orthogeriatric ward team members and awareness of prescribing responsibility were implicated in accurate prescribing of prophylactic antibiotics. We aim to address these with further education and amendments to performas and then re-audit to look for further improvements.

Controlling silver release from antibacterial surface coatings on stainless steel for biofouling control

This study focuses on the in-situ nucleation of silver nanoparticles (AgNPs) on stainless steel (SS) to provide a localized antibacterial action for biofouling control during space missions. Since AgNPs rapidly dissolve in water, partial passivation of AgNPs was provided to slow down silver release and extend the lifetime of the antibacterial coating. Two different passivation approaches, based on the formation of low solubility silver sulfide (Ag₂S) or silver bromide (AgBr) shells, were compared to identify the optimal passivation for biofouling control. Highest bacterial inactivation (up to 75%) occurred with sulfidized AgNPs as opposed to bromidized (up to 50%) NPs. The optimal passivation treatment for biofouling control was found at 10^-5 M Na₂S (for Ag₂S) and 10^-3 M NaBr (for AgBr) concentrations. Scanning Electron Microscopy (SEM) analyses confirmed the presence of AgNPs on AgBr and Ag₂S-coated samples. Further investigation revealed that compared to pristine AgNPs, Ag release from both sulfidized and bromidized NPs was significantly lower (16% vs 6% or less). Overall, both sulfidized and bromidized AgNPs were effective at controlling biofilm formation; however, sulfidized NPs exhibited the maximum antibacterial activity, making it the preferable passivation strategy for AgNPs on SS surfaces.

COVID-19 and Acute Kidney Injury: A Systematic Review

Introduction

Acute kidney injury (AKI) has been associated with an increased mortality rate among hospitalized patients with Coronavirus disease 2019 (COVID-19). The current review aimed to evaluate the symptoms, complications, and treatments performed to manage AKI in patients with COVID-19.

Methods

We searched PubMed/Medline, Web of Science, and Embase for the relevant scientific literature published up to February 1, 2022. The following keywords were used: “COVID-19”, “SARS-CoV-2”, and “Acute kidney injury”.

Results

Forty-four studies with a total number of 114 COVID-19 patients with AKI (Mean age: 53.6 years) were included in our systematic review. The most common comorbidities in patients with COVID-19 suffering from AKI were the history of diabetes, hypertension, and hyperlipidemia. Twelve out of the 44 included studies reported a history of chronic kidney disease (CKD) in this group of patients. Focal segmental glomerulosclerosis (FSGS) and acute tubular necrosis (ATN) were the most common pathological evidence. The average length of hospital stay was 19 days, and the average duration of need for mechanical ventilation was 3 days.

Conclusions

The current systematic review shows that AKI frequently complicates the course of COVID-19 hospitalizations and is associated with increased severity of illness, prolonged duration of hospitalization, and poor prognosis. Given the extent of the adverse impact of AKI, early detection of comorbidities and renal complications is essential to improve the outcomes of COVID-19 patients.

Injectable Extracellular Matrix Microparticles Promote Heart Regeneration in Mice with Post-ischemic Heart Injury

Ischemic heart injury causes permanent cardiomyocyte loss and fibrosis impairing cardiac function. Tissue derived biomaterials have shown promise as an injectable treatment for the post-ischemic heart. Specifically, decellularized extracellular matrix (dECM) is a protein rich suspension that forms a therapeutic hydrogel once injected and improves the heart post-injury response in rodents and pig models. Current dECM-derived biomaterials are delivered to the heart as a liquid dECM hydrogel precursor or colloidal suspension, which gels over several minutes. To increase the functionality of the dECM therapy, an injectable solid dECM microparticle formulation derived from heart tissue to control sizing and extend stability in aqueous conditions is developed. When delivered into the infarcted mouse heart, these dECM microparticles protect cardiac function promote vessel density and reduce left ventricular remodeling by sustained delivery of biomolecules. Longer retention, higher stiffness, and slower protein release of dECM microparticles are noted compared to liquid dECM hydrogel precursor. In addition, the dECM microparticle can be developed as a platform for macromolecule delivery. Together, the results suggest that dECM microparticles can be developed as a modular therapy for heart injury.

Abstract P486: Decellularized Extracellular Matrix Microparticles Promote Heart Regeneration And Neovascularization In Post-mi Mice

Hypothesis and objective: We hypothesize that solid hydrogel particles will improve therapeutic efficacy of hydrogels derived from decellularized fetal hearts (dECM) on myocardial infarction (MI). In this study we developed dECM microparticles (MPs) to compare with liquid hydrogel. The objectives are 1) develop dECM MPs for increased stability at site of injection; 2) establish reduced degradation in vivo ; and 3) evaluate potential regenerative benefits from dispersed particles of dECM.

Methods: Microparticles were generated by electrospray of solubilized dECM. Microparticles were injected immediately after coronary artery ligation in adolescent mice. Echocardiography and histology were conducted 21days post-MI.

Results: Electrospray with emulsification produced solid dECM microparticles ranging in size from nanometers to microns depending on parameters. The dECM MPs showed prolonged release of proteins and decreased degradation rate in vitro compared to dECM hydrogel. The dECM MPs were observed to protect cardiac function (Fig. 1), lower fibrosis, stimulate cardiogenesis, and promote vascularization compared to MI control. Cardiogenesis and neovascularization were observed with dECM microparticles treatment compared to hydrogel treatment (Fig. 2). This study suggests the solid dECM particles provides unique advantages as an injectable therapy directed at the ischemic heart.

COVID-19 and Cardiomyopathy: A Systematic Review

Background: Cardiomyopathies (CMPs) due to myocytes involvement are among the leading causes of sudden adolescent death and heart failure. During the COVID-19 pandemic, there are limited data available on cardiac complications in patients with COVID-19, leading to severe outcomes.

Methods: We conducted a systematic search in Pubmed/Medline, Web of Science, and Embase databases up to August 2020, for all relevant studies about COVID-19 and CMPs.

Results: A total of 29 articles with a total number of 1460 patients were included. Hypertension, diabetes, obesity, hyperlipidemia, and ischemic heart disease were the most reported comorbidities among patients with COVID-19 and cardiomyopathy. In the laboratory findings, 21.47% of patients had increased levels of troponin. Raised D-dimer levels were also reported in all of the patients. Echocardiographic results revealed mild, moderate, and severe Left Ventricular (LV) dysfunction present in 17.13, 11.87, and 10% of patients, respectively.

Conclusions: Cardiac injury and CMPs were common conditions in patients with COVID-19. Therefore, it is suggested that cardiac damage be considered in managing patients with COVID-19.

Diagnostic accuracy of apparent diffusion coefficient (ADC) value in differentiating malignant from benign solid liver lesions: a systematic review and meta-analysis

OBJECTIVES

We undertook a systematic review and meta-analysis of the diagnostic performance of mean apparent diffusion coefficient (ADC) values derived by diffusion-weighted (DW)-MRI in the characterization of solid benign and malignant liver lesions, and to assess their value in discriminating these lesions in daily routine practice.

METHODS

A systematic review of PubMed, Embase, Scopus, and Web of Science was conducted to retrieve studies that used ADC values for differentiating solid benign/dysplastic nodules and malignant liver lesions. A bivariate random-effects model with pooled sensitivity and specificity values with 95% CI (confidence interval) was used. This meta-analysis was performed on the per-lesion basis. Summary receiver operating characteristic (SROC) plot and area under curve (AUC) were created.

RESULTS

A total of 14 original articles were retrieved. The combined (95% CI) sensitivity and specificity of mean ADC values for differentiating solid benign from malignant lesions were 78% (67-86%) and 74% (64-81%), respectively. The pooled (95% CI) positive and negative LRs were respectively 3 (2.3-3.8) and 0.3 (0.21-0.43). The DOR (95% CI) was 10 (7-15). The AUC (95% CI) of the SROC plot was 82% (78-85%). Reporting bias was negligible (p value of regression test = 0.36). Mean size of malignant lesions and breathing pattern of MRI were found to be sources of heterogeneity of pooled sensitivity.

CONCLUSION

ADC measurement independently may not be an optimal diagnostic imaging method for differentiating solid malignant from solid benign hepatic lesions. The meta-analysis showed that ADC measurement had moderate diagnostic accuracy for characterizing solid liver lesions. Further prospective and comparative studies with pre-specified ADC thresholds could be performed to investigate the best MRI protocol and ADC threshold for characterizing solid liver lesions.

ADVANCES IN KNOWLEDGE

ADC measurement by DW-MRI does not have a good diagnostic performance to differentiate solid malignant from solid benign lesions. Therefore, we suggest not using ADC values in clinical practice to evaluate solid liver lesions.

Preclinical studies conducted on nanozyme antioxidants: shortcomings and challenges based on US FDA regulations

The wide prevalence of oxidative stress-induced diseases has led to a growing demand for antioxidant therapeutics worldwide. Nanozyme antioxidants are drawing enormous attention as practical alternatives for conventional antioxidants. The considerable body of research over the last decade and the promising results achieved signify the potential of nanozyme antioxidants to secure a place in the expanding market of antioxidant therapeutics. Nonetheless, there is no report on clinical trials for their further evaluation. Through analyzing in-depth selected papers which have conducted in vivo studies on nanozyme antioxidants, this review aims to pinpoint and discuss possible reasons impeding development of research toward clinical studies and to offer some practical solutions for future studies to bridge the gap between preclinical and clinical stages.

Diagnostic performance of apparent diffusion coefficient (ADC) for differentiating endometrial carcinoma from benign lesions: a systematic review and meta-analysis

To determine the diagnostic performance of mean ADC values in the characterization of endometrial carcinoma (EC) from benign lesions by systematic review of the literature and performing meta-analysis. A systematic search of major electronic bibliographic databases was performed to find studies that used ADC values for differentiating EC from benign lesions. Two reviewers independently screened the titles and abstracts of the search results and then by reading the full texts selected the pertinent studies for final analyses. A bivariate random-effects model with pooled sensitivity and specificity values with 95% CI (confidence interval) was used. Summary receiver operating characteristic (SROC) curve and area under curve (AUC) were created. Between-study heterogeneity was measured using I squared (I2) index. Eleven studies including 269 ECs and 208 benign lesions were analyzed. Pooled average (95% CI) ADC in EC and benign lesions groups were, respectively, 0.82 (0.77-0.87) × 10-3 mm2/s and 1.41 (1.29-1.52) × 10-3 mm2/s. The combined (95% CI) sensitivity and specificity of mean ADC values for differentiating EC from benign lesions were 93% (87-96%; I2 = 41.19%) and 94% (88-97%; I2 = 46.91%), respectively. The AUC (95% CI) of the SROC curve was 98% (96-99%). ADC values had good diagnostic accuracy for differentiating EC from benign lesions. In order to recommend ADC measurement for detecting endometrial lesions in routine clinical practice, more primary studies, especially trials and comparative studies including hysteroscopically-guided biopsy method, with larger sample sizes are still required.

Increasing Silicone Mold Longevity: A Review of Surface Modification Techniques for PDMS-PDMS Double Casting

Polydimethyl siloxane (PDMS) has been used extensively for microfluidic devices due to its chemical properties allowing for rapid molding and versatile biological application. Soft lithography based PDMS fabrication primarily comprises casting from patterned photoresist on a silicon wafer. The patterned photoresist is often replaced with the cast PDMS as a more durable template mold for final PDMS fabrication that is less fragile and expensive. PDMS-PDMS double casting prolongs the longevity of soft lithography molds and reduces overall costs to microfuidic applications. A common end to the lifetime of PDMS negative masters is the risk of bonding between the replicate and mold and distorted topographrical features. This review examines common chemical and physical debonding approaches between PDMS-PDMS castings to exend the lifetime of PDMS masters.

Estimation of External Contamination and Exposure Rates Due to Fission Product Release

In the event of a radiological incident, the release of fission products into the surrounding environment and the ensuing external contamination present a challenge for triage assessment by emergency response personnel. Reference exposure rate and skin dose rate calibration data for emergency response personnel are currently lacking for cases where receptors are externally contaminated with fission products. Simulations were conducted to compute reference exposure rate coefficients and skin dose rate coefficients from photon-emitting fission products of radiological concern. To accomplish this task, simplified mathematical skin phantoms were created using surface area and height specifications from International Commission on Radiological Protection Publication 89. Simulations were conducted using Monte Carlo radiation transport code using newborn, 1-y-old, 5-y-old, 10-y-old, 15-y-old, and adult phantoms for 22 photon-emitting radionuclides. Exposure rate coefficient data were employed in a case study simulating the radionuclide inventory for a 17 × 17 Westinghouse pressurized water reactor, following three burn-up cycles at 14,600 MWd per metric ton of uranium. The decay times following the final cycle represent the relative activity fractions over a period of 0.5-30 d. The resulting data can be used as calibration standards for triage efforts in emergency response protocols.

Microbially-induced mineral scaling in desalination conditions: Mechanisms and effects of commercial antiscalants

Reverse osmosis (RO) technology is promising in the sustainable production of fresh water. However, expansion of RO use has been hindered by membrane fouling, mainly inorganic fouling known as scaling. Although membrane mineral scaling by chemical means have been investigated extensively, mineral scaling triggered by microbial activity has been largely neglected. In this study, the simultaneous biomineralization of CaCO₃ and CaSO₄ in the presence of three different microbial communities from fresh water, wastewater, and seawater was investigated. In the presence of either 13 or 79 mM of Ca²⁺ and SO₄^2- in the media, the fresh water microbial community produced calcite/vaterite and vaterite/gypsum, respectively; the wastewater community produced vaterite and vaterite/gypsum, respectively; and the seawater community produced aragonite in both conditions. The results showed that the concentration of salts and the microbial composition influence the types of precipitates produced. The mechanisms of crystal formation of CaCO₃ and gypsum by these communities were also investigated by determining the need for metabolic active cells, the effect of a calcium channel blocker, and the presence of extracellular polymeric substances (EPS). The results showed that metabolically active cells can lead to production of EPS and formation of Ca²⁺ gradient along the cells through calcium channels, which will trigger formation of biominerals. The prevention of biomineralization by these consortia was also investigated with two common polymeric RO antiscalants, i.e. polyacrylic acid (PAA) and polymaleic acid (PMA). Results showed that these antiscalants do not prevent the formation of the bio-precipitates suggesting that novel approaches to prevent biomineralization in RO systems still needs to be investigated.

The Convergence of Cell-Based Surface Plasmon Resonance and Biomaterials: The Future of Quantifying Bio-molecular Interactions-A Review

Cell biology is driven by complex networks of biomolecular interactions. Characterizing the kinetic and thermodynamic properties of these interactions is crucial to understanding their role in different physiological processes. Surface plasmon resonance (SPR)-based approaches have become a key tool in quantifying biomolecular interactions, however conventional approaches require isolating the interacting components from the cellular system. Cell-based SPR approaches have recently emerged, promising to enable precise measurements of biomolecular interactions within their normal biological context. Two major approaches have been developed, offering their own advantages and limitations. These approaches currently lack a systematic exploration of 'best practices' like those existing for traditional SPR experiments. Toward this end, we describe the two major approaches, and identify the experimental parameters that require exploration, and discuss the experimental considerations constraining the optimization of each. In particular, we discuss the requirements of future biomaterial development needed to advance the cell-based SPR technique.

Magnetic Active Water Filter Membrane for Induced Heating to Remove Biofoulants

Filter membrane processes are water purification methods that use a partially permeable membrane to separate contaminants from drinking water and wastewater. Although highly effective, they suffer from biofouling due to the aggregation of bacteria and contaminants from the filtrate, thus rendering the membrane unusable. Consequently, the membrane needs to be replaced on a regular basis, which interrupts filtration operation, reduces throughput, and increases production cost. To address this issue, we have developed a new method to remove biofoulants via induction heating on a modified membrane with magnetite (Fe₃O₄) magnetic nanoparticles (MNPs) coating. Under applied alternating magnetic field (AMF), the surface temperature of the MNPs coating reaches 180 °C with a heating rate of 1.03 °C/s, which disintegrates biofoulants generated by model bacteria (Bacillus subtilis) and by those present in environmental water samples collected from a local lake. The heating process is capable of cleaning biofoulants for several cycles without damaging the filtration function of the membrane. Furthermore, magnetic induction heating on the modified membrane allows uniform high-intensity heat generation on a large surface in only a few minutes using inexpensive MNPs, which can potentially be scaled up for industrial applications.

Extensive Spinal Epidural Abscess Associated with an Unremarkable Recovery

Spinal epidural abscess is a rare complication of epidural catheter insertion, with an incidence reported to be as low as 0.02%, but with a high morbidity and mortality. This reflects the difficulty in diagnosis of the condition, as early symptoms and signs are usually non-specific with late neurological manifestations. We report a case of spinal epidural abscess in a diabetic patient who underwent splenectomy and distal pancreatectomy. Early investigation with magnetic resonance imaging was effective in demonstrating an extensive epidural abscess involving the thoracic spine, with extension to the base of the skull and associated cord compression. Extensive multilevel laminectomies with thorough irrigation and washout of the epidural space were successful in treating this patient and preventing the development of permanent neurological sequelae.

Cardiac Pathology in Patients with End-Stage Renal Disease Maintained on Hemodialysis

We report the spectrum of cardiovascular pathology found on autopsy examination in 106 consecutive patients with end-stage renal disease. Cardiovascular pathology was present in nearly all patients, and was the most frequent cause of death (36%), with acute myocardial infarction accounting for 15%. Particularly frequent pathologic findings were left ventricular hypertrophy, coronary and aortic atherosclerosis, pericarditis with effusion, myocardial fibrosis, and valvular dilatation. Cardiovascular death rate was higher during the first year than after the fifth year of dialysis. Nearly all patients had a history of hypertension. The nature of the underlying cause of renal failure and pre-existing cardiovascular disease, specifically diabetes mellitus and hypertension, were the principal predictors of cardiovascular mortality rather than maintenance hemodialysis therapy per se.

Multivariate analysis of cytokine profiles in pregnancy complications

PROBLEM

The immunoregulation to tolerate the semiallogeneic fetus during pregnancy includes a harmonious dynamic balance between anti- and pro-inflammatory cytokines. Several earlier studies reported significantly different levels and/or ratios of several cytokines in complicated pregnancy as compared to normal pregnancy. However, as cytokines operate in networks with potentially complex interactions, it is also interesting to compare groups with multi-cytokine data sets, with multivariate analysis. Such analysis will further examine how great the differences are, and which cytokines are more different than others.

METHODS

Various multivariate statistical tools, such as Cramer test, classification and regression trees, partial least squares regression figures, 2-dimensional Kolmogorov-Smirmov test, principal component analysis and gap statistic, were used to compare cytokine data of normal vs anomalous groups of different pregnancy complications.

RESULTS

Multivariate analysis assisted in examining if the groups were different, how strongly they differed, in what ways they differed and further reported evidence for subgroups in 1 group (pregnancy-induced hypertension), possibly indicating multiple causes for the complication.

CONCLUSION

This work contributes to a better understanding of cytokines interaction and may have important implications on targeting cytokine balance modulation or design of future medications or interventions that best direct management or prevention from an immunological approach.

Novel use of bioelectric impedence technique to detect alterations in body composition in advanced small cell lung cancer

BACKGROUND

Malnutrition is frequent in lung cancer and is measured using various tools, including the novel bioelectric impedance technique for measuring body composition. However, the validation of this technique for assessing body composition in advanced small cell lung cancer (SCLC) is untested.

METHODS

Forty-one treatment naïve patients (all males) and an equal number of age- and sex-matched controls were evaluated by anthropometric measurements of skinfold thicknesses and body composition parameters such as body fat%, fat mass, fat-free mass (FFM), and total body water (TBW).

RESULTS

The mean (SD) age of the patient group was 55.7 (7.5) years, median pack-years was 20 (range, 0-80), and mean (SD) duration of symptoms was 152.6 (153.7) days. Median Karnofsky Performance Scale was 70 (range, 50-90). Majority of our patients (68.3%) were Stage IV followed by Stage III (31.7%). The percentage of patients with low, normal, and high body mass index (BMI) was 31.7%, 61%, and 7.3%, respectively. All components of body composition, i.e., body fat%, FFM, and TBW were significantly lower in patients compared to controls. However, the body composition in patients and controls with normal BMI was similar. The phenomenon of sarcopenia as a cause of cancer cachexia may explain these findings, whereas the combination of loss of body fat and lean body mass may lead to weight loss and reduced BMI.

CONCLUSION

Our results indicate that body composition is markedly altered in Indian patients with advanced SCLC. The impact of these parameters on clinically relevant outcomes needs further evaluation.

Relationship of Biodiversity with Heavy Metal Tolerance and Sorption Capacity: A Meta-Analysis Approach

Microbial remediation of metals can alleviate the concerns of metal pollution in the environment. The microbial remediation, however, can be a complex process since microbial metal resistance and biodiversity can play a direct role in the bioremediation process. This study aims to understand the relationships among microbial metal resistance, biodiversity, and metal sorption capacity. Meta-analyses based on 735 literature data points of minimum inhibitory concentrations (MIC) of Plantae, Bacteria, and Fungi exposed to As, Cd, Cr Cu, Ni, Pb, and Zn showed that metal resistance depends on the microbial Kingdom and the type of heavy metal and that consortia are significantly more resistant to heavy metals than pure cultures. A similar meta-analysis comparing 517 MIC values from different bacterial genera (Bacillus, Cupriavidus, Klebsiella, Ochrobactrum, Paenibacillus, Pseudomonas, and Ralstonia) confirmed that metal tolerance depends on the type of genus. Another meta-analysis with 195 studies showed that the maximum sorption capacity is influenced by microbial Kingdoms, the type of biosorbent (whether consortia or pure cultures), and the type of metal. This study also suggests that bioremediation using microbial consortia is a valid option to reduce environmental metal contaminations.

A Method of Targeted Cell Isolation via Glass Surface Functionalization

One of the limiting factors to the adoption and advancement of personalized medicine is the inability to develop diagnostic tools to probe individual nuances in expression from patient to patient. Current methodologies that try to separate cells to fill this niche result in disruption of physiological expression, making the separation technique useless as a diagnostic tool. In this protocol, we describe the functionalization and optimization of a surface for the cellular capture and release. This functionalized surface integrates biotinylated antibodies with a glass surface functionalized with an aminosilane (APTES), desthiobiotin and streptavidin. Cell release is facilitated through the introduction of biotin, allowing the recollection and purification of cells captured by the surface. This release is done through the targeting of the secondary moiety desthiobiotin, which results in a much more gentle release paradigm. This reduction in harsh reagents and shear forces reduces changes in cellular expression. The functionalized surface captures up to 80% of cells in a single cell mixture and has demonstrated 50% capture in a dual-cell mixture. Applications of this technology to xenografts and cancer separation studies are investigated. Quantification techniques for surface verification such as plate reader and ImageJ analyses are described as well.

Abstract P5-03-03: Designing a novel platinum chemotherapeutic (IO-125) for treatment of breast cancer

Triple-negative breast cancer (TNBC) is an aggressive form of cancer occurring in 15-20% of breast cancer patients, with most patients relapsing on currently approved therapy. Recent studies have shown activity of platinum chemotherapy in this class of patients. IO-125 is a novel platinum (II) chemotherapeutic agent with an unique coordination environment. In this study, we investigated the anti-tumor activity of IO-125 in pre-clinical models of TNBC.

The coordination environment in IO-125 facilitates supramolecular assembly and releases diaminocyclohexane (DACH)-platinum in a sustained pH-dependent manner. In vitro cell viability studies using an array of breast cancer cell lines shows IO-125 exerts increased potency compared to carboplatin or oxaliplatin. The maximum tolerated (platinum-equivalent) dose (MTD) of IO-125 in mice was 8-fold higher than the MTD (platinum-equivalent) dose of oxaliplatin. The biodistribution and pharmacokinetic profile of IO-125 in plasma and tumor revealed preferential tumor accumulation, significantly increased area-under-the-curve (AUC), a reduction in clearance (CL) and a longer terminal half-life (42 hours) in comparison to oxaliplatin (18 hours). In addition, DNA-Pt adduct formation in tumors was significantly higher for IO-125. When administered at their respective MTDs, IO-125 led to sustained regression of the tumor in a 4T1 syngeneic breast cancer model. Based on these observations, we conclude that IO-125 may emerge as a novel therapeutic against triple negative breast cancer.

Citation Format: Sengupta A, Roy M, Sarkar A, Mylavarapu S, Modi S, Gupta N, B H, Hossain S, Ansari A, Pandey M, Yadav Y, Sengupta S. Designing a novel platinum chemotherapeutic (IO-125) for treatment of breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-03-03.

Secondary anchor targeted cell release

Personalized medicine offers the promise of tailoring therapy to patients, based on their cellular biomarkers. To achieve this goal, cellular profiling systems are needed that can quickly and efficiently isolate specific cell types without disrupting cellular biomarkers. Here we describe the development of a unique platform that facilitates gentle cell capture via a secondary, surface-anchoring moiety, and cell release. The cellular capture system consists of a glass surface functionalized with APTES, d-desthiobiotin, and streptavidin. Biotinylated mCD11b and hIgG antibodies are used to capture mouse macrophages (RAW 264.7) and human breast cancer (MCF7-GFP) cell lines, respectively. The surface functionalization is optimized by altering assay components, such as streptavidin, d-desthiobiotin, and APTES, to achieve cell capture on 80% of the functionalized surface and cell release upon biotin treatment. We also demonstrate an ability to capture 50% of target cells within a dual-cell mixture. This engineering advancement is a critical step towards achieving cell isolation platforms for personalized medicine.

Strategic aspects of higher education reform to cultivate specialists in diagnostic and biopharma industry as applicable to Predictive, Preventive and Personalized Medicine as the Medicine of the Future

Predictive, Preventive and Personalized Medicine as the Medicine of the Future represents an innovative model for advanced healthcare and robust platform for relevant industrial branches for diagnostics and pharmaceutics. However, rapid market penetration of new medicines and technologies demands the implementation of reforms not only in the spheres of biopharmaceutical industries and healthcare, but also in education. Therefore, the problem of the fundamental, modern preparation of specialists in bioengineering and affiliated fields is becoming particularly urgent, and it requires significant revision of training programs of higher education practice into current medical universities. Modernization and integration of widely accepted medical and teaching standards require consolidation of both the natural sciences and medical sciences that may become the conceptual basis for a university medical education. The main goal of this training is not simply to achieve advanced training and expansion of technological skills, but to provide development of novel multifaceted approaches to build academic schools for future generations.

A hybrid artificial neural network and particle swarm optimization for prediction of removal of hazardous dye brilliant green from aqueous solution using zinc sulfide nanoparticle loaded on activated carbon

In the present study, zinc sulfide nanoparticle loaded on activated carbon (ZnS-NP-AC) simply was synthesized in the presence of ultrasound and characterized using different techniques such as SEM and BET analysis. Then, this material was used for brilliant green (BG) removal. To dependency of BG removal percentage toward various parameters including pH, adsorbent dosage, initial dye concentration and contact time were examined and optimized. The mechanism and rate of adsorption was ascertained by analyzing experimental data at various time to conventional kinetic models such as pseudo-first-order and second order, Elovich and intra-particle diffusion models. Comparison according to general criterion such as relative error in adsorption capacity and correlation coefficient confirm the usability of pseudo-second-order kinetic model for explanation of data. The Langmuir models is efficiently can explained the behavior of adsorption system to give full information about interaction of BG with ZnS-NP-AC. A multiple linear regression (MLR) and a hybrid of artificial neural network and partial swarm optimization (ANN-PSO) model were used for prediction of brilliant green adsorption onto ZnS-NP-AC. Comparison of the results obtained using offered models confirm higher ability of ANN model compare to the MLR model for prediction of BG adsorption onto ZnS-NP-AC. Using the optimal ANN-PSO model the coefficient of determination (R(2)) were 0.9610 and 0.9506; mean squared error (MSE) values were 0.0020 and 0.0022 for the training and testing data set, respectively.

Comparison of nickel doped Zinc Sulfide and/or palladium nanoparticle loaded on activated carbon as efficient adsorbents for kinetic and equilibrium study of removal of Congo Red dye

In this study, the efficiency of nickel doped Zinc Sulfide nanoparticle loaded on activated carbon (Ni-ZnS-NP-AC) and palladium nanoparticles loaded on activated carbon (Pd-NP-AC) for the removal of Congo Red (CR) from aqueous solution was investigated. These materials were fully identified and characterized in term of structure, surface area and pore volume with different techniques such XRD, FE-SEM and TEM analysis. The dependency of CR removal percentage to variables such as pH, contact time, amount of adsorbents, CR concentration was examined and optimum values were set as: 0.03g Ni-ZnS-NP-AC and 0.04g of Pd-NP-AC at pH of 3 and 2 after mixing for 22 and 26min for Ni-ZnS-NP-AC and Pd-NP-AC, respectively. Subsequently, it was revealed that isotherm data efficiency can be correlated Langmuir with maximum monolayer adsorption capacities of 286 and 126.6mgg(-1) at room temperature for Ni-ZnS-NP-AC and Pd-NP-AC, respectively. Investigation of correlation between time and rate of adsorption reveal that the CR adsorption onto both adsorbents followed pseudo second order and interparticle diffusion simultaneously.

Bristol index of patellar width to thickness (BIPWiT): a reproducible measure of patellar thickness from adult MRI

BACKGROUND

The restoration of an adequate patellar thickness is a key to the successful outcome of knee arthroplasty. This study investigated the relationship between the thickness of the native patellar and medial-lateral patellar width using magnetic resonance imaging (MRI).

METHODS

75 MRI scans of young adults, with an average age of 27 (range 16-40) were studied. Exclusion criteria included a diagnosis of degenerative joint disease, patello-femoral pathology or age under 16/over 40 (170 patients). The bony thickness of the patellar, the chondral thickness and patellar width were measured, as was the location of maximal patellar thickness. Inter/intraobserver variability was calculated and correlation analysis was performed.

RESULTS

We found a strong correlation between patellar width and thickness (bone plus cartilage) (Pearson 0.75, P<0.001). The mean width to thickness ratio was 1.8:1 (standard deviation 0.1, 95% confidence interval 1.78-1.83). Without cartilage the ratio was 2.16:1 (SD 0.15, 95% CI 2.11-2.21), correlation was moderate (Pearson 0.59, P<0.001). The average maximal patellar cartilage thickness was 4.1mm (SD 1.3).

CONCLUSION

The strong correlation and narrow confidence intervals for the ratio of patellar width to thickness, suggest that patellar width might be used as a guide for accurate restoration of patellar thickness during total knee or patello-femoral replacement. After removing osteophytes we would recommend a ratio of 1.8:1. Further work is required to establish whether there is a relationship between anterior knee pain post total knee arthroplasty and an abnormal patellar width:thickness ratio.

LEVEL OF EVIDENCE

Level III.