Developing an intervention package to optimise the management of vancomycin therapy using theory informed co-design

BACKGROUND

Optimising the management of vancomycin by achieving target therapeutic concentrations early during therapy has been associated with reduced mortality and morbidity. Despite the availability of guidelines and training, the management of vancomycin remains suboptimal.

OBJECTIVES

The primary outcome was the development of interventions and associated implementation strategies to optimise the management of vancomycin therapy. This paper describes how co-design process was used to build a theory informed intervention package, which was implemented across a wide range of in-patient hospital settings in Queensland, Australia.

METHODS

This multiple methods study was conducted in four phases: 1) a baseline audit to identify the nature of the problem and associated determinants informed by stakeholder interviews 2) mapping these findings to the Theoretical Domains Framework (TDF) to identify behavioural correlates and modifiers 3) prioritising the behavioural modifiers and associated implementation strategies to inform a protype of the intervention in a series of co-design sessions and 4) implementing and evaluating the intervention package. The study was conducted across the four teaching hospitals in a large Queensland Hospital and Health Service across multiple healthcare disciplines namely nurses, doctors, and pharmacists. This intervention package was subsequently implemented across Queensland Health with the support of the local champions under the guidance of the steering group.

RESULTS

Clinicians identified that a multifaceted intervention package and training which can be tailored to the health-care professional disciplines, would be best suited to shift clinician behaviour to align with guidelines. The findings from the co-design process aligned with theory-informed intervention package. Each of the intervention strategies varied in their frequency and popularity of use.

CONCLUSIONS

The use of theory-informed and participatory approach assisted with the intervention development process and aligned the intervention content with the priorities of stakeholders. The TDF provided a structured process for developing intervention content which is both acceptable and useful to stakeholders and may improve the management of vancomycin.

Expanding the Coordination of f-Block Metals with Tris[2-(2-methoxyethoxy)ethyl]amine: From Molecular Complexes to Cage-like Structures

Low-valent f-block metals have intrinsic luminescence, electrochemical, and magnetic properties that are modulated with ligands, causing the coordination chemistry of these metals to be imperative to generating critical insights needed to impact modern applications. To this end, we synthesized and characterized a series of twenty-seven complexes of f-metal ions including EuII, YbII, SmII, and UIII and hexanuclear clusters of LaIII and CeIII to study the impact of tris[2-(2-methoxyethoxy)ethyl]amine, a flexible acyclic analogue of the extensively studied 2.2.2-cryptand, on the coordination chemistry and photophysical properties of low-valent f-block metals. We demonstrate that the flexibility of the ligand enables luminescence tunability over a greater range than analogous cryptates of EuII in solution. Furthermore, the ligand also displays a variety of binding modes to f-block metals in the solid state that are inaccessible to cryptates of low-valent f-block metals. In addition to serving as a ligand for f-block metals of various sizes and oxidation states, tris[2-(2-methoxyethoxy)ethyl]amine also deprotonates water molecules coordinated to trivalent triflate salts of f-block metal ions, enabling the isolation of hexanuclear clusters containing either LaIII or CeIII. The ligand was also found to bind more tightly to YbII and UIII in the solid state compared to 2.2.2-cryptand, suggesting that it can play a role in the isolation of other low-valent f-block metals such CfII, NpIII, and PuIII. We expect that our findings will inspire applications of tris[2-(2-methoxyethoxy)ethyl]amine in the design of light-emitting diodes and the synthesis of extremely reducing divalent f-block metal complexes that are of interest for a wide range of applications.

Partial Parasagittal Patellectomy in Dogs: A Retrospective Case Series of 19 Dogs

OBJECTIVE

 The aim of this study was to describe partial parasagittal patellectomy for the surgical management of patellar luxation, including surgical technique, proposed indications, complications, and outcomes in a cohort of dogs.

STUDY DESIGN

 This is a single-center retrospective clinical case series.

METHODS

 Medical records (2019-2020) of dogs presenting for patellar luxation were reviewed. Clinical signs, luxation direction and grade, preoperative imaging and intraoperative findings, and complications were retrospectively retrieved. Owners were contacted via questionnaire for medium- and long-term follow-up.

RESULTS

 A total of 24 stifles in 19 dogs met the inclusion criteria. Intraoperative minor complications occurred in four stifles. A single minor complication occurred postoperatively with no major complications. Increased thickness and radiographic attenuation of the patellar ligament were noted in 14 stifles at radiographic reassessment. Re-luxation was not encountered, with long-term owner-assessed outcome as good to excellent in all cases.

CONCLUSION

 Partial parasagittal patellectomy, used in conjunction with block recession trochleoplasty and tibial tuberosity transposition, provided reliable resolution of patellar luxation in canine stifles with grade 2 or 3 luxation where width mismatch between the patella and the trochlea was noted intraoperatively. Long-term outcome appears to be good to excellent with a low rate of complication.

Cryptands on a Solid Support for the Separation of Europium from Gadolinium

With the great demand for europium in green-energy technologies comes the need for innovative methods to isolate the elements. We introduce a solid-liquid extraction method using a 2.2.2-cryptand-modified solid support to separate europium from gadolinium using their differences in electrochemical potential. The method overcomes challenges associated with the separation of those two ions that have similar coordination chemistry in the +3 oxidation state. A competitive adsorption study in the cryptand system between EuII/EuIII and GdIII shows greater affinity for EuII relative to GdIII. After separation from GdIII, Eu was released by oxidizing EuII to EuIII with 99.3% purity. The purity of separated Eu is unaffected by pH between pH 3.0 and 5.5. Overall, we demonstrate that by modifying a solid support with 2.2.2-cryptand, divalent europium can be separated from trivalent gadolinium based on the differences of affinities of 2.2.2-cryptand for the two ions.

Outersphere Approach to Increasing the Persistance of Oxygen-Sensitive Europium(II)-Containing Contrast Agents for Magnetic Resonance Imaging with Perfluorocarbon Nanoemulsions toward Imaging of Hypoxia

Radiographic mapping of hypoxia is needed to study a wide range of diseases. Complexes of Eu(II) are a promising class of molecules to fit this need, but they are generally limited by their rapid oxidation rates in vivo. Here, a perfluorocarbon-nanoemulsion perfused with N2 , forms an interface with aqueous layers to hinder oxidation of a new perfluorocarbon-soluble complex of Eu(II). Conversion of the perfluorocarbon solution of Eu(II) into nanoemulsions results in observable differences between reduced and oxidized forms by magnetic resonance imaging both in vitro and in vivo. Oxidation in vivo occurrs over a period of ≈30 min compared to <5 min for a comparable Eu(II)-containing complex without nanoparticle interfaces. These results represent a critical step toward delivery of Eu(II)-containing complexes in vivo for the study of hypoxia.

3D-printed, patient-specific cutting guides improve femoral and tibial cut alignment in canine total knee replacement

OBJECTIVES

The purpose of this cadaveric study was to determine whether patient-specific guides (PSGs) improve the accuracy of tibial and femoral cut alignment in canine total knee replacement (TKR), as compared with generic cutting guides.

STUDY DESIGN

Original research.

ANIMALS

Sixteen pelvic limbs from skeletally mature medium- to large-breed canine cadavers.

METHODS

Specimens were randomly allocated to one of two groups (PSG or Generic; N = 8/group). In the Generic group, femoral and tibial ostectomies were made using the standard canine TKR femoral cutting blocks and tibial alignment guide. In the PSG group, the cuts were made using a series of custom 3D-printed cutting guides. "Planned" and "actual" tibial and femoral cut alignments were compared in the frontal and sagittal planes, and errors were calculated by subtracting actual from planned values.

RESULTS

Use of 3D-printed PSGs improved tibial cut alignment in the frontal plane but not the sagittal plane. PSGs also improved the alignment of the cranial and distal femoral ostectomies but did not impact varus-valgus alignment.

CONCLUSIONS

These findings support the use of PSGs for TKR in dogs. Clinical trials are now needed to determine whether the benefits of PSGs translate into measurable improvements in joint function and implant longevity.

CLINICAL SIGNIFICANCE

PSGs have the potential to improve femoral and tibial component alignment in canine TKR.

Three-Dimensional Morphometry of the Canine Pelvis: Implications for Total Hip Replacement Surgery

OBJECTIVES

 Two-dimensional measurements of acetabular geometry are widely used for the assessment of acetabular component orientation following total hip replacement (THR). With the increasing availability of computed tomography scans, there is an opportunity to develop three-dimensional (3D) planning to improve surgical accuracy. The aim of this study was to validate a 3D workflow for measuring angles of lateral opening (ALO) and version, and to establish reference values for dogs.

METHODS

 Pelvic computed tomography scans were obtained from 27 skeletally mature dogs with no radiographic evidence of hip joint pathology. Patient-specific 3D models were built, and ALO and version angles were measured for both acetabula. The validity of the technique was determined by calculating intra-observer coefficient of variation (CV, %). Reference ranges were calculated and data from left and right hemipelves were compared using a paired t-test and symmetry index.

RESULTS

 Measurements of acetabular geometry were highly repeatable (intra-observer CV 3.5-5.2%, inter-observer CV 3.3-5.2%). Mean (± standard deviation) values for ALO and version angle were 42.9 degrees (± 4.0 degrees) and 27.2 degrees (± 5.3 degrees) respectively. Left-right measurements from the same dog were symmetrical (symmetry index 6.8 to 11.1%) and not significantly different.

CONCLUSIONS

 Mean values of acetabular alignment were broadly similar to clinical THR guidelines (ALO of 45 degrees, version angle of 15-25 degrees), but the wide variation in angle measurements highlights the potential need for patient-specific planning to reduce the risk of complications such as luxation.

Systemic Delivery of Divalent Europium from Ligand Screening with Implications to Direct Imaging of Hypoxia

Hypoxia is a hallmark of many diseases, including cancer, arthritis, heart and kidney diseases, and diabetes, and it is often associated with disease aggressiveness and poor prognosis. Consequently, there is a critical need for imaging hypoxia in a noninvasive and direct way to diagnose, stage, and monitor the treatment and development of new therapies for these diseases. Eu-containing contrast agents for magnetic resonance imaging have demonstrated potential for in vivo imaging of hypoxia via changes in metal oxidation state from +2 to +3, but rapid oxidation in blood limits EuII-containing complexes to studies compatible with direct injection to sites. Here, we report a new EuII-containing complex that persists in oxygenated environments and is capable of persisting in blood long enough for imaging by magnetic resonance imaging. We describe the screening of a library of ligands that led to the discovery of the complex as well as a pH-dependent mechanism that hinders oxidation to enable usefulness in vivo. These studies of the first divalent lanthanide complex that persists in oxygenated solutions open the door to the use of EuII-based contrast agents for imaging hypoxia in a wide range of diseases.

Properties of Amine-Containing Ligands That Are Necessary for Visible-Light-Promoted Catalysis with Divalent Europium

We describe a study of the influence of amine-containing ligands on the photoredox-relevant properties of Eu^II toward the rational design of Eu^II-containing catalysts for visible-light-promoted photoredox reactions. We report our observations of the effects of the degree of functionalization of amines, denticity, and macrocylic ligands on the absorbance of Eu^II. Ligands that contain secondary amines bathochromically shift the absorbance of EuCl₂ relative to ligands that contain primary or tertiary amines. Similarly, ligands of larger denticity have a larger bathochromic shift of the absorbance than ligands of smaller denticity. We observed that macrocyclic ligands have a larger effect on the absorbance of EuCl₂ than nonmacrocyclic ligands. Also, we report the photoredox reactivity of four new Eu^II-containing complexes. These observations are potentially influential in understanding the ligand properties that promote the use of Eu^II in visible-light-promoted photoredox catalysis.

Development of a Highly Selective Ni(II) Chelator in Aqueous Solution

The design, synthesis, and characterization of a novel Ni(II) chelator SG-20 is reported. SG-20 is selective in binding to Ni(II) versus other metal ions including Cu(II), Fe(II), Co(II), and Zn(II). At pH = 7.1, SG-20 binds Ni(II) with a Kd = 7.0 ± 0.4 μM. Job analysis indicates that SG-20 binds to both Ni(II) and Cu(II) with a 1:1 stoichiometry. Affinity of SG-20 for Ni(II) is pH dependent and decreases upon lowering to pH 4.0. A green solid was isolated from the reaction of SG-20 with NiCl2·6H2O in MeOH and characterized by X-ray photoelectron spectroscopy (XPS), electronic absorption and infrared (IR) spectroscopies, and mass spectrometry. Collectively, XPS and IR analysis revealed Ni-N and Ni-O interactions and a shift in C-O asymmetric and symmetric stretches consistent with Ni binding. Attempts to crystalize a mononuclear complex were unsuccessful, likely due to the Ni-SG-20 complex being in equilibrium with higher order species in solution. However, reaction of SG-20 with NiCl2·6H2O in water followed by slow evaporation yielded green crystals that were characterized by electronic absorption spectroscopy (λmax = 260 nm) and X-ray crystallography. These analyses revealed that SG-20 supports formation of a complex cluster containing six SG-20 ligands, 15 Ni(II), and three Na(I) centers, with two distinct types of Ni atoms in its outer and inner core. The nine Ni atoms present in the inner core were bound by oxo and carbonate bridges, whereas the six Ni atoms present in its outer shell were bound to N, O, and S donor atoms derived from SG-20. Overall, X-ray crystallographic analysis revealed that two chelator arms of SG-20 bind to one Ni(II) ion with an axial aqua ligand, whereas the third arm is free to interact with Ni ions within the central cluster, supporting the goal of Ni capture.

A Mouse Holder for Awake Functional Imaging in Unanesthetized Mice: Applications in 31P Spectroscopy, Manganese-Enhanced Magnetic Resonance Imaging Studies, and Resting-State Functional Magnetic Resonance Imaging

Anesthesia is often used in preclinical imaging studies that incorporate mouse or rat models. However, multiple reports indicate that anesthesia has significant physiological impacts. Thus, there has been great interest in performing imaging studies in awake, unanesthetized animals to obtain accurate results without the confounding physiological effects of anesthesia. Here, we describe a newly designed mouse holder that is interfaceable with existing MRI systems and enables awake in vivo mouse imaging. This holder significantly reduces head movement of the awake animal compared to previously designed holders and allows for the acquisition of improved anatomical images. In addition to applications in anatomical T₂-weighted magnetic resonance imaging (MRI), we also describe applications in acquiring ³¹P spectra, manganese-enhanced magnetic resonance imaging (MEMRI) transport rates and resting-state functional magnetic resonance imaging (rs-fMRI) in awake animals and describe a successful conditioning paradigm for awake imaging. These data demonstrate significant differences in ³¹P spectra, MEMRI transport rates, and rs-fMRI connectivity between anesthetized and awake animals, emphasizing the importance of performing functional studies in unanesthetized animals. Furthermore, these studies demonstrate that the mouse holder presented here is easy to construct and use, compatible with standard Bruker systems for mouse imaging, and provides rigorous results in awake mice.

Solid-state and solution-phase characterization of SmII-aza[2.2.2]cryptate and its methylated analogue

Two new Sm^II-azacryptates are reported that differ in steric hindrance and Lewis basicity of donor atoms. The sterically hindered complex has a smaller coordination number and a more negative electrochemical potential than the complex with less steric hindrance.

Bone density of the humeral condyle in Labrador retrievers with medial coronoid process disease

OBJECTIVES

To estimate, using CT imaging, differences in the regional bone density of the humeral condyle in Labrador retriever elbows with and without medial coronoid process disease.

MATERIALS AND METHODS

The elbows of Labrador Retrievers that had undergone CT were reviewed. Scans were divided into three categories: elbows without medial coronoid process disease; elbows with medial coronoid process disease involving fragmentation of the radial incisure; elbows with medial coronoid process disease involving fragmentation of the medial coronoid apex. A templating technique was employed to define the weight-bearing regions of the medial and lateral portion of the humeral condyle and estimates of volumetric bone density (defined by Hounsfield unit measurement) were compared across the three groups.

RESULTS

CT evaluation was performed on 122 elbows in 81 dogs. There was a higher mean Hounsfield unit measurement in the medial and lateral portions of the humeral condyles in elbows with medial coronoid process disease involving fragmentation of the medial coronoid apex compared with elbows with medial coronoid process disease involving fragmentation of the radial incisure.

CLINICAL SIGNIFICANCE

Dogs with apical fragmentation of the medial coronoid process exhibited significantly higher estimated bone mineral density within the medial portion of the humeral condyle when compared to dogs with radial incisure fragmentation. The medial portion of the humeral condyle may be associated with the pathogenesis of apical but not radial incisure medial coronoid process fragmentation in Labrador Retrievers.

Dual-Mode Tumor Imaging Using Probes That Are Responsive to Hypoxia-Induced Pathological Conditions

Hypoxia in solid tumors is associated with poor prognosis, increased aggressiveness, and strong resistance to therapeutics, making accurate monitoring of hypoxia important. Several imaging modalities have been used to study hypoxia, but each modality has inherent limitations. The use of a second modality can compensate for the limitations and validate the results of any single imaging modality. In this review, we describe dual-mode imaging systems for the detection of hypoxia that have been reported since the start of the 21st century. First, we provide a brief overview of the hallmarks of hypoxia used for imaging and the imaging modalities used to detect hypoxia, including optical imaging, ultrasound imaging, photoacoustic imaging, single-photon emission tomography, X-ray computed tomography, positron emission tomography, Cerenkov radiation energy transfer imaging, magnetic resonance imaging, electron paramagnetic resonance imaging, magnetic particle imaging, and surface-enhanced Raman spectroscopy, and mass spectrometric imaging. These overviews are followed by examples of hypoxia-relevant imaging using a mixture of probes for complementary single-mode imaging techniques. Then, we describe dual-mode molecular switches that are responsive in multiple imaging modalities to at least one hypoxia-induced pathological change. Finally, we offer future perspectives toward dual-mode imaging of hypoxia and hypoxia-induced pathophysiological changes in tumor microenvironments.

Owner-reported outcome measures in veterinary care for companion animal orthopedic patients: An international online survey of veterinarians' expectations and practices

OBJECTIVE

To report veterinarians' familiarity with and perceptions of owner/observer-reported outcome measures (OROMs) and their applications in routine clinical practice.

STUDY DESIGN

Cross-sectional online survey.

ANIMALS OR SAMPLE POPULATION

A total of 441 veterinarians with a caseload of companion animal orthopedic patients.

METHODS

Respondents answered questions regarding their familiarity with and application of OROMs. Respondents provided opinions on statements related to reasons for using or not using OROMs in routine clinical practice, prerequisites to implement OROMs in routine clinical practice, and whether they would implement OROMs in routine clinical practice if adequate tools/technologies were available.

RESULTS

Most (293/441, 66.4%) respondents felt familiarity with at least one OROM. Only 17.5% (77 out of the 440 answering the question about the application of OROMs) applied OROMs in routine clinical practice. The two main reasons for not using OROMs in routine clinical practice were the lack of opportunity/feasibility and the lack sufficient information/knowledge/experiences. User-friendliness, time efficiency, and interpretability were considered the most important prerequisites for implementing OROMs in routine clinical practice. If adequate tools/technologies were available, 266/439 (60.6%) respondents indicated that they would definitely implement OROMs in routine clinical practice.

CONCLUSION

Although most respondents were familiar with at least one OROM, fewer than one-fifth applied them in routine clinical practice. Most respondents were willing to implement OROMs in routine clinical practice if adequate tools/technologies were available.

CLINICAL SIGNIFICANCE

Our results justify further investigations to improve the application of OROMs in routine clinical practice in veterinary care of companion animal orthopedic patients.

Identification of seven-coordinate LnIII ions in a LnIII[15-MCFe III N(shi)-5](OAc)2Cl species crystallized from methanol and pyridine

The title metallacrown (MC) complexes Ln^III[15-MC_Fe^IIIN(shi)-5](OAc)₂CI(C₅H₅N)₆ (Ln1), where OAc^- is acetate, shi^3- is salicylhydroximate, and Ln = Gd and Dy, were synthesized via a self-assembly reaction in methanol and pyridine. Single crystals were grown using slow evaporation and characterized using X-ray diffraction. Seven-coordinate capped octahedron geometries were observed for the lanthanide ion in both complexes, which is uncommon for trivalent lanthanide species. The 15-MC-5 is a ruffled metallacrown archetype similar to previously reported mixed-valent manganese metallacrowns.

Near-Infrared Lanthanide-Based Emission from Fused Bis[Ln(III)/Zn(II) 14-metallacrown-5] Coordination Compounds

A set of (Ln[14-MC_{Zn(II)N(quinHA)}-5])₂Ln₂Zn₂(quinHA)₂(ph)₂(Hph)₄(OH)₈(H₂O)₄ metallacrowns (Ln-1, Ln = Tb, Gd, or Yb; H₂quinHA = quinaldic hydroxamic acid, H₂ph = phthalic acid) have been synthesized via solution-state self-assembly. The metallacrowns possess an uncommon topology within the metallacrown family where two rarely seen 14-metallacrown-5 moieties are fused by a Yb₂Zn₂(quinHA)₂ bridge. Moreover, Yb-1 analyzed in the solid state exhibits a characteristic near-infrared luminescence signal arising from Yb^{3+ 2}F_5/2→²F_7/2 transition despite the proximity of high energy O-H oscillators.

Versatile Para-Substituted Pyridine Lanthanide Coordination Complexes Allow Late Stage Tailoring of Complex Function

A series of cationic and neutral p-Br and p-NO2 pyridine substituted Eu(III) and Gd(III) coordination complexes serve as versatile synthetic intermediates. Nucleophilic aromatic substitution occurs readily at the para position under mild conditions, allowing C-N and C-C bond forming reactions to take place, permitting the introduction of azide, amino and alkynyl substituents. For Eu(III) complexes, this approach allows late stage tuning of absorption and emission spectral properties, exemplified by the lowering of the energy of an LMCT transition accompanied by a reduction in the Eu-Npy bond length. Additionally, these complexes provide direct access to the corresponding Eu(II) analogues. With the Gd(III) series, the nature of the p-substituent does not significantly change the EPR properties (linewidth, relaxation times), as required for their development as EPR spin probes that can be readily conjugated to biomolecules under mild conditions.

Hexa-μ-acetato-chlorido-(μ-N,2-dioxodo-benzene-1-carboximidato)-μ3-oxido-tetra-iron(III)-water (1/1) and hexa-μ-acetato-(μ-N,2-dioxodo-benzene-1-carboximidato)fluorido-μ3-oxido-tri-pyridine-tetra-iron(III)-pyridine-water (1/1/0.24)

The title compounds, [Fe4(C2H3O2)6(C7H4O3)FO(C5H5N)3]·C5H5N·0.24H2O (1-F) and [Fe4(C2H3O2)6(C7H4O3)ClO(C5H5N)3]·H2O (1-Cl) were synthesized using a self-assembly reaction in methanol and pyridine with stoichiometric addition of salicyl-hydroxamic acid (H3shi), acetic acid (HOAc), and the appropriate ferric halide salt. The compounds crystallize as solvates, where 1-F has one pyridine mol-ecule that is disordered about a twofold axis and one water mol-ecule with an occupancy of 0.24 (2); and 1-Cl has one water mol-ecule that is disordered over two sites with occupancies of 0.71 (1) and 0.29 (1). The space groups for each analog differ as 1-F crystallizes in Fdd2 while 1-Cl crystallizes in P21. The difference in packing is due to changes in the inter-molecular inter-actions involving the different halides. The two mol-ecules are mostly isostructural, differing only by the torsion of the pyrine ligands and slight orientation changes in the acetate ligands. All of the iron(III) ions are in six-coordinate octa-hedral ligand field geometries but each one exhibits a unique coordination environment with various numbers of O (four to six) and N (nought to two) atom donors. Bond-valence sums confirm each iron is trivalent. The hydroximate ligand is bound to three iron(III) ions using a fused chelate motif similar to those in metallacrown compounds.

Kinematics of a Novel Canine Cervical Fusion System

OBJECTIVE

 The aim of this study was to determine the biomechanical behaviour of a novel distraction-fusion system, consisting of an intervertebral distraction screw, pedicle locking screws and connecting rods, in the canine caudal cervical spine.

STUDY DESIGN

 Biomechanical study in cadaveric canine cervicothoracic (C3-T3) spines (n = 6). Cadaveric spines were harvested, stripped of musculature, mounted on a four-point bending jig, and tested using non-destructive four-point bending loads in extension (0-100 N), flexion (0-60 N) and lateral bending (0-40 N). Angular displacement was recorded from reflective optical trackers rigidly secured to C5, C6 and C7. Data for primary and coupled motions were collected from intact spines and following surgical stabilization (after ventral annulotomy and nucleotomy) with the new implant system.

RESULTS

 As compared with the intact spine, instrumentation significantly reduced motion at the operated level (C5-C6) with a concomitant non-significant increase at the adjacent level (C6-C7).

CONCLUSION

 The combination of a locking pedicle screw-rod system and intervertebral spacer provides an alternative solution for surgical distraction-stabilization in the canine caudal cervical spine and supports the feasibility of using this new implant system in the management of disc-associated cervical spondylomyelopathy in dogs. The increase in motion at C6-C7 may suggest the potential for adjacent level effects and clinical trials should be designed to address this.

Magnetic resonance thermometry using a GdIII-based contrast agent

The complexes described here serve as contrast agents for magnetic resonance imaging thermometry. The complexes differentially enhance contrast between 275 and 325 K. The basis of the temperature response of the fluorinated contrast complex is the modulation of water exchange caused by trifluoromethyl groups that can be chemically controlled.

Rational Design of High-Relaxivity EuII -Based Contrast Agents for Magnetic Resonance Imaging of Low-Oxygen Environments

Metal-based contrast agents for magnetic resonance imaging present a promising avenue to image hypoxia. EuII -based contrast agents have a unique biologically relevant redox couple, EuII/III , that distinguishes this metal for use in hypoxia imaging. To that end, we investigated a strategy to enhance the contrast-enhancing capabilities of EuII -based cryptates in magnetic resonance imaging by controlling the rotational dynamics. Two dimetallic, EuII -containing cryptates were synthesized to test the efficacy of rigid versus flexible coupling strategies. A flexible strategy to dimerization led to a modest (114 %) increase in contrast enhancement per Eu ion (60 MHz, 298 K), but a rigid linking strategy led to an excellent (186 %) increase in contrast enhancement despite this compound's having the smaller molecular mass of the two dimetallic complexes. We envision the rigid linking strategy to be useful in the future design of potent EuII -based contrast agents for magnetic resonance imaging.

The effect of plate fixation on supination and pronation of the feline antebrachium: a model of pancarpal arthrodesis

BACKGROUND

Pancarpal arthrodesis is purported to limit supination and pronation of the feline antebrachium. The objective of this study was to investigate whether plate fixation of the radius to the carpus and metacarpus limits supination and pronation of the ulna relative to the radius as a model for pancarpal arthrodesis in the cat. Eight feline cadaveric forelimbs were rotated from supination to pronation in a testing jig and CT (computed tomography) was performed in the neutral, supinated and pronated positions. A locking plate was then secured dorsally to the radius, radial carpal bone and metacarpal III of each of the limbs. CT was repeated in each of the testing positions following plate application. The radius and ulna of the control specimens, and the radius, ulna and plate of the plated specimens were then segmented using software. Alignment of the bones to the radius in the control specimens, and to the plate in the plated specimens was used to compare the changes in degrees of movement of the ulna relative to the radius in dorsal, sagittal and transverse planes.

RESULTS

Based on the results of the paired t test, there was no significant difference in degrees of movement, or total range of motion between control and plated specimens in supinated and pronated testing conditions.

CONCLUSION

The results of this ex-vivo study indicate that under the testing conditions employed, plate fixation of the radius to the carpus and metacarpus does not limit supination and pronation of the feline antebrachium.

Evaluation of the repeatability of kinetic and temporospatial gait variables measured with a pressure-sensitive treadmill for dogs

OBJECTIVE

To evaluate intrasession and intersession repeatability of measurements for temporospatial and kinetic variables obtained with a pressure-sensitive treadmill designed for gait analysis of dogs.

ANIMALS

16 client-owned dogs.

PROCEDURES

The influence of treadmill speed on accuracy of ground reaction force (GRF) measurements was assessed by simulated gait analysis at 0 to 7.5 km/h with a custom test device. A similar test was performed with 1 client-owned dog ambulating on the treadmill at 5 speeds (3 to 7 km/h) for GRF calculations. Fifteen client-owned dogs were then walked on the treadmill at 3 km/h for collection of temporospatial and kinetic data. Intrasession repeatability was determined by comparing 2 sets of measurements obtained ≤ 2 hours apart. Intersession repeatability was determined by comparing the first set of these measurements with those for a second session ≥ 4 days later. Intraclass correlation coefficients (ICCs; consistency test) and difference ratios were calculated to assess repeatability.

RESULTS

Increases in treadmill speed yielded a mean 9.1% decrease in weight-normalized force data at belt speeds of up to 7.5 km/h for the test device, compared with the value when the treadmill belt was stationary. Results were similar for the dog at increasing treadmill speeds (mean decrease, 12.4%). For temporospatial data, intrasession ICCs were > 0.9 and intersession ICCs ranged from 0.75 to 0.9; for GRFs, intrasession and intersession ICCs ranged from 0.68 to 0.97 and from 0.35 to 0.78, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

Repeatability of temporospatial data for healthy dogs was good to excellent; results for kinetic data varied. Further research is needed to investigate use of this system for gait analysis with larger samples of dogs and dogs with lameness.

Synthetic Function and Regulation of Osteoblasts: Current Knowledge and Applications

N/A

Modeling Primary Bone Tumors and Bone Metastasis with Solid Tumor Graft Implantation into Bone

Primary bone tumors or bone metastasis from solid tumors result in painful osteolytic, osteoblastic, or mixed osteolytic/osteoblastic lesions. These lesions compromise bone structure, increase the risk of pathologic fracture, and leave patients with limited treatment options. Primary bone tumors metastasize to distant organs, with some types capable of spreading to other skeletal sites. However, recent evidence suggests that with many solid tumors, cancer cells that have spread to bone may be the primary source of cells that ultimately metastasize to other organ systems. Most syngeneic or xenograft mouse models of primary bone tumors involve intra-osseous (orthotopic) injection of tumor cell suspensions. Some animal models of skeletal metastasis from solid tumors also depend on direct bone injection, while others attempt to recapitulate additional steps of the bone metastatic cascade by injecting cells intravascularly or into the organ of the primary tumor. However, none of these models develop bone metastasis reliably or with an incidence of 100%. In addition, direct intra-osseous injection of tumor cells has been shown to be associated with potential tumor embolization of the lung. These embolic tumor cells engraft but do not recapitulate the metastatic cascade. We reported a mouse model of osteosarcoma in which fresh or cryopreserved tumor fragments (consisting of tumor cells plus stroma) are implanted directly into the proximal tibia using a minimally invasive surgical technique. These animals developed reproducible engraftment, growth, and, over time, osteolysis and lung metastasis. This technique has the versatility to be used to model solid tumor bone metastasis and can readily employ grafts consisting of one or multiple cell types, genetically-modified cells, patient-derived xenografts, and/or labeled cells that can be tracked by optical or advanced imaging. Here, we demonstrate this technique, modeling primary bone tumors and bone metastasis using solid tumor graft implantation into bone.

Lanthanide Luminescence in Visible-Light-Promoted Photochemical Reactions

The excitation of lanthanides with visible light to promote photochemical reactions has garnered interest in recent years. Lanthanides serve as initiators for photochemical reactions because they exhibit visible-light-promoted 4f→5d transitions that lead to emissive states with electrochemical potentials that are more negative than the corresponding ground states. The lanthanides that have shown the most promising characteristics for visible-light promoted photoredox are Sm^II, Eu^II, and Ce^III. By understanding the effects that ligands have on the 5d orbitals of Sm^II, Eu^II, and Ce^III, luminescence and reactivity can be rationally modulated using coordination chemistry. This review briefly overviews the photochemical reactivity of Sm^II, Eu^II, and Ce^III with visible light; the properties that influence the reactivity of these ions; and the research that has been reported towards modulating their photochemical-relevant properties using visible light and coordination chemistry.

Systematic Tuning of the Optical Properties of Discrete Complexes of EuII in Solution Using Counterions and Solvents

We describe a systematic study of the influence of halides and solvents on the optical properties of Eu^II-containing complexes in solution starting from well-defined crystalline precursors. Anionic halides, chloride and bromide, blue-shift the spectroscopic properties of Eu^II, whereas neutral ligands, methanol and acetonitrile, cause a red shift. This system provides evidence that Eu^II has a stronger affinity for chloride, and to some extent bromide, relative to acetonitrile but not methanol. We also describe a simple procedure using an ion-exchange resin for the exchange of iodide counterions to hexafluorophosphate. These findings are a step toward designing ligands that can tune the optical properties of Eu^II-containing complexes for solution-based applications.

Spectroscopic and Electrochemical Trends in Divalent Lanthanides through Modulation of Coordination Environment

Due to the importance of both visible-light luminescence and lanthanides in modern society, the influence of the ligand environment on complexes of Yb^II were studied and compared with analogous complexes of Eu^II. Four ligands with systematically varied electronic and steric characteristics were used to probe the coordination environment and electronic and redox properties of the corresponding Yb^II-containing complexes. Strong-field nitrogenous donors gave rise to bathochromic shifts, leading to visible-light absorption by Yb^II. Trends in properties across the series of Yb^II-containing complexes were compared to trends reported for the analogous Eu^II-containing complexes, revealing the translatability of coordination environment effects across the divalent lanthanide series. These studies provide valuable information regarding the behavior of small and medium-sized divalent lanthanides outside of the solid state.

Measurement of the Dissociation of EuII-Containing Cryptates Using Murexide

The dissociation rates of five Eu^II-containing cryptates in water were measured using UV-visible spectroscopy and murexide at pH 6.5, 7, 7.5, 8, and 9. Murexide was used as a coordinating dye for Eu^II. The results for a known cryptate were within experimental error of the value obtained using other methods and enabled the measurement of other cryptates. This validation of the use of murexide to study the dissociation of Eu^II-containing cryptates enables its use with other complexes of Eu^II.

Organic waste as a sustainable feedstock for platform chemicals

Biorefineries have been established since the 1980s for biofuel production, and there has been a switch lately from first to second generation feedstocks in order to avoid the food versus fuel dilemma. To a lesser extent, many opportunities have been investigated for producing chemicals from biomass using by-products of the present biorefineries, simple waste streams. Current facilities apply intensive pre-treatments to deal with single substrate types such as carbohydrates. However, most organic streams such as municipal solid waste or algal blooms present a high complexity and variable mixture of molecules, which makes specific compound production and separation difficult. Here we focus on flexible anaerobic fermentation and hydrothermal processes that can treat complex biomass as a whole to obtain a range of products within an integrated biorefinery concept.

Summary of Imaging in 2020: Visualizing the Future of Healthcare with MR Imaging

The Imaging in 2020 meeting convenes biannually to discuss innovations in medical imaging. The 2018 meeting, titled "Visualizing the Future of Healthcare with MR Imaging," sought to encourage discussions of the future goals of MRI research, feature important discoveries, and foster scientific discourse between scientists from a variety of fields of expertise. Here, we highlight presented research and resulting discussions of the meeting.

Screening of ligands for redox-active europium using magnetic resonance imaging

We report a screening procedure to predict ligand coordination to Eu^II and Eu^III using magnetic resonance imaging in which bright images indicate complexation and dark images indicate no complexation. Here, paramagnetic Gd^III is used as a surrogate for Eu^III in the screening procedure to enable detection with magnetic resonance imaging. The screening procedure was tested using a set of eight ligands with known coordination to Eu^II and Eu^III, and results were found to be consistent with expected binding. Validation of the screening procedure with known coordination chemistry enables use with new ligands in the future.

Randomised, masked study of local anaesthesia administered prior to external dacryocystorhinostomy under general anaesthesia

OBJECTIVES

To determine whether administration of local anaesthetic at the site of skin incision during open lacrimal drainage surgery under general anaesthesia alters the total dosage of anaesthetic drugs required during total intravenous anaesthesia (TIVA), and whether it alters postoperative pain and recovery.

STUDY DESIGN

Masked comparison of a randomized, two-group interventional study.

PATIENTS AND METHODS

Patients undergoing unilateral external dacryocystorhinostomy under total intravenous general anaesthesia were recruited from the lacrimal service at Moorfields Eye Hospital between September 2012 and February 2014. The patients were randomised to receive, after induction and stabilisation of general anaesthesia, infiltration of the ipsilateral paranasal tissues with 2.5 ml of 0.5% bupivacaine with 1:100000 epinephrine ("treatment" group), or a sham injection ("control" group); the infiltration was performed about 7 min prior to the skin incision. The infusion rates for propofol and remifentanil were adjusted to maintain a steady intra-operative mean blood pressure of 55-70 mmHg and BIS score of 40-60%. The time taken for extubation of the patient after cessation of TIVA was recorded, and postoperative pain scores (on a Likert scale from 0-10) were taken at regular intervals after extubation. The average intra-operative mean blood pressures, total drug usage, extubation time and pain scores for each of the two groups were compared using two-tail Student's t-testing and Wilcoxon rank sum testing.

RESULTS

There were 12 patients (7 female; 58%) in the treatment group and 11 (7 female; 64%) in the control group, with similar average age at surgery (59 years treatment, 53 years control; p = 0.38) The average operative time was 45 min in the treatment group (median 42, range 30-55) and 47 min (median 45; range 37-61) in the control group (p = 0.52). The mean dosage of propofol required to maintain satisfactory GA was significantly less in the "treatment" group (89.8 mcg/kg/min) as compared to the "control" group (mean 126 mcg/kg/min) (p = 0.0007). Likewise, remifentanil dosage was significantly less in the "treatment" group (100 ng/kg/min) as compared to controls (259 ng/kg/min) (p = 0.00007). The mean non-invasive blood pressure was consistently lower during surgery in the "treated" group, and showed less intra-operative variation. After surgery, the patients receiving LA had a significantly shorter extubation time (mean time 6.0 min in "treated" group, 12.1 min in "controls"; P < 0.0002) and also significantly lower pain scores at 10, 30, 60, 120 and 180 min after extubation (p < 0.01, p < 0.01, p < 0.01, p < 0.01 and p < 0.05, respectively).

CONCLUSIONS

Ipsilateral infiltration of local anaesthesia containing epinephrine in the paranasal tissues just prior to open dacryocystorhinostomy under total intravenous anaesthesia is associated with a 28% reduction in mean propofol usage, and a 61% reduction in remifentanil usage. LA usage during GA also produces improved and less variable intra-operative mean blood pressures, a significantly shorter extubation time and significantly lower postoperative pain scores.

Molecular dynamics investigation of water-exchange reactions on lanthanide ions in water/1-ethyl-3-methylimidazolium trifluoromethylsufate ([EMIm][OTf])

We report a kinetic study of the water exchange on lanthanide ions in water/[1-ethyl-3-methylimidazolium][trifluoromethylsufate] (water/[EMIm][OTf]). The results from ¹⁷O-NMR measurements show that the water-exchange rates in water/[EMIm][OTf] increase with decreasing size of the lanthanide ions. This trend for water-exchange is similar to the previously reported trend in water/1-ethyl-3-methylimidazolium ethyl sulfate (water/[EMIm][EtSO₄]) but opposite to that in water. To gain atomic-level insight into these water-exchange reactions, molecular dynamics simulations for lanthanide ions in water/[EMIm][OTf] have been performed using the atomic-multipole-optimized-energetics-for-biomolecular-application polarizable force field. Our molecular dynamics simulations reproduce the experimental water-exchange rates in terms of the trend and provide possible explanations for the observed experimental behavior. The smaller lanthanide ions in water/[EMIm][OTf] undergo faster water exchange because the smaller lanthanide ions coordinate to the first shell [OTf]^- anions more tightly, resulting in a stronger screening effect for the second-shell water. The screening effect weakens the interaction of the lanthanide ions with the second-shell water molecules, facilitating the dissociation of water from the second-shell and subsequent association of water molecules from the outer solvation shells.

Photophysical characterization of a highly luminescent divalent-europium-containing azacryptate

We report a new luminescent EuII-containing complex. The complex is excited with visible light, leading to emission centered at 447 nm with a lifetime of 1.25 μs. Computational studies suggest that the steric bulk of the ligand is a major factor influencing the wavelength of emission.

Evaluating Stiffness of Fibreglass and Thermoplastic Splint Materials and Inter-fragmentary Motion in a Canine Tibial Fracture Model

OBJECTIVES

 Various materials are used to construct splints for mid-diaphyseal tibial fracture stabilization. The objective of this study was to compare construct stiffness and inter-fragmentary bone motion when fibreglass (FG) or thermoplastic (TP) splints are applied to either the lateral or cranial aspect of the tibia in a mid-diaphyseal fracture model.

METHODS

 A coaptation bandage was applied to eight cadaveric canine pelvic limbs, with a custom-formed splint made of either FG or TP material applied to either the lateral or cranial aspect of the osteotomized tibia. Four-point bending tests were performed to evaluate construct stiffness and inter-fragmentary motion in both frontal and sagittal planes.

RESULTS

 For a given material, FG or TP, construct stiffness was not affected by splint location. Construct stiffness was significantly greater with cranial FG splints than with cranial TP splints (p < 0.05), but this difference was not significant when comparing splints applied laterally (p = 0.15). Inter-fragmentary motions in the sagittal and frontal planes were similar across splint types for cranial splints, but for lateral splints there was a 64% reduction in frontal plane motion when FG was used as the splint material (p = 0.03).

CLINICAL SIGNIFICANCE

 FG produces a stiffer construct, but the difference is not reflected in a reduction in inter-fragmentary motion. For lateral splints, FG splints are associated with reduced inter-fragmentary motion as compared with TP and may therefore have slight superiority for this application.

Synthesis, Characterization, and Handling of EuII-Containing Complexes for Molecular Imaging Applications

Considerable research effort has focused on the in vivo use of responsive imaging probes that change imaging properties upon reacting with oxygen because hypoxia is relevant to diagnosing, treating, and monitoring diseases. One promising class of compounds for oxygen-responsive imaging is Eu^II-containing complexes because the Eu^II/III redox couple enables imaging with multiple modalities including magnetic resonance and photoacoustic imaging. The use of Eu^II requires care in handling to avoid unintended oxidation during synthesis and characterization. This review describes recent advances in the field of imaging agents based on discrete Eu^II-containing complexes with specific focus on the synthesis, characterization, and handling of aqueous Eu^II-containing complexes.

First use of a divalent lanthanide for visible-light-promoted photoredox catalysis

We report the first catalytic use of a divalent lanthanide in visible-light-promoted bond-forming reactions. Our new precatalyst uses europium in the +2 oxidation state and is active in the presence of blue light from light-emitting diodes. The use of low-energy visible light reduces the occurrence of potential side reactions that might be induced by higher-energy UV light. The system described here uses zinc metal as a sacrificial reductant and is tolerant to wet, protic solvents. The catalyst can be made in situ from relatively inexpensive and air-stable EuCl3·6H2O, and the ligand can be synthesized in large quantities in two steps. With 0.5% loading of precatalyst, an average of 120 turnovers was observed in six hours for reductive coupling of benzyl chloride. We expect that the results will initiate the study of visible-light-promoted photoredox catalysis using divalent europium in a variety of reactions.

Fluorinated EuII-based multimodal contrast agent for temperature- and redox-responsive magnetic resonance imaging

Magnetic resonance imaging (MRI) using redox-active, EuII-containing complexes is one of the most promising techniques for noninvasively imaging hypoxia in vivo. In this technique, positive (T1-weighted) contrast enhancement persists in areas of relatively low oxidizing ability, such as hypoxic tissue. Herein, we describe a fluorinated, EuII-containing complex in which the redox-active metal is caged by intramolecular interactions. The position of the fluorine atoms enables temperature-responsive contrast enhancement in the reduced form of the contrast agent and detection of the oxidized contrast agent via MRI in vivo. Positive contrast is observed in 1H-MRI with Eu in the +2 oxidation state, and chemical exchange saturation transfer and 19F-MRI signal are observed with Eu in the +3 oxidation state. Contrast enhancement is controlled by the redox state of Eu, and modulated by the fluorous interactions that cage a bound water molecule reduce relaxivity in a temperature-dependent fashion. Together, these advancements constitute the first report of in vivo, redox-responsive imaging using 19F-MRI.

Electrochemical investigation of the Eu3+/2+ redox couple in complexes with variable numbers of glycinamide and acetate pendant arms

The Eu^3+/2+ redox couple provides a convenient design platform for responsive pO₂ sensors for magnetic resonance imaging (MRI). Specifically the Eu²⁺ ion provides T_1w contrast enhancement under hypoxic conditions in tissues, whereas, under normoxia, the Eu³⁺ ion can produce contrast from chemical exchange saturation transfer in MRI. The oxidative stability of the Eu^3+/2+ redox couple for a series of tetraaza macrocyclic complexes was investigated in this work using cyclic voltammetry. A series of Eu-containing cyclen-based macrocyclic complexes revealed positive shifts in the Eu^3+/2+ redox potentials with each replacement of a carboxylate coordinating arm of the ligand scaffold with glycinamide pendant arms. The data obtained reveal that the complex containing four glycinamide coordinating pendant arms has the highest oxidative stability of the series investigated.