Resolvin D2/GPR18 signaling enhances monocytic myeloid-derived suppressor cell function to mitigate abdominal aortic aneurysm formation

Abdominal aortic aneurysm (AAA) formation is a chronic vascular pathology characterized by inflammation, leukocyte infiltration and vascular remodeling. The aim of this study was to delineate the protective role of Resolvin D2 (RvD2), a bioactive isoform of specialized proresolving lipid mediators, via G-protein coupled receptor 18 (GPR18) receptor signaling in attenuating AAAs. Importantly, RvD2 and GPR18 levels were significantly decreased in aortic tissue of AAA patients compared with controls. Furthermore, using an established murine model of AAA in C57BL/6 (WT) mice, we observed that treatment with RvD2 significantly attenuated aortic diameter, pro-inflammatory cytokine production, immune cell infiltration (neutrophils and macrophages), elastic fiber disruption and increased smooth muscle cell α-actin expression as well as increased TGF-β2 and IL-10 expressions compared to untreated mice. Moreover, the RvD2-mediated protection from vascular remodeling and AAA formation was blocked when mice were previously treated with siRNA for GPR18 signifying the importance of RvD2/GPR18 signaling in vascular inflammation. Mechanistically, RvD2-mediated protection significantly enhanced infiltration and activation of monocytic myeloid-derived suppressor cells (M-MDSCs) by increasing TGF-β2 and IL-10 secretions that mitigated smooth muscle cell activation in a GPR18-dependent manner to attenuate aortic inflammation and vascular remodeling via this intercellular crosstalk. Collectively, this study demonstrates RvD2 treatment induces an expansion of myeloid-lineage committed progenitors, such as M-MDSCs, and activates GPR18-dependent signaling to enhance TGF-β2 and IL-10 secretion that contributes to resolution of aortic inflammation and remodeling during AAA formation.

Perioperative Cerebrospinal Fluid Drain Placement Does Not Increase Venous Thromboembolism Risk After Thoracic and Fenestrated Endovascular Aortic Repair

BACKGROUND

Venous thromboembolism (VTE) incidence after thoracic and fenestrated endovascular aortic repair (TEVAR/FEVAR) is high (up to 6-7%) relative to other vascular procedures; however, the etiology for this discrepancy remains unknown. Notably, patients undergoing TEVAR/FEVAR commonly receive cerebrospinal fluid drains (CSFDs) for neuroprotection, requiring interruption of perioperative anticoagulation and prolonged immobility. We hypothesized that CSFDs are a risk factor for VTE after TEVAR/FEVAR.

METHODS

Consecutive TEVAR/FEVAR patients at a single center were reviewed (2011-2020). Cerebrospinal fluid drains (CSFDs) were placed based on surgeon preference preoperatively or for spinal cord ischemia (SCI) rescue therapy postoperatively. The primary end-point was VTE occurrence, defined as any new deep venous thrombosis (DVT) or pulmonary embolism (PE) confirmed on imaging within 30 days postoperatively. Routine postoperative VTE screening was not performed. Patients with and without VTE, and subjects with and without CSFDs were compared. Logistic regression was used to explore associations between VTE incidence and CSFD exposure.

RESULTS

Eight hundred ninety-seven patients underwent TEVAR/FEVAR and 43% (n = 387) received a CSFD at some point during their care (preoperative: 94% [n = 365/387]; postoperative SCI rescue therapy: 6% [n = 22/387]). CSFD patients were more likely to have previous aortic surgery (44% vs. 37%; P = 0.028) and received more postoperative blood products (780 vs. 405 mL; P = 0.005). The overall VTE incidence was 2.2% (n = 20). 70% (14) patients with VTE had DVT, 50% (10) had PE, and 20% (4) had DVT and PE. Among TEVAR/FEVAR patients with VTE, 65% (n = 13) were symptomatic. Most VTEs (90%, n = 18) were identified inhospital and the median time to diagnosis was 12.5 (interquartile range 7.5-18) days postoperatively. Patients with VTE were more likely to have nonelective surgery (95% vs. 41%; P < 0.001), had higher American Society of Anesthesiologists classification (4.1 vs. 3.7; P < 0.001), required longer intensive care unit admission (24 vs. 12 days; P < 0.001), and received more blood products (1,386 vs. 559 mL; P < 0.001). Venous thromboembolism (VTE) incidence was 1.8% in CSFD patients compared to 3.5% in non-CSFD patients (odds ratio 0.70 [95% confidence interval 0.28-1.78, P = 0.300). However, patients receiving CSFDs postoperatively for SCI rescue therapy had significantly greater VTE incidence (9.1% vs. 1.1%; P = 0.044).

CONCLUSIONS

CSFD placement was not associated with an increased risk of VTE in patients undergoing TEVAR/FEVAR. Venous thromboembolism (VTE) risk was greater in patients undergoing nonelective surgery and those with complicated perioperative courses. Venous thromboembolism (VTE) risk was greater in patients receiving therapeutic CSFDs compared to prophylactic CSFDs, highlighting the importance of careful patient selection for prophylactic CSFD placement.

Using a Clinical Data Warehouse to Calculate and Present Key Metrics for the Radiology Department: Implementation and Performance Evaluation

BACKGROUND

Due to the importance of radiologic examinations, such as X-rays or computed tomography scans, for many clinical diagnoses, the optimal use of the radiology department is 1 of the primary goals of many hospitals.

OBJECTIVE

This study aims to calculate the key metrics of this use by creating a radiology data warehouse solution, where data from radiology information systems (RISs) can be imported and then queried using a query language as well as a graphical user interface (GUI).

METHODS

Using a simple configuration file, the developed system allowed for the processing of radiology data exported from any kind of RIS into a Microsoft Excel, comma-separated value (CSV), or JavaScript Object Notation (JSON) file. These data were then imported into a clinical data warehouse. Additional values based on the radiology data were calculated during this import process by implementing 1 of several provided interfaces. Afterward, the query language and GUI of the data warehouse were used to configure and calculate reports on these data. For the most common types of requested reports, a web interface was created to view their numbers as graphics.

RESULTS

The tool was successfully tested with the data of 4 different German hospitals from 2018 to 2021, with a total of 1,436,111 examinations. The user feedback was good, since all their queries could be answered if the available data were sufficient. The initial processing of the radiology data for using them with the clinical data warehouse took (depending on the amount of data provided by each hospital) between 7 minutes and 1 hour 11 minutes. Calculating 3 reports of different complexities on the data of each hospital was possible in 1-3 seconds for reports with up to 200 individual calculations and in up to 1.5 minutes for reports with up to 8200 individual calculations.

CONCLUSIONS

A system was developed with the main advantage of being generic concerning the export of different RISs as well as concerning the configuration of queries for various reports. The queries could be configured easily using the GUI of the data warehouse, and their results could be exported into the standard formats Excel and CSV for further processing.

Low-Frequency Entrainment to Visual Motion Underlies Sign Language Comprehension

When people listen to speech, neural activity tracks the entropy fluctuation in the acoustic envelope of the signal. This signal-based entrainment has been shown to be the basis of speech parsing and comprehension. In this electroencephalography (EEG) study, we compute sign language users’ cortical tracking of changes in visual dynamics of the communicative signal in the time-direct videos of sign language, and their time-reversed counterparts, and assess the relative contribution of response frequencies between.2 and 12.4 Hz to comprehension using a machine learning approach to brain state classification. Lower frequencies of EEG response (.2–4 Hz) yield 100% classification accuracy, while information about cortical tracking of the visual envelope in higher frequencies is less informative. This suggests that signers rely on lower visual frequency data, such as envelope of visual signal, for sign language comprehension. In the context of real-time language processing, given the speed of comprehension responses, this suggests that fluent signers employ a predictive processing heuristic based on sign language knowledge.

Calculating Key Figures for Radiology Departments Using a Clinical Data Warehouse - A Technical Case Report

Optimizing the utilization of radiology departments is one of the primary objectives for many hospitals. To support this, a solution has been developed, which at first transforms the export of different Radiological Information Systems (RIS) into the data format of a clinical data warehouse (CDW). Additional features, like for example the time between the creation of a radiologic request and the finalization of the diagnosis for the created images, can then be defined using a simple interface and are calculated and saved in the CDW as well. Finally, the query language of the CDW can be used to create custom reports with all the RIS data including the calculated features and export them into the standard formats Excel and CSV. The solution has been successfully tested with data from two German hospitals.

Prevalence of chronic opioid use in patients with peripheral arterial disease undergoing revascularization

OBJECTIVE

Opiate use, dependence, and the associated morbidity and mortality are major current public health problems in the United States. Little is known about patterns of opioid use in patients with peripheral arterial disease (PAD). The purpose of this study was to identify the prevalence of chronic preoperative and postoperative prescription opioid use in patients with PAD. A secondary aim was to determine the demographic, comorbid conditions, and operative characteristics associated with chronic opioid use.

METHODS

Using a single-institution database of patients with PAD undergoing open or endovascular lower extremity intervention from 2013 to 2014, data regarding opiate use and associated conditions were abstracted for analysis. Patients were excluded if they did not live in North Carolina or surgery was not for PAD. Preoperative (PreCOU) and postoperative chronic opioid use (PostCOU) were defined as consistent opioid prescription filling in the 3 months before and after the index procedure, respectively. Opioid prescription filling was assessed using the North Carolina Controlled Substance Reporting System. Demographics, comorbid conditions, other adjunct pain medication data, and operative characteristics were abstracted from our institutional electronic medical record. Associations with PreCOU were evaluated using the t test, Wilcoxon test, or two-sample median test (continuous), or the χ² or Fisher exact tests (categorical).

RESULTS

A total of 202 patients undergoing open (108; 53.5%) or endovascular (94; 46.5%) revascularization for claudication or critical limb ischemia were identified for analysis. The mean age was 64.6 years, and 36% were female. Claudication was the indication for revascularization in 26.7% of patients, and critical limb ischemia was the indication in 73.3% of patients. The median preoperative ankle-brachial index (ABI) was 0.50. Sixty-eight patients (34%) met the definition for PreCOU. PreCOU was associated with female gender, history of chronic musculoskeletal pain, benzodiazepine use, and self-reported illicit drug use. Less than 50% of patients reported use of non-opiate adjunct pain medications. No association was observed between PreCOU and pre- or postoperative ABI, or number of prior lower extremity interventions. Following revascularization, the median ABI was 0.88. PreCOU was not associated with significant differences in postoperative complications, length of stay, or mortality. Overall, 71 patients (35%) met the definition for PostCOU, 14 of whom had no history of preoperative chronic opiate use. Ten patients with PreCOU did not demonstrate PostCOU.

CONCLUSIONS

Chronic opiate use was common in patients with PAD with a prevalence of approximately 35%, both prior to and following revascularization. Revascularization was associated with a termination of chronic opiate use in less than 15% of patients with PreCOU. Additionally, 10% of patients who did not use opiates chronically before their revascularization did so afterwards. Patients with PAD requiring intervention represent a high-risk group with regards to chronic opiate use. Increased diligence in identifying opioid use among patients with PAD and optimizing the use of non-narcotic adjunct pain medications may result in a lower prevalence of chronic opiate use and its attendant adverse effects.

Information Extraction from Echocardiography Reports for a Clinical Follow-up Study-Comparison of Extracted Variables Intended for General Use in a Data Warehouse with Those Intended Specifically for the Study

BACKGROUND

 The interest in information extraction from clinical reports for secondary data use is increasing. But experience with the productive use of information extraction processes over time is scarce. A clinical data warehouse has been in use at our university hospital for several years, which also provides an information extraction of echocardiography reports developed for general use.

OBJECTIVES

 This study aims to illustrate the difficulties encountered, while using data from a preexisting information extraction process for a large clinical study. To compare the data from the preexisting process with the data obtained from a specially developed process designed to improve the quality and completeness of the study data.

METHODS

 We extracted the echocardiography variables for 440 patients from the general-use information extraction of the data warehouse (678 reports). Then we developed an information extraction process for the same variables but specifically for this study, with the aim to extract as much information as possible from the text. The extracted data of both processes were compared with a newly created gold standard defined by a cardiologist with long-standing experience in heart failure.

RESULTS

 Among 57 echocardiography variables considered relevant for the study, 50 were documented in the routine text reports and could be extracted. Twenty of the required variables were not provided by the general-use extraction process, some others were not provided correctly. The median macro F1-score (precision, recall) across the 30 variables for which values were extracted was 0.81 (0.94, 0.77). Across all 50 variables, as relevant for the study, median macro F1-score was only 0.49 (0.56, 0.46). Employing the study-specific approach considerably improved the quality and completeness of the variables, resulting in F1-scores of 0.97 (0.98, 0.96) across all variables.

CONCLUSION

 Data from information extractions can be used for large clinical studies. However, preexisting information extraction processes should be treated with caution, as the time and effort spent defining each variable in the information extraction process may not be clear.

Implementation of a HL7-CQL Engine Using the Graph Database Neo4J

The Clinical Quality Language (CQL) is a useful tool for defining search requests for data stores containing FHIR data. Unfortunately, there are only few execution engines that are able to evaluate CQL queries. As FHIR data represents a graph structure, the authors pursue the approach of storing all data contained in a FHIR server in the graph database Neo4J and to translate CQL queries into Neo4J's query language Cypher. The query results returned by the graph database are retranslated into their FHIR representation and returned to the querying user. The approach has been positively tested on publicly available FHIR servers with a handcrafted set of example CQL queries.

Query Translation Between AQL and CQL

Secondary use of electronic health records using data aggregation systems (DAS) with standardized access interfaces (e.g. openEHR, i2b2, FHIR) have become an attractive approach to support clinical research. In order to increase the volume of underlying patient data, multiple DASs at different institutions can be connected to research networks. Two obstacles to connect a DAS to such a network are the syntactical differences between the involved DAS query interfaces and differences in the data models the DASs operate on. The current work presents an approach to tackle both problems by translating queries from a DAS using openEHR's query language AQL (Archetype Query Language) into queries using the query language CQL (Clinical Quality Language) and vice versa. For the subset of queries which are expressible in both query languages the presented approach is well feasible.

High-Definition Zoom Mode, a High-Resolution X-Ray Microscope for Neurointerventional Treatment Procedures: A Blinded-Rater Clinical-Utility Study

BACKGROUND AND PURPOSE

Quality of visualization of treatment devices during critical stages of endovascular interventions, can directly impact their safety and efficacy. Our aim was to compare the visualization of neurointerventional procedures and treatment devices using a 194-μm pixel flat panel detector mode and a 76-μm pixel complementary metal oxide semiconductor detector mode (high definition) of a new-generation x-ray detector system using a blinded-rater study.

MATERIALS AND METHODS

Deployment of flow-diversion devices for the treatment of internal carotid artery aneurysms was performed under flat panel detector and high-definition-mode image guidance in a neurointerventional phantom simulating patient cranium and tissue attenuation, embedded with 3D-printed intracranial vascular models, each with an aneurysm in the ICA segment. Image-sequence pairs of device deployments for each detector mode, under similar exposure and FOV conditions, were evaluated by 2 blinded experienced neurointerventionalists who independently selected their preferred image on the basis of visualization of anatomic features, image noise, and treatment device. They rated their selection as either similar, better, much better, or substantially better than the other choice. Inter- and intrarater agreement was calculated and categorized as poor, moderate, and good.

RESULTS

Both raters demonstrating good inter- and intrarater agreement selected high-definition-mode images with a frequency of at least 95% each and, on average, rated the high-definition images as much better than flat panel detector images with a frequency of 73% from a total of 60 image pairs.

CONCLUSIONS

Due to their higher resolution, high-definition-mode images are sharper and visually preferred compared with the flat panel detector images. The improved imaging provided by the high-definition mode can potentially provide an advantage during neurointerventional procedures.

Replicating medication trend studies using ad hoc information extraction in a clinical data warehouse

Background

Medication trend studies show the changes of medication over the years and may be replicated using a clinical Data Warehouse (CDW). Even nowadays, a lot of the patient information, like medication data, in the EHR is stored in the format of free text. As the conventional approach of information extraction (IE) demands a high developmental effort, we used ad hoc IE instead. This technique queries information and extracts it on the fly from texts contained in the CDW.

Methods

We present a generalizable approach of ad hoc IE for pharmacotherapy (medications and their daily dosage) presented in hospital discharge letters. We added import and query features to the CDW system, like error tolerant queries to deal with misspellings and proximity search for the extraction of the daily dosage. During the data integration process in the CDW, negated, historical and non-patient context data are filtered. For the replication studies, we used a drug list grouped by ATC (Anatomical Therapeutic Chemical Classification System) codes as input for queries to the CDW.

Results

We achieve an F1 score of 0.983 (precision 0.997, recall 0.970) for extracting medication from discharge letters and an F1 score of 0.974 (precision 0.977, recall 0.972) for extracting the dosage. We replicated three published medical trend studies for hypertension, atrial fibrillation and chronic kidney disease. Overall, 93% of the main findings could be replicated, 68% of sub-findings, and 75% of all findings. One study could be completely replicated with all main and sub-findings.

Conclusion

A novel approach for ad hoc IE is presented. It is very suitable for basic medical texts like discharge letters and finding reports. Ad hoc IE is by definition more limited than conventional IE and does not claim to replace it, but it substantially exceeds the search capabilities of many CDWs and it is convenient to conduct replication studies fast and with high quality.

Query Translation Between openEHR and i2b2

Secondary use of electronic health records using data warehouses (DW) has become an attractive approach to support clinical research. In order to increase the volume of underlying patient data DWs at different institutions can be connected to research networks. Two obstacles to connect a DW to such a network are the syntactical differences between the involved DW technologies and differences in the data models of the connected DWs. The current work presents an approach to tackle both problems by translating queries from the DW system openEHR into queries from the DW system i2b2 and vice versa. For the subset of queries expressible in the query languages of both systems, the presented approach is well feasible.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Initial investigations of a special high-definition (Hi-Def) zoom capability in a new detector system for neuro-interventional procedures

Real-time visualization of fine details ranging to 100 um or less in neuro-vascular imaging guided interventions is important. A separate high-resolution detector mounted on a standard flat panel detector (FPD) was previously reported. This device had to be rotated mechanically into position over the FPD for high resolution imaging. Now, the new detector reported here has a high definition (Hi-Def) zoom capability along with the FPD built into one unified housing. The new detector enables rapid switching, by the operator between Hi-Def and FPD modes. Standard physical metrics comparing the new Hi-Def modes with those of the FPD are reported, demonstrating improved imaging resolution and noise capability at patient doses similar to those used for the FPD. Semi-quantitative subjective studies involving qualitative clinician feedback on images of interventional devices such as a Pipeline Embolization Device (PED) acquired in both Hi-Def and FPD modes are presented. The PED is deployed in a patient specific 3D printed neuro-vascular phantom embedded inside realistic bone and with tissue attenuating material. Field-of-view (FOV), exposure and magnification were kept constant for FPD and Hi-Def modes. Static image comparisons of the same view of the PED within the phantom were rated by expert interventionalists who chose from the following ratings: Similar, Better, or Superior. Generally, the Hi-Def zoomed images were much preferred over the FPD, indicating the potential to improve endovascular procedures and hence outcomes using such a Hi-Def feature.

Spectroscopy with a CdTe-based photon-counting imaging detector (PCD) having charge sharing correction capability

The spectroscopic capabilities of a newly upgraded version of a prototype imaging photon counting detector (PCD) was investigated. The XCounter Actaeon has four acquisition modes in which signal processing is varied including one mode having a charge sharing correction so that neighboring pixels that share a detected event will not be erroneously counted twice, hence it is designated the Anti-Coincidence Circuit On or ACC On mode. Since this CdTe-based direct conversion PCD has 100 μm pixels, such charge sharing may frequently occur for typical medical x-ray energies. Each pixel of this PCD has two scalers and two energy discriminators that enable counting without instrumentation noise of events above each threshold level; hence, a spectrum can be obtained by sequentially moving the thresholds of both discriminators. It became evident from the spectra for the various acquisition modes that only those obtained with the charge sharing correction enabled, compared favorably with theoretically predicted spectra. After verifying the energy calibration using the mono-energetic emissions from an Am-241 source, spectra at various kVps from a standard medical x-ray generator were obtained. The spectra generated by ACC On mode for 70 kVp and 110 kVp were the closest match to the theoretical spectra generated by SpekCal. For dual energy applications, ACC On mode with charge sharing correction circuitry would be the best choice among various acquisition modes. Also investigated was the dual energy imaging capability of the Actaeon PCD with ACC On mode to separate Aluminum and Iodine while imaging an artery stenosis phantom.

Ad Hoc Information Extraction for Clinical Data Warehouses

Background: Clinical Data Warehouses (CDW) reuse Electronic health records (EHR) to make their data retrievable for research purposes or patient recruitment for clinical trials. However, much information are hidden in unstructured data like discharge letters. They can be preprocessed and converted to structured data via information extraction (IE), which is unfortunately a laborious task and therefore usually not available for most of the text data in CDW.

Objectives: The goal of our work is to provide an ad hoc IE service that allows users to query text data ad hoc in a manner similar to querying structured data in a CDW. While search engines just return text snippets, our systems also returns frequencies (e.g. how many patients exist with “heart failure” including textual synonyms or how many patients have an LVEF < 45) based on the content of discharge letters or textual reports for special investigations like heart echo. Three subtasks are addressed: (1) To recognize and to exclude negations and their scopes, (2) to extract concepts, i.e. Boolean values and (3) to extract numerical values.

Methods: We implemented an extended version of the NegEx-algorithm for German texts that detects negations and determines their scope. Furthermore, our document oriented CDW PaDaWaN was extended with query functions, e.g. context sensitive queries and regex queries, and an extraction mode for computing the frequencies for Boolean and numerical values.

Results: Evaluations in chest X-ray reports and in discharge letters showed high F1-scores for the three subtasks: Detection of negated concepts in chest X-ray reports with an F1-score of 0.99 and in discharge letters with 0.97; of Boolean values in chest X-ray reports about 0.99, and of numerical values in chest X-ray reports and discharge letters also around 0.99 with the exception of the concept age.

Discussion: The advantages of an ad hoc IE over a standard IE are the low development effort (just entering the concept with its variants), the promptness of the results and the adaptability by the user to his or her particular question. Disadvantage are usually lower accuracy and confidence.

This ad hoc information extraction approach is novel and exceeds existing systems: Roogle [ 1 ] extracts predefined concepts from texts at preprocessing and makes them retrievable at runtime. Dr. Warehouse [ 2 ] applies negation detection and indexes the produced subtexts which include affirmed findings. Our approach combines negation detection and the extraction of concepts. But the extraction does not take place during preprocessing, but at runtime. That provides an ad hoc, dynamic, interactive and adjustable information extraction of random concepts and even their values on the fly at runtime.

Conclusions: We developed an ad hoc information extraction query feature for Boolean and numerical values within a CDW with high recall and precision based on a pipeline that detects and removes negations and their scope in clinical texts.

Gantry rotational motion-induced blur in cone-beam computed tomography

As neuro-endovascular image-guided interventions (EIGIs) make use of higher resolution detectors, gantry rotational motion-induced blur becomes more noticeable in acquired projections as well as reconstructed images by reducing the visibility of vascular and device features whose visualization could be critical in the treatment of vascular pathology. Motion-induced blur in projections views is a function of an object's position in the field-of-view (FOV), gantry rotational speed, and frame capture or exposure time. In this work different frame rates were used to investigate the effects of blurring from individual projections on the reconstructed image. To test the effects of these parameters on reconstructed images, a regular pattern phantom of small objects was simulated and projection views were generated at various different frame rates for a given simulated rotational velocity. The reconstruction was made using a linear interpolation of filtered backprojections. Images reconstructed from lower frame rates showed significant blurring in the azimuthal direction, increasingly worse towards the periphery of the image. However, those reconstructed from higher frame rates showed significantly less blur throughout the entire FOV. While lower frame rates could be used with slower gantry speeds this would increase the risk of voluntary or involuntary patient motion contributing to blur over the entire FOV. A high frame rate used with high gantry speeds could reliable provide images without gantry-motion blur while reducing the risk of patient-motion blur. Frame rates exceeding 2000 fps available with photon counting detectors such as the X-counter Actaeon¹ are available.

Evaluation of a new photon-counting imaging detector (PCD) with various acquisition modes

The prospect of improved low noise, high speed, and dual-energy imaging that may be associated with the use of photon-counting imaging detectors (PCD) has motivated this evaluation of a newly upgraded version of a prototype PCD. The XCounter Actaeon was evaluated in its four acquisition modes each based upon varying signal processing firmware including a mode with charge sharing correction that enables neighboring pixels that share the energy from one incident x-ray photon detection to be counted only once at the proper summed energy in the pixel with the largest charge deposition. Since this PCD is a CdTe-based direct detector with 100 μm pixels, such charge sharing for typical medical x-ray energy photons may occur frequently and must be corrected to achieve more accurate counts. This charge sharing correction is achieved with an Anti-Coincidence Circuit (ACC) which prevents double pixel counting from one event as well as prevents counting from either event if they are below a preset threshold. Various physical parameters of the PCD were evaluated including linearity, sensitivity, pulse pile-up effects, dark noise, spatial resolution, noise power spectrum, and detective quantum efficiency.

Exporting Data from a Clinical Data Warehouse

Data Warehouses (DW) are useful tools to support clinical studies as they can provide exports of routine care data for scientific reuse. Exported DW data is usually post-processed and integrated into study databases by study staff that is reasonably trained in specific tools like SPSS and Excel but which are no programmers or computer scientists. DW systems should therefore be configurable to satisfy export format desiderata as much as possible so that exports contain no unnecessary post-processing obstacles. In the presented work the authors analyze various existing DW systems in respect to a list of potential export formats.

Estimating a Bias in ICD Encodings for Billing Purposes

ICD encoded diagnoses are a popular criterion for eligibility algorithms for study cohort recruitment. However, "official" ICD encoded diagnoses used for billing purposes are afflicted with a bias originating from legal issues. This work presents an approach to estimate the degree of the encoding bias for the complete ICD catalogue at a German university hospital. The free text diagnoses sections of discharge letters are automatically classified using a supervised machine learning algorithm. The automatic classifications are compared with the official, manually classified codes. For selected ICD codes the approach works sufficiently well.

Finding Needles in the Haystack: Identifying Patients with Rare Subtype of Multiple Myeloma Supported by a Data Warehouse and Information Extraction

Finding patient cases with extremely rare pathologies is a laborious task. To decrease time spent on manually searching through thousands of discharge letters and reports, a data warehouse with a fast fulltext search index was queried. Our use case is to find "macrofocal myeloma", i.e. Multiple Myeloma patients with few large lesions. We guessed the number of those patients in the University Hospital Würzburg at about 20. Most criteria were available in the data warehouse in an unstructured form requiring information extraction. 8 patient cases were found by searching for different spellings of "macrofocal myeloma" in discharge letters directly. With an indirect search combining several criteria, we found additional 23 candidate patient cases, from which 10 were classified by a domain expert as correct. The most difficult criteria were determining the degree of bone marrow infiltration. We achieved an F1 score of 93.2 % for this task. The number of patient cases to be screened manually for this disease decreased from about 25000 to 23.

The effects of antimuscarinic treatment on the cognition of spinal cord injured individuals with neurogenic lower urinary tract dysfunction: a prospective controlled before-and-after study

STUDY DESIGN

Prospective controlled before-and-after study.

OBJECTIVES

To investigate the effects of antimuscarinic treatment of neurogenic lower urinary tract dysfunction on the cognition of individuals with spinal cord injury (SCI) during the early post-acute phase.

SETTING

Single SCI rehabilitation center.

METHODS

Patients with acute traumatic SCI admitted for primary rehabilitation from 2011 to 2015 were screened for study enrollment. Study participants underwent baseline neuropsychological assessments prior to their first urodynamic evaluation (6-8 weeks after SCI). Individuals suffering from neurogenic detrusor overactivity received antimuscarinic treatment, and those not requiring antimuscarinic treatment constituted the control group. The neuropsychological follow-up assessment was carried out 3 months after the baseline assessment. The effects of group and time on the neuropsychological parameters were investigated.

RESULTS

The data of 29 individuals were evaluated (control group 19, antimuscarinic group 10). The group had a significant (P≤0.033) effect on immediate recall, attention ability and perseveration. In the control group, individuals performed significantly (P≤0.05) better in immediate recall both at baseline (percentile rank 40, 95% CI 21-86 versus 17, 95% CI 4-74) and follow-up (percentile rank 40, 95% CI 27-74 versus 16, 95% CI 2-74). The time had a significant (P≤0.04) effect on attention ability, processing speed, word fluency and visuospatial performance. The individuals in both groups performed better at the follow-up compared to the baseline assessment.

CONCLUSION

Even though, we did not observe cognitive deterioration in the investigated, cognitively intact SCI individuals during the first 3 treatment months, the concerns regarding deleterious effects of antimuscarinics on cognition remain.

Cast aluminium single crystals cross the threshold from bulk to size-dependent stochastic plasticity

Metals are known to exhibit mechanical behaviour at the nanoscale different to bulk samples. This transition typically initiates at the micrometre scale, yet existing techniques to produce micrometre-sized samples often introduce artefacts that can influence deformation mechanisms. Here, we demonstrate the casting of micrometre-scale aluminium single-crystal wires by infiltration of a salt mould. Samples have millimetre lengths, smooth surfaces, a range of crystallographic orientations, and a diameter D as small as 6 μm. The wires deform in bursts, at a stress that increases with decreasing D. Bursts greater than 200 nm account for roughly 50% of wire deformation and have exponentially distributed intensities. Dislocation dynamics simulations show that single-arm sources that produce large displacement bursts halted by stochastic cross-slip and lock formation explain microcast wire behaviour. This microcasting technique may be extended to several other metals or alloys and offers the possibility of exploring mechanical behaviour spanning the micrometre scale.

Extending the Query Language of a Data Warehouse for Patient Recruitment

Patient recruitment for clinical trials is a laborious task, as many texts have to be screened. Usually, this work is done manually and takes a lot of time. We have developed a system that automates the screening process. Besides standard keyword queries, the query language supports extraction of numbers, time-spans and negations. In a feasibility study for patient recruitment from a stroke unit with 40 patients, we achieved encouraging extraction rates above 95% for numbers and negations and ca. 86% for time spans.

A Customizable Importer for the Clinical Data Warehouses PaDaWaN and I2B2

In recent years, clinical data warehouses (CDW) storing routine patient data have become more and more popular to support scientific work in the medical domain. Although CDW systems provide interfaces to import new data, these interfaces have to be used by processing tools that are often not included in the systems themselves. In order to establish an extraction-transformation-load (ETL) workflow, already existing components have to be taken or new components have to be developed to perform the load part of the ETL. We present a customizable importer for the two CDW systems PaDaWaN and I2B2, which is able to import the most common import formats (plain text, CSV and XML files). In order to be run, the importer only needs a configuration file with the user credentials for the target CDW and a list of XML import configuration files, which determine how already exported data is indented to be imported. The importer is provided as a Java program, which has no further software requirements.

Semi-Automatic Terminology Generation for Information Extraction from German Chest X-Ray Reports

Extraction of structured data from textual reports is an important subtask for building medical data warehouses for research and care. Many medical and most radiology reports are written in a telegraphic style with a concatenation of noun phrases describing the presence or absence of findings. Therefore a lexico-syntactical approach is promising, where key terms and their relations are recognized and mapped on a predefined standard terminology (ontology). We propose a two-phase algorithm for terminology matching: In the first pass, a local terminology for recognition is derived as close as possible to the terms used in the radiology reports. In the second pass, the local terminology is mapped to a standard terminology. In this paper, we report on an algorithm for the first step of semi-automatic generation of the local terminology and evaluate the algorithm with radiology reports of chest X-ray examinations from Würzburg university hospital. With an effort of about 20 hours work of a radiologist as domain expert and 10 hours for meetings, a local terminology with about 250 attributes and various value patterns was built. In an evaluation with 100 randomly chosen reports it achieved an F1-Score of about 95% for information extraction.

Risk factors for symptomatic urinary tract infections in individuals with chronic neurogenic lower urinary tract dysfunction

STUDY DESIGN

Retrospective investigation.

OBJECTIVES

To investigate the association of patient and injury characteristics, as well as bladder management, with the occurrence of patient-reported, symptomatic urinary tract infection(s) UTI(s) in patients with chronic neurogenic lower urinary tract dysfunction (NLUTD).

SETTING

Tertiary urologic referral center.

METHODS

The patient database was screened for patients with chronic (>12 months) NLUTD who had presented between 2008 and 2012. Patient characteristics, bladder evacuation management, the annual number of patient-reported, symptomatic UTIs and the type of prophylactic treatment to prevent UTIs were collected. Binary logistic regression analysis was used to investigate the effects of the investigated risk factors on the occurrence of symptomatic UTI(s) and recurrent symptomatic UTIs (⩾3 annual UTIs).

RESULTS

The data of 1104 patients with a mean NLTUD duration of 20.3±11.6 years were investigated. The evacuation method was a significant (P⩽0.004) predictor for the occurrence of symptomatic UTI and recurrent symptomatic UTIs. The greatest annual number of symptomatic UTIs was observed in patients using transurethral indwelling catheters, and the odds of experiencing a UTI and recurrent UTIs were increased more than 10- and 4-fold, respectively. The odds of a UTI or recurrent UTIs were also increased significantly (P⩽0.014) in patients using intermittent catheterization (IC). Botulinum toxin injections into the detrusor increased the odds of a UTI ~10-fold (P=0.03).

CONCLUSIONS

The bladder evacuation method is the main predictor for symptomatic UTIs in individuals with NLUTD. Transurethral catheters showed the highest odds of symptomatic UTI and should be avoided whenever possible.

Testicular resistive index determined by Doppler ultrasonography in men with spinal cord injury - a case series

In this case series, the testicular resistive index was determined in men with spinal cord injury. In ten men participating in our fertility programme, the peak systolic and end-diastolic velocity of centripetal testicular arteries was measured in triplicates by Doppler ultrasonography to calculate the testicular resistive index. Furthermore, the right and left testicular volume was determined by ultrasonography, blood samples were obtained for hormonal evaluation, and sperm analysis was performed according to the WHO guidelines. The median testicular resistive index measured 0.69 and was significantly (P < 0.001) greater than the reported cut-off value of 0.6. The spermiograms were characterised by normal sperm count but decreased sperm motility and plasma membrane integrity. The median right and left testicular volume was significantly (P < 0.01) smaller compared to the volumes measured in able-bodied adult males without scrotal pathology and measured 8.4 ml and 7.2 ml respectively. There was a significant (P = 0.005) correlation (rs  = 0.81) between testicular resistive index and sperm concentration. However, no correlations were observed between testicular resistive index and other variables. The testicular resistive index in men with spinal cord injury was significantly greater than 0.6. Measuring the testicular resistive index may represent a useful additional parameter in the assessment of infertility in spinal cord-injured men.

Release of ANP and fat oxidation in overweight persons during aerobic exercise in water

Exercise in water compared to land-based exercise (LE) results in a higher release of natriuretic peptides, which are involved in the regulation of exercise-induced adipose tissue lipolysis. The present study was performed to compare the release of atrial natriuretic peptide (ANP) and free fatty acids (FFA) during prolonged aerobic water-based exercise (WE) with the release after an identical LE. 14 untrained overweight subjects performed 2 steady state workload tests on the same ergometer in water and on land. Before and after exercise, venous blood samples were collected for measuring ANP, FFA, epinephrine, norepinephrine, insulin and glucose. The respiratory exchange ratio (RER) was determined for fat oxidation.The exercises resulted in a significant increase in ANP in LE (61%) and in WE (177%), and FFA increased about 3-fold in LE and WE with no significant difference between the groups. Epinephrine increased, while insulin decreased similarly in both groups. The RER values decreased during the exercises, but there was no significant difference between LE and WE. In conclusion, the higher ANP concentrations in WE had no additional effect on lipid mobilization, FFA release and fat oxidation. Moderate-intensity exercises in water offer no benefit regarding adipose tissue lipolysis in comparison to LE.

Effects of solifenacin in patients with neurogenic detrusor overactivity as a result of spinal cord lesion

STUDY DESIGN

Retrospective analysis.

OBJECTIVES

To investigate the urodynamic effects of solifenacin treatment for neurogenic detrusor overactivity (NDO) in patients with spinal cord injury (SCI).

SETTING

Paraplegic center in Switzerland.

METHODS

Retrospective analysis of case histories and urodynamic data of 35 SCI patients receiving solifenacin for treatment of NDO between 2008 and 2012. Patients were categorized as being at risk of renal damage when maximum detrusor pressure was >40 cm H2O or detrusor compliance was <20 ml cm(-1) H2O.

RESULTS

Solifenacin treatment was initiated 7.3 years after SCI. Most patients (63%) had already been taking other antimuscarinic drugs. After 13.1 months (median, interquartile range 6.1-19.5 months), solifenacin treatment had resulted in significant (P<0.03) improvements in bladder capacity (median +30.0 ml), maximum detrusor pressure (median -7.0 cm H2O), reflex volume (median +62.5 ml) and detrusor compliance (median +25.0 ml cm(-1) H2O). Furthermore, fewer patients presented with a risk of renal damage. However, this difference was not significant (P>0.1). The number of patients suffering from incontinence had not changed significantly. Eight and two patients discontinued solifenacin treatment as a result of insufficient efficacy and intolerable adverse events, respectively. One patient had discontinued solifenacin treatment without further explanation.

CONCLUSION

Solifenacin treatment significantly improved bladder capacity, detrusor compliance, reflex volume and maximum detrusor pressure. Solifenacin treatment seems to be an effective oral treatment of NDO after SCI.

Cranio-maxillofacial injuries in victims of interpersonal violence

BACKGROUND

Recent research has indicated an increase in the severity of head injuries in Switzerland. The aim of the present study was to describe the epidemiological features of cranio-maxillofacial (CMF) injuries due to interpersonal violence in patients at the Bern University Hospital Emergency Department (ED), based on injury patterns.

METHODS

Retrospective analysis was performed on data collected during an 11-year period between 1 January 2000 and 31 December 2010 covering 1,585 patients. A distinction was drawn between neurocranial and maxillofacial injuries, and two time periods (2000-2004 and 2005-2010) were compared.

RESULTS

The patients' median age at the time of admission was 26 years (range 12-82), and 1,473 of 1,585 patients (92.9%) were males. Referrals increased from an annual average of 119.6 in 2000-2004 to 164.5 in 2005-2010 (p <0.001). Severe neurocranial injuries doubled in number - from an annual average of 4.2 in 2000-2004 to 8.5 in 2005-2010 (p = 0.010). Maxillofacial injuries seen in the ED increased from an average of 163.6 per year in 2000-2004 to 247.8 in 2005-2010 (p <0.001), and the number of maxillofacial injuries per patient increased from 1.37 to 1.51 (p = 0.015).

CONCLUSIONS

Cranio-maxillofacial (CMF) injuries chiefly affect young people, and thus impose a heavy economic burden on society. Synergies are possible between the implementation of violence prevention strategies and other prevention objectives in every age group and intervention area.

120 THE DEVELOPMENTAL COMPETENCE OF TADPOLES PRODUCED IN VITRO FROM THE ENDANGERED DUSKY GOPHER FROG (RANA SEVOSA) USING EXOGENOUS HORMONE TREATMENT

Dusky gopher frogs once existed throughout the states of Mississippi, Alabama and Louisiana. Presently, the USA Fish and Wildlife Service estimates that there are less than 100 frogs left in the wild, with almost all of these residing in a single pond in Mississippi, making the dusky gopher frog America's most endangered frog species. Their habitat has been threatened by residential and forestry development, as well as from fire suppression and the decline of gopher tortoises, whose burrows the frogs use for shelter. The USA Fish and Wildlife Service brought the first dusky gopher frogs into captivity in 2001 and they have been kept at the Memphis Zoo since 2003 and at Omaha's Henry Doorly Zoo since 2004. Natural breeding attempts in captivity have been unsuccessful despite efforts to artificially mimic what is known to be the appropriate seasonal environmental (e.g. light, humidity, temperature) and social cues (e.g. calls from wild frogs during the breeding season) that stimulate reproduction in situ. Also, there was a concern about the incidences of abnormalities (e.g. spindly legs) from inadequate husbandry conditions (e.g. nutritional deficiencies) or diseases in tadpoles and froglets produced ex situ (e.g. dermomycoides). The objectives of this study were (1) to examine the developmental competence of tadpoles produced by exogenous hormone treatment for IVF to complete normal metamorphosis into viable froglets ex situ and (2) to determine the incidence of developmental abnormalities or dermomycoides in the froglets produced ex situ. Males and females were first separated by the identification of black male nuptial pads used during amplexus. Males and females were stimulated to spermiate and ovulate, respectively, using a variation of a standard amphibian hormonal stimulation protocol (Kouba et al. 2012 Reprod. Fertil. Dev. 24). As a result, more than 1460 viable tadpoles (61% of fertilized eggs) were produced from 18 segregated genetic pairings. To date, 602 (41%) of the tadpoles have completed normal metamorphosis into viable froglets (over 6 times the known existing population in situ), 51% were either culled to examine for dermomycoides or died for a variety of known (accidental) and unknown reasons (abnormal appendage development accounting for less than 7%) and 8% have yet to metamorphose after 9 months. The incidence of dermomycoides in the culled individuals was 100%; however, a study being conducted concurrently in their native habitat has confirmed that the organism does exist in situ with the dusky gopher frogs, which act as natural carriers. Efforts are currently in place to establish reintroduction programs for the dusky gopher froglets produced ex situ to increase the dwindling wild population now that tadpoles produced by IVF have been shown to be developmentally competent. In conclusion, IVF can be used to produce tadpoles of the dusky gopher frog with a low incidence of abnormalities, but the tadpoles were found to be carriers of the organism dermomycoides similar to their counterparts in the wild.

116 DEVELOPMENT OF ASSISTED REPRODUCTION TECHNOLOGIES FOR THE ENDANGERED MISSISSIPPI GOPHER FROG (RANA SEVOSA) AND SPERM TRANSFER FOR IN VITRO FERTILIZATION

Species-specific differences in breeding strategies and physiology have limited the application of assisted reproductive technologies (ART) for critically endangered amphibians in captive assurance colonies. In 2006, the Memphis Zoo (MZ) initiated a program to develop ART for the critically endangered Mississippi gopher frog after natural breeding failed. Standard gamete collection and IVF developed by MZ for reproducing endangered toads such as the Wyoming or boreal toad were applied to the gopher frog with little success, especially hormonal therapy for sperm production. Using the leopard frog as a model species for Ranids, we tested the time and dose dependence of a luteinizing hormone releasing hormone analogue (LHRHa) and hCG on sperm quantity and quality. Initial findings from the leopard frog study were critical in designing the study on gopher frogs. Our objectives were to (1) compare 2 different hormones administered intraperitoneal (500 IU hCG vs 15 μg LHRHa) or their combination on spermiation in gopher frogs; (2) develop in vivo oocyte maturation and ovulation protocols using LHRHa (15 μg) and hCG (500 IU); and (3) transfer this technology to another institution as proof of principle. In gopher frogs, 100 and 83% of the males produced sperm in response to the LHRHa and the combination treatment, respectively, whereas only 16% responded to hCG alone. Sperm concentration peaked at 1 h post-administration for all treatments, with the LHRH/hCG cocktail treatment producing the highest concentration of sperm (mean = 4.6 × 106 ± 1.2 × 106 sperm mL–1, n = 6). No differences in motility were observed between treatments (P > 0.05). For females, a series of priming hormones of hCG and LHRHa were given several months before an ovulatory hormone regimen resulting in ovulation by 100% of the females (n = 6), whereas animals not primed failed to ovulate (n = 4). These 3 separate priming and IVF trials conducted between 2008 and 2010 resulted in each female laying ∼2000 eggs, with an average fertilization rate of 76% for inseminated eggs and hundreds of tadpoles produced. These IVF tadpoles represent the first captive reproduction of gopher frogs and highlight how ART can be applied to conservation and genetic management of threatened species. Subsequently, we tested our IVF protocols on gopher frogs at Omaha's Henry Doorly Zoo using fresh (collected on site) and chilled, shipped sperm from MZ. We collected 6169 eggs from 9 hormone-primed females with all animals ovulating. A portion of the total eggs ovulated were inseminated, resulting in 2401 fertilized eggs (38.9% of total eggs collected) across 18 different male–female pairings leading to viable tadpoles. In addition, sperm transferred overnight from the MZ produced 202/441 fertilized eggs (46%). The transfer of this technology and production of endangered amphibians using chilled, shipped sperm from live animals is a conservation milestone that can be applied to other captive breeding programs.

Aerosolized semifluorinated alkanes as excipients are suitable for inhalative drug delivery--a pilot study

Semifluorinated alkanes (SFAs) have been described as potential excipients for pulmonary drug delivery, but proof of their efficacy is still lacking. We tested whether SFA formulations with the test drug ibuprofen can be nebulised and evaluated their pharmacokinetics. Physico-chemical properties of five different ibuprofen formulations were evaluated: an aqueous solution (H2O), two different SFAs (perfluorohexyloctane (F6H8), perfluorobutylpentane (F4H5)) with and without ethanol (SFA/EtOH). Nebulisation was performed with a jet catheter system. Inhalative characteristics were evaluated by laser diffraction. A confirmative animal study with an inhalative single-dose (6 mg/kg) of ibuprofen with each formulation was performed in anaesthetised healthy rabbits. Plasma samples at defined time points and lung tissue harvested after the 6-h study period were analyzed by HPLC-MS/MS. Pharmacokinetics were calculated using a non-compartment model. All formulations were nebulisable. No differences in aerodynamic diameters (MMAD) were detected between SFA and SFA/EtOH. The ibuprofen plasma concentration-time curve (AUC) was highest with F4H5/EtOH. In contrast, F6H8/EtOH had the highest deposition of ibuprofen into lung tissue but the lowest AUC. All tested SFA and SFA/EtOH formulations are suitable for inhalation. F4H5/EtOH formulations might be used for rapid systemic availability of drugs. F6H8/EtOH showed intrapulmonary deposition of the test drug.

Semifluorinated alkanes--a new class of excipients suitable for pulmonary drug delivery

INTRODUCTION

Semifluorinated alkanes (SFAs) are considered as diblock molecules with fluorocarbon and hydrocarbon segments. Unlike Perfluorocarbons (PFCs), SFAs have the potential to dissolve several lipophilic or water-insoluble substances. This makes them possibly suitable as new excipients for inhalative liquid drug carrier systems.

PURPOSE

The aim of the study was to compare physico-chemical properties of different SFAs and then to test their respective effects in healthy rabbit lungs after nebulisation.

METHODS

Physico-chemical properties of four different SFAs, i.e. Perfluorobutylpentane (F4H5), Perfluorohexylhexane (F6H6), Perfluorohexyloctane (F6H8) and Perfluorohexyldodecane (F6H12) were measured. Based on these results, aerosol characteristics of two potential candidates suitable as excipients for pulmonary drug delivery, i.e. F6H8 and F4H5, were determined by laser light diffraction. Tracheotomised and ventilated New Zealand White rabbits were nebulised with either a high- or a low dose of SFAs (F6H8(low/high) and F4H5(low/high)) or saline (NaCl). Ventilated healthy animals served as controls (Sham). Arterial blood gases, lung mechanics, heart rate and blood pressure were recorded prior to nebulisation and in 30 min intervals during the 6-h study period.

RESULTS

Out of the four SFAs studied initially, no satisfactory behaviour as a solvent has to be expected because of low lipophilicity for F6H6. Output rate during aerosolisation was very low for F6H12. F6H8 and F4H5 presented comparable aerosolisation characteristics and lipophilicity and were therefore tested in the in vivo model. Aerosol therapy, either SFAs or saline, impaired paO2/FiO2 ratio, dynamic lung compliance and respiratory mechanics in all groups, except for F4H5(low) group which behaved like the control group (Sham). F4H5(low) had no adverse effects on gas exchange or pulmonary mechanics.

CONCLUSIONS

Perfluorobutylpentane (F4H5) in a low-dose application may be suitable as a new inhalable excipient in SFA-based pulmonary drug delivery systems for lipophilic or water-insoluble substances.

The bioclimatic envelope of the wolverine (Gulo gulo): do climatic constraints limit its geographic distribution?

We propose a fundamental geographic distribution for the wolverine ( Gulo gulo (L., 1758)) based on the hypothesis that the occurrence of wolverines is constrained by their obligate association with persistent spring snow cover for successful reproductive denning and by an upper limit of thermoneutrality. To investigate this hypothesis, we developed a composite of MODIS classified satellite images representing persistent snow cover from 24 April to 15 May, which encompasses the end of the wolverine’s reproductive denning period. To investigate the wolverine’s spatial relationship with average maximum August temperatures, we used interpolated temperature maps. We then compared and correlated these climatic factors with spatially referenced data on wolverine den sites and telemetry locations from North America and Fennoscandia, and our contemporary understanding of the wolverine’s circumboreal range. All 562 reproductive dens from Fennoscandia and North America occurred at sites with persistent spring snow cover. Ninety-five percent of summer and 86% of winter telemetry locations were concordant with spring snow coverage. Average maximum August temperature was a less effective predictor of wolverine presence, although wolverines preferred summer temperatures lower than those available. Reductions in spring snow cover associated with climatic warming will likely reduce the extent of wolverine habitat, with an associated loss of connectivity.

161 CRYOPRESERVATION OF CORN SNAKE, ELAPHE GUTATTA, SEMEN

The purpose of this investigation was to develop a protocol for cryopreserving snake semen using the corn snake, Elaphe gutatta, as the model species. This experiment is part of a five year investigation where the influences of diluents, cryoprotectants, cooling and thawing rates on sperm survival were studied. This report presents one protocol found to be effective for cryopreserving corn snake semen as determined by post-thaw motility parameters in vitro. Semen was collected by applying pressure to the lower abdomen and continuing distally towards the cloaca to remove any feces or urates. The cloaca was washed using PBS, then a more local pressure was applied to each side of the vent to cause the hemipenes to evert and subsequently ejaculate. The semen (approximately 5 μL) was then collected using a sterile transfer pipette, placed in 120 μL Biladyl A containing 20% egg yolk (Minitube, 13502/0501), and analyzed for motility, rate of forward progression (RFP; 0–5), and concentration. The semen was further diluted at room temperature at 1:1 v/v with Biladyl A containing 20% egg yolk and 34% Glycerol (Sigma, G2025), yielding a final concentration of 17% Glycerol. The diluted semen was then loaded into 250-μL straws and slowly cooled for 1 hour. The straws were then placed 1 inch above a liquid nitrogen bath for ten minutes and finally plunged into the nitrogen where it remained frozen. The cryopreserved semen was thawed by placing the straws into a 50°C water bath for 8 s, then emptied into microcentrifuge tubes and the sperm were evaluated for motility and RFP. The mean motility of the fresh samples was 72.5% (66.4–77.7%). The mean post-thaw motility of sperm over six trials was 27.1% (17.8–50.2%). The mean RFP was 0.75 (0.5–1.0). The differences between fresh and post-thawed mean motilities were shown to be significant using a chi-square analysis (P < 0.0001). Density gradient centrifugation (DGC) was applied in one trial where the semen had an initial post-thaw motility of 50.2% with an RFP of 0.5. After the centrifugation treatment, the motility increased to 64.8% with an RFP of 3. The DGC media was composed of 400 μL 45% Percoll (Sigma, P4937) layered over 400 μL 90% Percoll. The density gradients were centrifuged at 700g for 30 min after which time the pellets were washed in 500 μL pre-warmed TL Hepes Solution (Lonza, 04-616F) and centrifuged at 300g for 10 min to remove the Percoll. The resulting sperm pellets were then resuspended in a small volume of the pre-warmed Hepes. Thus far, the protocol using 17% Glycerol in Biladyl A with 20% egg yolk has proven to be the most successful for cryopreserving corn snake semen. The use of DGC enhanced the number of usable sperm leaving sperm of higher motility and RFP possibly due to the absence of seminal plasma or cryoprotective agents that may detrimentally affect sperm quality. There are no known reports of the use of DCG with snake semen. Further studies are underway to improve these results and successfully use cryopreserved snake semen for artificial insemination and cryobanking for the long-term genetic management of endangered snake species.