Multi-liposomal containers.

Small unilamellar liposomes, 40-60 nm in diameter, composed of anionic diphosphatidylglycerol (cardiolipin, CL(2-)) or phosphatidylcerine (PS(1-)) and zwitter-ionic egg yolk lecithin (EL) or dipalmitoylphosphatidylcholine (DPPC), electrostatically complex with polystyrene microspheres, ca. 100 nm in diameter, grafted by polycationic chains ("spherical polycationic brushes", SPBs). Polymer/liposome binding studies were carried out using electrophoretic mobility (EPM), dynamic light scattering (DLS), fluorescence, conductometry, differential scanning calorimetry (DSC), and cryogenic transmission electron microscopy (cryo-TEM) as the main analytical tools. By these means a remarkably detailed picture emerges of molecular events inside a membrane. The following are among the most important conclusions that arose from the experiments: (a) binding of liposomes to SPBs is accompanied by flip-flop of anionic lipids from the inner to the outer leaflet of the liposomal membrane along with lateral lipid segregation into "islands". (b) The SPB-induced structural reorganization of the liposomal membrane, together with the geometry of anionic lipid molecules, determines the maximum molar fraction of anionic lipid (a key parameter designated as ν) that ensures the structural integrity of liposomes upon complexation: ν=0.3 for liposomes with conically-shaped CL(2-) and ν=0.5 for liposomes with anionic cylindrically-shaped PS(1-). (c) The number of intact liposomes per SPB particle varies from 40 for (ν=0.1) to 13 (ν=0.5). (d) By using a mixture of liposomes with variety of encapsulated substances, multi-liposomal complexes can be prepared with a high loading capacity and a controlled ratio of the contents. (e) In order to make the mixed anionic liposomes pH-sensitive, they are additionally modified by 30 mol% of a morpholinocyclohexanol-based lipid that undergoes a conformational flip when changing pH. Being complexed with SPBs, such liposomes rapidly release their contents when the pH is reduced from 7.0 to 5.0. The results allow loaded liposomes to be concentrated within a rather small volume and, thereby, the preparation of multi-liposomal containers of promise in the drug delivery field.

Cryogenic-temperature electron microscopy direct imaging of carbon nanotubes and graphene solutions in superacids.

Cryogenic electron microscopy (cryo-EM) is a powerful tool for imaging liquid and semiliquid systems. While cryogenic transmission electron microscopy (cryo-TEM) is a standard technique in many fields, cryogenic scanning electron microscopy (cryo-SEM) is still not that widely used and is far less developed. The vast majority of systems under investigation by cryo-EM involve either water or organic components. In this paper, we introduce the use of novel cryo-TEM and cryo-SEM specimen preparation and imaging methodologies, suitable for highly acidic and very reactive systems. Both preserve the native nanostructure in the system, while not harming the expensive equipment or the user. We present examples of direct imaging of single-walled, multiwalled carbon nanotubes and graphene, dissolved in chlorosulfonic acid and oleum. Moreover, we demonstrate the ability of these new cryo-TEM and cryo-SEM methodologies to follow phase transitions in carbon nanotube (CNT)/superacid systems, starting from dilute solutions up to the concentrated nematic liquid-crystalline CNT phases, used as the 'dope' for all-carbon-fibre spinning. Originally developed for direct imaging of CNTs and graphene dissolution and self-assembly in superacids, these methodologies can be implemented for a variety of highly acidic systems, paving a way for a new field of nonaqueous cryogenic electron microscopy.

Hydrogels from phospholipid vesicles.

It is shown that phospholipid dispersions with a few percent of diacylphosphocholine PC in water can be swollen to single-phase lyotropic liquid crystalline Lα-phases by the addition of co-solvents like glycerol, 1,3-butyleneglycol BG or 1,2-propyleneglycol PG. The birefringent Lα-phases contain small unilamellar and multilamellar vesicles if the temperature of the samples is above the Krafft-Temperature Tm of the phospholipid. When such transparent birefringent viscous samples are cooled down below Tm the samples are transformed into birefringent gels. Cryo-TEM and FF-TEM measurements show that the bilayers of the vesicles are transformed from the liquid to the crystalline state during the transformation while the vesicle structure remains. The bilayers of the crystalline vesicles form adhesive contacts in the gel. Pulsed-field gradient NMR measurements show that two different kinds of water or co-solvent can be distinguished in the gels. One type of solvent molecules can diffuse like normal solvent in a continuous bulk phase. A second type of water diffuses much more slowly. This type of solvent is obviously trapped in the vesicles. The permeability of the crystalline vesicles for water and solvent molecules is much lower in the crystalline state than in the fluid state. Maximum swelling of the diacylphosphocholin dispersions occurs when the refractive index of the solvent is matched to the refractive index of the bilayers. The attraction between the bilayers is at a minimum in this state and the liquid crystalline Lα-phase's undulation forces between the bilayers push the bilayers apart. On transformation to the gel state the crystalline bilayers assume a high elastic bending rigidity. Undulations of the bilayers are now suppressed, and the bilayers can form adhesive contacts. Oscillating rheological measurements show that the gels with only 1% of phospholipids can have a storage modulus of 1000Pa. The gels are very brittle. They break when they are deformed by a few percent.

Complexes between anionic liposomes and spherical polycationic brushes. An assembly of assemblies.

This paper has at its objective the assembling of liposomal assemblies onto nanoparticles. In this manner, one generates nanoparticles with a high loading capacity. Thus, spherical spherical polycationic "brushes" (SPBs) were synthesized by graft polymerizing a cationic monomer, (trimethylammonium)ethylmethacrylate chloride, onto the surface of monodisperse polystyrene particles, ca. 100 nm in diameter. These particles were complexed with small unilamellar anionic liposomes, 40-60 nm in diameter, composed of egg lecithin (EL) and anionic phosphatidylserine (PS(1-)) in PS(1-)/EL ratios from 0.10 to 0.54, a key parameter designated as ν. These complexes were then characterized according to electrophoretic mobility, dynamic light scattering, conductivity, fluorescence, and cryogenic transmission electron microscopy, with the following main conclusions: (a) All added liposomes are totally associated with SPBs up to a certain saturation concentration (specific for each ν value). (b) The number of liposomes per SPB particle varies from 40 (ν = 0.1) to 14 (ν = 0.5). (c) At sufficiently high liposome concentrations, the SPBs experience an overall change from positive to negative charge. (d) SPB complexes tend to aggregate when their initial positive charge has been precisely neutralized by the anionic liposomes. Aggregation is impeded by either positive charge at lower lipid concentrations, or negative charge at higher lipid concentrations. (e) The liposomes remain intact (i.e., do not leak) when associated with SPBs, at ν ≤ 0.5. (f) Complete SPB/liposome dissociation occurs at external [NaCl] = 0.3 M for ν = 0.1 and at 0.6 M for ν = 0.5. Liposomes with ν = 0.54 do not dissociate from the SPBs even in NaCl solutions up to 1.0 M. (g) Complexation of the PS(1-)/EL liposomes to the SPBs induces flip-flop of PS(1-) from the inner leaflet to the outer leaflet. (h) The differences in the ability of PS(1-) (a cylindrical lipid) and CL(2-) (a conical lipid) to create membranes defects are attributed to geometric factors.

Cryo-SEM specimen preparation under controlled temperature and concentration conditions.

Cryogenic temperature scanning electron microscopy (cryo-SEM) is an excellent technique for imaging liquid and semi-liquid materials of high vapour pressure, which are highly viscous or contain large (>0.5 µm) aggregates, in which nanometric details are to be studied. However, so far there have been no adequate tools for controlled cryo-specimen preparation. The specimen preparation stage is critical, because most of those samples are very sensitive to concentration and temperature changes, leading to nanostructural artefacts in the specimens. We designed and built a system for easy and reliable cryo-SEM specimen preparation under controlled conditions of fixed temperature and humidity. We describe this new methodology, and demonstrate its applicability, by showing imaging data of three liquid material systems. We have studied carbon nanotubes (CNTs) dispersions in superacid. We also characterized a number of systems made of water/isooctane/nonionic and cationic surfactant that showed different microemulsion phases as function of the system composition and temperature. In all of the examples given, we demonstrate artefact- and contamination-free specimens, which have preserved their native nanostructure. Our new system paves the way for a new methodology for the newly emerging field of cryo-SEM.

Microemulsions with a HIPME (high internal phase microemulsion) structure.

We report a phase diagram for a novel microemulsion that consists of oil and water and of 15% of a surfactant mixture of an anionic and a nonionic surfactant. The phase diagram shows an optically isotropic channel that passes from the water-rich side to the oil-rich side. In contrast to the isotropic channel in microemulsions of nonionic surfactants, the reported system undergoes an abrupt transition of the structure in the isotropic channel with increasing oil content. The structural transition is reflected in the conductivity and the viscosity of the channel. Between the L(3) phase and the sample with 6% of oil the conductivity decreases 3 orders of magnitude. Thus, the bicontinuous structure at the origin of the channel transforms already with 6% of oil to a w/o structure. The viscosity shows a strong maximum at the transition. The w/o structures with low oil content were successful directly imaged by cryo-TEM. It can be seen that water is contained inside a polyhedral foam-like structure, where the polyhedral film is formed of the oil and the surfactant. The dimensions of the polyhedra are in the range of 20-100 nm. We call this structure "high internal phase microemulsion" (HIPME).

Nanostructures formed by self-assembly of negatively charged polymer and cationic surfactants.

The formation of nanoparticles by interaction of an anionic polyelectrolyte, sodium polyacrylate (NaPA), was studied with a series of oppositely charged surfactants with different chain lengths, alkyltrimethylammonium bromide (CnTAB). The binding and formation of nanoparticles was characterized by dynamic light scattering, zeta-potential, and self-diffusion NMR. The inner nanostructure of the particles was observed by direct-imaging cryogenic-temperature transmission electron microscopy (cryo-TEM), indicating aggregates of hexagonal liquid crystal with nanometric size.

Spontaneous formation of bilayers and vesicles in mixtures of single-chain alkyl carboxylates: effect of pH and aging and cytotoxicity studies.

We report the observation of bilayer fragments, some of which close to form vesicles, over a large range of pH at room temperature from mixtures of single-chain biocompatible commercially available nontoxic alkyl carboxylic surfactants after neutralization with HCl. The pH at which the morphological transitions occur is varied only by changing the ratio between two surfactants: the alkyloligoethyleneoxide carboxylate and sodium laurate. The effect of aging of the mixed surfactant systems in the pH region desired for dermatologic application (4.5 < pH < 7) is also studied. Finally, we show results of cytotoxicity studies on the surfactant mixtures.

Phase behavior of aqueous mixtures of 2-phenylbenzimidazole-5-sulfonic acid and cetyltrimethylammonium bromide: hydrogels, vesicles, tubules, and ribbons.

We studied the phase behavior and aggregation in mixed aqueous solutions of the anionic UV-absorber 2-phenylbenzimidazole-5-sulfonic acid sodium salt, PhBSA (Na salt), and the cationic surfactant cetyltrimethylammonium bromide, CTAB. The mixtures of the two components behave similarly to catanionic surfactant mixtures. The samples on the PhBSA-rich side have low viscosity and are turbid. The turbidity, due to uni- and multilamellar vesicles (SUVs and MLVs), increases with the mole ratio of CTAB. The interbilayer distance inside the MLV changes with the mole ratio of the two components from a few 10 nm for the 7:3 (molar ratio of PhBSA, Na salt, to CTAB) system to practically zero for the 5:5 mixture. The latter mixture forms a precipitate within less than 1 h. With the exception of the 5:5 mixture, all samples on the PhBSA-rich side are stable for many days. After that period, within one more day, the turbid vesicle phases are transformed into more or less clear hydrogels. We found that the gelation is due to the formation of very long stiff tubules about 14 nm in diameter, which is independent of the mixing ratio of the samples. The hydrogels and the tubules melt around 45 degrees C. On the CTAB-rich side, the 4:6 sample behaves like the 6:4 sample, whereas at 3:7 a precipitate was found to form shortly after mixing. At still smaller PhBSA (Na salt) to CTAB ratios, only clear, viscoelastic solutions are found that do not change with time. We determined the micellar structures in the samples by cryo-TEM and by SAXS. The rheological properties of the hydrogels and of the viscoelastic samples were characterized by oscillating rheological measurements. DSC measurements indicated that the tubules are in a semicrystalline state and melt at around 45 degrees C. The semicrystalline bilayer of the tubules seems to have a 1:1 composition of PhBSA to CTAB. The excess PhBSA seems to be adsorbed on the tubules. It is assumed that the stiffness of the bilayer of the vesicles and the stiffness of the tubules are due to the stiffness of the PhBSA molecule.

Structural and dynamical properties of ribbonlike self-assemblies of a fluorinated cationic surfactant.

The structural and dynamic properties of low ionic strength micellar solutions of the cationic surfactant perfluorooctylbutane trimethylammonium bromide have been investigated by cryo-TEM, small-angle neutron scattering, small-angle X-ray scattering, T-jump and rheological experiments. The surfactant molecules self-assemble into narrow ribbons with average dimensions on the order of 4 nm x 3 nm, either under salt-free conditions or in the presence of up to 30 mM KBr or NaF. Cryo-TEM also reveals in the salt-free systems the presence of networks of multiconnected micelles. Rheological experiments showed that these surfactant systems exhibit a strong shear-thickening effect even in the presence of up to 30 mM KBr. The T-jump response of the micellar solutions was found to be multiexponential. This observation rules out the presence of only linear micelles with an exponential length distribution and suggests more complex topologies of the micellar aggregates. The relaxation time associated with the predominant process in the T-jump relaxation is strongly correlated to the critical shear rate beyond which shear thickening occurs, thus indicating that this critical shear rate is controlled by the micellar kinetics.

Effect of the spacer length on the association and adsorption behavior of dissymmetric gemini surfactants.

A series of dissymmetric gemini surfactants with the general formula [C12H25(CH3)2N(CH2)sN(CH3)2C14H29]Br2 designed as 12-s-14, where s=2, 6, and 10, were synthesized and their physicochemical properties investigated. The effect of spacer length on Krafft temperature, adsorption at the air/solution interface, and association in aqueous solution was studied by tensiometry, conductometry, and cryo-transmission electron microscopy. The Krafft temperature was found to increase linearly with spacer length. In the submicellar concentration range the dissymmetric 12-s-14 surfactants display ion pairing and premicellar association. Adsorption at air/solution interfaces and micellization in aqueous solution are similar to the behavior of their symmetric counterparts and depend strongly on spacer length.

Microstructural characterization of micro- and nanoparticles formed by polymer-surfactant interactions.

We have studied the nano- and microparticles formed by complexation of PDAC [poly(diallyldimethyl-ammoniumchloride)] and SDS (sodium dodecyl sulfate). The complexation phenomenon was characterized by light scattering and zeta-potential measurements. The nature of the complexes was revealed by direct-imaging cryogenic temperature transmission electron microscopy (cryo-TEM), showing nanometric details of the complexes formed around the point of neutralization. The images also reveal how those aggregates are solubilized by excess surfactant, first into faceted particles with threadlike micelles attached to their surfaces, prior to complete solubilization, then into lacelike aggregates, and finally into spheroidal micelles. The nanostructure of the complexes strongly suggests they are made of a hexagonal liquid crystalline phase. This was further supported by small-angle X-ray scattering (SAXS).

Microscopics of complexation between long DNA molecules and positively charged colloids.

Extensive atomic force and electron microscopy reveal a new, generic DNA-colloid complex with a fixed number of DNA bases per colloid. The fiber shaped complex is stable in the presence of excess colloids in the solution. As more DNA is added to the solution and the ratio between colloids and DNA approaches the fiber's stoichiometry, the system undergoes a sharp coagulation transition. The system is restabilized at even higher DNA concentrations through localization of small colloid clusters on extensive DNA networks.

[Verrucous carcinoma of the nose and maxillary sinus].

Verrucous carcinoma is a rare type of squamous cell carcinoma that is most commonly seen in the oral cavity, and seldom in the larynx. It should be distinguished from benign papilloma, verrucous hyperplasia and well-differentiated non verrucous squamous cell carcinoma. Verrucous carcinoma is a rare tumor of the sinonasal tract. Only 28 such cases have been described in the medical literature reviewed until this time. We describe the first case in Israel of a patient with such a tumor in the nasal cavity. We reviewed the existing literature dealing with Verrucous Carcinoma of paranasal sinuses.

Medium-term middle ear ventilation with self-manufactured polyethylene T-tubes for the treatment of children with middle ear effusion.

We present the results of the insertion of self-made polyethylene T-tubes for a period of 15-24 months for the treatment of chronic middle-ear effusion. We compare the outcome of our patients to the reported outcome of patients treated with other commonly used ventilation tubes for either shorter or longer periods of time. In a retrospective review of 603 T-tubes inserted in 306 children up to the age of 12 years, charts were reviewed for age, sex, surgical procedure performed, duration of ventilation and complications. In all cases the indication for surgery was chronic middle-ear effusion. The tubes were electively removed by the authors after 15-24 months of ventilation. Spontaneous extrusion was considered a complication. The mean period of ventilation was 20 months. Post-operative otorrhoea was experienced in 6.6 per cent of ears; 4.8 per cent of tubes extruded spontaneously, whereas 3.15 per cent had to be removed earlier than originally planned; 4.9 per cent of ears were re-ventilated at a later date, and 1.49 per cent of ears developed a persistent perforation. We demonstrate that the outcome of patients treated with our self-manufactured tubes for a period of 15-24 months is, in many respects, better or at least comparable to the reported outcome of patients treated with other commonly used ventilation tubes for either shorter or longer periods of time, and that the many complications associated with the conventional T-tube can be reduced. We suggest that our favourable outcome may be due to the duration of ventilation, which was controlled to be shorter than the conventional long-term T-tubes and longer than that of grommets.

Vascular transformation of lymph node sinuses.

Vascular transformation of lymph node sinuses is an uncommon condition and only isolated cases have been reported. It is characterized by conversion of nodal sinuses into capillary-like channels, often accompanied by fibrosis. Venous or lymphatic obstruction is thought to be the underlying mechanism, and in most cases factors that may contribute to lymphovascular obstruction can be identified such as tumour in the vicinity, vascular thrombosis, heart failure, previous surgery or radiotherapy. Most cases involve abdominal lymph nodes, and head and neck involvement is rare. We present two cases of vascular transformation of lymph node sinuses presenting only as cervical lymphadenopathy, without an obvious cause of lymphovascular obstruction.

Phase behavior, DNA ordering, and size instability of cationic lipoplexes. Relevance to optimal transfection activity.

Mechanisms of cationic lipid-based nucleic acid delivery are receiving increasing attention, but despite this the factors that determine high or low activity of lipoplexes are poorly understood. This study is focused on the fine structure of cationic lipid-DNA complexes (lipoplexes) and its relevance to transfection efficiency. Monocationic (N-(1-(2,3-dioleoyloxy)propyl),N,N,N-trimethylammonium chloride, N-(1-(2,3-dimyristyloxypropyl)-N,N-dimethyl-(2-hydroxyethyl)ammonium bromide) and polycationic (2,3-dioleyloxy-N-[2(sperminecarboxamido)ethyl]-N,N-dimethyl-1-propanammonium trifluoroacetate) lipid-based assemblies, with or without neutral lipid (1,2-dioleoyl-sn-glycero-3-phosphatidylethanolamine, 1,2-dioleoyl-sn-glycero-3-phosphatidylcholine, cholesterol) were used to prepare lipoplexes of different L(+)/DNA(-) charge ratios. Circular dichroism, cryogenic-transmission electron microscopy, and static light scattering were used for lipoplex characterization, whereas expression of human growth hormone or green fluorescent protein was used to quantify transfection efficiency. All monocationic lipids in the presence of inverted hexagonal phase-promoting helper lipids (1,2-dioleoyl-sn-glycero-3-phosphatidylethanolamine, cholesterol) induced appearance of Psi(-) DNA, a chiral tertiary DNA structure. The formation of Psi(-) DNA was also dependent on cationic lipid-DNA charge ratio. On the other hand, monocationic lipids either alone or with 1,2-dioleoyl-sn-glycero-3-phosphatidylcholine as helper lipid, or polycationic 2,3-dioleyloxy-N-[2(sperminecarboxamido)ethyl]-N,N-dimethyl-1-propanammonium trifluoroacetate-based assemblies, neither of which promotes a lipid-DNA hexagonal phase, did not induce the formation of Psi(-) DNA. Parallel transfection studies reveal that the size and phase instability of the lipoplexes, and not the formation of Psi(-) DNA structure, correlate with optimal transfection.

Formation of complement-activating particles in aqueous solutions of Taxol: possible role in hypersensitivity reactions.

We reported earlier that the anticancer drug paclitaxel (Taxol) activated the complement (C) system in human serum in vitro, raising the possibility that C activation might play a role in the ill-understood hypersensitivity reactions (HSRs) to this drug [J. Natl. Cancer Inst. 90 (1998) 300]. In pursuing the mechanism of C activation by Taxol, the present study provided evidence that dilution of the injection concentrate in aqueous solvents led to the formation of micelles and needle-like structures, both of which caused C activation in vitro. Micelles were formed mainly from Cremophor EL (CrEL), the nonionic emulsifier vehicle of paclitaxel, whose level in Taxol infusion exceeded its critical micelle concentration by at least 400-fold. CrEL micelles were shown by quasi-elastic light scattering and cryo-transmission electron microscopy (cryo-TEM) to be spherical with diameters in the 8-22 nm range; however, de novo formation of 50-300 nm microdroplets following incubation with human plasma suggested further fundamental structural transformation in blood. The needle-like structures extended to the multimicron range and were shown by electron diffraction to be crystalline paclitaxel. Taxol-induced C activation was manifested in varying rises of serum C3a-desarg, iC3b and SC5b-9. The causal role of CrEL micelles in C activation was demonstrated by the fact that filtration of aqueous solutions of Taxol or pure CrEL via 30-kDa cutoff filters eliminated, while the filter retentate restored C activation. C activation by Taxol was also inhibited by 10 mg/ml human immunoglobulin (IVIG). If proven clinically, HSRs to Taxol may represent a hitherto vaguely classified adverse drug reaction recently called C activation-related pseudoallergy (CARPA) [Circulation 99 (1999) 2302].

Self-made tooth guard using Turbocast.

Tooth protection during suspension microlaryngeal surgery is a challenge when teeth are damaged or missing. We present an effective, disposable and cheap tooth guard for microlaryngeal surgical procedures using Turbocast. The tooth guard transits the laryngoscope's pressure directly to the hard palate leaving the teeth uninvolved and free of any pressure.

Total inferior turbinectomy: operative results and technique.

The internal nasal structures, including the turbinates, regulate the nasal airflow. The surgical treatment of turbinate hypertrophy remains controversial. A wide variety of surgical procedures is performed, with universally unsatisfactory results. Interference with nasal physiology and possible postoperative complications have been the main reasons for the objection to total inferior turbinectomy. Over a 6-year period, 357 total inferior bilateral turbinectomies were performed at our institution. We present the results of these procedures and describe our surgical technique. We conclude that even in a hot and dusty climate, total inferior turbinectomy is an effective and relatively safe procedure.