A 100-V Withstanding Analog-Front-End for High-Resolution Intravascular Ultrasound Imaging

Intravascular Ultrasound ultrasonic imaging (IVUS) can microscopically image blood vessels and reveal tissue layers from within the blood vessel lumen. It has high tissue penetration ability for lesion classification and can image through blood. Compared to optical techniques, however, IVUS has lower resolution arising from low acoustic bandwidths which cannot resolve sharp edges. The presented 100-V withstanding Analog-Front-End (AFE) was developed to enable a high resolution, low cost IVUS system using a high-bandwidth focused polymer transducer with 40-MHz center frequency. The fabricated AFE interfaced with the transducer with minimal insertion loss, could withstand and duplex 100-V high voltage pulses and echo signal, and had a total signal chain gain of 9.8 dB. The AFE achieved a signal-to-noise ratio (SNR) of 20.1 dB including the insertion loss of the high-impedance transducer. AFE SNR was limited by input impedance required for high-voltage pulse clamping circuitry, but was sufficient for IVUS echo reception.Clinical Relevance- This work has the potential to enable much higher resolution, and potentially cheaper, IVUS imaging in blood vessels by integrating low-cost acoustic transducers with interface amplifiers directly on the catheter.

Microfluidic chip for graduated magnetic separation of circulating tumor cells by their epithelial cell adhesion molecule expression and magnetic nanoparticle binding

The enumeration of circulating tumor cells (CTCs) in the peripheral bloodstream of metastatic cancer patients has contributed to improvements in prognosis and therapeutics. There have been numerous approaches to capture and counting of CTCs. However, CTCs have potential information beyond simple enumeration and hold promise as a liquid biopsy for cancer and a pathway for personalized cancer therapy by detecting the subset of CTCs having the highest metastatic potential. There is evidence that epithelial cell adhesion molecule (EpCAM) expression level distinguishes these highly metastatic CTCs. The few previous approaches to selective CTC capture according to EpCAM expression level are reviewed. A new two-stage microfluidic device for separation, enrichment and release of CTCs into subpopulations sorted by EpCAM expression level is presented here. It relies upon immunospecific magnetic nanoparticle labeling of CTCs followed by their field- and flow-based separation in the first stage and capture as discrete subpopulations in the second stage. To fine tune the separation, the magnetic field profile across the first stage microfluidic channel may be modified by bonding small Vanadium Permendur strips to its outer walls. Mathematical modeling of magnetic fields and fluid flows supports the soundness of the design.

The P387 thrombospondin-4 variant promotes accumulation of macrophages in atherosclerotic lesions

Thrombospondin-4 (TSP4) is a pro-angiogenic protein that has been implicated in tissue remodeling and local vascular inflammation. TSP4 and, in particular, its SNP variant, P387 TSP4, have been associated with cardiovascular disease. Macrophages are central to initiation and resolution of inflammation and development of atherosclerotic lesions, but the effects of the P387 TSP4 on macrophages remain essentially unknown. We examined the effects of the P387 TSP4 variant on macrophages in cell culture and in vivo in a murine model of atherosclerosis. Furthermore, the levels and distributions of the two TSP4 variants were assessed in human atherosclerotic arteries. In ApoE^{- /-} /P387-TSP4 knock-in mice, lesions size measured by Oil Red O did not change, but the lesions accumulated more macrophages than lesions bearing A387 TSP4. The levels of inflammatory markers were increased in lesions of ApoE^{- / -} /P387-TSP4 knock-in mice compared to ApoE^{- / -} mice. Lesions in human arteries from individuals carrying the P387 variant had higher levels of TSP4 and higher macrophage accumulation. P387 TSP4 was more active in supporting adhesion of cultured human and mouse macrophages in experiments using recombinant TSP4 variants and in cells derived from P387-TSP4 knock-in mice. TSP4 supports the adhesion of macrophages and their accumulation in atherosclerotic lesions without changing the size of lesions. P387 TSP4 is more active in supporting these pro-inflammatory events in the vascular wall, which may contribute to the increased association of P387 TSP4 with cardiovascular disease.

Towards safe operation of an active retinal prosthesis during functional MRI and diffusion tensor imaging

OBJECTIVE

To determine if the Argus II retinal prosthesis can operate during functional MRI (fMRI) and diffusion tensor imaging (DTI) acquisitions and if currents induced in the prosthesis by imaging are at safe levels.

MATERIALS AND METHODS

One Argus II retinal prosthesis was modified to enable current measurements during imaging. Active electronics were modified to enable operation during scans. Induced current was measured during diagnostic scans, which were previously shown to be safe for implanted patients, and during fMRI and DTI scans. All measurements were performed using an ASTM phantom to ensure reproducible placement.

RESULTS

The prosthesis was able to maintain communication with the external RF coil during the fMRI and DTI scans except briefly during pre-scans. Current levels induced during fMRI and DTI scans were consistently below those measured during diagnostic scans.

CONCLUSIONS

fMRI and DTI may be safely performed while the Argus II retinal prosthesis is operating.

Catheter-Mounted CMOS Front-Ends for Broadband Intravascular Ultrasonic Imaging

Intravascular ultrasonic (IVUS) imaging catheters currently use ceramic piezoelectric transducers to form radial images of blood vessel walls. Further improvements in image quality may be enabled through Capacitive and Piezoelectric Micromachined Ultrasonic Transducers (CMUTs and PMUTs). Polymer PMUTs offer many benefits in imaging quality, however, the low acoustic sensitivity and high electrical impedance of polymer PMUTs prevents unbuffered use with 50-Ω IVUS cables. Here, we present the design and optimization of an integrated CMOS front-end specifically designed to be integrated on a 0.8-mm imaging catheter. A series-duplexer topology with active limiter was selected for simplicity of integration, and compatibility with conventional high-voltage IVUS pulser-receiver systems. Noise optimization of the front-end revealed that an impedance-matching optimum exists, which balances the system parasitic capacitances relative to the transducer complex impedance. Optimized design equations compared favorably to simulation results in predicting front-end bandwidth and transducer-referred SNR. Large-signal transient simulation showed that the front-end can withstand 100-V pulses while recovering in 240 ns for echo reception. The integrated front-end occupied 0.74 × 1.8 mm die area (including large solder-bump bond pads), with an estimated transducer-referred noise floor of 6.5 n V R M S / H z over a 100-MHz imaging bandwidth.

Biocompatibility evaluation of a thermoplastic rubber for wireless telemetric intracranial pressure sensor coating

This study investigated the biocompatibility of the experimental thermoplastic rubber Arbomatrix(™) that will be used as the protective coating on a novel intracranial pressure (ICP) sensor silicon chip. Arbomatrix(™) was benchmarked against biocompatible commercial silicone rubber shunt tubing in the brain via a rat model with 60-day implant duration. A bare silicon chip was also implanted. The results showed similar cellular distribution in the brain-implant boundary and surrounding tissues. Quantitative analysis of neuron and glia density did not show significant difference between implants. Through histological and immunohistochemical evaluation we conclude that Arbomatrix(™) is well tolerated by the brain. Due to its exceptional barrier properties Arbomatrix(™) has already been shown to be an excellent protective coating for new ICP monitoring chip.

Schizophrenia and violent crime: a population-based study

BACKGROUND

Previous studies have found that patients with schizophrenia are more likely to be violent than the general population. The aim of this study was to investigate the association between schizophrenia and violent crime in the Israeli population.

METHOD

Using the Israeli Psychiatric Hospitalization Case Registry we identified 3187 patients with a discharge diagnosis of schizophrenia. For each proband we identified parents and siblings, and gender- and age-matched controls for patients, parents and siblings. Information on violent crimes was obtained from police records.

RESULTS

Patients with schizophrenia were at increased risk for violent crimes compared with controls [odds ratio (OR) 4.3, 95% confidence interval (CI) 3.8-4.9], especially women (OR 9.9, 95% CI 6.2-15.7). Risk for violent crimes was higher among patients with co-morbid substance misuse than in patients without such co-morbidity (OR 5.1, 95% CI 4.2-6.3).

CONCLUSIONS

The results of this study suggest that increased risk of violence is part of the clinical picture of schizophrenia and needs to be recognized as a legitimate, essential, aspect of clinical management.

Effects of exercise and lifestyle modification on fitness, insulin resistance, skeletal muscle oxidative phosphorylation and intramyocellular lipid content in obese children and adolescents

BACKGROUND

Obesity is associated with poor fitness and adverse metabolic consequences in children.

OBJECTIVE

To investigate how exercise and lifestyle modification may improve fitness and insulin sensitivity in this population.

DESIGN AND SUBJECTS

Randomized controlled trial, 21 obese (body mass index ≥ 95% percentile) subjects, ages 10 to 17 years.

METHODS

Subjects were given standardized healthful lifestyle advice for 8 weeks. In addition, they were randomized to an in-home supervised exercise intervention (n = 10) or control group (n = 11).

MEASUREMENTS

Fasting laboratory studies (insulin, glucose, lipid profile) and assessments of fitness, body composition, skeletal muscle oxidative phosphorylation and intramyocellular lipid content (IMCL), were performed at baseline and study completion.

RESULTS

Subjects were 13.0 ± 1.9 (standard deviation) years old, 72% female and 44% non-white. Exercise improved fitness (P = 0.03) and power (P = 0.01), and increased IMCL (P = 0.02). HOMA-IR decreased among all subjects in response to lifestyle modification advice (P = 0.01), regardless of exercise training assignment. In univariate analysis in all subjects, change in cardiovascular fitness was associated with change in HOMA-IR. In exploratory analyses, increased IMCL was associated with greater resting energy expenditure (r = 0.78, P = 0.005) and a decrease in fasting respiratory quotient (r = -0.70, P = 0.02) (n = 11).

CONCLUSIONS

Change in fitness was found to be related to change in insulin resistance in response to lifestyle modification and exercise in obese children. IMCL increased with exercise in these obese children, which may reflect greater muscle lipid oxidative capacity.

Circulating branched-chain amino acid concentrations are associated with obesity and future insulin resistance in children and adolescents

What is already known about this subject Circulating concentrations of branched-chain amino acids (BCAAs) can affect carbohydrate metabolism in skeletal muscle, and therefore may alter insulin sensitivity. BCAAs are elevated in adults with diet-induced obesity, and are associated with their future risk of type 2 diabetes even after accounting for baseline clinical risk factors. What this study adds Increased concentrations of BCAAs are already present in young obese children and their metabolomic profiles are consistent with increased BCAA catabolism. Elevations in BCAAs in children are positively associated with insulin resistance measured 18 months later, independent of their initial body mass index.

BACKGROUND

Branched-chain amino acid (BCAA) concentrations are elevated in response to overnutrition, and can affect both insulin sensitivity and secretion. Alterations in their metabolism may therefore play a role in the early pathogenesis of type 2 diabetes in overweight children.

OBJECTIVE

To determine whether paediatric obesity is associated with elevations in fasting circulating concentrations of BCAAs (isoleucine, leucine and valine), and whether these elevations predict future insulin resistance.

METHODS

Sixty-nine healthy subjects, ages 8-18 years, were enrolled as a cross-sectional cohort. A subset of subjects who were pre- or early-pubertal, ages 8-13 years, were enrolled in a prospective longitudinal cohort for 18 months (n = 17 with complete data).

RESULTS

Elevations in the concentrations of BCAAs were significantly associated with body mass index (BMI) Z-score (Spearman's Rho 0.27, P = 0.03) in the cross-sectional cohort. In the subset of subjects that followed longitudinally, baseline BCAA concentrations were positively associated with homeostasis model assessment for insulin resistance measured 18 months later after controlling for baseline clinical factors including BMI Z-score, sex and pubertal stage (P = 0.046).

CONCLUSIONS

Elevations in the concentrations of circulating BCAAs are significantly associated with obesity in children and adolescents, and may independently predict future insulin resistance.

Monitoring the effect of mild ischemia with a built-in light-emitting diode contact lens electrode and a low-cost custom-made apparatus

Electroretinography (ERG) is widely used in clinical work and research to assess the retinal function. We evaluated an easy to build ERG setup adapted for small animals comprising two contact lens electrodes with a built-in light-emitting diode and a custom-made amplification system. The system's sensitivity was tested by monitoring ERG in albino rat eyes subjected to mild ischemia. Flash ERG was recorded by two contact lens electrodes positioned on the rat's corneas and used alternately as test or reference. The a- and b-wave amplitudes, a-wave latency, b-wave implicit time and oscillatory potentials (OPs) were analyzed. Ischemia was achieved by elevating the intraocular pressure in the eye's anterior chamber. ERG was recorded on post-ischemia (PI) days -1, 1, 3 and 7. Morphological changes were analyzed on hematoxylin/eosin stained 5 µm sections of control 7d PI retinas. In control eyes, ERG exhibited a pattern similar to a standard recording. Retinas subjected to mild ischemia preserved ordered layered morphology, exhibiting approximately 30% loss of ganglion cells and no changes in gross morphology. By day 3 PI, ischemia caused an increase in the a-wave amplitude (from 34.9 ± 2.7 to 45.4 ± 4.3 µV), a decrease in the b-wave amplitude (from 248 ± 13 to 162 ± 8 µV), an increase in a-wave latency (from 11.1 ± 0.3 to 17.3 ± 1.4 ms) and b-wave implicit time (from 81.0 ± 1.6 to 90.0 ± 2.5 ms), and attenuation of OPs. The described setup proved sensitive and reliable for evaluating subtle changes in the retinal function in small animals.

Implanted renal replacement for end-stage renal disease

The nearly 400000 American patients on dialysis suffer high cardiovascular and infectious mortality, but there is now evidence that this morbid phenotype can be rescued by intensive dialytic therapy. Self-care dialysis at home is limited by patient fears about skill and safety. An implanted artificial kidney would provide the benefits of intensive therapy while avoiding the focal points of patient concern. Hollow fiber polymer membranes and dialytic waste removal are lifesaving innovations but are difficult to adapt to implantable therapies. Biomimetic membranes and living cells can replicate the native kidney's strategy for waste removal. Three key technology developments are necessary for implementation of an implantable artificial kidney: high efficiency ultrafiltration membranes, control of blood-materials interactions such as thrombosis and fouling, and stable differentiated function of renal proximal tubule cells in an engineered construct. There has been significant progress in demonstrating proof-of-concept experiments in each key technology area.

Three-dimensional in vitro follicle growth: overview of culture models, biomaterials, design parameters and future directions

In vitro ovarian follicle culture is a new frontier in assisted reproductive technology with tremendous potential, especially for fertility preservation. Folliculogenesis within the ovary is a complex process requiring interaction between somatic cell components and the oocyte. Conventional two-dimensional culture on tissue culture substrata impedes spherical growth and preservation of the spatial arrangements between oocyte and surrounding granulosa cells. Granulosa cell attachment and migration can leave the oocyte naked and unable to complete the maturation process. Recognition of the importance of spatial arrangements between cells has spurred research in to three-dimensional culture system. Such systems may be vital when dealing with human primordial follicles that may require as long as three months in culture. In the present work we review pertinent aspects of in vitro follicle maturation, with an emphasis on tissue-engineering solutions for maintaining the follicular unit during the culture interval. We focus primarily on presenting the various 3-dimensional culture systems that have been applied for in vitro maturation of follicle:oocyte complexes. We also try to present an overview of outcomes with various biomaterials and animal models and also the limitations of the existing systems.

Demonstration of second-harmonic IVUS feasibility with focused broadband miniature transducers

Focused broadband miniature polyvinylidene fluoride-trifluoroethylene (PVDF TrFE) ultrasonic transducers were investigated for intravascular (IVUS) second-harmonic imaging. Modeling and experimental studies demonstrated that focused transducers, unlike conventional flat transducers, build up second harmonic peak pressures faster and stronger, leading to an increased SNR of second harmonic content within the coronary geometry. Experimental results demonstrated that focused second harmonic pressures could be controlled to occur at specific depths by controlling the f-number of the transducer. The experimental results were in good agreement with the modeled results. Experiments were conducted using three imaging modalities: fundamental 20 MHz (F20), second harmonic 40 MHz (H40), and fundamental 40 MHz (F40). The lateral resolutions for a 1-mm transducer (f-number 3.2) at F20, F40, and H40 were experimentally measured to be 162, 123, and 124 microm, respectively, which agreed well with the theoretical calculations with <<8% error. Lateral resolution was further characterized in the three modes, using a micromachined phantom consisting of fixed bars and spaces with widths ranging from 20 to 160 microm. H40 exhibited better lateral resolution, clearly displaying 40- and 60-microm bars with about 4 dB and 7 dB greater signal strength compared with F20. Ex vivo human aorta images were obtained in the second-harmonic imaging mode to show the feasibility of high resolution second-harmonic IVUS using focused transducers.

Permeability - Selectivity Analysis for Ultrafiltration: Effect of Pore Geometry

The effects of pore size on the performance of ultrafiltration membranes are fairly well understood, but there is currently no information on the impact of pore geometry on the trade-off between the selectivity and permeability for membranes with pore size below 100 nm. Experimental data are presented for both commercial ultrafiltration membranes and for novel silicon membranes having slit-shaped nanopores of uniform size fabricated by photolithography using a sacrificial oxide technique. Data are compared with theoretical calculations based on available hydrodynamic models for solute and solvent transport through membranes composed of a parallel array of either cylindrical or slit-shaped pores. The results clearly demonstrate that membranes with slit-shaped pores have higher performance, i.e., greater selectivity at a given value of the permeability, than membranes with cylindrical pores. Theoretical calculations indicate that this improved performance becomes much less pronounced as the breadth of the pore size distribution increases. These results provide new insights into the effects of pore geometry on the performance of ultrafiltration membranes.

Quantification of magnetic susceptibility in several strains of Bacillus spores: implications for separation and detection

Three strains of Bacillus: Bacillus atrophaeus (formally Bacillus globigii), Bacillus thuringiensis, and Bacillus cereus were tested for their intrinsic magnetic susceptibility. All three strains when sporulated demonstrated significant magnetic susceptibility using an instrument referred to as Cell Tracking Velocimetry. Energy dispersive spectroscopy also confirmed the presence of paramagnetic elements, Fe and Mn, in the spore form of the bacteria. It was demonstrated that this magnetic susceptibility is sufficient to separate and deposit these spores on glass slides in a magnetic deposition system. These results indicate the potential to separate spores with intrinsic magnetic susceptibility directly out of water or air samples.

Electrochemical detection and characterization of proteins

On-line detection of serum proteins is of clinical relevance, in detecting leaks and biofouling in hemofiltration equipment, biofilm growth on prosthetic devices, or hemolysis within a prosthetic or therapeutic device. Electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV) were employed to detect and analyze micromolar concentrations of four globular proteins of clinical importance. CV testing showed that identification and quantification of each of these proteins was possible through analysis of current changes at specific potentials. Preliminary CV studies into the contamination of Bovine Serum Albumin with a microgram amount of one of the other three proteins illustrated that direct detection of the contaminant protein was possible. The analysis of the EIS data demonstrated that with increase in relative concentration of proteins, the amount of electroactive proteins adsorption at the interface increases, leading to increase in surface charge density and capacitance, especially for lower molecular weight proteins. The impedance data was used to determine the values of Gibbs adsorption energy, adsorption coefficients for the four proteins, and develop an equivalent circuit model for the protein-containing solutions.

Evaluation of MEMS materials of construction for implantable medical devices

Medical devices based on microelectro-mechanical systems (MEMS) platforms are currently being proposed for a wide variety of implantable applications. However, biocompatibility data for typical MEMS materials of construction and processing, obtained from standard tests currently recognized by regulatory agencies, has not been published. Likewise, the effects of common sterilization techniques on MEMS material properties have not been reported. Medical device regulatory requirements dictate that materials that are biocompatibility tested be processed and sterilized in a manner equivalent to the final production device. Material, processing, and sterilization method can impact the final result. Six candidate materials for implantable MEMS devices, and one encapsulating material, were fabricated using typical MEMS processing techniques and sterilized. All seven materials were evaluated using a baseline battery of ISO 10993 physicochemical and biocompatibility tests. In addition, samples of these materials were evaluated using a scanning electron microscope (SEM) pre- and post-sterilization. While not addressing all facets of ISO 10993 testing, the biocompatibility and SEM data indicate few concerns about use of these materials in implant applications.

Carbamazepine overdose recognized by a tricyclic antidepressant assay

Altered mental status in an adolescent presents a diagnostic challenge, and the clinician depends on clinical evaluation and laboratory studies to determine therapy and prognosis. We report the case of an adolescent with altered consciousness caused by carbamazepine overdose with a positive tricyclic antidepressant level to alert clinicians to the cross-reactivity of carbamazepine with a toxicology screen for tricyclic antidepressants.

Adenosine deaminase deficiency and purine nucleoside phosphorylase deficiency in common variable immunodeficiency

The clinical presentations of adenosine deaminase deficiency and purine nucleoside phosphorylase deficiency are widely variable and include clinical and immunologic findings compatible with common variable immunodeficiency. The screening of 44 patients with common variable immunodeficiency failed to identify any individuals with deficiencies of these enzymes.

Adenosine deaminase deficiency in adults

Adenosine deaminase (ADA) deficiency typically causes severe combined immunodeficiency (SCID) in infants. We report metabolic, immunologic, and genetic findings in two ADA-deficient adults with distinct phenotypes. Patient no. 1 (39 years of age) had combined immunodeficiency. She had frequent infections, lymphopenia, and recurrent hepatitis as a child but did relatively well in her second and third decades. Then she developed chronic sinopulmonary infections, including tuberculosis, and hepatobiliary disease; she died of viral leukoencephalopathy at 40 years of age. Patient no. 2, a healthy 28-year-old man with normal immune function, was identified after his niece died of SCID. Both patients lacked erythrocyte ADA activity but had only modestly elevated deoxyadenosine nucleotides. Both were heteroallelic for missense mutations: patient no. 1, G216R and P126Q (novel); patient no. 2, R101Q and A215T. Three of these mutations eliminated ADA activity, but A215T reduced activity by only 85%. Owing to a single nucleotide change in the middle of exon 7, A215T also appeared to induce exon 7 skipping. ADA deficiency is treatable and should be considered in older patients with unexplained lymphopenia and immune deficiency, who may also manifest autoimmunity or unexplained hepatobiliary disease. Metabolic status and genotype may help in assessing prognosis of more mildly affected patients.

GM1 ganglioside concentration in the cerebrospinal fluid of neonates and children

GM1 ganglioside concentration was measured by radioassay technique in individual samples of lumbar cerebrospinal fluid from 20 neonatal and 17 older pediatric patients. The lumbar CSF GM1 ganglioside concentration of neonates (76.6 +/- 27.4 ng/ml) is greater than that of older infants and children (31.9 +/- 22.2 ng/ml). The lower range of GM1 ganglioside concentration of CSF from older pediatric patients is similar to the previously reported adult CSF values. The mean CSF GM1 ganglioside concentration in pediatric patients with active neurologic disease (53.1 +/- 30.0 ng/ml) is greater than that of children without central nervous system pathology. The temporal evolution and magnitude above baseline values of lumbar CSF GM1 ganglioside concentration in three neonates was correlated with the clinical status of these patients.