Finding the Right Balance: Partial REBOA in a Swine Model of Uncontrolled Vascular Injury.

BACKGROUND: We have previously shown that partial REBOA (pREBOA) deployment in the thoracic aorta is safe for 2 to 4 hours, but it is unclear whether the distal blood flow after partial aortic occlusion would lead to ongoing hemorrhage. The objective of this study was to evaluate the hemostatic efficacy of pREBOA in a model of uncontrolled vascular injury. STUDY DESIGN: Female Yorkshire swine (n = 10, 40 to 45 kg) were anesthetized and instrumented. A through-and-through injury was created in the common iliac artery. The animals were randomly assigned to: (1) pREBOA-PRO deployment after 3 minutes and (2) control. Both groups were given normal saline resuscitation for hypotension. The pREBOA was adjusted to partial occlusion (distal mean arterial pressure of 30 mmHg), and then left without titration for 2 hours. Then, fresh frozen plasma was transfused and the vessel repaired. The balloon was deflated and the animals were monitored for 2 hours. In the critical care period, 2 L of normal saline was infused, norepinephrine was given for mean arterial pressure ≤55, and electrolytes and acidosis were corrected. Organs were examined for gross and histologic evidence of ischemic injuries. The primary endpoint was post-inflation blood loss. RESULTS: All the pREBOA animals survived until the end, whereas control animals had a mean survival time of 38.2 minutes (p < 0.05). The pREBOA group showed significantly less bleeding after balloon deployment (93.8 vs 1,980.0 mL, p < 0.05), and had appropriate lactate clearance, with minimal histologic distal organ ischemia. CONCLUSIONS: Partial aortic occlusion with the newly designed balloon can achieve the desired balance between effective hemorrhage control and adequate distal flow, without a need for ongoing balloon titration.

A brain atlas for the camouflaging dwarf cuttlefish, Sepia bandensis.

The coleoid cephalopods (cuttlefish, octopus, and squid) are a group of soft-bodied marine mollusks that exhibit an array of interesting biological phenomena, including dynamic camouflage, complex social behaviors, prehensile regenerating arms, and large brains capable of learning, memory, and problem-solving.1,2,3,4,5,6,7,8,9,10 The dwarf cuttlefish, Sepia bandensis, is a promising model cephalopod species due to its small size, substantial egg production, short generation time, and dynamic social and camouflage behaviors.11 Cuttlefish dynamically camouflage to their surroundings by changing the color, pattern, and texture of their skin. Camouflage is optically driven and is achieved by expanding and contracting hundreds of thousands of pigment-filled saccules (chromatophores) in the skin, which are controlled by motor neurons emanating from the brain. We generated a dwarf cuttlefish brain atlas using magnetic resonance imaging (MRI), deep learning, and histology, and we built an interactive web tool (https://www.cuttlebase.org/) to host the data. Guided by observations in other cephalopods,12,13,14,15,16,17,18,19,20 we identified 32 brain lobes, including two large optic lobes (75% the total volume of the brain), chromatophore lobes whose motor neurons directly innervate the chromatophores of the color-changing skin, and a vertical lobe that has been implicated in learning and memory. The brain largely conforms to the anatomy observed in other Sepia species and provides a valuable tool for exploring the neural basis of behavior in the experimentally facile dwarf cuttlefish.

Monitoring Canine Myocardial Infarction Formation and Recovery via Transthoracic Cardiac Strain Imaging.

Myocardial elastography (ME) is an ultrasound-based strain imaging method that aims to determine the degree of ischemia or infarction as a result of the change in the elastic properties of the myocardium. A survival canine model (n = 11) was employed to investigate the ability of ME to image myocardial infarction formation and recovery. Infarcts were generated by ligation of the left anterior descending coronary artery. Canines were survived and imaged for 4 days (n = 7) or 4 weeks (n = 4), allowing sufficient time for recovery via collateral perfusion. A radial strain-based metric, percentage of healthy myocardium by strain (PHMε), was developed as a marker for healthy myocardial tissue. PHMε was strongly linearly correlated with actual infarct size as determined by gross pathology (R2 = 0.80). Mean PHMε was reduced 1-3 days post-infarction (p < 0.05) at the papillary and apical short-axis levels; full infarct recovery was achieved by day 28, with mean PHMε returning to baseline levels. ME was capable of diagnosing individual myocardial segments as non-infarcted or infarcted with high sensitivity (82%), specificity (92%) and precision (85%) (area under the receiver operating characteristic curve = 0.90). The study therefore strengthens the ME premise that it can detect and assess myocardial infarction progression and recovery in vivo and could thus provide an important role in both disease diagnosis and treatment assesssment.

Assessment of a Noninvasive Chronic Glucose Monitoring System in Euglycemic and Diabetic Swine (Sus scrofa).

Models of type-I diabetes are well-characterized and commonly used in the preclinical evaluation of drugs and medical devices. The diabetic minipig is an excellent example of a translational model. However, chronic glucose monitoring in this species can be challenging; frequent blood sampling can be technically difficult and poorly tolerated in conscious swine. Skin-patch continuous blood glucose monitors are FDA-approved for human use and offer a potential refinement to cageside blood collection. However, this modality has not been evaluated in pigs. In this study, young adult male STZ-induced diabetic Yucatan minipigs (n = 4) and healthy York pigs (n = 4) were implanted with a 14-d skin-patch continuous glucose monitor. Readings from continuous glucose monitors were time-matched to whole blood samples, with glucose measurements performed using point-of-care blood glucose monitors, serum chemistry or both. The aims of the study were to assess if a continuous glucose monitoring system could accurately detect glucose levels in swine, and to compare the readings toboth point-of-care glucometers and serum chemistry results. We hypothesized that a continuous glucose monitoring system would accurately detect glucose levels in swine in comparison with a validated analyzer and could serve as an animal welfarerefinement for studies of diabetes. We found that the continuous glucose monitor used in this study provided an adequateadjunct for clinical management in the stable diabetic pig and a minimally invasive and inexpensive option for colony maintenanceof chronically diabetic swine.

Increased microbiome diversity at the time of infection is associated with improved growth rates of pigs after co-infection with porcine reproductive and respiratory syndrome virus (PRRSV) and porcine circovirus type 2 (PCV2).

Porcine reproductive and respiratory syndrome virus (PRRSV) and porcine circovirus type 2 (PCV2) are two of the most important pathogens affecting the swine industry worldwide. Co-infections are common on a global scale, resulting in pork production losses through reducing weight gain and causing respiratory disease in growing pigs. Our initial work demonstrated that the fecal microbiome was associated with clinical outcome of pigs 70days post-infection (dpi) with PRRSV and PCV2. However, it remained uncertain if microbiome characteristics could predispose response to viral infection. The purpose of this study was to determine if microbiome characteristics present at the time of virus exposure were associated with outcome after co-infection. Using the Lawrence Livermore Microbial Detection Array, we profiled the microbiome in feces prior to infection from pigs identified retrospectively as having high or low growth rates after co-infection. High growth rate pigs had less severe interstitial pneumonia, reduced virus replication, and a significant increase in average daily weight gain throughout the study. At the level of the fecal microbiome, high growth rate pigs had increased microbial diversity on both a family and species level. Shifts in the microbiome composition of high growth rate pigs included reduced Methanobacteriaceae species, increased Ruminococcaceae species, and increased Streptococcaceae species when compared to low growth rate pigs. The results indicate that both microbiome diversity and composition at the time of virus exposure may play a role in the subsequent response of pigs to PRRSV/PCV2 co-infection.