Point-Of-Care Ultra-Portable Single-Molecule Bioassays for One-Health

Screening asymptomatic organisms (humans, animals, plants) with a high-diagnostic accuracy using point-of-care-testing (POCT) technologies, though still visionary holds great potential. Convenient surveillance requires easy-to-use, cost-effective, ultra-portable but highly reliable, in-vitro-diagnostic devices that are ready for use wherever they are needed. Currently, there are not yet such devices available on the market, but there are a couple more promising technologies developed at readiness-level 5: the Clustered-Regularly-Interspaced-Short-Palindromic-Repeats (CRISPR) lateral-flow-strip tests and the Single-Molecule-with-a-large-Transistor (SiMoT) bioelectronic palmar devices. They both hold key features delineated by the World-Health-Organization for POCT systems and an occurrence of false-positive and false-negative errors <1-5% resulting in diagnostic-selectivity and sensitivity >95-99%, while limit-of-detections are of few markers. CRISPR-strip is a molecular assay that, can detect down to few copies of DNA/RNA markers in blood while SiMoT immunometric and molecular test can detect down to a single oligonucleotide, protein marker, or pathogens in 0.1mL of blood, saliva, and olive-sap. These technologies can prospectively enable the systematic and reliable surveillance of asymptomatic ones prior to worsening/proliferation of illnesses allowing for timely diagnosis and swift prognosis. This could establish a proactive healthcare ecosystem that results in effective treatments for all living organisms generating diffuse and well-being at efficient costs.

Analysis of Clinical Samples of Pancreatic Cyst's Lesions with A Multi-Analyte Bioelectronic Simot Array Benchmarked Against Ultrasensitive Chemiluminescent Immunoassay

Pancreatic cancer, ranking as the third factor in cancer-related deaths, necessitates enhanced diagnostic measures through early detection. In response, SiMoT-Single-molecule with a large Transistor multiplexing array, achieving a Technology Readiness Level of 5, is proposed for a timely identification of pancreatic cancer precursor cysts and is benchmarked against the commercially available chemiluminescent immunoassay SIMOA (Single molecule array) SP-X System. A cohort of 39 samples, comprising 33 cyst fluids and 6 blood plasma specimens, undergoes detailed examination with both technologies. The SiMoT array targets oncoproteins MUC1 and CD55, and oncogene KRAS, while the SIMOA SP-X planar technology exclusively focuses on MUC1 and CD55. Employing Principal Component Analysis (PCA) for multivariate data processing, the SiMoT array demonstrates effective discrimination of malignant/pre-invasive high-grade or potentially malignant low-grade pancreatic cysts from benign non-mucinous cysts. Conversely, PCA analysis applied to SIMOA assay reveals less effective differentiation ability among the three cyst classes. Notably, SiMoT unique capability of concurrently analyzing protein and genetic markers with the threshold of one single molecule in 0.1 mL positions it as a comprehensive and reliable diagnostic tool. The electronic response generated by the SiMoT array facilitates direct digital data communication, suggesting potential applications in the development of field-deployable liquid biopsy.

Kelvin probe force microscopy on patterned large-area biofunctionalized surfaces: a reliable ultrasensitive platform for biomarker detection

Kelvin probe force microscopy (KPFM) allows the detection of single binding events between immunoglobulins (IgM, IgG) and their cognate antibodies (anti-IgM, anti-IgG). Here an insight into the reliability and robustness of the methodology is provided. Our method is based on imaging the surface potential shift occurring on a dense layer of ∼5 × 107 antibodies physisorbed on a 50 μm × 90 μm area when assayed with increasing concentrations of antigens in phosphate buffer saline (PBS) standard solutions, in air and at a fixed scanning location. A comprehensive investigation of the influence of the main experimental parameters that may interfere with the outcomes of KPFM immune-assay is provided, showing the robustness and reliability of our approach. The data are supported also by a thorough polarization modulation infrared reflection-absorption spectroscopy (PM-IRRAS) analysis of the physisorbed biolayer, in the spectral region of the amide I, amide II and amide A bands. Our findings demonstrate that a 10 min incubation in 500 μL PBS encompassing ≈ 30 antigens (100 zM) triggers an extended surface potential shift that involves the whole investigated area. Such a shift quickly saturates at increasing ligand concentration, showing that the developed sensing platform works as an OFF/ON detector, capable of assessing the presence of a few specific biomarkers in a given assay volume. The reliability of the developed methodology KPFM is an important asset in single molecule detections at a wide electrode interface.

Lab-made flexible third-generation fructose biosensors based on 0D-nanostructured transducers

Herein, we report a scalable benchtop electrode fabrication method to produce highly sensitive and flexible third-generation fructose dehydrogenase amperometric biosensors based on water-dispersed 0D-nanomaterials. The electrochemical platform was fabricated via Stencil-Printing (StPE) and insulated via xurography. Carbon black (CB) and mesoporous carbon (MS) were employed as 0D-nanomaterials promoting an efficient direct electron transfer (DET) between fructose dehydrogenase (FDH) and the transducer. Both nanomaterials were prepared in water-phase via a sonochemical approach. The nano-StPE exhibited enhanced electrocatalytic currents compared to conventional commercial electrodes. The enzymatic sensors were exploited for the determination of D-fructose in model solutions and various food and biological samples. StPE-CB and StPE-MS integrated biosensors showed appreciable sensitivity (∼150 μA cm-2 mM-1) with μmolar limit of detection (0.35 and 0.16 μM, respectively) and extended linear range (2-500 and 1-250 μM, respectively); the selectivity of the biosensors, ensured by the low working overpotential (+0.15 V), has been also demonstrated. Good accuracy (recoveries between 95 and 116%) and reproducibility (RSD ≤8.6%) were achieved for food and urine samples. The proposed approach because of manufacturing versatility and the electro-catalytic features of the water-nanostructured 0D-NMs opens new paths for affordable and customizable FDH-based bioelectronics.

A Single-Molecule Bioelectronic Portable Array for Early Diagnosis of Pancreatic Cancer Precursors

A cohort of 47 patients is screened for pancreatic cancer precursors with a portable 96-well bioelectronic sensing-array for single-molecule assay in cysts fluid and blood plasma, deployable at point-of-care (POC). Pancreatic cancer precursors are mucinous cysts diagnosed with a sensitivity of at most 80% by state-of-the-art cytopathological molecular analyses (e.g., KRASmut DNA). Adding the simultaneous assay of proteins related to malignant transformation (e.g., MUC1 and CD55) is deemed essential to enhance diagnostic accuracy. The bioelectronic array proposed here, based on single-molecule-with-a-large-transistor (SiMoT) technology, can assay both nucleic acids and proteins at the single-molecule limit-of-identification (LOI) (1% of false-positives and false-negatives). It comprises an enzyme-linked immunosorbent assay (ELISA)-like 8 × 12-array organic-electronics disposable cartridge with an electrolyte-gated organic transistor sensor array, and a reusable reader, integrating a custom Si-IC chip, operating via software installed on a USB-connected smart device. The cartridge is complemented by a 3D-printed sensing gate cover plate. KRASmut , MUC1, and CD55 biomarkers either in plasma or cysts-fluid from 5 to 6 patients at a time, are multiplexed at single-molecule LOI in 1.5 h. The pancreatic cancer precursors are classified via a machine-learning analysis resulting in at least 96% diagnostic-sensitivity and 100% diagnostic-specificity. This preliminary study opens the way to POC liquid-biopsy-based early diagnosis of pancreatic-cancer precursors in plasma.

A stable physisorbed layer of packed capture antibodies for high-performance sensing applications

Antibody physisorption at a solid interface is a very interesting phenomenon that has important effects on applications such as the development of novel biomaterials and the rational design and fabrication of high-performance biosensors. The strategy selected to immobilize biorecognition elements can determine the performance level of a device and one of the simplest approaches is physical adsorption, which is cost-effective, fast, and compatible with printing techniques as well as with green-chemistry processes. Despite its huge advantages, physisorption is very seldom adopted, as there is an ingrained belief that it does not lead to high performance because of its lack of uniformity and long-term stability, which, however, have never been systematically investigated, particularly for bilayers of capture antibodies. Herein, the homogeneity and stability of an antibody layer against SARS-CoV-2-Spike1 (S1) protein physisorbed onto a gold surface have been investigated by means of multi-parametric surface plasmon resonance (MP-SPR). A surface coverage density of capture antibodies as high as (1.50 ± 0.06) × 10¹² molecules per cm^-2 is measured, corresponding to a thickness of 12 ± 1 nm. This value is compatible with a single monolayer of homogeneously deposited antibodies. The effect of the ionic strength (i_s) of the antibody solution in controlling physisorption of the protein was thoroughly investigated, demonstrating an enhancement in surface coverage at lower ionic strength. An atomic force microscopy (AFM) investigation shows a globular structure attributed to i_s-related aggregations of antibodies. The long-term stability over two weeks of the physisorbed proteins was also assessed. High-performance sensing was proven by evaluating figures of merit, such as the limit of detection (2 nM) and the selectivity ratio between a negative control and the sensing experiment (0.04), which is the best reported performance for an SPR S1 protein assay. These figures of merit outmatch those measured with more sophisticated biofunctionalization procedures involving chemical bonding of the capture antibodies to the gold surface. The present study opens up interesting new pathways toward the achievement of a cost-effective and scalable biofunctionalization protocol, which could guarantee the prolonged stability of the biolayer and easy handling of the biosensing system.

Self-Standing Bioinspired Polymer Films Doped with Ultrafine Silver Nanoparticles as Innovative Antimicrobial Material

Thin self-standing films with potential antimicrobial synergistic activity have been produced by a simple green chemical synthesis with overnight thermal treatment. Their properties have been studied by scanning electron microscopy, X-ray photoelectron spectroscopy and other techniques to understand their potential range of applications. In this work, the focus was set on the development of a potential novel and effective alternative to conventional antimicrobial materials. By creating an antimicrobial polymer blend, and using it to develop and immobilize fine (~25 nm) silver nanophases, we further aimed to exploit its film-forming properties and create a solid composite material. The resulting polymer matrix showed improved water uptake percentage and better stability in the presence of water. Moreover, the antimicrobial activity of the films, which is due to both organic and inorganic components, has been evaluated by Kirby-Bauer assay against common foodborne pathogens (Staphylococcus aureus and Salmonella enterica) and resulted in a clear inhibition zone of 1.2 cm for the most complex nanocomposition. The excellent performance against bacteria of fresh and 6-month-old samples proves the prospects of this material for the development of smart and biodegradable food packaging applications.

Fast and Reliable Electronic Assay of a Xylella fastidiosa Single Bacterium in Infected Plants Sap

Pathogens ultra-sensitive detection is vital for early diagnosis and provision of restraining actions and/or treatments. Among plant pathogens, Xylella fastidiosa is among the most threatening as it can infect hundreds of plant species worldwide with consequences on agriculture and the environment. An electrolyte-gated transistor is here demonstrated to detect X. fastidiosa at a limit-of-quantification (LOQ) of 2 ± 1 bacteria in 0.1 mL (20 colony-forming-unit per mL). The assay is carried out with a millimeter-wide gate functionalized with Xylella-capturing antibodies directly in saps recovered from naturally infected plants. The proposed platform is benchmarked against the quantitave polymerase chain reaction (qPCR) gold standard, whose LOQ turns out to be at least one order of magnitude higher. Furthermore, the assay selectivity is proven against the Paraburkholderia phytofirmans bacterium (negative-control experiment). The proposed label-free, fast (30 min), and precise (false-negatives, false-positives below 1%) electronic assay, lays the ground for an ultra-high performing immunometric point-of-care platform potentially enabling large-scale screening of asymptomatic plants.

Why a Diffusing Single-Molecule can be Detected in Few Minutes by a Large Capturing Bioelectronic Interface

Single-molecule detection at a nanometric interface in a femtomolar solution, can take weeks as the encounter rate between the diffusing molecule to be detected and the transducing nanodevice is negligibly small. On the other hand, several experiments prove that macroscopic label-free sensors based on field-effect-transistors, engaging micrometric or millimetric detecting interfaces are capable to assay a single-molecule in a large volume within few minutes. The present work demonstrates why at least a single molecule out of a few diffusing in a 100 µL volume has a high probability to hit a large capturing and detecting electronic interface. To this end, sensing data, measured with an electrolyte-gated FET whose gate is functionalized with 10¹² capturing anti-immunoglobulin G, are here provided along with a Brownian diffusion-based modeling. The EG-FET assays solutions down to some tens of zM in concentrations with volumes ranging from 25 µL to 1 mL in which the functionalized gates are incubated for times ranging from 30 s to 20 min. The high level of accordance between the experimental data and a model based on the Einstein's diffusion-theory proves how the single-molecule detection process at large-capturing interfaces is controlled by Brownian diffusion and yet is highly probable and fast.

A large-area organic transistor with 3D-printed sensing gate for noninvasive single-molecule detection of pancreatic mucinous cyst markers

Early diagnosis in a premalignant (or pre-invasive) state represents the only chance for cure in neoplastic diseases such as pancreatic-biliary cancer, which are otherwise detected at later stages and can only be treated using palliative approaches, with no hope for a cure. Screening methods for the purpose of secondary prevention are not yet available for these cancers. Current diagnostic methods mostly rely on imaging techniques and conventional cytopathology, but they do not display adequate sensitivity to allow valid early diagnosis. Next-generation sequencing can be used to detect DNA markers down to the physical limit; however, this assay requires labeling and is time-consuming. The additional determination of a protein marker that is a predictor of aggressive behavior is a promising innovative approach, which holds the potential to improve diagnostic accuracy. Moreover, the possibility to detect biomarkers in blood serum offers the advantage of a noninvasive diagnosis. In this study, both the DNA and protein markers of pancreatic mucinous cysts were analyzed in human blood serum down to the single-molecule limit using the SiMoT (single-molecule assay with a large transistor) platform. The SiMoT device proposed herein, which exploits an inkjet-printed organic semiconductor on plastic foil, comprises an innovative 3D-printed sensing gate module, consisting of a truncated cone that protrudes from a plastic substrate and is compatible with standard ELISA wells. This 3D gate concept adds tremendous control over the biosensing system stability, along with minimal consumption of the capturing molecules and body fluid samples. The 3D sensing gate modules were extensively characterized from both a material and electrical perspective, successfully proving their suitability as detection interfaces for biosensing applications. KRAS and MUC1 target molecules were successfully analyzed in diluted human blood serum with the 3D sensing gate functionalized with b-KRAS and anti-MUC1, achieving a limit of detection of 10 zM and 40 zM, respectively. These limits of detection correspond to (1 ± 1) KRAS and (2 ± 1) MUC1 molecules in the 100 μL serum sample volume. This study provides a promising application of the 3D SiMoT platform, potentially facilitating the timely, noninvasive, and reliable identification of pancreatic cancer precursor cysts.

Large-Area Interfaces for Single-Molecule Label-free Bioelectronic Detection

Bioelectronic transducing surfaces that are nanometric in size have been the main route to detect single molecules. Though enabling the study of rarer events, such methodologies are not suited to assay at concentrations below the nanomolar level. Bioelectronic field-effect-transistors with a wide (μm²-mm²) transducing interface are also assumed to be not suited, because the molecule to be detected is orders of magnitude smaller than the transducing surface. Indeed, it is like seeing changes on the surface of a one-kilometer-wide pond when a droplet of water falls on it. However, it is a fact that a number of large-area transistors have been shown to detect at a limit of detection lower than femtomolar; they are also fast and hence innately suitable for point-of-care applications. This review critically discusses key elements, such as sensing materials, FET-structures, and target molecules that can be selectively assayed. The amplification effects enabling extremely sensitive large-area bioelectronic sensing are also addressed.

Organic Field-Effect Transistor Platform for Label-Free, Single-Molecule Detection of Genomic Biomarkers

The increasing interest in technologies capable of tracking a biomarker down to the physical limit points toward new opportunities in early diagnostics of progressive diseases. Indeed, single-molecule detection technologies are foreseen to enable clinicians to associate the tiniest increase in a biomarker with the progression of a disease, particularly at its early stage. Bioelectronic organic transistors represent an extremely powerful tool to achieve label-free and single-molecule detection of clinically relevant biomarkers. These electronic devices are millimetric in size and in the future could be mass-produced at low cost. The core of the single molecule with a large transistor (SiMoT) platform, based on an electrolyte-gated field-effect transistor, is a gold gate electrode biofunctionalized with a self-assembled monolayer, a densely packed layer of recognition elements. So far, only the SiMoT detection of proteins, using the corresponding antibodies as recognition elements, has been reported. In this study, the SiMoT sensing response toward genomic biomarkers is proposed. Herein, the gate is functionalized with a genomic biomarker for multiple sclerosis (miR-182). This is relevant, not only because a limit of detection of a single molecule is achieved but also because it proves that the SiMoT label-free, single-molecule detection principle is the only one of its kind that can detect, by means of the same platform, both protein and genomic markers.

Ultra-low HIV-1 p24 detection limits with a bioelectronic sensor

Early diagnosis of the infection caused by human immunodeficiency virus type-1 (HIV-1) is vital to achieve efficient therapeutic treatment and limit the disease spreading when the viremia is at its highest level. To this end, a point-of-care HIV-1 detection carried out with label-free, low-cost, and ultra-sensitive screening technologies would be of great relevance. Herein, a label-free single molecule detection of HIV-1 p24 capsid protein with a large (wide-field) single-molecule transistor (SiMoT) sensor is proposed. The system is based on an electrolyte-gated field-effect transistor whose gate is bio-functionalized with the antibody against the HIV-1 p24 capsid protein. The device exhibits a limit of detection of a single protein and a limit of quantification in the 10 molecule range. This study paves the way for a low-cost technology that can quantify, with single-molecule precision, the transition of a biological organism from being "healthy" to being "diseased" by tracking a target biomarker. This can open to the possibility of performing the earliest possible diagnosis.

A Study on the Stability of Water-Gated Organic Field-Effect-Transistors Based on a Commercial p-Type Polymer

Robust electrolyte-gated organic field-effect-transistors (OFETs) are particularly needed for the development of biosensing devices. However, when a FET biosensor operates in aqueous environments or even in real biological fluids, some critical issues may arise due to the possible lack of environmental long-term and/or operational stability. An important source of instability is associated with the degradation of the organic electronic channel materials such as for instance, poly-3-hexylthiophene (P3HT), a benchmark commercially available p-type organic semiconductor. In this work, the investigation of critical parameters, such as the control over spurious electrochemical phenomena as well as the operating conditions that can affect water-gated OFETs lifetime, is reported, together with a proposed modeling of the P3HT stability curve over 1 week in water. The investigation of possible morphological/chemical modifications occurring at the polymer surface after operating in water for 2 weeks was carried out. Moreover, it is proven how the addition of a gel layer can extend the P3HT based water-gated OFET shelf life up to 2 months.

Selective single-molecule analytical detection of C-reactive protein in saliva with an organic transistor

In the last decade, saliva has been suggested as non-invasive diagnostic fluid, suitable for clinical use alternatively to blood serum and plasma. However, the clinical applicability of saliva has been hampered so far by the inadequate sensitivity of current methods to detect the lower salivary concentrations of many biomarkers monitored in blood products. Herein, a label-free biosensor based on electrolyte-gated organic thin-film transistor (EGOTFT) has been developed for the detection at the physical limit of C-reactive protein (CRP) in human saliva. CRP is a key relevant biomarker for inflammatory processes and is routinely monitored for many clinical purposes. Herein, an electrolyte-gated thin-film transistor (EGOTFT) has been proposed as a transducer of the biorecognition event taking place at the gate electrode, functionalized with a self-assembled monolayer (SAM) of highly densely packed capturing anti-CRP proteins. Thanks to the SAM, the biosensing platform herein proposed is endowed with ultra-high sensitivity, along with an extremely high selectivity, assessed by measuring the dose curves of CRP interacting with a bovine serum albumin-functionalized gate. Moreover, the biosensing platform is compatible with low-cost fabrication techniques and applicable to the ultra-sensitive detection of a plethora of clinically relevant biomarkers. Therefore, the EGOTFT device herein proposed, being able to operate in physiologically relevant fluids such as saliva, will set the ground to a major revolution in biosensing applications for early clinical detection.

In vitro and ex vivo studies on diltiazem hydrochloride-loaded microsponges in rectal gels for chronic anal fissures treatment

Diltiazem hydrochloride, topically applied at 2% concentration, is considered effective for the treatment of chronic anal fissures, although it involves several side effects among which anal pruritus and postural hypotension. To test the hypothesis that a sustained delivery system of diltiazem hydrochloride may be helpful for the treatment of chronic anal fissures, in the present study we evaluated the potential of gels containing diltiazem hydrochloride entrapped in microsponges. Such microsponges were based on Eudragit RS 100 and the effect of some formulation variables was assessed by a 2³ full factorial screening design. An optimized formulation of diltiazem hydrochloride microsponges was dispersed in Methylcellulose 2% or Poloxamer 407 20% and the resulting gels (micro-l-diltiazem hydrochloride 2%) were subjected to in vitro drug release, ex vivo permeability and drug deposition after application on porcine rectal mucosa. The results showed a prolonged release up to 24 h from micro-l-diltiazem hydrochloride at 2% in the gels. The permeation tests revealed up to 18% higher drug retention on the mucosal tissue after 24 h by the micro-l-diltiazem hydrochloride 2% gels compared to conventional diltiazem hydrochloride gels at 2%. These results suggest that diltiazem hydrochloride-loaded microsponges dispersed in rectal gels may be useful to overcome some limitations of conventional local chronic anal fissure therapy.

Single-molecule detection with a millimetre-sized transistor

Label-free single-molecule detection has been achieved so far by funnelling a large number of ligands into a sequence of single-binding events with few recognition elements host on nanometric transducers. Such approaches are inherently unable to sense a cue in a bulk milieu. Conceptualizing cells' ability to sense at the physical limit by means of highly-packed recognition elements, a millimetric sized field-effect-transistor is used to detect a single molecule. To this end, the gate is bio-functionalized with a self-assembled-monolayer of 1012 capturing anti-Immunoglobulin-G and is endowed with a hydrogen-bonding network enabling cooperative interactions. The selective and label-free single molecule IgG detection is strikingly demonstrated in diluted saliva while 15 IgGs are assayed in whole serum. The suggested sensing mechanism, triggered by the affinity binding event, involves a work-function change that is assumed to propagate in the gating-field through the electrostatic hydrogen-bonding network. The proposed immunoassay platform is general and can revolutionize the current approach to protein detection.

A Micellar-Hydrogel Nanogrid from a UV Crosslinked Inulin Derivative for the Simultaneous Delivery of Hydrophobic and Hydrophilic Drugs

Hydrogels are among the most common materials used in drug delivery, as polymeric micelles are too. They, preferentially, load hydrophilic and hydrophobic drugs, respectively. In this paper, we thought to combine the favorable behaviors of both hydrogels and polymeric micelles with the specific aim of delivering hydrophilic and hydrophobic drugs for dual delivery in combination therapy, in particular for colon drug delivery. Thus, we developed a hydrogel by UV crosslinking of a methacrylated (MA) amphiphilic derivative from inulin (INU) (as known INU is specifically degraded into the colon) and vitamin E (VITE), called INVITEMA. The methacrylated micelles were physicochemically characterized and subjected to UV irradiation to form what we called the "nanogrids". The INVITEMA nanogrids were characterized by DSC, SEM, TEM, water uptake and beclomethasone dipropionate (BDP) release. In particular, the release of the hydrophobic drug was specifically assessed to verify that it can spread along the hydrophilic portions and, therefore, effectively released. These systems can open new pharmaceutical applications for known hydrogels or micelle systems, considering that in literature only few examples are present.

Low-picomolar, label-free procalcitonin analytical detection with an electrolyte-gated organic field-effect transistor based electronic immunosensor

Herein a label-free immunosensor based on electrolyte-gated organic field-effect transistor (EGOFET) was developed for the detection of procalcitonin (PCT), a sepsis marker. Antibodies specific to PCT were immobilized on the poly-3-hexylthiophene (P3HT) organic semiconductor surface through direct physical adsorption followed by a post-treatment with bovine serum albumin (BSA) which served as the blocking agent to prevent non-specific adsorption. Antibodies together with BSA (forming the whole biorecognition layer) served to selectively capture the procalcitonin target analyte. The entire immunosensor fabrication process was fast, requiring overall 45min to be completed before analyte sensing. The EGOFET immunosensor showed excellent electrical properties, comparable to those of bare P3HT based EGOFET confirming reliable biosensing with bio-functional EGOFET immunosensor. The detection limit of the immunosensor was as low as 2.2pM and within a range of clinical relevance. The relative standard deviation of the individual calibration data points, measured on immunosensors fabricated on different chips (reproducibility error) was below 7%. The developed immunosensor showed high selectivity to the PCT analyte which was evident through control experiments. This report of PCT detection is first of its kind among the electronic sensors based on EGOFETs. The developed sensor is versatile and compatible with low-cost fabrication techniques.

Solvent-gated thin-film-transistors

Electrical double layer (EDL) thin film transistors (TFTs) are an interesting class of transistors that use an electrolyte as the gating medium. Recently it has been demonstrated that pure organic solvents can also be used as gating media for TFTs without the addition of exogenous electrolytes. Here we present a systematic study of the performances of TFTs based on two different semiconductors (P3HT and ZnO) gated through nine different solvents either pure or loaded with NaCl. The nature of the solvent impacts the transfer characteristics of the TFT through a change in the gating capacitance while the threshold voltage remains unaffected. Depending on the polarity of solvents, addition of NaCl gives rise to different responses. TFTs gated through highly polar solvents are unaffected by the salt concentration while for low polarity solvents the output current increases with salt up to a plateau. Furthermore, when the semiconductor surface is covered with a high capacitance thin dielectric layer, the TFT output current becomes dependent on the NaCl concentration also for high polarity solvents. This phenomenology was rationalized considering the different contributions of Helmholtz and Guy-Chapman EDLs to the capacitance and the dielectric saturation that decreases the solvent dielectric constant within the Helmholtz EDL.

Spectroscopic Characterization and Nanosafety of Ag-Modified Antibacterial Leather and Leatherette

The development of antibacterial coatings is of great interest from both industry and the consumer's point of view. In this study, we characterized tanned leather and polyurethane leatherette, typically employed in the automotive and footwear industries, which were modified by photo-deposition of antibacterial silver nanoparticles (AgNPs). Material surface chemical composition was investigated in detail by X-ray photoelectron spectroscopy (XPS). The material's antibacterial capability was checked against Escherichia coli and Staphylococcus aureus, as representative microorganisms in cross transmissions. Due to the presence of silver in a nanostructured form, nanosafety issues were considered, as well. Ionic release in contact media, as well as whole nanoparticle release from treated materials, were quantitatively evaluated, thus providing specific information on potential product nanotoxicity, which was further investigated through cytocompatibility MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assays, also after surface abrasion of the materials. The proved negligible nanoparticle release, as well as the controlled release of antibacterial ions, shed light on the materials' potentialities, in terms of both high activity and safety.

Gas sensing properties of MWCNT layers electrochemically decorated with Au and Pd nanoparticles

Multiwalled carbon nanotube (MWCNT)-based chemiresistors were electrochemically decorated with Au and Pd nanoparticles (NPs), resulting in an improvement in the detection of gaseous pollutants as compared to sensors based on pristine MWCNTs. Electrophoresis was used to decorate MWCNTs with preformed Au or Pd NPs, thus preserving their nanometer-sized dimensions and allowing the metal content to be tuned by simply varying the deposition time. The sensing response of unmodified and metal-decorated MWCNTs was evaluated towards different gaseous pollutants (e.g., NO2, H2S, NH3 and C4H10) at a wide range of concentrations in the operating temperature range of 45-200 °C. The gas sensing results were related to the presence, type and loading of metal NPs used in the MWCNT functionalization. Compared to pristine MWCNTs, metal-decorated MWCNTs revealed a higher gas sensitivity, a faster response, a better stability, reversibility and repeatability, and a low detection limit, where all of these sensing properties were controlled by the type and loading of the deposited metal catalytic NPs. Specifically, in the NO2 gas sensing experiments, MWCNTs decorated with the lowest Au content revealed the highest sensitivity at 150 °C, while MWCNTs with the highest Pd loading showed the highest sensitivity when operated at 100 °C. Finally, considering the reported gas sensing results, sensing mechanisms have been proposed, correlating the chemical composition and gas sensing responses.

Sensitive detection of hydrocarbon gases using electrochemically Pd-modified ZnO chemiresistors

Pristine and electrochemically Pd-modified ZnO nanorods (ZnO NRs) were proposed as active sensing layers in chemiresistive gas sensors for hydrocarbon (HC) gas detection (e.g., CH₄, C₃H_8, C₄H₁₀). The presence of Pd nanoparticles (NPs) on the surface of ZnO NRs, obtained after the thermal treatment at 550 °C, was revealed by morphological and surface chemical analyses, using scanning electron microscopy and X-ray photoelectron spectroscopy, respectively. The effect of the Pd catalyst on the performance of the ZnO-based gas sensor was evaluated by comparing the sensing results with those of pristine ZnO NRs, at an operating temperature of 300 °C and for various HC gas concentrations in the range of 30-1000 ppm. The Pd-modified ZnO NRs showed a higher selectivity and sensitivity compared to pristine ZnO NRs. The mean sensitivity of Pd-modified ZnO NRs towards the analyzed HCs gases increased with the length of the hydrocarbon chain of the target gas molecule. Finally, the evaluation of the selectivity revealed that the presence or the absence of metal nanoparticles on ZnO NRs improves the selectivity in the detection of specific HCs gaseous molecules.

In Vitro Assessment of the Antibacterial Potential of Silver Nano-Coatings on Cotton Gauzes for Prevention of Wound Infections

Multidrug-resistant organisms are increasingly implicated in acute and chronic wound infections, thus compromising the chance of therapeutic options. The resistance to conventional antibiotics demonstrated by some bacterial strains has encouraged new approaches for the prevention of infections in wounds and burns, among them the use of silver compounds and nanocrystalline silver. Recently, silver wound dressings have become widely accepted in wound healing centers and are commercially available. In this work, novel antibacterial wound dressings have been developed through a silver deposition technology based on the photochemical synthesis of silver nanoparticles. The devices obtained are completely natural and the silver coatings are characterized by an excellent adhesion without the use of any binder. The silver-treated cotton gauzes were characterized through scanning electron microscopy (SEM) and thermo-gravimetric analysis (TGA) in order to verify the distribution and the dimension of the silver particles on the cotton fibers. The effectiveness of the silver-treated gauzes in reducing the bacterial growth and biofilm proliferation has been demonstrated through agar diffusion tests, bacterial enumeration test, biofilm quantification tests, fluorescence and SEM microscopy. Moreover, potential cytotoxicity of the silver coating was evaluated through 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide colorimetric assay (MTT) and the extract method on fibroblasts and keratinocytes. Inductively coupled plasma mass spectrometry (ICP-MS) was performed in order to determine the silver release in different media and to relate the results to the biological characterization. All the results obtained were compared with plain gauzes as a negative control, as well as gauzes treated with a higher silver percentage as a positive control.

Evaluation of gas-sensing properties of ZnO nanostructures electrochemically doped with Au nanophases

A one-step electrochemical method based on sacrificial anode electrolysis (SAE) was used to deposit stabilized gold nanoparticles (Au NPs) directly on the surface of nanostructured ZnO powders, previously synthesized through a sol-gel process. The effect of thermal annealing temperatures (300 and 550 °C) on chemical, morphological, and structural properties of pristine and Au-doped ZnO nancomposites (Au@ZnO) was investigated. Transmission and scanning electron microscopy (TEM and SEM), as well as X-ray photoelectron spectroscopy (XPS), revealed the successful deposition of nanoscale gold on the surface of spherical and rod-like ZnO nanostructures, obtained after annealing at 300 and 550 °C, respectively. The pristine ZnO and Au@ZnO nanocomposites are proposed as active layer in chemiresistive gas sensors for low-cost processing. Gas-sensing measurements towards NO2 were collected at 300 °C, evaluating not only the Au-doping effect, but also the influence of the different ZnO nanostructures on the gas-sensing properties.

A comparative study of the gas sensing behavior in P3HT- and PBTTT-based OTFTs: the influence of film morphology and contact electrode position

Bottom- and top-contact organic thin film transistors (OTFTs) were fabricated, using poly(3-hexylthiophene-2,5-diyl) (P3HT) and poly[2,5-bis(3-tetradecylthiophen-2-yl)thieno[3,2-b]thiophene] (PBTTT-C16) as p-type channel semiconductors. Four different types of OTFTs were fabricated and investigated as gas sensors against three volatile organic compounds, with different associated dipole moments. The OTFT-based sensor responses were evaluated with static and transient current measurements. A comparison between the different architectures and the relative organic semiconductor was made.

Bio-sorbable, liquid electrolyte gated thin-film transistor based on a solution-processed zinc oxide layer

Among the metal oxide semiconductors, ZnO has been widely investigated as a channel material in thin-film transistors (TFTs) due to its excellent electrical properties, optical transparency and simple fabrication via solution-processed techniques. Herein, we report a solution-processable ZnO-based thin-film transistor gated through a liquid electrolyte with an ionic strength comparable to that of a physiological fluid. The surface morphology and chemical composition of the ZnO films upon exposure to water and phosphate-buffered saline (PBS) are discussed in terms of the operation stability and electrical performance of the ZnO TFT devices. The improved device characteristics upon exposure to PBS are associated with the enhancement of the oxygen vacancies in the ZnO lattice due to Na⁺ doping. Moreover, the dissolution kinetics of the ZnO thin film in a liquid electrolyte opens the possible applicability of these devices as an active element in “transient” implantable systems.

Quantum cascade laser technology for the ultrasensitive detection of low-level nitric oxide

Several spectroscopic methods based on mid-infrared quantum cascade lasers for the ultrasensitive detection of nitric oxide have been developed with detection limit in ppbv and sub-ppbv range. We will describe here a selection of the most effective techniques, i.e., laser absorption spectroscopy, cavity-enhanced spectroscopy, photoacoustic spectroscopy, and Faraday modulation spectroscopy. For each technique, advantages and drawbacks will be underlined.

Clinical implications of epidural fat in the spinal canal. A scanning electron microscopic study

BACKGROUND AND OBJECTIVES

This review of articles summarizes recent developments in relation to fat located in the epidural space and also in dural sleeves of spinal nerve roots in order to improve our understanding of the clinical effects of the epidural blockade.

METHOD

Medline search was carried cross-matching of the following words: "epidural fat", "epidural space", "adipose tissue" and "fat cells" from 1966 to 2008 in which articles referring to different pathologies that alter the epidural fat were also reviewed. Techniques used by different authors included the use of samples from dissections, cryomicrotome sections, as well as light and electron microscopy.

RESULTS

Fat in the epidural space has a metameric distribution along the spinal canal that can be altered in some pathological conditions. Epidural fat is not evenly distributed. At cervical level fat is absent while in the lumbar region, fat in the anterior and posterior aspects of the epidural space forms two unconnected structures. Fat cells are found also in the thickness of dural sleeves enveloping spinal nerve roots but not in the region of the dural sac. Epidural lipomatosis is characterized by an increase in epidural fat content. When a patient has a combination of kyphosis and scoliosis of the spine, the epidural fat distributes asymmetrically. Spinal stenosis is frequently accompanied by a reduction in the amount of epidural fat around the stenotic area.

CONCLUSIONS

The epidural space contains abundant epidural fat that distributes along the spinal canal in a predictable pattern. Fat cells are also abundant in the dura that forms the sleeves around spinal nerve roots but they are not embedded within the laminas that form the dura mater of the dural sac. Drugs stored in fat, inside dural sleeves, could have a greater impact on nerve roots than drugs stored in epidural fat, given that the concentration of fat is proportionally higher inside nerve root sleeves than in the epidural space, and that the distance between nerves and fat is shorter. Similarly, changes in fat content and distribution caused by different pathologies may alter the absorption and distribution of drugs injected in the epidural space.

Buprenorphine added to the local anesthetic for brachial plexus block to provide postoperative analgesia in outpatients

BACKGROUND AND OBJECTIVES

Over the past 10 years, several studies have suggested that the addition of certain opiates to the local anesthetic used for brachial block may provide effective, long-lasting postoperative analgesia. One of these studies indicated that the agonist-antagonist, buprenorphine, added to bupivacaine provided a longer period of postoperative analgesia than the traditional opiates, but in this study, it is impossible to determine the relative contributions of the local anesthetic and the opiate to the postoperative analgesia because of the extremely long duration of the anesthesia provided by the local anesthetic, bupivacaine. By repeating the study using a local anesthetic of a shorter duration, the present study delineates more clearly the contribution of the buprenorphine to postoperative analgesia when added to a shorter-acting local anesthetic.

METHODS

Forty, healthy, consenting adult patients scheduled for upper extremity surgery were enrolled in the study. Premedication was provided by intravenous midazolam 2 mg/70 kg and anesthesia by a subclavian perivascular brachial plexus block. The patients were assigned randomly to 1 of 2 equal groups based on the agents used for the blocks. The patients in group I received 40 mL of a local anesthetic alone, while those in group II received the same local anesthetic plus buprenorphine 0.3 mg. The study was kept double-blind by having 1 anesthesiologist prepare the solutions, a second anesthesiologist perform the blocks, and a third anesthesiologist monitor the anesthesia and analgesia thereafter, up to and including the time of the first request for an analgesic medication. The data were reported as means (+/- SEM), and differences between groups were determined using repeated measures of analysis of variance (ANOVA) and chi(2), followed by the Fisher exact test for post hoc comparison. A P value of less than.05 was considered to be statistically significant.

RESULTS

The mean duration of postoperative pain relief following the injection of the local anesthetic alone was 5.3 (+/- 0.15) hours as compared with 17.4 (+/- 1.26) hours when buprenorphine was added, a difference that was statistically (and clinically) significant (P <.0001).

CONCLUSIONS

The addition of buprenorphine to the local anesthetic used for brachial plexus block in the present study provided a 3-fold increase in the duration of postoperative analgesia, with complete analgesia persisting 30 hours beyond the duration provided by the local anesthetic alone in 75% of the patients. This practice can be of particular benefit to patients undergoing ambulatory upper extremity surgery by providing prolonged analgesia after discharge from the hospital.

1,001 subclavian perivascular brachial plexus blocks: success with a nerve stimulator

BACKGROUND AND OBJECTIVES

Among the supraclavicular approaches to the brachial plexus, the subclavian perivascular technique is a well-established method of anesthesia of the upper extremity. Ever since Kulenkampf described his technique, eliciting a paresthesia has been almost mandatory ("no paresthesia, no anesthesia"). Lately, nerve stimulators have become more popular. However, up to the present time, clinical studies involving the nerve stimulator have failed to show success rates comparable to paresthesia techniques.

METHODS

Data from 1,001 consecutive, subclavian perivascular blocks were prospectively gathered over 2.5 years. All blocks were performed according to Winnie's technique, but using a nerve stimulator instead of a paresthesia. When an adequate response was obtained, 35 to 40 mL of local anesthetic solution was injected.

RESULTS

Nine hundred seventy-three blocks (97.2%) were completely successful; 16 blocks (1.6%) were incomplete and needed supplementation; and 12 blocks (1.2%) failed and required general anesthesia, giving a success rate for regional anesthesia of 98.8%.

CONCLUSIONS

The subclavian perivascular block consistently provides an effective block for surgery on the upper extremity. At the site of injection with this technique, the plexus is reduced to its smallest components and the sheath is reduced to its smallest volume, which explains in great part the success obtained with this block. We believe that we have demonstrated a nerve stimulator technique that is both highly successful and safe; no clinical pneumothorax was found nor did any other major complications develop.

Intragenomic distribution and stability of transposable elements in euchromatin and heterochromatin of Drosophila melanogaster: non-LTR retrotransposon

The intragenomic location of the elements of the I, G, jockey, F, and Doc transposon families has been studied by the Southern blot analysis, in 12 laboratory Drosophila melanogaster stocks. Elements located in euchromatin, heterochromatin, and on the Y chromosome are identified, and their stability has been assessed by comparing the autoradiographs detected in different stocks and analysis of individual flies. Evidence is shown suggesting that preferential location in euchromatin or heterochromatin and the distribution within heterochromatin are distinctive of transposon families. Elements located in heterochromatin can be unstable. These results are discussed in the context of the relationship between transposable elements and the host genome.

Management of arterial injuries produced by percutaneous femoral procedures

BACKGROUND

A significant number of vascular injuries occur with the use of percutaneous diagnostic and therapeutic procedures. This study was done to indicate the types of these injuries and their management.

METHODS

Over a 30-month period, 55 patients required operation for vascular complications after percutaneous femoral procedures including infrarenal arteriography (six patients) and angioplasty (22 patients), coronary angiography (16 patients) and angioplasty (five patients), and aortic balloon pump insertion (six patients).

RESULTS

The 14 iliac and 41 femoral artery injuries included 29 pseudoaneurysms, six lacerations with persistent bleeding, seven dissections, six occlusions, three ruptures, two arteriovenous fistulas, and two large hematomas. Control for all femoral and distal external iliac artery lesions was obtained solely through a groin incision in 45 (82%) patients. Our technique for exposure of the external iliac artery through the groin is described. A separate retroperitoneal incision was necessary in 10 patients because of proximal injury, massive pseudoaneurysm, morbid obesity, or heavily scarred groins. In this series 34 lateral suture repairs, 11 interposition or bypass grafts, four patch angioplasties, one endarterectomy, three thrombectomies, and two hematoma evacuations were performed. Although no limb loss occurred, we encountered nine wound complications, five myocardial infarctions, and two deaths.

CONCLUSIONS

This experience shows the wide variety of vascular complications caused by percutaneous procedures and the different techniques necessary for their management.

Superoxide anion production by leukocytes exposed to post-ischemic skeletal muscle

Superoxide anion (O2-) and polymorphonuclear leukocytes (PMNs) have been implicated in the genesis of skeletal muscle ischemia-reperfusion (I-R) injury, but the source of (O2-) has not been established. We studied PMNs as a potential source of O2- using a ferricytochrome reduction assay in 5 anesthetized dogs. Using a gracilis muscle model of I-R, 6 hours of ischemia was followed by 2 hours of reperfusion. The contralateral muscle served as control. Prior to ischemia and after 0.5 and 2.0 hours of reperfusion, PMNs were separated from the gracilis venous effluent of ischemic (I) and control (C) muscles. Central venous samples were also obtained prior to surgical preparation and after reperfusion. Assays for O2- were performed with and without zymosan (Z) activation. Results are expressed as nmol O2-/2 x 10(6) PMNs +/- SEM. Baseline production of O2- was 0.49 +/- 0.54 in central venous samples; Z increased the values to 6.77 +/- 2.13. After 2 hrs of reperfusion, central O2- was 1.57 +/- 0.75, which increased to 7.1 +/- 1.04 with Z. Gracilis venous samples O2- values with and without Z are reported in Table I. One way measures of analysis of variance showed no significant (p > 0.05) differences between samples. Our results demonstrate that PMNs are not the sole source of O2- in the pathophysiology of skeletal muscle I-R injury. PMN associated injury may be mediated by mechanisms other than O2- production.

Comparison of heated-probe laser Doppler and transcutaneous oxygen measurements for predicting outcome of ischemic wounds

Transcutaneous oxygen (TcPO2) measurement has proven to be an accurate means of predicting healing of ischemic wounds. This study compares the ability of TcPO2 and laser Doppler, modified by the addition of a heated probe (LDHP), to assess wound outcome. TcPO2 and LDHP measurements were made at the same site for 80 wounds, which consisted of 51 amputations (25 above knee, 6 below knee, 20 forefoot) and 29 ulcerations. Healing was defined as complete wound closure. Failure to heal was defined by the necessity for proximal amputation in 22 wounds (6 amputations, 16 ulcers). Outcome criteria were chosen to maximize accuracy and either positive or negative predictive values. Criteria with the greatest accuracy and positive predictive value for wound healing were > or = 11 mmHg for TcPO2 and > or = 50 mv for LDHP range. Criteria with the most appropriate accuracy and negative predictive value for wound failure were < 5 mmHg for TcPO2 and < 35 mv LDHP range. All wounds whose LDHP range was < 35 mv failed to heal, whereas some wounds with a TcPO2 of 0-1 mmHg healed successfully. An absolute prediction of wound healing (100% specificity and negative predictive value) was offered when either LDHP range was > or = 125 mv or TcPO2 was > or = 33 mmHg, although accuracy of either measurement at this criteria was unacceptable for more general application. We conclude that TcPO2 or LDHP will assess wound outcome with similar overall accuracy, although each test may be better for predicting a specific outcome.

A prospective evaluation of arterial intimal injuries in an experimental model

The management of arterial intimal defects remains controversial because of uncertainty concerning their natural history. We developed an experimental canine model to prospectively evaluate posterior wall intimal flaps in the superficial femoral artery. Arterial intimal flaps were constructed in 20 anesthetized dogs (40 arteries) and evaluated by arteriography, and angioscopy, and intravascular ultrasound. Postoperative patency rates at 1 (n = 20) and 3 weeks (n = 20) were compared with a control group of ten animals (n = 20, arteriotomy without intimal flap). Acute thromboses occurred in five experimental arteries with thromboses of eight additional experimental arteries at followup. Control patency was 100%, while experimental group patencies were 75% (p less than 0.05) at 1 week and 60% (p less than 0.009) at 3 weeks. All thrombosed arteries had intimal flaps with greater than 75% luminal stenosis. We conclude that intimal injuries cause arterial thromboses acutely and during subsequent followup. Intimal flaps with stenosis greater than 75% as determined arteriographically are at greatest risk for thrombosis. Angioscopy and intravascular ultrasound characterize arterial intimal defects and may delineate injuries requiring surgical or endovascular repair.

Carotid endarterectomy for asymptomatic carotid stenosis: a ten-year experience with 120 procedures in a fellowship training program

Performance of carotid endarterectomy for asymptomatic carotid stenosis has been restricted during recent years because of concern of reported complications in as high as 10-15% of patients, as well as limited long-term data on stroke protection. During the last 10 years, we have studied immediate and long-term results of carotid endarterectomy for asymptomatic disease in 120 patients. Operations were performed by a clinical vascular fellow with a staff surgeon in attendance in 113 (94%) cases with the remainder performed by the staff surgeon. Patients' mean age was 66 years; 82% were men. Risk factors included hypertension (56%), smoking (52%), coronary artery disease (32%), diabetes (24%), and hypercholesterolemia (6%). Arteriographic severity of stenoses was 80-99% in 74%, 60-79% in 22%, and 40-59% in 4% of cases. Postoperative complications included two transient neurological events (1.7%). No permanent strokes or deaths occurred. Using the life table method, cumulative stroke rate was 4.5% for ipsilateral events and 7.3% for contralateral events, confirming the high degree of stroke protection afforded by carotid endarterectomy in this population. Since these results were accomplished in a fellowship training program, we regard adequacy of this experience as the most influential factor in accomplishing this record. Surgeons who are unable to achieve comparable results should consider abandonment of the procedure or an extended period of additional training.

Popliteal artery agenesis: a new anatomic variant

Agenesis of the popliteal artery has not been described as a vascular anomaly in the lower extremity. This case report describes congenital absence of the popliteal artery discovered during operative exploration after a traumatic injury to the lower extremity. The preoperative arteriogram suggested acute occlusion of the popliteal artery. Intraoperative exploration and arteriography were consistent with agenesis of the popliteal arterial segment, and postmortem examination confirmed these arteriographic and intraoperative observations. Embryologically, failure of the middle portion of the sciatic artery to persist would account for this anomaly. A review of series reporting congenital anomalies of the lower extremity vasculature failed to discover previous mention of this particular abnormality. Agenesis of the popliteal artery should be included among those vascular anomalies that may affect management of lower extremity vascular disease.

Unsuspected inflow disease in candidates for axillofemoral bypass operations: a prospective study

Routine arteriography of the axillary, subclavian, and innominate arteries before axillofemoral bypass surgery has not been advocated because of the presumed rarity of stenosis of these inflow vessels. However, we have noted in this patient population with extensive atherosclerosis that inflow disease can cause axillofemoral graft failure despite normal preoperative clinical and noninvasive parameters. We prospectively determined the incidence of unsuspected inflow stenosis with arteriography in 40 consecutive candidates for primary (28) or secondary (12) axillofemoral bypass surgery. A new arteriographic technique with a single translumbar puncture was developed to safely and clearly visualize the potential inflow and outflow tracts. Ten of the 40 patients (25%) exhibited inflow stenosis greater than 50% of luminal diameter (unilateral in eight patients and bilateral in two patients). Seven were on the left side (five subclavian, two axillary) and five were on the right side (three subclavian, one axillary, one innominate). In eight of the 40 patients (20%) the stenotic inflow lesion was ipsilateral to the ischemic leg and therefore proximal to the preferred inflow site of an axillofemoral bypass. Upper extremity arterial pressure measurements suggested potential inflow artery stenosis in only three of the 12 (25%) instances. These findings show that equal arterial pressures in the upper extremities do not ensure adequate inflow for an axillofemoral graft. Routine arteriographic assessment of inflow intacts is recommended before axillofemoral bypass surgery.

A modified method for management of prosthetic graft infections involving an anastomosis to the common femoral artery

In the last 10 years we have treated 28 patients with 33 groin infections involving a common femoral artery anastomosis of prosthetic arterial grafts (2 aortic Dacron grafts, 31 peripheral polytetrafluoroethylene grafts). Management included complete graft preservation for patent infected grafts (11 cases), subtotal excision of occluded infected grafts leaving an oversewn 2 to 3 mm graft remnant attached to a patent artery critical for limb survival (16 cases), and total graft excision with arterial oversewing or ligation for anastomotic bleeding (6 cases). Essential treatment adjuncts included (1) radical operative wound debridement, and (2) secondary revascularization by means of bypasses tunneled via lateral uninfected routes, and unusual approaches to uninvolved patent outflow arteries (i.e., the distal superficial or deep femoral or popliteal arteries) after isolation of the infected wound. Follow-up averaged 3 years (1 to 10 years). This plan of treatment resulted in an 11% (3/28) hospital mortality and an amputation rate of 13% (4/30 threatened limbs). Of the 25 survivors with 30 infected groin grafts, 87% (26) of the wounds healed uneventfully by secondary intention within 1 to 8 weeks (mean, 4 weeks) and have remained healed. One infected groin wound did not heal and required delayed total graft excision. Three patients had late anastomotic disruption with hemorrhage at 8 months, 2 years, and 4 years after initial treatment. This selected use of complete or partial graft preservation and other essential treatment adjuncts are proposed as a safer, easier method for managing infected prosthetic arterial grafts in the groin.

Resting gated pool ejection fraction: a poor predictor of perioperative myocardial infarction in patients undergoing vascular surgery for infrainguinal bypass grafting

Ventricular ejection fraction is widely regarded as a prognostic indicator of perioperative myocardial infarction. To evaluate this premise the prevalence of perioperative myocardial infarction or cardiac death was analyzed in relation to preoperative resting gated pool ejection fraction in 85 patients undergoing vascular surgery for infrainguinal bypass grafting. Patients were divided into three groups on the basis of ejection fraction. Group I consisted of 50 patients with ejection fractions of 56% to 92%. Nine (18%) perioperative myocardial infarctions occurred in group I, and there were no cardiac deaths. Group II consisted of 20 patients with ejection fractions of 37% to 55%. Three (15%) myocardial infarctions occurred in this group, and there were no cardiac deaths. Group III included 15 patients with ejection fractions of 20% to 35%. Three (20%) cardiac events occurred in group III including one nonfatal myocardial infarction and two (13%) cardiac deaths. Statistical analysis showed no significant difference in prevalence of cardiac events between any group. These results suggest that resting ejection fraction is a poor predictor of perioperative myocardial infarction in patients undergoing vascular surgery. Patients with normal ejection fractions, but underlying coronary artery disease, are still at significant risk for a perioperative cardiac event.

Acute ischemia-reperfusion injury in the canine hindlimb

A canine arterial ligation preparation was used to produce whole limb ischemia-reperfusion injury. Alterations in the distribution of arterial blood flow as well as the morphology of skeletal muscle ischemia-reperfusion have not been investigated completely in this setting. Five anesthetized adult mongrel dogs underwent multiple infrarenal aortic branch ligations; one randomly selected hindlimb was subjected to six hours of ischemia and two hours of reperfusion, while the opposite limb served as control. Distribution of arterial blood flow was analyzed by injection of radiolabeled microspheres. Electromagnetically measured femoral arterial blood flow was 92 +/- 10 ml/min during control, and increased significantly (p less than 0.05) to 254 +/- 94 ml/min during reperfusion. Flow distribution to skin, muscle, and bone was 9 +/- 2%, 68 +/- 7%, and 8 +/- 1% during control, and 7 +/- 3%, 65 +/- 8%, and 9 +/- 4% after reperfusion, which did not represent significant changes. Arteriovenous shunting was 11 +/- 4% during control, and was 13 +/- 5% during reperfusion, which was not significantly different. Subcellular injury in the ischemic and reperfused hindlimb was demonstrated by light and electron microscopy. These findings further characterize whole limb ischemia-reperfusion injury in the canine hindlimb.

Technetium 99m pyrophosphate quantitation of skeletal muscle ischemia and reperfusion injury

The study of ischemia and reperfusion injury in the extremity has been hampered by lack of an accurate method of measuring skeletal muscle injury. We used a bilateral isolated in vivo canine gracilis muscle model in 15 anesthetized dogs. The experimental muscles had 4, 6, or 8 hours of ischemia and 1 hour of reperfusion. The contralateral gracilis muscle served as a control. Technetium 99m pyrophosphate (99mTc-PYP), an agent which localizes in injured muscle cells, was used to quantitate canine skeletal muscle damage. After 6 hours of ischemia and 1 hour of reperfusion, there was a significant increase of 215% of 99mTc-PYP uptake in the experimental vs the control muscle. Experimental muscle uptake was 8% greater than control after 4 hours and 405% more after 8 hours of ischemia and reperfusion. Segmental distribution of 99mTc-PYP uptake showed localization to be greatest in the middle of the muscle at the entry site of the gracilis artery. Electron microscopic evaluation also documented this area to have undergone the most severe injury. Distal portions of the muscle did not show increased damage. Our results show that 99mTc-PYP effectively quantitates skeletal muscle ischemia and reperfusion injury. The pattern of 99mTc-PYP uptake suggests that considerable injury is caused during reperfusion.