Correlation of light microscopic findings with transmission electron microscopy within a vascular occlusion device.

Host response to an implanted biomaterial is a complex process involving microscopic changes in extracellular matrix (ECM) composition. Reliable pathology analysis is imperative for accurate assessment of the tissue response to an implanted device. Plastic histology is commonly used for histology evaluation of medical devices to assess the device-tissue interface; however, this technique is prone to variable staining that can confound histology interpretation. Appropriately, we propose using transmission electron microscopy (TEM) to confirm histologic ECM findings in order to provide sufficient host-response data. Tissue response to an absorbable shape memory polymer intravascular occlusion device with a nitinol wire backbone was evaluated. Representative plastic-embedded, micro-ground sections from 30-day, 60-day, and 90-day timepoints were analyzed. ECM regions were selected, and ultrathin sections were created for TEM evaluation. Histological changes in ECM composition were compared for light microscopy (LM) and TEM findings; specifically, TEM fibrillary patterns for collagen and fibrin were used to confirm LM results. Throughout this study, LM reveals inconsistent staining in plastic-embedded sections. TEM, on the other hand, provides clear insight into the tissue response by morphologically discerning distinct fibrillary patterns within ECM structures; loose to dense collagen surrounds the implant as fibrin degrades, demonstrating progression of postimplant ECM maturation. Moreover, TEM serves as a definitive method for confirming tissue substrate morphology when LM findings prove ambiguous.

Polyurethane Microparticles for Stimuli Response and Reduced Oxidative Degradation in Highly Porous Shape Memory Polymers.

Shape memory polymers (SMPs) have been found to be promising biomaterials for a variety of medical applications; however, the clinical translation of such technology is dependent on tailorable properties such as gravimetric changes in degradation environments. For SMPs synthesized from amino-alcohols, oxidation resulting in rapid mass loss may be problematic in terms of loss of material functionality as well as toxicity and cytocompatibility concerns. Control of gravimetric changes was achieved through the incorporation of small molecule antioxidants, either directly into the polymer matrix or included in microparticles to form a SMP composite material. With direct incorporation of small molecule phenolic antioxidant 2,2'-methylenebis(6- tert-butyl)-methylphenol (Methyl), SMPs displayed reduce strain recovery by more than 50% (Methyl) and increase elastic modulus from approximately 1.4 to 2.3 MPa, at the expense of the strain to failure being reduced from 45% to 32%. Importantly, such changes could not ensure retention of the antioxidants and therefore did not increase oxidative stability beyond 15 days in accelerated oxidative conditions (equivalent to approximately 800 days in porcine aneurysms) in all cases except for the inclusion of a hindered amine that capped network growth, which also resulted in shape memory reduction (only 80% recoverable strain achieved). However, the inclusion of antioxidants in microparticles was found to produce materials with similar thermomechanical ( Tg migration below 1.0 °C) and shape recovery of 100%, while increasing oxidative resistance compared to controls (oxidation onset was delayed by 3 days and material lifespan increased to approximately 20-22 days in accelerated oxidative solution or beyond 1000 days in the porcine aneurysm). The microparticle composite SMPs also act as a platform for environmental sensing, such as pH-dependent fluorescence shifts and payload release, as demonstrated by fluorescent dye studies using phloxine B and nile blue chloride and the release of antioxidants over a 3 week period. The use of polyurethane-urea microparticles in porous SMPs is demonstrated to increase biostability of the materials, by approximately 25%, and ultimately extend their lifespan for use in aneurysm occlusion as determined through calculated in vivo degradation rates corresponding to a porcine aneurysm environment.

Perceptions of transcatheter device closure of patent ductus arteriosus in veterinary cardiology and evaluation of a canine model to simulate device placement: a preliminary study.

OBJECTIVES: The purpose of this study was to evaluate a canine patent ductus arteriosus (PDA) model developed for practicing device placement and to determine practices and perceptions regarding transcatheter closure of PDA from the veterinary cardiology community. METHOD: A silicone model was developed from images obtained from a dog with a PDA and device placement was performed with catheter equipment and a document camera to simulate fluoroscopy. A total of 36 individuals including 24 diplomates and 12 residents participated, and the feedback was obtained. The study included an initial questionnaire, practice with the model, observation of device placement using the model, and a follow-up questionnaire. RESULTS: A total of 92% of participants including 100% of residents indicated they did not have the opportunity to practice device placement before performing the procedure and obtained knowledge of the procedure from reading journal articles or observation. Participants indicated selecting the appropriate device size (30/36, 83%) and ensuring the device is appropriately positioned before release (18/36, 50%) as the most common areas of difficulty with device placement. Confidence level was higher after practicing with the model for residents when compared with diplomates and for participants that had performed 1-15 procedures when compared with those that had performed >15 procedures. These findings suggest those that have performed fewer procedures may benefit the most from practicing with a model. CONCLUSIONS: This preliminary study demonstrates the feasibility of a PDA model for practicing device placement and suggests that there is a potential benefit from providing additional training resources.

Shape memory polymers with enhanced visibility for magnetic resonance- and X-ray imaging modalities.

Currently, monitoring of minimally invasive medical devices is performed using fluoroscopy. The risks associated with fluoroscopy, including increased risk of cancer, make this method especially unsuitable for pediatric device delivery and follow-up procedures. A more suitable method is magnetic resonance (MR) imaging, which makes use of harmless magnetic fields rather than ionizing radiation when imaging the patient; this method is safer for both the patient and the performing technicians. Unfortunately, there is a lack of research available on bulk polymeric materials to enhance MR-visibility for use in medical devices. Here we show the incorporation of both physical and chemical modifying agents for the enhancement of both MR and X-ray visibility. Through the incorporation of these additives, we are able to control shape recovery of the polymer without sacrificing the thermal transition temperatures or the mechanical properties. For long-term implantation, these MR-visible materials do not have altered degradation profiles, and the release of additives is well below significant thresholds for daily dosages of MR-visible compounds. We anticipate our materials to be a starting point for safer, MR-visible medical devices incorporating polymeric components. STATEMENT OF SIGNIFICANCE: Shape memory polymers (SMPs) are polymeric materials with unique shape recovery abilities that are being considered for use in biomedical and medical device applications. This paper presents a methodology for the development of MR and X-ray visible SMPs using either a chemically loaded or physical loaded method during polymer synthesis. Such knowledge is imperative for the development and clinical application of SMPs for biomedical devices, specifically for minimally-invasive vascular occlusion treatments, and while there are studies pertaining to the visibility of polymeric particles, little work has been performed on the utility of biomaterials intended for medical devices and the impact of how adding multiple functionalities, such as imaging, may impact material safety and degradation.

Shape memory polymers with visible and near-infrared imaging modalities: Synthesis, characterization and in vitro analysis.

Shape memory polymers (SMPs) are promising for non-invasive medical devices and tissue scaffolds, but are limited by a lack of visibility under clinical imaging. Fluorescent dyes are an alternative to radiocontrast agents in medical applications, they can be utilized in chemical sensors and monitors and may be anti-microbial agents. Thus, a fluorescent SMP could be a highly valuable biomaterial system. Here, we show that four fluorescent dyes (phloxine B (PhB), eosin Y (Eos), indocyanine green(IcG), and calcein (Cal)) can be crosslinked into the polymer backbone to enhance material optical properties without alteration of shape memory and thermomechanical properties. Examinations of the emission wavelengths of the materials compared with the dye solutions showed a slight red shift in the peak emissions, indicative of crosslinking of the material. Quantitative analysis revealed that PhB enabled visibility through 1 cm of blood and through soft tissue. We also demonstrate the utility of these methods in combination with radio-opaque microparticle additives and the use of laser-induced shape recovery to allow for rapid shape recovery below the glass transition temperature. The crosslinking of fluorescent dyes into the SMP enables tuning of physical properties and shape memory and independently of the fluorescence functionality. This fluorescent SMP biomaterial system allows for use of multiple imaging modalities with potential application in minimally invasive medical devices.

A shape memory foam composite with enhanced fluid uptake and bactericidal properties as a hemostatic agent.

Uncontrolled hemorrhage accounts for more than 30% of trauma deaths worldwide. Current hemostatic devices focus primarily on time to hemostasis, but prevention of bacterial infection is also critical for improving survival rates. In this study, we sought to improve on current devices used for hemorrhage control by combining the large volume-filling capabilities and rapid clotting of shape memory polymer (SMP) foams with the swelling capacity of hydrogels. In addition, a hydrogel composition was selected that readily complexes with elemental iodine to impart bactericidal properties to the device. The focus of this work was to verify that the advantages of each respective material (SMP foam and hydrogel) are retained when combined in a composite device. The iodine-doped hydrogel demonstrated an 80% reduction in bacteria viability when cultured with a high bioburden of Staphylococcus aureus. Hydrogel coating of the SMP foam increased fluid uptake by 19× over the uncoated SMP foam. The composite device retained the shape memory behavior of the foam with more than 15× volume expansion after being submerged in 37°C water for 15 min. Finally, the expansion force of the composite was tested to assess potential tissue damage within the wound during device expansion. Expansion forces did not exceed 0.6N, making tissue damage during device expansion unlikely, even when the expanded device diameter is substantially larger than the target wound site. Overall, the enhanced fluid uptake and bactericidal properties of the shape memory foam composite indicate its strong potential as a hemostatic agent to treat non-compressible wounds. STATEMENT OF SIGNIFICANCE: No hemostatic device currently used in civilian and combat trauma situations satisfies all the desired criteria for an optimal hemostatic wound dressing. The research presented here sought to improve on current devices by combining the large volume-filling capabilities and rapid clotting of shape memory polymer (SMP) foams with the swelling capacity of hydrogels. In addition, a hydrogel composition was selected that readily complexes with elemental iodine to impart bactericidal properties to the device. The focus of this work was to verify that the advantages of each respective material are retained when combined into a composite device. This research opens the door to generating novel composites with a focus on both hemostasis, as well as wound healing and microbial prevention.

Modification of Shape Memory Polymer Foams Using Tungsten, Aluminum Oxide, and Silicon Dioxide Nanoparticles.

Shape memory polymer (SMP) foams were synthesized with three different nanoparticles (tungsten, silicon dioxide, and aluminum oxide) for embolization of cerebral aneurysms. Ultra-low density SMP foams have previously been utilized for aneurysm occlusion, resulting in a rapid, stable thrombus. However, the small cross section of foam struts can potentially lead to fracture and particulate generation, which would be a serious adverse event for an embolic device. The goal of this study was to improve the mechanical properties of the system by physically incorporating fillers into the SMP matrix. Thermal and mechanical characterization suggested minimal changes in thermal transition of the SMP nanocomposites and improved mechanical strength and toughness for systems with low filler content. Actuation profiles of the three polymer systems were tuned with filler type and content, resulting in faster SMP foam actuation for nanocomposites containing higher filler content. Additionally, thermal stability of the SMP nanocomposites improved with increasing filler concentration, and particulate count remained well below accepted standard limits for all systems. Extraction studies demonstrated little release of silicon dioxide and aluminum oxide from the bulk over 16 days. Tungstun release increased over the 16 day examination period, with a maximum measured concentration of approxiately 2.87 µg/mL. The SMP nanocomposites developed through this research have the potential for use in medical devices due to their tailorable mechanical properties, thermal resisitivity, and actuation profiles.

Solvent stimulated actuation of polyurethane-based shape memory polymer foams using dimethyl sulfoxide and ethanol.

Solvent exposure has been investigated to trigger actuation of shape memory polymers (SMPs) as an alternative to direct heating. This study aimed to investigate the feasibility of using dimethyl sulfoxide (DMSO) and ethanol (EtOH) to stimulate polyurethane-based SMP foam actuation and the required solvent concentrations in water for rapid actuation of hydrophobic SMP foams. SMP foams exhibited decreased Tg when submerged in DMSO and EtOH when compared to water submersion. Kinetic DMA experiments showed minimal or no relaxation for all SMP foams in water within 30 min, while SMP foams submerged in EtOH exhibited rapid relaxation within 1 min of submersion. SMP foams expanded rapidly in high concentrations of DMSO and EtOH solutions, where complete recovery over 30 min was observed in DMSO concentrations greater than 90% and in EtOH concentrations greater than 20%. This study demonstrates that both DMSO and EtOH are effective at triggering volume recovery of polyurethane-based SMP foams, including in aqueous environments, and provides promise for use of this actuation technique in various applications.

Virtual treatment of basilar aneurysms using shape memory polymer foam.

Numerical simulations are performed on patient-specific basilar aneurysms that are treated with shape memory polymer (SMP) foam. In order to assess the post-treatment hemodynamics, two modeling approaches are employed. In the first, the foam geometry is obtained from a micro-CT scan and the pulsatile blood flow within the foam is simulated for both Newtonian and non-Newtonian viscosity models. In the second, the foam is represented as a porous media continuum, which has permeability properties that are determined by computing the pressure gradient through the foam geometry over a range of flow speeds comparable to those of in vivo conditions. Virtual angiography and additional post-processing demonstrate that the SMP foam significantly reduces the blood flow speed within the treated aneurysms, while eliminating the high-frequency velocity fluctuations that are present within the pre-treatment aneurysms. An estimation of the initial locations of thrombus formation throughout the SMP foam is obtained by means of a low fidelity thrombosis model that is based upon the residence time and shear rate of blood. The Newtonian viscosity model and the porous media model capture similar qualitative trends, though both yield a smaller volume of thrombus within the SMP foam.

Novel flavonoids with antioxidant activity from a Chenopodiaceous plant.

OBJECTIVE: Atriplex lentiformis (Torr.) S.Wats (Chenopodiaceae) is a wild plant which is in use by Bedouin in treatment of general fatigue, therefore, there is a need to explore the potential antioxidant activity of the extracts and isolated compounds of this plant. METHODS: Column chromatography and spectroscopic analysis were used for isolation and identification of the compounds. The antioxidant activity was evaluated in vitro using the ABTS(•+) (2,2'-azino-bis-3-ethyl-bezthiazoine-6-sulphuric acid) radical scavenging model. Liver and kidney functions were investigated after oral administration of total alcohol, successive extracts, and isolated compounds. RESULTS: Two new flavonoids, quercetin-6,4'-dimethoxy-3-fructo-rhamnoside 1 and quercetin-4'-methoxy-3-fructo-rhamnoside 2 in addition to five known compounds (kaempferol-4'-methoxy-3-rutinoside 3, kaempferol-7-O-rhamnoside 4, kaempferol-3,7-O,O-dirhamnoside 5, quercetin 6, and kaempferol 7) were isolated. Oral administration of total ethanol, diethyl ether, chloroform, ethyl acetate and n-butanol extracts showed no signs of toxicity up to (5 g/kg. b.wt.). All extracts and isolated compounds showed varied antioxidant activity ranged from 129 to 952 µmol Trolox equivalent/gram dry weight with maximum level for the two new isolated flavonoids (985 and 895 µmol Trolox equivalent/gram dry weight). Animals received both total ethanol and n-butanol extracts showed a significant increase in ALT, AST, blood urea, and serum creatinine levels.

Post-Polymerization Crosslinked Polyurethane Shape-Memory Polymers.

Novel urethane shape-memory polymers (SMPs) of significant industrial relevance have been synthesized and characterized. Chemically crosslinked SMPs have traditionally been made in a one-step polymerization of monomers and crosslinking agents. However, these new post-polymerization crosslinked SMPs can be processed into complex shapes by thermoplastic manufacturing methods and later crosslinked by heat exposure or by electron beam irradiation. Several series of linear, olefinic urethane polymers were made from 2-butene-1,4-diol, other saturated diols, and various aliphatic diisocyanates. These thermoplastics were melt-processed into desired geometries and thermally crosslinked at 200°C or radiation crosslinked at 50 kGy. The SMPs were characterized by solvent swelling and extraction, differential scanning calorimetry (DSC), dynamic mechanical analysis (DMA), tensile testing, and qualitative shape-recovery analysis. Swelling and DMA results provided concrete evidence of chemical crosslinking, and further characterization revealed that the urethanes had outstanding mechanical properties. Key properties include tailorable transitions between 25 and 80°C, tailorable rubbery moduli between 0.2 and 4.2 MPa, recoverable strains approaching 100%, failure strains of over 500% at T(g), and qualitative shape-recovery times of less than 12 seconds at body temperature (37°C). Because of its outstanding thermo-mechanical properties, one polyurethane was selected for implementation in the design of a complex medical device. These post-polymerization crosslinked urethane SMPs are an industrially relevant class of highly processable shape-memory materials.

Embolectomy in a rabbit acute arterial occlusion model using a novel electromechanical extraction device.

A prototype endovascular electromechanical clot-extraction device was fabricated using a combination of shape memory polymer and shape memory nickel-titanium alloy (nitinol). Five embolic vascular occlusions were created in 4 rabbits by injecting thermally coagulated blood through a 4F catheter in the common carotid artery. Angiography immediately after clot injection showed complete or partial occlusion of the common carotid artery. Posttreatment angiography showed complete (2/5), partial (2/5), or no (1/5) restoration of blood flow.

Hepatoprotective activity of Schouwia thebica webb.

Oral administration of alcoholic extracts of Schouwia thebica Webb showed that extracts are safe for human use. The studied extracts are considered safe, since they failed to induce death of mice in doses up to 4000 mg/kg body weight. Hepatoprotective activity was studied for the total alcoholic extracts. The total extract was fractionated in turn with diethyl ether, chloroform, ethyl acetate, and n-butanol, respectively. These extracts were tested for possible hepatoprotective activity. It was found that the ethyl acetate and n-butanol extracts of S. thebica Webb showed hepatoprotective activity. These extracts significantly reduced the increase in activities of ALT, AST, and GGT, and levels of glucose, triglycerides, and cholesterol in serum of CCl(4)-treated rats. The extracts showing activity were found to contain flavonoids; one new compound, chrysoeriol-7-O-xylosoide- (1,2)-arabinofuranoside (2), in addition to another known four compound chrysoeriol (1), quercetin (3), quercetin-7-O-rhamnoside (4), and kaempferol-3-O-beta-D-glucoside (5). The isolated new compound was mainly found to be responsible for this activity when tested on animals in the laboratory. The structures were established by melting point, UV spectroscopy, EI-Mass, Fab-Mass, and 1D and 2D NMR spectroscopic techniques on a 600MHz instrument.

Polarized light propagation through tissue phantoms containing densely packed scatterers.

We demonstrate that polarized light is maintained differently in densely packed versus dilute suspensions of polystyrene microspheres. The degrees of linear and circular polarization were measured versus scatterer concentration in aqueous suspensions of 0.48-, 0.99-, 2.092-, and 9.14-mum-diameter polystyrene microspheres. The results indicate that, for dilute suspensions of microspheres where independent scattering is assumed, the degrees of linear and circular polarization decrease as the scatterer concentration increases. For dense suspensions, however, the degree of polarization begins to increase as the scatterer concentration increases. The preferential propagation of linear over circular polarization states in dense suspensions is similar to results seen in biological tissue.

Comparison of polarized-light propagation in biological tissue and phantoms.

We demonstrate significant differences in the propagation of polarized light through biological tissue compared with two common tissue phantoms. Depolarization of linearly and circularly polarized light was measured versus propagation distance by use of two independent measurement techniques. The measurements were performed on adipose and myocardial tissues and on tissue phantoms that consisted of polystyrene microsphere suspensions and Intralipid. The results indicate that, in contrast with results obtained in tissue phantoms, linearly polarized light survives through longer propagation distances than circularly polarized light in biological tissue.

Polarization discrimination of coherently propagating light in turbid media.

We describe the use of degree of polarization to discriminate unscattered and weakly scattered light from multiply scattered light in an optically turbid material. We use spatially resolved measurements of the degree of polarization to compare how well linearly and circularly polarized light survives in a sample. Experiments were performed on common tissue phantoms consisting of polystyrene and Intralipid microsphere suspensions and on adipose and arterial tissue. The results indicate that polarization is maintained even after unpolarized irradiance through each sample has been extinguished by several orders of magnitude. The results also show that polarized light propagation in common tissue phantoms is distinctly different from polarized light propagation in the two tissues investigated. Further, these experiments illustrate when polarization is an effective discrimination criterion and when it is not. The potential of a polarization-based discrimination scheme to image through the biological and nonbiological samples investigated here is also discussed.

The aging self in an 'ageist' culture: getting beyond denial.

What is certain is that we will age. Demonizing this inevitability hardly encourages people to get on with the distinctive work often possible for the first time only in life's later years. That work calls for the belated recognition and some integration of humanity's enduring ambivalences: we are both angels and animals, both natural creatures and societally nurtured.

Mapping of Birefringence and Thermal Damage in Tissue by use of Polarization-Sensitive Optical Coherence Tomography.

We demonstrate cross-sectional birefringence- and polarization-independent backscatter imaging of laser-induced thermal damage in porcine myocardium in vitro, using a polarization-sensitive optical coherence tomography system. We compare the generated images with histological sections of the tissue and demonstrate that birefringence is a more sensitive indicator of thermal damage than is backscattered light. Loss of birefringence in thermally damaged regions is quantified and shown to have significant contrast with undamaged sections of the tissue. A detailed theoretical analysis of the birefringence measurements is provided, including a calculation of the systematic errors associated with background noise, system imperfections, and tissue dichroism.

Experimental and computational laser tissue welding using a protein patch.

An in vitro study of laser tissue welding mediated with a dye-enhanced protein patch was conducted. Fresh sections of porcine aorta were used for the experiments. Arteriotomies were treated using an indocyanine green dye-enhanced collagen patch activated by an 805-nm continuous-wave fiber-delivered diode laser. Temperature histories of the surface of the weld site were obtained using a hollow glass optical fiber-based two-color infrared thermometer. The experimental effort was complemented by simulations with the LATIS (LAser-TISsue) computer code, which uses coupled Monte Carlo, thermal transport, and mass transport models. Comparison of simulated and experimental thermal data indicated that evaporative cooling clamped the surface temperature of the weld site below 100 °C. For fluences of approximately 200 J/cm2, peak surface temperatures averaged 74°C and acute burst strengths consistently exceeded 0.14×106 dyn/cm (hoop tension). The combination of experimental and simulation results showed that the inclusion of water transport and evaporative losses in the computer code has a significant impact on the thermal distributions and hydration levels throughout the tissue volume. The solid-matrix protein patch provided a means of controllable energy delivery and yielded consistently strong welds. © 1998 Society of Photo-Optical Instrumentation Engineers.