The Impact of Seasonal Changes on Thyroxine and Thyroid-Stimulating Hormone in Newborns.

Newborn screening for congenital hypothyroidism (CH) is performed by measuring the concentration of thyroxine (T4) and/or thyroid-stimulating hormone (TSH) in dried blood spots. Unfortunately, the levels of T4 and TSH vary due to multiple factors, and therefore the false-positive rate for the test is a challenge. We analyzed screening data from 2008 to 2017 to determine the effect of seasonal changes and manufacturer kit lot changes on T4 and TSH values and on numbers of infants referred. Over a 10-year period, we screened 2.4 million infants using commercially available fluoroimmunoassays to measure T4 and TSH concentrations in dried blood spots. During colder months, daily mean T4 and TSH values were higher and referral rates and false-positive rates were higher. However, there was no significant difference between the number of confirmed CH cases. Furthermore, in rare instances, we observed differences in T4 daily mean values during the 10-year period when manufacturer kit lot changes were made. Seasonal temperature variations influence measured T4 and TSH values and consequently lower the positive predictive value for CH testing in colder months. Newborn screening (NBS) programs should be aware that manufacturer kit lot changes may also influence T4 values.

Efficacy of Wound Cleansers on Wound-Specific Organisms Using In Vitro and Ex Vivo Biofilm Models.

Biofilms are believed to be a source of chronic inflammation in non-healing wounds. PURPOSE: In this study, the pre-clinical anti-biofilm efficacy of several wound cleansers was examined using the Calgary minimum biofilm eradication concentration (MBEC) and ex vivo porcine dermal explant (PDE) models on Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), and Candida albicans biofilms. METHODS: A surfactant-based cleanser and antimicrobial-based cleansers containing ionic silver, hypochlorous acid (HOCl), sodium hypochlorite (NaOCl), and polyhexamethylene biguanide (PHMB) were tested on the MBEC model biofilms with a 10-minute application time. Select cleansers were then tested on the mature PDE biofilms with 10-minute applications followed by the application of cleanser-soaked gauze. The PDE model was further expanded to include single and daily applications of the cleansers to mimic daily and 72-hour dressing changes. RESULTS: In the MBEC model, PHMB- and HOCl-based cleansers reduced immature MRSA, C albicans, and P aeruginosa biofilm regrowth by > 3× when compared with silver, surfactant, and saline cleansers. The major differences could be elucidated in the PDE model in which, after daily application, 1 PHMB-based cleanser showed a statistically significant reduction (3-8 CFU/mL log reduction) in all mature biofilms tested, while a NaOCl-based cleanser showed significant reduction in 2 microorganisms (3-5 CFU/mL log reduction, P aeruginosa and MRSA).The other PHMB-based cleanser showed a statistically significant 3 log CFU/mL reduction in P aeruginosa. The remaining cleansers showed no statistically significant difference from the saline control. CONCLUSION: Results confirm that there are model-dependent differences in the outcomes of these studies, suggesting the importance of model selection for product screening. The results indicate that 1 PHMB-based cleanser was effective in reducing mature P aeruginosa, MRSA, and C albicans biofilms and that sustained antimicrobial presence was necessary to reduce or eliminate these mature biofilms.

Synergistic Effect and Antibiofilm Activity of a Skin and Wound Cleanser.

INTRODUCTION: Biofilm in chronic wounds impedes the wound healing process. Each biofilm has differing characteristics requiring a multifaceted approach for removal while maintaining a surrounding environment conducive to wound healing. OBJECTIVE: In this study, 3 of the components in a wound cleanser are tested to determine synergy in eradicating biofilms of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in vitro. MATERIALS AND METHODS: The 3 components assessed for synergy were ethylenediamine tetraacetic acid sodium salts (EDTA), vicinal diols (VD; ethylhexylglycerin and octane-1,2-diol), and polyhexamethylene biguanide (PHMB). Each component was assessed individually and in combination while dissolved in a base solution. The Calgary assay method was used for biofilm growth and treatment. Kull Equation analysis for synergy was conducted using viable count results. RESULTS: Synergy is defined as the interaction of components to produce a combined effect greater than the sum of their separate effects. The base solution containing all 3 components (EDTA, VD, and PHMB) reduced biofilm viability by more than 5 logs, demonstrating statistically significant synergy. The 3 components tested individually in the base solution resulted in the following: EDTA did not reduce bacteria viability; VD reduced viability by about 1 log; and PHMB reduced P aeruginosa viability by about 2.5 logs and MRSA viability by about 4 logs. Of importance, the MRSA biofilm failed to regrow in the recovery plates after combined treatment, indicating complete elimination of the biofilm bacteria. CONCLUSIONS: The experimental and calculated results indicate the 3 components (VD, EDTA, and PHMB) when used together act synergistically to eradicate MRSA and P aeruginosa biofilms in vitro.

Gender disparities in screening for congenital hypothyroidism using thyroxine as a primary screen.

OBJECTIVE: Newborn screening for congenital hypothyroidism (CH) is based on testing for the markers thyroxine (T4) and/or thyroid-stimulating hormone (TSH). Diagnosis of CH is complicated because many factors affect the levels of these hormones including infant birth weight, prematurity and age at specimen collection. We investigated whether the sex of the newborn affected the levels of T4 and TSH and consequently the outcome of newborn screening. DESIGN: In New York State, the Newborn Screening program initially tests all infants for T4 and any baby with a result in the lowest 10% is triaged for TSH screening. We analyzed data from 2008 to 2016 to determine mean and median T4 and TSH values and how these results correlate with the sex of infants who are reported as borderline, referred and confirmed with CH. METHODS: T4 and TSH concentrations in dried blood spots were measured using commercially available fluoroimmunoassays. RESULTS: From 2008 to 2016, of the 2.4 million specimens tested for thyroxine, 51.5% were from male and 48.5% were from female infants. Male infants constituted 60% of specimens triaged for TSH testing, 64.9% of repeat requests and 59.6% of referrals, but only 49% of confirmed CH cases. The mean and median T4 values were lower (a difference of approximately 0.8-1.1 µg/dL each year) and the median TSH values were higher in male compared to female infants. CONCLUSIONS: Natural differences in thyroid hormone levels in male and female infants leads to male infants being disproportionately represented in the false-positive category.

Newborn screening for congenital adrenal hyperplasia in New York State.

From 2007 to 2014 the New York State (NYS) Newborn Screening (NBS) program screened 2 million newborns for congenital adrenal hyperplasia (CAH). The data was analyzed to determine factors that affect 17α-hydroxyprogesterone levels and assist in developing algorithm changes that would improve the positive predictive value of the methodology being used. The concentration of 17-OHP in dried blood spots was measured using the AutoDELFIA Neonatal 17-OHP kit (Perkin Elmer, Turku, Finland). During the 8 year period of this study 2476 babies were referred, 105 babies were diagnosed with CAH (90 with the salt-wasting (SW), 8 with simple virilizing (SV), 5 with non-classical CAH, and 2 with another enzyme deficiency) and, 14 with possible CAH. Three false negative cases with SV-CAH were reported to the program. Of the total 108 known cases, 74 (69%) infants were detected by newborn screening in the absence of clinical information, or, known family history. The incidence of CAH in NYS is 1 in 18,170 with a ratio of SW to SV of 8.2:1. The incidence of CAH is lower in Black infants than in White, Hispanic and Asian infants. Despite a lower mean birth weight, female infants have a lower mean 17-OHP value than male infants and are under-represented in the referred category. As per other NBS programs the false positive rate is exacerbated by prematurity/low birth weight and by over-early specimen collection.

Grand challenge in Biomaterials-wound healing.

Providing improved health care for wound, burn and surgical patients is a major goal for enhancing patient well-being, in addition to reducing the high cost of current health care treatment. The introduction of new and novel biomaterials and biomedical devices is anticipated to have a profound effect on the future improvement of many deleterious health issues. This publication will discuss the development of novel non-stinging liquid adhesive bandages in healthcare applications developed by Rochal Industries. The scientists/engineers at Rochal have participated in commercializing products in the field of ophthalmology, including rigid gas permeable contact lenses, soft hydrogel contact lenses, silicone hydrogel contact lenses, contact lens care solutions and cleaners, intraocular lens materials, intraocular controlled drug delivery, topical/intraocular anesthesia, and in the field of wound care, as non-stinging, spray-on liquid bandages to protect skin from moisture and body fluids and medical adhesive-related skin injuries. Current areas of entrepreneurial activity at Rochal Industries pertain to the development of new classes of biomaterials for wound healing, primarily in regard to microbial infection, chronic wound care, burn injuries and surgical procedures, with emphasis on innovation in product creation, which include cell-compatible substrates/scaffolds for wound healing, antimicrobial materials for opportunistic pathogens and biofilm reduction, necrotic wound debridement, scar remediation, treatment of diabetic ulcers, amelioration of pressure ulcers, amelioration of neuropathic pain and adjuvants for skin tissue substitutes.

Cell layer-electrospun mesh composites for coronary artery bypass grafts.

This work investigates the potential of cell layer-electrospun mesh constructs as coronary artery bypass grafts. These cell-mesh constructs were generated by first culturing a confluent layer of 10T½ smooth muscle progenitor cells on a high strength electrospun mesh with uniaxially aligned fibers. Cell-laden mesh sheets were then wrapped around a cylindrical mandrel such that the mesh fibers were aligned circumferentially. The resulting multi-layered constructs were then cultured for 4 wks in media supplemented with TGF-ß1 and ascorbic acid to support 10T½ differentiation toward a smooth muscle cell-like fate as well as to support elastin and collagen production. The underlying hypothesis of this work was that extracellular matrix (ECM) deposited by the cell layers would act as an adhesive agent between the individual mesh layers, providing strength to the construct as well as a source for structural elasticity at low strains. In addition, the structural anisotropy of the mesh would inherently guide desired circumferential cell and ECM alignment. Results demonstrate that the cell-mesh constructs exhibited a J-shaped circumferential stress-strain response similar to that of native coronary artery, while also displaying acceptable tensile strength. Furthermore, associated 10T½ cells and deposited collagen fibers showed a high degree of circumferential alignment. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2200-2209, 2016.

Screening for cystic fibrosis in New York State: considerations for algorithm improvements.

Newborn screening for cystic fibrosis (CF), a chronic progressive disease affecting mucus viscosity, has been beneficial in both improving life expectancy and the quality of life for individuals with CF. In New York State from 2007 to 2012 screening for CF involved measuring immunoreactive trypsinogen (IRT) levels in dried blood spots from newborns using the IMMUCHEM(™) Blood Spot Trypsin-MW ELISA kit. Any specimen in the top 5% IRT level underwent DNA analysis using the InPlex(®) CF Molecular Test. Of the 1.48 million newborns screened during the 6-year time period, 7631 babies were referred for follow-up. CF was confirmed in 251 cases, and 94 cases were diagnosed with CF transmembrane conductance regulated-related metabolic syndrome or possible CF. Nine reports of false negatives were made to the program. Variation in daily average IRT was observed depending on the season (4-6 ng/ml) and kit lot (<3 ng/ml), supporting the use of a floating cutoff. The screening method had a sensitivity of 96.5%, specificity of 99.6%, positive predictive value of 4.5%, and negative predictive value of 99.5%. CONCLUSION: Considerations for CF screening algorithms should include IRT variations resulting from age at specimen collection, sex, race/ethnicity, season, and manufacturer kit lots. WHAT IS KNOWN: Measuring IRT level in dried blood spots is the first-tier screen for CF. Current algorithms for CF screening lead to substantial false-positive referral rates. WHAT IS NEW: IRT values were affected by age of infant when specimen is collected, race/ethnicity and sex of infant, and changes in seasons and manufacturer kit lots The prevalence of CF in NYS is 1 in 4200 with the highest prevalence in White infants (1 in 2600) and the lowest in Black infants (1 in 15,400).

Phosphate-enhanced cytotoxicity of zinc oxide nanoparticles and agglomerates.

Zinc oxide (ZnO) nanoparticles (NPs) have been found to readily react with phosphate ions to form zinc phosphate (Zn3(PO4)2) crystallites. Because phosphates are ubiquitous in physiological fluids as well as waste water streams, it is important to examine the potential effects that the formation of Zn3(PO4)2 crystallites may have on cell viability. Thus, the cytotoxic response of NIH/3T3 fibroblast cells was assessed following 24h of exposure to ZnO NPs suspended in media with and without the standard phosphate salt supplement. Both particle dosage and size have been shown to impact the cytotoxic effects of ZnO NPs, so doses ranging from 5 to 50 µg/mL were examined and agglomerate size effects were investigated by using the bioinert amphiphilic polymer polyvinylpyrrolidone (PVP) to generate water-soluble ZnO ranging from individually dispersed 4 nm NPs up to micron-sized agglomerates. Cell metabolic activity measures indicated that the presence of phosphate in the suspension media can led to significantly reduced cell viability at all agglomerate sizes and at lower ZnO dosages. In addition, a reduction in cell viability was observed when agglomerate size was decreased, but only in the phosphate-containing media. These metabolic activity results were reflected in separate measures of cell death via the lactate dehydrogenase assay. Our results suggest that, while higher doses of water-soluble ZnO NPs are cytotoxic, the presence of phosphates in the surrounding fluid can lead to significantly elevated levels of cell death at lower ZnO NP doses. Moreover, the extent of this death can potentially be modulated or offset by tuning the agglomerate size. These findings underscore the importance of understanding how nanoscale materials can interact with the components of surrounding fluids so that potential adverse effects of such interactions can be controlled.

Development of nanomaterials for bone repair and regeneration.

Bone is a nanocomposite composed of organic (mainly collagen) and inorganic (nanocrystalline hydroxyapatite) components, with a hierarchical structure ranging from nano- to macroscale. Its functions include providing mechanical support and transmitting physio-chemical and mechano-chemical cues. Clinical repair and reconstruction of bone defects has been conducted using autologous and allogeneic tissues and alloplastic materials, with functional limitations. The design and development of biomaterial scaffolds that will replace the form and function of native tissue while promoting regeneration without necrosis or scar formation is a challenging area of research. Nanomaterials and nanocomposites are promising platforms to recapitulate the organization of natural extracellular matrix for the fabrication of functional bone tissues because nanostructure provides a closer approximation to native bone architecture. Nanostructured scaffolds provide structural support for the cells and regulate cell proliferation, differentiation, and migration, which results in the formation of functional tissues. Unique properties of nanomaterials, such as increased wettability and surface area, lead to increased protein adsorption when compared with conventional biomaterials. Cell-scaffold interactions at the cell-material nanointerface may be mediated by integrin-triggered signaling pathways that affect cell behavior. The materials selection and processing techniques can affect the chemical, physical, mechanical, and cellular recognition properties of biomaterials. In this article, we focused on reviewing current fabrication techniques for nanomaterials and nanocomposites, their cell interaction properties and their application in bone tissue engineering and regeneration.

A comparative study of the cytotoxicity and corrosion resistance of nickel-titanium and titanium-niobium shape memory alloys.

Nickel-titanium (NiTi) shape memory alloys (SMAs) are commonly used in a range of biomedical applications. However, concerns exist regarding their use in certain biomedical scenarios due to the known toxicity of Ni and conflicting reports of NiTi corrosion resistance, particularly under dynamic loading. Titanium-niobium (TiNb) SMAs have recently been proposed as an alternative to NiTi SMAs due to the biocompatibility of both constituents, the ability of both Ti and Nb to form protective surface oxides, and their superior workability. However, several properties critical to the use of TiNb SMAs in biomedical applications have not been systematically explored in comparison with NiTi SMAs. These properties include cytocompatibility, corrosion resistance, and alterations in alloy surface composition in response to prolonged exposure to physiological solutions. Therefore, the goal of the present work was to comparatively investigate these aspects of NiTi (49.2 at.% Ti) and TiNb (26 at.% Nb) SMAs. The results from the current studies indicate that TiNb SMAs are less cytotoxic than NiTi SMAs, at least under static culture conditions. This increased TiNb cytocompatibility was correlated with reduced ion release as well as with increased corrosion resistance according to potentio-dynamic tests. Measurements of the surface composition of samples exposed to cell culture medium further supported the reduced ion release observed from TiNb relative to NiTi SMAs. Alloy composition depth profiles also suggested the formation of calcium phosphate deposits within the surface oxide layers of medium-exposed NiTi but not of TiNb. Collectively, the present results indicate that TiNb SMAs may be promising alternatives to NiTi for certain biomedical applications.

Hydrogel-electrospun mesh composites for coronary artery bypass grafts.

The aim of the present study was to investigate the potential of hydrogel-electrospun mesh hybrid scaffolds as coronary artery bypass grafts. The circumferential mechanical properties of blood vessels modulate a broad range of phenomena, including vessel stress and mass transport, which, in turn, have a critical impact on cardiovascular function. Thus, coronary artery bypass grafts should mimic key features of the nonlinear stress-strain behavior characteristic of coronary arteries. In native arteries, this J-shaped circumferential stress-strain curve arises primarily from initial load transfer to low stiffness elastic fibers followed by progressive recruitment and tensing of higher stiffness arterial collagen fibers. This nonlinear mechanical response is difficult to achieve with a single-component scaffold while simultaneously meeting the suture retention strength and tensile strength requirements of an implantable graft. For instance, although electrospun scaffolds have a number of advantages for arterial tissue engineering, including relatively high tensile strengths, tubular mesh constructs formed by conventional electrospinning methods do not generally display biphasic stress-strain curves. In the present work, we demonstrate that a multicomponent scaffold comprised of polyurethane electrospun mesh layers (intended to mimic the role of arterial collagen fibers) bonded together by a fibrin hydrogel matrix (designed to mimic the role of arterial elastic fibers) results in a composite construct which retains the high tensile strength and suture retention strength of electrospun mesh but which displays a J-shaped mechanical response similar to that of native coronary artery. Moreover, we show that these hybrid constructs support cell infiltration and extracellular matrix accumulation following 12-day exposure to continuous cyclic distension.

Regulation of smooth muscle cell phenotype by glycosaminoglycan identity.

The retention of lipoproteins in the arterial intima is an initial event in early atherosclerosis and occurs, in part, through interactions between negatively charged glycosaminoglycans (GAGs) and the positively charged residues of apolipoproteins. Smooth muscle cells (SMCs) which infiltrate into the lipoprotein-enriched intima have been observed to transform into lipid-laden foam cells. This phenotypic switch is associated with SMC acquisition of a macrophage-like capacity to phagocytose lipoproteins and/or of an adipocyte-like capacity to synthesize fatty acids de novo. The aim of the present work was to explore the impact of GAG identity on SMC foam cell formation using a scaffold environment intended to be mimetic of early atherosclerosis. In these studies, we focused on chondroitin sulfate C (CSC), dermatan sulfate (DS), and an intermediate molecular weight hyaluronan (HAIMW, ∼400 kDa), the levels and/or distribution of each of which are significantly altered in atherosclerosis. DS hydrogels were associated with greater SMC phagocytosis of apolipoprotein B than HAIMW gels. Similarly, only SMCs in DS constructs maintained increased expression of the adipocyte marker A-FABP relative to HAIMW gels over 35 days of culture. The increased SMC foam cell phenotype in DS hydrogels was reflected in a corresponding decrease in SMC myosin heavy chain expression in these constructs relative to HAIMW gels at day 35. In addition, this DS-associated increase in foam cell formation was mirrored in an increased SMC synthetic phenotype, as evidenced by greater levels of collagen type I and glucose 6-phosphate dehydrogenase in DS gels than in HAIMW gels. Combined, these results support the increasing body of literature that suggests a critical role for DS-bearing proteoglycans in early atherosclerosis.

Approach for fabricating tissue engineered vascular grafts with stable endothelialization.

A major roadblock in the development of tissue engineered vascular grafts (TEVGs) is achieving construct endothelialization that is stable under physiological stresses. The aim of the current study was to validate an approach for generating a mechanically stable layer of endothelial cells (ECs) in the lumen of TEVGs. To accomplish this goal, a unique method was developed to fabricate a thin EC layer using poly(ethylene glycol) diacrylate (PEGDA) as an intercellular "cementing" agent. This EC layer was subsequently bonded to the lumen of a tubular scaffold to generate a bi-layered construct. The viability of bovine aortic endothelial cells (BAECs) through the "cementing" process was assessed. "Cemented" EC layer expression of desired phenotypic markers (AcLDL uptake, VE-cadherin, eNOS, PECAM-1) as well as of injury-associated markers (E-selectin, SM22alpha) was also examined. These studies indicated that the "cementing" process allowed ECs to maintain high viability and expression of mature EC markers while not significantly stimulating primary injury pathways. Finally, the stability of the "cemented" EC layers under abrupt application of high shear pulsatile flow (approximately 11 dyn/cm(2), P (avg) approximately 95 mmHg, DeltaP approximately 20 mmHg) was evaluated and compared to that of conventionally "seeded" EC layers. Whereas the "cemented" ECs remained fully intact following 48 h of pulsatile flow, the "seeded" EC layers delaminated after less than 1 h of flow. Furthermore, the ability to extend this approach to degradable PEGDA "cements" permissive of cell elongation was demonstrated. Combined, these results validate an approach for fabricating bi-layered TEVGs with stable endothelialization.

Inorganic-organic hybrid scaffolds for osteochondral regeneration.

Ligament graft failure frequently results from poor integration of the replacement tissue with associated bone. Thus, the ability to regenerate the bone-ligament osteochondral interface would be advantageous in ligament reconstruction. At the osteochondral interface, the tissue transitions from a bone-like matrix to fibrocartilage. Therefore, a scaffold which promotes a spatially regulated transition in cell behavior from osteoblast-like to chondrocyte-like would be desirable. Previous research indicates that addition of inorganic components to organic scaffolds can enhance the deposition of bone-like matrix by associated osteoblasts. We therefore reasoned that a gradient in the inorganic content of a hybrid inorganic-organic scaffold may induce an osteochondral-like transition in cell phenotype and matrix production. To test this hypothesis, hydrogels were prepared from poly(ethylene glycol) (PEG) and star poly(dimethylsiloxane) (PDMS(star)). As anticipated, both the matrix deposition and phenotype of encapsulated osteoblasts varied with scaffold inorganic content, although the directionality of this modulation was contrary to expectation. Specifically, osteoblasts appeared to transdifferentiate into chondrocyte-like cells with increasing scaffold inorganic content, as indicated by increased chondroitin sulfate and collagen type II production and by upregulation of sox9, a transcription factor associated with chondrocytic differentiation. Furthermore, the deposition of bone-like matrix (collagen type I, calcium phosphate, and osteocalcin) decreased with increasing PDMS(star) content. The resistance of the PDMS(star)-PEG scaffolds to protein adsorption and/or the changes in gel modulus/mesh structure accompanying PDMS(star) incorporation may underlie the unexpected increase in chondrocytic phenotype with increasing inorganic content. Combined, the present results indicate that PDMS(star)-PEG hybrid gels may prove promising for osteochondral regeneration. (c) 2010 Wiley Periodicals, Inc. J Biomed Mater Res, 2010.

Probing vocal fold fibroblast response to hyaluronan in 3D contexts.

A number of treatments are being investigated for vocal fold (VF) scar, including designer implants. The aim of the present study was to validate a 3D model system for probing the effects of various bioactive moieties on VF fibroblast (VFF) behavior toward rational implant design. We selected poly(ethylene glycol) diacrylate (PEGDA) hydrogels as our base-scaffold due to their broadly tunable material properties. However, since cells encapsulated in PEGDA hydrogels are generally forced to take on rounded/stellate morphologies, validation of PEGDA gels as a 3D VFF model system required that the present work directly parallel previous studies involving more permissive scaffolds. We therefore chose to focus on hyaluronan (HA), a polysaccharide that has been a particular focus of the VF community. Toward this end, porcine VFFs were encapsulated in PEGDA hydrogels containing consistent levels of high Mw HA (HA(HMW)), intermediate Mw HA (HA(IMW)), or the control polysaccharide, alginate, and cultured for 7 and 21 days. HA(HMW) promoted sustained increases in active ERK1/2 relative to HA(IMW). Furthermore, VFFs in HA(IMW) gels displayed a more myofibroblast-like phenotype, higher elastin production, and greater protein kinase C (PkC) levels at day 21 than VFFs in HA(HMW) and alginate gels. The present results are in agreement with a previous 3D study of VFF responses to HA(IMW) relative to alginate in collagen-based scaffolds permissive of cell elongation, indicating that PEGDA hydrogels may serve as an effective 3D model system for probing at least certain aspects of VFF behavior.