Characterizing Brain Perfusion in a Swine Model of Raised Intracranial Pressure.

INTRODUCTION: Perfusion of the brain is critical, but this can be compromised due to focal space occupying lesions (SOL). SOLs can raise intracranial pressure (ICP), resulting in reduced cerebral blood flow (CBF). Most gyrencephalic models of brain injury focus on parenchymal injury, with few models of acutely elevated ICP. We hypothesized that we could employ a SOL technique to develop a titratable ICP model and sought to quantitate the resulting decrease in brain perfusion. METHODS: Six swine were anesthetized and instrumented. A Fogarty balloon catheter was inserted intracranially. Blood CO2 partial pressure was maintained between 35 and 45 mmHg. The Fogarty balloon was infused with normal saline at 1 mL/min to ICP targets of 10, 20, 30, and 40 mmHg. CBF (mL/100 g/min) were assessed at each ICP level using computed tomography perfusion (CTP). Data are presented as the mean ± standard deviation with all pressures measured in mmHg. CBF values were compared between baseline and each ICP level using analysis of variance. RESULTS: Baseline ICP was 5 ± 2 and systolic blood pressure was 106 ± 7. Balloon volumes (mL) required to achieve each incremental ICP level were 2.4 ± 0.5, 4.9 ± 1.7, 7.6 ± 1.6, and 9.9 ± 1.7. CBF decreased with each raised ICP level, with CBF being significantly less than baseline at ICP values of 30 (56.1 ± 34.7 versus 20.6 ± 11.0, P < 0.05) and 40 (56.1 ± 34.7 versus 6.5 ± 10.6, P < 0.05). CONCLUSIONS: An intracranial balloon catheter can be used to increase ICP, delivering a proportionate reduction in CBF. This model can be used in the future studies to examine adjuncts that manipulate intracranial pressure and their effect on brain perfusion.

Syntheses of Group 5 Amide Amidinates and Their Reactions with Water: Different Reactivities of Nb(V) and Ta(V) Complexes.

Chemistries of Nb(V) and Ta(V) compounds are essentially identical as a result of lanthanide contraction. Hydrolysis of M(NMe2)5 (M = Nb, Ta), for example, yields [M(µ3-O)(NMe2)3]4 (M = Nb, 1; Ta, 2) reported earlier. The similar reactivities of Nb(V) and Ta(V) compounds make it challenging, for example, to separate the two metals from their minerals. We have found that the reactions of H2O with amide amidinates M(NMe2)4[MeC(NiPr)2] (M = Nb, 3; Ta, 4) show that the niobium and tantalum analogues take different principal paths. For the Nb(V) complex 3, the amidinate and one amide ligand are liberated upon treatment with water, yielding [Nb(µ3-O)(NMe2)3]4 (1). For the Ta(V) complex 4, the amide ligands are released in the reaction with H2O, leaving the amidinate ligand intact. [Ta(µ3-O)(NMe2)3]4 (2), the analogue of 1, was not observed as a product in the reaction of 4 with H2O. To our knowledge, this is the first example of the formation of two different complexes that maintain the (V) oxidation state in both metals. The new complexes M(NMe2)4[MeC(NiPr)2] (M = Nb, 3; Ta, 4) have been prepared by the aminolysis of M(NMe2)5 (M = Nb, Ta) with iPrN(H)C(Me)=NiPr (5). The hydrolysis of 3 and 4 has been investigated by DFT electronic structure calculations. The first step in each hydrolysis reaction involves the formation of a hydrogen-bonded complex that facilitates a proton transfer to the amidinate ligand in 3 and protonation of an axial dimethylamide ligand in 4. Both proton transfers furnish an intermediate metal-hydroxide species. The atomic charges in 3 and 4 have been computed by Natural Population Analysis (NPA), and these data are discussed relative to which of the ancillary ligands is protonated initially in the hydrolysis sequence. Ligand exchanges in 3 and 4 as well as the exchange in iPrN(H)C(Me)=NiPr (5) were probed by EXSY NMR spectroscopy, giving rate constants of the exchanges: 0.430(13) s-1 (3), 0.033(6) s-1 (4), and 2.23(7) s-1 (5), showing that the rate of the Nb complex Nb(NMe2)4[MeC(NiPr)2] (3) is 13 times faster than that of its Ta analogue 4.

The functional vascular anatomy of the swine for research.

OBJECTIVES: Swine (Sus Scrofa) are utilized broadly in research settings, given similarities to human vessel size and function; however, there are some important differences for clinicians to understand in order to interpret and perform translational research. This review article uses angiograms acquired in the course of a translational research program to present a description of the functional anatomy of the swine. METHODS: Digital subtraction angiography and computed tomography angiography were obtained throughout the course of multiple studies utilizing power injection with iodinated contrast. Subtracted two-dimensional images and three-dimensional multiplanar reformations were utilized post image acquisition to create maximal intensity projections and three-dimensional renderings of using open-source software (OsiriX). These imaging data are presented along with vessel measurements for reference. RESULTS: An atlas highlighting swine vascular anatomy, with an emphasis on inter-species differences that may influence how studies are conducted and interpreted, was compiled. CONCLUSIONS: Swine are utilized in broad-reaching fields for preclinical research. While many similarities between human and swine vasculature exist, there are important differences to consider when conducting and interpreting research. This review article highlights these differences and presents accompanying images to inform clinicians gaining experience in swine research.

Development of an Endovascular Model of Pelvic Hemorrhage Using Volumetric Computed Tomography Validation.

PURPOSE: Uncontrolled pelvic hemorrhage from trauma is associated with mortality rates above 30%. The ability of an intervention to reduce blood loss from pelvic trauma is paramount to its success. The objective of this study was to determine if computed tomography volumetric analysis could be used to quantify blood loss in a porcine endovascular pelvic hemorrhage model. MATERIALS AND METHODS: Yorkshire swine under general anesthesia underwent balloon dilation and rupture of the profunda femoris artery, which was confirmed by digital subtraction angiography. Computed tomography angiography and postprocessing segmentation were performed to quantify pelvic hemorrhage volume at 5 and 30 minutes after injury. Continuous hemodynamic and iliofemoral flow data were obtained. Baseline and postinjury hemoglobin, hematocrit and lactate were collected. RESULTS: Of 6 animals enrolled, 5 survived the 30-minute post-injury period. One animal died at 15 minutes. Median volume of pelvic hemorrhage was 141±106 cm3 at 5 minutes and 302±79 cm3 at 30 minutes with a 114% median increase in hematoma volume over 25 minutes (p=0.040). There was a significant decrease in mean arterial pressure (107 to 71 mm Hg, p=0.030) and iliofemoral flow (561 to 122 mL/min, p=0.014) at 30 minutes postinjury, but no significant changes in hemoglobin, hematocrit, or heart rate. CONCLUSION: Computed tomography volumetric analysis can be used to quantify rate and volume of blood loss in a porcine endovascular pelvic hemorrhage model. Future studies can incorporate this approach when evaluating the effect of hemorrhage control interventions associated with pelvic fractures.

Improving the safety of resuscitative endovascular balloon occlusion of the aorta - Compliant versus semi-compliant balloon systems.

OBJECTIVES: Resuscitative endovascular balloon occlusion of the aorta is an alternative to resuscitative thoracotomy in non-compressible torso haemorrhage. Low-profile, compliant balloon catheter systems have been developed, which can be deployed without the need for fluoroscopy. However, concern exists for over inflation and aortic injury, especially as compliant balloon material can stretch reducing syringe feedback and limiting the effectiveness of a safety valve. An alternative material would be a semi-compliant balloon material, but its performance is unknown. The aim of this study was to compare the inflation characteristics of compliant versus semi-compliant balloon systems and to determine whether a pressure relief safety valve can be practically applied to a semi-compliant balloon catheter as a safety device. METHODS: This was an ex vivo study using porcine segments of thoracic aorta. The study consisted of two phases. The first phase involved intermittent inflation of six compliant balloon and six semi-compliant balloon balloons until balloon or aortic rupture. In the second phase, six semi-compliant balloons with the pressure-relief valve set at 0.45 atmospheres were inflated in the aortas until the valve release, followed by injection with additional 30 mL. Data including pressure, volume, balloon working length, diameter and circumferential stretch ratio were collected. RESULTS: At failure, mean balloon volume was almost double in compliant balloon group vs semi-compliant balloon group - 49.83 mL (±23.25) and 25.16 mL (±8.93), respectively (p = 0.004), with 36% increase in working length in the compliant balloon group - 81.17 mm (±19.11) vs 59.49 (±4.86) for semi-compliant balloon (p = 0.023). When plotted, the relationship pattern between volume and pressure fit a linear model for the compliant balloon, and a quadratic model for the semi-compliant balloon. Following attempted over inflation with the pressure valve, there was no change in parameters before and after attempted over inflation. CONCLUSIONS: The inflation profile differs between balloon designs. In contrast to semi-compliant balloons, compliant balloons will accommodate more volume to mitigate increase in pressure. This does not completely eliminate the risk of over inflation. The inflation characteristics of the semi-compliant balloon permit pairing it with a safety valve, which could lead to a development of a safer balloon technology in the future.

Nonheme Fe(IV) Oxo Complexes of Two New Pentadentate Ligands and Their Hydrogen-Atom and Oxygen-Atom Transfer Reactions.

Two new pentadentate {N5} donor ligands based on the N4Py (N4Py = N,N-bis(2-pyridylmethyl)-N-bis(2-pyridyl)methylamine) framework have been synthesized, viz. [N-(1-methyl-2-benzimidazolyl)methyl-N-(2-pyridyl)methyl-N-(bis-2-pyridyl methyl)amine] (L(1)) and [N-bis(1-methyl-2-benzimidazolyl)methyl-N-(bis-2-pyridylmethyl)amine] (L(2)), where one or two pyridyl arms of N4Py have been replaced by corresponding (N-methyl)benzimidazolyl-containing arms. The complexes [Fe(II)(CH3CN)(L)](2+) (L = L(1) (1); L(2) (2)) were synthesized, and reaction of these ferrous complexes with iodosylbenzene led to the formation of the ferryl complexes [Fe(IV)(O)(L)](2+) (L = L(1) (3); L(2) (4)), which were characterized by UV-vis spectroscopy, high resolution mass spectrometry, and Mössbauer spectroscopy. Complexes 3 and 4 are relatively stable with half-lives at room temperature of 40 h (L = L(1)) and 2.5 h (L = L(2)). The redox potentials of 1 and 2, as well as the visible spectra of 3 and 4, indicate that the ligand field weakens as ligand pyridyl substituents are progressively substituted by (N-methyl)benzimidazolyl moieties. The reactivities of 3 and 4 in hydrogen-atom transfer (HAT) and oxygen-atom transfer (OAT) reactions show that both complexes exhibit enhanced reactivities when compared to the analogous N4Py complex ([Fe(IV)(O)(N4Py)](2+)), and that the normalized HAT rates increase by approximately 1 order of magnitude for each replacement of a pyridyl moiety; i.e., [Fe(IV)(O)(L(2))](2+) exhibits the highest rates. The second-order HAT rate constants can be directly related to the substrate C-H bond dissociation energies. Computational modeling of the HAT reactions indicates that the reaction proceeds via a high spin transition state.

Synthesis, Structure, and Conformational Dynamics of Rhodium and Iridium Complexes of Dimethylbis(2-pyridyl)borate.

Rhodium(I) and Iridium(I) borate complexes of the structure [Me2B(2-py)2]ML2 (L2 = (tBuNC)2, (CO)2, (C2H4)2, cod, dppe) were prepared and structurally characterized (cod = 1,5-cyclooctadiene; dppe = 1,2-diphenylphosphinoethane). Each contains a boat-configured chelate ring that participates in a boat-to-boat ring flip. Computational evidence shows that the ring flip proceeds through a transition state that is near planarity about the chelate ring. We observe an empirical, quantitative correlation between the barrier of this ring flip and the π acceptor ability of the ancillary ligand groups on the metal. The ring flip barrier correlates weakly to the Tolman and Lever ligand parameterization schemes, apparently because these combine both σ and π effects while we propose that the ring flip barrier is dominated by π bonding. This observation is consistent with metal-ligand π interactions becoming temporarily available only in the near-planar transition state of the chelate ring flip and not the boat-configured ground state. Thus, this is a first-of-class observation of metal-ligand π bonding governing conformational dynamics.

Does postoperative pain predict the outcome of endometrial ablation?

AIM: In this article, we hypothesized that significant pain in the immediate postoperative period is due to a deeper degree of thermal ablation, down to the myometrial layer, and consequently an increased likelihood of successful outcome. MATERIAL AND METHODS: We retrospectively reviewed the medical records of 87 subjects who underwent thermal balloon endometrial ablation as the sole procedure under general anesthesia, administered by the same anesthetist using a standard protocol over a 10-year period from 2000 to 2010 at Thornbury Hospital, Sheffield, UK. All the cases were performed by the same surgeon in one hospital. RESULTS: Twenty-eight (32.2%) subjects experienced severe or intractable pain within 1 h after the thermal balloon endometrial ablation procedure, while 26 (29.9%) subjects required morphine injection in the postoperative period. Overall, more than 70% of women experienced significant reduction in their menstrual flow. There was no difference in the clinical outcome between those who did or did not experience severe pain or between those who did or did not require morphine injection in the postoperative period. CONCLUSION: The amount of postoperative pain did not predict the outcome of thermal balloon endometrial ablation.

Ruthenium complexes of 1,4-diazabutadiene ligands with a cis-RuCl2 moiety for catalytic acceptorless dehydrogenation of alcohols: DFT evidence of chemically non-innocent ligand participation.

The acceptorless dehydrogenative coupling (ADC) of primary alcohols to esters by diazabutadiene-coordinated ruthenium compounds is reported. Treatment of cis-Ru(dmso)4Cl2 in acetone at 56 °C with different 1,4-diazabutadienes [p-XC6H4N[double bond, length as m-dash]C(H)(H)C[double bond, length as m-dash]NC6H4X-p; X = H, CH3, OCH3, and Cl; abbreviated as DAB-X], gives trans-Ru[κ2-N,N-DAB-X]2Cl2 as the kinetic product of substitution. Heating these products in o-xylene at 144 °C gives the thermodynamically favored cis-Ru[κ2-N,N-DAB-X]2Cl2 isomers. Electronic structure calculations confirm the greater stability of the cis diastereomer. The molecular structures for each pair of geometric isomers have been determined by X-ray diffraction analyses. Cyclic voltammetry experiments on the complexes show an oxidative response and a reductive response within 0.50 to 0.93 V and -0.76 to -1.24 V vs. SCE respectively. The cis-Ru[κ2-N,N-DAB-X]2Cl2 complexes function as catalyst precursors for the acceptorless dehydrogenative coupling of primary alcohols to H2 and homo- and cross-coupled esters. When 1,4-butanediol and 1,5-pentanediol are employed as substrates, lactones and hydroxyaldehydes are produced as the major dehydrogenation products, while secondary alcohols afforded ketones in excellent yields. The mechanism for the dehydrogenation of benzyl alcohol to benzyl benzoate and H2 using cis-Ru[κ2-N,N-DAB-H]2Cl2 (cis-1) as a catalyst precursor was investigated by DFT calculations. The data support a catalytic cycle that involves the four-coordinate species Ru[κ2-N,N-DAB-H][κ1-N-DAB-H](κ1-OCH2Ph) whose protonated κ1-diazabutadiene moiety functions as a chemically non-innocent ligand that facilitates a ß-hydrogen elimination from the κ1-O-benzoxide ligand to give the corresponding hydride HRu[κ2-N,N-DAB-H][κ1-N-DAB-H](κ2-O,C-benzaldehyde). H2 production follows a Noyori-type elimination to give (H2)Ru[κ2-N,N-DAB-H][κ1-N-DAB-H](κ1-O-benzaldehyde) as an intermediate in the catalytic cycle.

Reactions of diphosphine-stabilized Os3 clusters with triphenylantimony: syntheses and structures of new antimony-containing Os3 clusters via Sb-Ph bond cleavage.

The reactivity of the trimetallic clusters [Os3(CO)10(µ-dppm)] [dppm = bis(diphenylphosphino)methane] and [HOs3(CO)8{µ3-Ph2PCH2PPh(C6H4-µ2,σ1)}] with triphenylantimony (SbPh3) has been examined. [Os3(CO)10(µ-dppm)] reacts with SbPh3 in refluxing toluene to yield three new triosmium clusters [Os3(CO)9(SbPh3)(µ-dppm)] (1), [HOs3(CO)7(SbPh3){µ3-Ph2PCH2PPh(C6H4-µ2,σ1)}] (2), and [HOs3(CO)7(SbPh3)(µ-C6H4)(µ-SbPh2)(µ-dppm)] (3). [HOs3(CO)8{µ3-Ph2PCH2PPh(C6H4-µ2,σ1)}] reacts with SbPh3 (excess) at room temperature to afford [Os3(CO)8(SbPh3)(η1-Ph)(µ-SbPh2)(µ-dppm)] (4) as the sole product. A series of control experiments have also been conducted to establish the relationship between the different products. The molecular structure of each product has been determined by single-crystal X-ray diffraction analysis, and the bonding in these new clusters has been investigated by electronic structure calculations.

An investigation of steric influence on the reactivity of FeV(O)(OH) tautomers in stereospecific C-H hydroxylation.

Two new tetradentate N4 ligands (LN4), LN4 = Me2,Me2PyzTACN (1-(2-(3,5-dimethyl-1H-pyrazol-1-yl)ethyl)-4,7-dimethyl-1,4,7-triazacyclononane) and Me2,MeImTACN (1-((1-methyl-1H-imidazol-1-yl)methyl)-4,7-dimethyl-1,4,7-triazacyclononane) have been synthesized and their corresponding Fe(II) complexes [FeII(Me2,Me2PyzTACN)(CF3SO3)2], 1Pz, and [FeII(Me2,MeImTACN)(CF3SO3)2], 1Im, have been prepared and characterized. Complexes 1Pz and 1Im catalyse the hydroxylation of C-H bonds of alkanes with excellent efficiencies, using hydrogen peroxide as oxidant. The high H/D kinetic isotope effect values for C-H hydroxylation, large normalized tertiary/secondary C-H (C3/C2) bond selectivities in adamantane oxidation, and high degrees of stereoretention in the oxidation of cis-1,2-dimethylcyclohexane are indicative of metal-based oxidation processes. The complexes also catalyse the oxidation of cyclooctene to form its corresponding epoxide and syn-diol. For 1Pz the epoxide is the main product, while for the analogous complex 1Im the syn-diol predominates. The active oxidant is proposed to be an [(LN4)FeV(O)(OH)]2+ species (2Pz, LN4 = Me2,Me2PyzTACN and 2Im, LN4 = Me2,MeImTACN) which may exist in two tautomeric forms related by a proton shift between the oxo and hydroxo ligands. Isotope labelling experiments show that the oxygen atom in the hydroxylated products originates from both water and hydrogen peroxide, and labelling experiments involving oxygen atom transfer to sterically bulky substrates provide indirect information on the steric influence exerted by the two ligands in the relative reactivities of the two hypervalent iron tautomers. Based on these labelling studies, the steric influence exerted by each of the ligands towards the relative reactivity of the oxo ligands of the corresponding pair of Fe(V)(O)(OH) tautomers can be derived. Furthermore, this steric influence can be gauged relative to related complexes/ligands.

Biomimics of [FeFe]-hydrogenases incorporating redox-active ligands: synthesis, redox properties and spectroelectrochemistry of diiron-dithiolate complexes with ferrocenyl-diphosphines as Fe4S4 surrogates.

[FeFe]-Ase biomimics containing a redox-active ferrocenyl diphosphine have been prepared and their ability to reduce protons and oxidise H2 studied, including 1,1'-bis(diphenylphosphino)ferrocene (dppf) complexes Fe2(CO)4(µ-dppf)(µ-S(CH2)nS) (n = 2, edt; n = 3, pdt) and Fe2(CO)4(µ-dppf)(µ-SAr)2 (Ar = Ph, p-tolyl, p-C6H4NH2), together with the more electron-rich 1,1'-bis(dicyclohexylphosphino)ferrocene (dcpf) complex Fe2(CO)4(µ-dcpf)(µ-pdt). Crystallographic characterisation of four of these show similar overall structures, the diphosphine spanning an elongated Fe-Fe bond (ca. 2.6 Å), lying trans to one sulfur and cis to the second. In solution the diphosphine is flexible, as shown by VT NMR studies, suggesting that Fe2⋯Fe distances of ca. 4.5-4.7 Å in the solid state vary in solution. Cyclic voltammetry, IR spectroelectrochemistry and DFT calculations have been used to develop a detailed picture of electronic and structural changes occurring upon oxidation. In MeCN, Fe2(CO)4(µ-dppf)(µ-pdt) shows two chemically reversible one-electron oxidations occurring sequentially at Fe2 and Fc sites respectively. For other dppf complexes, reversibility of the first oxidation is poor, consistent with an irreversible structural change upon removal of an electron from the Fe2 centre. In CH2Cl2, Fe2(CO)4(µ-dcpf)(µ-pdt) shows a quasi-reversible first oxidation together with subsequent oxidations suggesting that the generated cation has some stability but slowly rearranges. Both pdt complexes readily protonate upon addition of HBF4·Et2O to afford bridging-hydride cations, [Fe2(CO)4(µ-H)(µ-dcpf)(µ-pdt)]+, species which catalytically reduce protons to generate H2. In the presence of pyridine, [Fe2(CO)4(µ-dppf)(µ-pdt)]2+ catalytically oxidises H2 but none of the other complexes do this, probably resulting from the irreversible nature of their first oxidation. Mechanistic details of both proton reduction and H2 oxidation have been studied by DFT allowing speculative reaction schemes to be developed.

Open chest selective aortic arch perfusion vs open cardiac massage as a means of perfusion during in exsanguination cardiac arrest: a comparison of coronary hemodynamics in swine.

AIM: To describe and compare the aortic-right atrial pressure (AoP-RAP) gradients and mean coronary perfusion pressures (CPPs) generated during open chest selective aortic arch perfusion (OCSAAP) with those generated during open cardiac massage (OCM) in hypovolemic swine. METHODS: Ten male Hanford swine utilized in a prior poly-trauma study were included in the study. Animals were rendered hypovolemic via a 30% volume bleed. Upon confirmation of death, animals underwent immediate clamshell thoracotomy and aortic cross-clamping followed by 5 min of OCM. A catheter suitable for OCSAAP was then inserted into the aorta and animals underwent 1 min of OCSAAP at a rate of 10 mL/kg/min. Aortic and right atrial pressures were recorded continuously using solid-state blood pressure catheters. Representative 10-s intervals from each resuscitation method were extracted. Hemodynamic parameters including AoP-RAP gradients and CPPs were calculated and compared. RESULTS: At baseline, time from death to intervention was significantly shorter for OCM. However, mean CPPs and AoP-RAP gradients were significantly higher in animals undergoing OCSAAP. 98% of OCSAAP segments had a mean CPP > 15, compared to 35% of OCM intervals. While OCM had a significant negative correlation between time to intervention and maximum CPP, this correlation was not significant for OCSAAP. CONCLUSION: OCSAAP generates favorable and potentially time-resistant pressure gradients when compared to those generated by OCM. Further investigation of the technique of OCSAAP is warranted, as it may have potential utility as a therapy during resuscitative thoracotomy (RT).

Whole Blood Selective Aortic Arch Perfusion for Exsanguination Cardiac Arrest: Assessing Myocardial Tolerance to the Duration of Cardiac Arrest.

INTRODUCTION: Selective aortic arch perfusion (SAAP) is an endovascular technique that consists of aortic occlusion with perfusion of the coronary and cerebral circulation. It been shown to facilitate return of spontaneous circulation (ROSC) after exanguination cardiac arrest (ECA), but it is not known how long arrest may last before the myocardium can no longer be durably recovered. The aim of this study is to assess the myocardial tolerance to exsanguination cardiac arrest before successful ROSC with SAAP. METHODS: Male adult swine (n = 24) were anesthetized, instrumented, and hemorrhaged to arrest. Animals were randomized into three groups: 5, 10, and 15 min of cardiac arrest before resuscitation with SAAP. Following ROSC, animals were observed for 60 min in a critical care environment. Primary outcomes were ROSC, and survival at 1-h post-ROSC. RESULTS: Shorter cardiac arrest time was associated with higher ROSC rate and better 1-h survival. ROSC was obtained for 100% (8/8) of the 5-min ECA group, 75% (6/8) of the 10-min group, 43% (3/7) of the 15-min group (P = 0.04). One-hour post-ROSC survival was 75%, 50%, and 14% in 5-, 10-, and 15-min groups, respectively (P = 0.02). One-hour survivors in the 5-min group required less norepinephrine (1.31 mg ±â€Š0.83 mg) compared with 10-SAAP (0.76 mg ±â€Š0.24 mg), P = 0.008. CONCLUSION: Whole blood SAAP can accomplish ROSC at high rates even after 10 min of unsupported cardiac arrest secondary to hemorrhage, with some viability beyond to 15 min. This is promising as a tool for ECA, but requires additional optimization and clinical trials.Animal Use Protocol, IACUC: 0919015.

An estrogen (17α-ethinyl estradiol-3-sulfate) reduces mortality in a swine model of multiple injuries and hemorrhagic shock.

BACKGROUND: Although 17α-ethinyl estradiol-3-sulfate (EES) reduces mortality in animal models of controlled hemorrhage, its role in a clinically relevant injury model is unknown. We assessed the impact of EES in a swine model of multiple injuries and hemorrhage. METHODS: The study was performed under Good Laboratory Practice, with 30 male uncastrated swine (25-50 kg) subjected to tibial fracture, pulmonary contusion, and 30% controlled hemorrhage for an hour. Animals were randomized to one of five EES doses: 0 (control), 0.3, 1, 3, and 5 mg/kg, administered postinjury. Subjects received no resuscitation and were observed for 6 hours or until death. Survival data were analyzed using Cox-proportional hazard regression. Left ventricular pressure-volume loops were used to derive preload recruitable stroke work as a measure of cardiac inotropy. Immediate postinjury preload recruitable stroke work values were compared with values at 1 hour post-drug administration. RESULTS: Six-hour survival for the 0, 0.3, 1, 3, and 5 mg/kg groups was 0%, 50%, 33.3%, 16.7%, and 0%, respectively. Following Cox regression, the hazard (95% confidence interval) of death was significantly reduced in the 0.3 (0.22 [0.05-0.93]) and 1 (0.24 [0.06-0.89]) mg/kg groups but not the 3 (0.49 [0.15-1.64]) and 5 (0.46 [0.14-1.47]) mg/kg groups. Mean survival time was significantly extended in the 1 mg/kg group (246 minutes) versus the 0 mg/kg group (96 minutes) (p = 0.04, t test). At 1 hour post-drug administration, inotropy was significantly higher than postinjury values in the 0.3 and 1 mg/kg groups (p = 0.003 and p < 0.001, respectively). Inotropy was unchanged in the 3 and 5 mg/kg groups but significantly depressed in the control (p = 0.022). CONCLUSION: Administration of EES even in the absence of fluid resuscitation reduces mortality and improves cardiac inotropy in a clinically relevant swine model of multiple injuries and hemorrhage. These findings support the need for a clinical trial in human trauma patients.

Automatic Hemorrhage Detection From Color Doppler Ultrasound Using a Generative Adversarial Network (GAN)-Based Anomaly Detection Method.

Hemorrhage control has been identified as a priority focus area both for civilian and military populations in the United States because exsanguination is the most common cause of preventable death in hemorrhagic injury. Non-compressible torso hemorrhage (NCTH) has high mortality rate and there are currently no broadly available therapies for NCTH outside of a surgical room environment. Novel therapies, which include High Intensity Focused Ultrasound (HIFU) have emerged as promising methods for hemorrhage control as they can non-invasively cauterize bleeding tissue deep within the body without injuring uninvolved regions. A major challenge in the application of HIFU with color Doppler US guidance is the interpretation and optimization of the blood flow images in real-time to identify the hemorrhagic focus. Today, this task requires an expert sonographer, limiting the utility of this therapy in non-clinical environments. In this work, we investigated the feasibility of an automated hemorrhage detection method using a Generative Adversarial Network (GAN) for anomaly detection that learns a manifold of normal blood flow variability and subsequently identifies anomalous flow patterns that fall outside the learned manifold. As an initial feasibility study, we collected ultrasound color Doppler images of femoral arteries in an animal model of vascular injury (N = 11 pigs). Velocity information of the blood flow were extracted from the color Doppler images that were used for training and testing the anomaly detection network. Normotensive images from 8 pigs were used for training, and testing was performed on normotensive, immediately after injury, 10 minutes post-injury and 30 minutes post-injury images from 3 other pigs. The residual images or the reconstructed error maps show promise in detecting hemorrhages with an AUC of 0.90, 0.87, 0.62 immediately, 10 minutes post-injury and 30 minutes post-injury respectively with an overall AUC of 0.83.

RapA, Escherichia coli RNA polymerase SWI/SNF subunit-dependent polyadenylation of RNA.

In this work, we describe RapA-dependent polyadenylation of model RNA substrates and endogenous, RNA polymerase-associated nucleic acid fragments. We demonstrate that the Escherichia coli RNA polymerase obtained through the classic purification procedure carries endogenous RNA oligonucleotides, which, in the presence of ATP, are polyriboadenylated in a RapA-dependent manner by an accessory poly(rA) polymerase. RNA polymerase isolated from poly(A) polymerase- (PAP-) and polynucleotide phosphorylase- (PNP-) deficient E. coli strain lacks accessory (rA)(n)-synthetic activity. Experiments with reconstituted RNA polymerase-PAP and RNA polymerase-PNP mixtures suggest that RapA enables the polyadenylation by PAP of RNA polymerase-associated RNA. Mutations disrupting RapA's ATP-hydrolytic function disrupt RapA-dependent polyadenylation, and the rapA(-)E. coli strain displays a measurable reduction in RNA polyadenylation. RapA-dependent polyadenylation can also be modulated by mutations in the section of RapA's SWI/SNF domain linked to interaction with single-stranded nucleic acid. We have developed enzymatic assays in which model, synthetic RNAs are polyriboadenylated in a RapA-dependent manner. Taken together, our results are consistent with RapA acting as an RNA polymerase-associated, ATP-dependent RNA translocase. Our work further links RapA to RNA remodeling and provides new mechanistic insights into the functional interaction between RNA polymerase and RapA.

The Cardiac Physiology Underpinning Exsanguination Cardiac Arrest: Targets for Endovascular Resuscitation.

ABSTRACT: Exsanguination leading to cardiac arrest is the terminal phase of uncontrolled hemorrhage. Resuscitative interventions have focused on preload and afterload support. Outcomes remain poor due to several factors but poor coronary perfusion undoubtedly plays a role. The aim of this study is to characterize the relationship between arterial pressure and flow during hemorrhage in an effort to better describe the terminal phases of exsanguination.Male swine weighing 60 kg to 80 kg underwent splenectomy and instrumentation followed by a logarithmic exsanguination until asystole. Changes in hemodynamic parameters over time were compared using one-way, repeated measures analysis of variance.Nine animals weighing 69 ±â€Š15 kg were studied. Asystole occurred at 53 ±â€Š13 min when 52 ±â€Š11% of total blood volume has been shed. The greatest fall in mean hemodynamic indices were noted in the first 15 min: SBP (80-42 mm Hg, P = 0.02), left ventricular end-diastolic volume (94-52 mL, P = 0.04), cardiac output (4.8-2.4 L/min, P = 0.03), coronary perfusion pressure (57-30 mm Hg, P = 0.01), and stroke volume (60-25 mL, P = 0.02). This corresponds to the greatest rate of exsanguination. Organized cardiac activity was observed until asystole without arrythmias. Coronary flow was relatively preserved throughout the study, with a precipitous decline once mean arterial pressure was less than 20 mm Hg, leading to asystole.In this model, initial hemodynamic instability was due to preload failure, with asystole occurring relatively late, secondary to failure of coronary perfusion. Future resuscitative therapies need to directly address coronary perfusion failure if effective attempts are to be made to salvage these patients.

Development of a computed tomography perfusion protocol to support large animal resuscitation research.

BACKGROUND: Adequate cerebral perfusion is crucial for a positive neurological outcome in trauma; however, it is difficult to characterize in the acute setting with noninvasive methods. Intra-arterial computed tomography perfusion may offer a solution. The aim of this study was to develop an intra-arterial computed tomography perfusion protocol for resuscitation research. METHODS: The study examined intra-arterial contrast administration for computed tomography perfusion (CTP) acquisition. It consisted of three phases: intra-arterial contrast dose finding, evaluation of reproducibility, and evaluation during hypotension. Blood pressure and laser Doppler flow data were collected. In phase 1, animals underwent CTPs using several intra-arterial contrast injection protocols. In phase 2, animals underwent two CTPs 7 hours apart using the 2.5 mL/s for 3-second protocol. In phase 3, animals underwent CTPs at several pressures following a computer-controlled bleed including euvolemia and at systolic pressures of 60, 40, and 20 mm Hg. Phase 1 CTPs were evaluated for contrast-to-noise ratio. In phase 2, CTPs were compared within each animal and with laser Doppler flow using linear regression. Phase 3 CTPs were graphed against systolic pressure and fitted with a nonlinear fit. RESULTS: The protocol using 2.5mL/s for 3 seconds was optimal, demonstrating a contrast-to-noise ratio of 40.1 and a superior arterial input function curve compared with the 1 mL/s bolus. Cerebral blood flow demonstrated high concordance between baseline and end of study CTPs (R2 = 0.82, p < 0.001). Cerebral blood flow also compared moderately well against laser Doppler flow during 8 (R2 = 0.53, p = 0.03); however, laser Doppler flow did not perform well during hypovolemia, and the favorable concordance was not maintained (R2 = 0.45, p = 0.06). Cerebral blood flow was graphed against systolic blood pressure and fitted with a nonlinear fit (R2 = 0.95, p = 0.003). CONCLUSION: Computed tomography perfusion using intra-arterial contrast injection may offer a novel alternative to traditional CTP protocols that could prove a useful additional tool in the setting of resuscitation research.

Development of a Swine Polytrauma Model in the Absence of Fluid Resuscitation.

BACKGROUND: In locations in which access to resuscitative therapy may be limited, treating polytraumatized patients present a challenge. There is a pressing need for adjuncts that can be delivered in these settings. To assess these adjuncts, a model representative of this clinical scenario is necessary. We aimed to develop a hemorrhage and polytrauma model in the absence of fluid resuscitation. MATERIALS AND METHODS: This study consisted of two parts: pulmonary contusion dose-finding (n = 6) and polytrauma with evaluation of varying hemorrhage volumes (n = 6). We applied three, six, or nine nonpenetrating captive bolt-gun discharges to the dose-finding group and obtained computed tomography (CT) images. We segmented images to assess contusion volumes. We subjected the second group to tibial fracture, pulmonary contusion, and controlled hemorrhage of 20%, 30%, or 40% and observed for 3 hours or until death. We used Kaplan-Meier analysis to assess survival. We also assessed hemodynamic and metabolic parameters. RESULTS: Contusion volumes for three, six, and nine nonpenetrating captive bolt-gun discharges were 24 ± 28, 50 ± 31, and 63 ± 77 cm3, respectively (p = .679). Animals receiving at least six discharges suffered concomitant parenchymal laceration, whereas one of two swine subjected to three discharges had lacerations. Mortality was 100% at 12 and 115 minutes in the 40% and 30% hemorrhage groups, respectively, and 50% at 3 hours in the 20% group. CONCLUSION: This study characterizes a titratable hemorrhage and polytrauma model in the absence of fluid resuscitation. This model can be useful in evaluating resuscitative adjuncts that can be delivered in areas remote to healthcare access.