Cotyledon-Specific Flow Evaluation of Rhesus Macaque Placental Injury Using Ferumoxytol Dynamic Contrast-Enhanced MRI.

BACKGROUND: Recently, dynamic contrast-enhanced (DCE) MRI with ferumoxytol as contrast agent has recently been introduced for the noninvasive assessment of placental structure and function throughout. However, it has not been demonstrated under pathological conditions. PURPOSE: To measure cotyledon-specific rhesus macaque maternal placental blood flow using ferumoxytol DCE MRI in a novel animal model for local placental injury. STUDY TYPE: Prospective animal model. SUBJECTS: Placental injections of Tisseel (three with 0.5 mL and two with 1.5 mL), monocyte chemoattractant protein 1 (three with 100 µg), and three with saline as controls were performed in a total of 11 rhesus macaque pregnancies at approximate gestational day (GD 101). DCE MRI scans were performed prior (GD 100) and after (GD 115 and GD 145) the injection (term = GD 165). FIELD STRENGTH/SEQUENCE: 3 T, T1-weighted spoiled gradient echo sequence (product sequence, DISCO). ASSESSMENT: Source images were inspected for motion artefacts from the mother or fetus. Placenta segmentation and DCE processing were performed for the dynamic image series to measure cotyledon specific volume, flow, and normalized flow. Overall placental histopathology was conducted for controls, Tisseel, and MCP-1 animals and regions of tissue infarctions and necrosis were documented. Visual inspections for potential necrotic tissue were conducted for the two Tisseelx3 animals. STATISTICAL TESTS: Wilcoxon rank sum test, significance level P < 0.05. RESULTS: No motion artefacts were observed. For the group treated with 1.5 mL of Tisseel, significantly lower cotyledon volume, flow, and normalized flow per cotyledon were observed for the third gestational time point of imaging (day ~145), with mean normalized flow of 0.53 minute-1 . Preliminary histopathological analysis shows areas of tissue necrosis from a selected cotyledon in one Tisseel-treated (single dose) animal and both Tisseelx3 (triple dose) animals. DATA CONCLUSION: This study demonstrates the feasibility of cotyledon-specific functional analysis at multiple gestational time points and injury detection in a placental rhesus macaque model through ferumoxytol-enhanced DCE MRI. LEVEL OF EVIDENCE: NA TECHNICAL EFFICACY: Stage 2.

Mild hypothermia fails to protect infant macaques from brain injury caused by prolonged exposure to Antiseizure drugs.

Barbiturates and benzodiazepines are GABAA-receptor agonists and potent antiseizure medications. We reported that exposure of neonatal macaques to combination of phenobarbital and midazolam (Pb/M) for 24 h, at clinically relevant doses and plasma levels, causes widespread apoptosis affecting neurons and oligodendrocytes. Notably, the extent of injury was markedly more severe compared to shorter (8 h) exposure to these drugs. We also reported that, in the infant macaque, mild hypothermia ameliorates the apoptosis response to the anesthetic sevoflurane. These findings prompted us explore whether mild hypothermia might protect infant nonhuman primates from neuro- and gliotoxicity of Pb/M. Since human infants with seizures may receive combinations of benzodiazepines and barbiturates for days, we opted for 24 h treatment with Pb/M. Neonatal rhesus monkeys received phenobarbital intravenously, followed by midazolam infusion over 24 h under normothermia (T > 36.5 °C-37.5 °C; n = 4) or mild hypothermia (T = 35 °C-36.5 °C; n = 5). Medication doses and blood levels measured were comparable to those in human infants. Animals were euthanized at 36 h and brains examined immunohistochemically and stereologically. Treatment was well tolerated. Extensive degeneration of neurons and oligodendrocytes was seen at 36 h in both groups within neocortex, basal ganglia, hippocampus and brainstem. Mild hypothermia over 36 h (maintained until terminal perfusion) conferred no protection against the neurotoxic and gliotoxic effects of Pb/M. This is in marked contrast to our previous findings that mild hypothermia is protective in the context of a 5 h-long exposure to sevoflurane in infant macaques. These findings demonstrate that brain injury caused by prolonged exposure to Pb/M in the neonatal primate cannot be ameliorated by mild hypothermia.

Brain pathology caused in the neonatal macaque by short and prolonged exposures to anticonvulsant drugs.

Barbiturates and benzodiazepines are potent GABAA receptor agonists and strong anticonvulsants. In the developing brain they can cause neuronal and oligodendroglia apoptosis, impair synaptogenesis, inhibit neurogenesis and trigger long-term neurocognitive sequelae. In humans, the vulnerable period is projected to extend from the third trimester of pregnancy to the third year of life. Infants with seizures and epilepsies may receive barbiturates, benzodiazepines and their combinations for days, months or years. How exposure duration affects neuropathological sequelae is unknown. Here we investigated toxicity of phenobarbital/midazolam (Pb/M) combination in the developing nonhuman primate brain. Neonatal rhesus monkeys received phenobarbital intravenously, followed by infusion of midazolam over 5 (n = 4) or 24 h (n = 4). Animals were euthanized at 8 or 36 h and brains examined immunohistochemically and stereologically. Treatment was well tolerated, physiological parameters remained at optimal levels. Compared to naïve controls, Pb/M exposed brains displayed widespread apoptosis affecting neurons and oligodendrocytes. Pattern and severity of cell death differed depending on treatment-duration, with more extensive neurodegeneration following longer exposure. At 36 h, areas of the brain not affected at 8 h displayed neuronal apoptosis, while oligodendroglia death was most prominent at 8 h. A notable feature at 36 h was degeneration of neuronal tracts and trans-neuronal death of neurons, presumably following their disconnection from degenerated presynaptic partners. These findings demonstrate that brain toxicity of Pb/M in the neonatal primate brain becomes more severe with longer exposures and expands trans-synaptically. Impact of these sequelae on neurocognitive outcomes and the brain connectome will need to be explored.

Mild hypothermia ameliorates anesthesia toxicity in the neonatal macaque brain.

Sedatives and anesthetics can injure the developing brain. They cause apoptosis of neurons and oligodendrocytes, impair synaptic plasticity, inhibit neurogenesis and trigger long-term neurocognitive deficits. The projected vulnerable period in humans extends from the third trimester of pregnancy to the third year of life. Despite all concerns, there is no ethically and medically acceptable alternative to the use of sedatives and anesthetics for surgeries and painful interventions. Development of measures that prevent injury while allowing the medications to exert their desired actions has enormous translational value. Here we investigated protective potential of hypothermia against histological toxicity of the anesthetic sevoflurane in the developing nonhuman primate brain. Neonatal rhesus monkeys underwent sevoflurane anesthesia over 5 h. Body temperature was regulated in the normothermic (>36.5 °C), mild hypothermic (35-36.5 °C) and moderately hypothermic (<35 °C) range. Animals were euthanized at 8 h and brains examined immunohistochemically (activated caspase 3) and stereologically to quantify apoptotic neuronal and oligodendroglial death. Sevoflurane anesthesia was well tolerated at all temperatures, with oxygen saturations, end tidal CO2 and blood gases remaining at optimal levels. Compared to controls, sevoflurane exposed brains displayed significant apoptosis in gray and white matter affecting neurons and oligodendrocytes. Mild hypothermia (35-36.5 °C) conferred significant protection from apoptotic brain injury, whereas moderate hypothermia (<35 °C) did not. Hypothermia ameliorates anesthesia-induced apoptosis in the neonatal primate brain within a narrow temperature window (35-36.5 °C). Protection is lost at temperatures below 35 °C. Given the mild degree of cooling needed to achieve significant brain protection, application of our findings to humans should be explored further.

Quantitative ultrasound and apoptotic death in the neonatal primate brain.

Apoptosis is triggered in the developing mammalian brain by sedative, anesthetic or antiepileptic drugs during late gestation and early life. Whether human children are vulnerable to this toxicity mechanism remains unknown, as there are no imaging techniques to capture it. Apoptosis is characterized by distinct structural features, which affect the way damaged tissue scatters ultrasound compared to healthy tissue. We evaluated whether apoptosis, triggered by the anesthetic sevoflurane in the brains of neonatal rhesus macaques, can be detected using quantitative ultrasound (QUS). Neonatal (n = 15) rhesus macaques underwent 5 h of sevoflurane anesthesia. QUS images were obtained through the sagittal suture at 0.5 and 6 h. Brains were collected at 8 h and examined immunohistochemically to analyze apoptotic neuronal and oligodendroglial death. Significant apoptosis was detected in white and gray matter throughout the brain, including the thalamus. We measured a change in the effective scatterer size (ESS), a QUS biomarker derived from ultrasound echo signals obtained with clinical scanners, after sevoflurane-anesthesia in the thalamus. Although initial inclusion of all measurements did not reveal a significant correlation, when outliers were excluded, the change in the ESS between the pre- and post-anesthesia measurements correlated strongly and proportionally with the severity of apoptotic death. We report for the first time in vivo changes in QUS parameters, which may reflect severity of apoptosis in the brains of infant nonhuman primates. These findings suggest that QUS may enable in vivo studies of apoptosis in the brains of human infants following exposure to anesthetics, antiepileptics and other brain injury mechanisms.

Observation of isotropic-isotropic demixing in colloidal platelet-sphere mixtures.

Mixtures of colloids with different sizes and shapes are ubiquitous in nature and industry. The possible existence of isotropic-isotropic (I1-I2) demixing of platelets and spheres remains an open question. Here we present direct experimental evidence of I1-I2 demixing using platelets with a very small thickness-to-diameter ratio mixed with silica spheres at the size ratio q = R(sphere)/R(disk) = 0.0901 ± 0.0004. The platelets cause the isotropic-to-nematic phase transition at a very low volume fraction because of their highly anisometric shape. The presence of silica spheres in the suspension accelerates the phase transition and packs the nematic phase more densely via depletion interaction. Increasing the sphere volume fraction to 0.0014, a tri-phase region emerges. This direct observation of I1-I2 demixing seems to validate the free-volume scaled particle theory and indicates the need for refinement of the fundamental measure density functional theory.

Gelation via ion exchange in discotic suspensions.

The phase behavior of charged disk suspensions displays a strong dependence on ionic strengths, as the interplay between excluded volume and electrostatic interactions determines the formation of glasses, gels, and liquid crystal states. The various ions in natural soil or brine, however, could present additional effects, especially considering that most platelet structures bear a momentous ion-exchange capacity. Here we observed how ion exchange modulates and controls the interaction between individual disks and leads to unconventional phase transitions from isotropic gel to nematic gel and finally to nematic liquid crystals.

Aspect ratio and polydispersity dependence of isotropic-nematic transition in discotic suspensions.

We demonstrate the strong dependency of the isotropic-nematic (I-N) transition of discotic suspensions on the aspect ratio (ξ = thickness/diameter) via control of the sizes of pristine ZrP crystals and subsequent exfoliation to monolayers. The size fractionation of the I-N transition facilitates the analysis of the effect of polydispersity. A systematic variation in the aspect ratio in the low aspect ratio region (0.001 < ξ < 0.01) showed that the I-N transition volume fraction increases with the aspect ratio in agreement with computer simulations. It was found that the transition volume fractions scale with aspect ratio φ_{I,N} = mξ^{1.36±0.07}, where the prefactor m strongly depends on size polydispersity for φ_{N} but does not depend on size polydispersity for φ_{I} with φ_{I} and φ_{N} being the volume fractions of the isotropic and the nematic phases on the cloud curves, respectively.

Hindrance function for sedimentation and creaming of colloidal disks.

We report the first measurement of the hindrance function for sedimentation or creaming of disk-shaped colloids via the analytical centrifugation. Disks align with the external flow right above a volume fraction of a few percent, and this effect is extremely sensitive to the aspect ratio of disks. Due to this alignment effect, disk sedimentation or creaming demonstrates distinct trends in dilute and semidilute regions.

Uniform discotic wax particles via electrospray emulsification.

We present a novel colloidal discotic system: the formation and self-assembling of wax microdisks with a narrow size distribution. Uniform wax emulsions are first fabricated by electrospraying of melt alpha-eicosene. The size of the emulsions can be flexibly tailored by varying the flow rate of the discontinuous phase, its electric conductivity, and the applied voltage. The process of entrainment of wax droplets, vital for obtaining uniform emulsions, is facilitated by the reduction of air-water surface tension and the density of the continuous phase. Then uniform wax discotic particles are produced via phase transition, during which the formation of a layered structure of the rotator phase of wax converts the droplets, one by one, into oblate particles. The time span for the conversion from spherical emulsions to disk particles is linearly dependent on the size of droplets in the emulsion, indicating the growth of a rotator phase from surface to the center is the limiting step in the shape transition. Using polarized light microscopy, the self-assembling of wax disks is observed by increasing disk concentration and inducing depletion attraction among disks, where several phases, such as isotropic, condensed, columnar stacking, and self-assembly of columnar rods are present sequentially during solvent evaporation of a suspension drop.

Thermosensitive hard spheres.

We demonstrate an extension of a UV-Vis spectroscopy method to determine the phase boundaries for thermosensitive colloids as an alternative to the time-consuming sedimentation method. The Bragg attenuation peak from colloidal crystallites was monitored during the quasi-equilibrium colloidal crystal melting. The melting and freezing boundaries of the coexistence region were determined via a blue shift of Bragg's peak and the disappearance of peak area. We confirm this method using poly(N-isopropylacrylamide) (PNIPAM) particles at different charge densities and temperatures far below the lower critical solution temperature. At low pH, the particles behave as thermosensitive hard spheres.

Preclinical model to test human papillomavirus virus (HPV) capsid vaccines in vivo using infectious HPV/cottontail rabbit papillomavirus chimeric papillomavirus particles.

A human papillomavirus (HPV) vaccine consisting of virus-like particles (VLPs) was recently approved for human use. It is generally assumed that VLP vaccines protect by inducing type-specific neutralizing antibodies. Preclinical animal models cannot be used to test for protection against HPV infections due to species restriction. We developed a model using chimeric HPV capsid/cottontail rabbit papillomavirus (CRPV) genome particles to permit the direct testing of HPV VLP vaccines in rabbits. Animals vaccinated with CRPV, HPV type 16 (HPV-16), or HPV-11 VLPs were challenged with both homologous (CRPV capsid) and chimeric (HPV-16 capsid) particles. Strong type-specific protection was observed, demonstrating the potential application of this approach.

Papillomavirus particles assembled in 293TT cells are infectious in vivo.

Papillomaviruses (PVs) demonstrate both tissue and species tropisms. Because PVs replicate only in terminally differentiating epithelium, the recent production of infectious PV particles in 293 cells marks an important breakthrough. In this article, we demonstrate that infectious PV particles produced in 293TT cells can cause papillomatous growths in the natural host animal. Moreover, we show that species-matched PV genomes can be successfully delivered in vivo by a heterologous, species-mismatched PV capsid. Additionally, our results indicate that the addition of the simian virus 40 origin of replication to the papillomavirus genome increases the production of infectious papillomavirus particles by increasing genome amplification in the transfected 293TT cells.

Manejo de abdomen abierto: nuevo concepto en cirugia abdominal / Open abdominal surgery

En los años ochenta, en nuestro país, se describió el uso de la laparostomía como herramienta terapéutica en pacientes con síndrome de compartimento abdominal. En la actualidad es una opción utilizada alrededor del mundo y se conoce como la bolsa de Bogotá. A lo largo de los años, las indicaciones de la laparostomía han aumentado y, entre otras, se encuentran la peritonitis terciaria, la hipertensión abdominal, el control de daños, la 'segunda mirada' y la pancreatitis necrotizante; con el auge de la laparostomía, surgieron también las complicaciones de la misma como son las fístulas intestinales en el abdomen abierto. El cirujano se vio expuesto, además, al reto que constituye el cierre de la eventración producida por la cicatrización de la laparostomía. A continuación se presenta una revisión de la anatomía y fisiología de la cavidad abdominal, así como las indicaciones actuales y las opciones para el manejo del abdomen abierto