Analysis of ultrasound fields in cell culture wells for in vitro ultrasound therapy experiments

Ultrasound is an established therapy method for bone fracture healing, hyperthermia and the ablation of solid tumors. In this new emerging field, ultrasound is further used for microbubble-enhanced drug delivery, gene therapy, sonoporation and thrombolysis. To study selected therapeutic effects in defined experimental conditions, in vitro setups are designed for cell and tissue therapy. However, in vitro studies often lack reproducibility and the successful transfer to other experimental conditions. This is partly because of the uncertainty of the experimental conditions in vitro. In this paper, the ultrasound wave propagation in the most common in vitro ultrasound therapy setups for cell culture wells is analyzed in simulations and verified by hydrophone measurements. The acoustic parameters of the materials used for culture plates and growth media are determined. The appearance and origin of standing waves and ring interference patterns caused by reflections at interfaces is revealed in simulations and measurements. This causes a local maximal pressure amplitude increase by up to the factor of 5. Minor variations of quantities (e.g., growth medium volume variation of 2.56%) increase or decrease the peak rarefaction pressure at a cell layer by the factor of 2. These pressure variations can affect cell therapy results to a large extent. A sealed cell culture well submersed in a water bath provides the best reproducibility and therefore promises transferable therapy results.     

Endovascular placement of an extraluminal arterial bypass graft – in vitro feasibility study

Purpose: A novel approach for arterial bypass grafting using exclusively endovascular techniques was established in-vitro in a phantom model.

Material and methods: The experimental setting consisted of a gel-wax phantom with two embedded parallel fluid-filled silicon tubes simulating the superficial femoral vessels. Through an 8-French sheath, a re-entry catheter (OUTBACK^®, Cordis) was placed in the simulated artery and used to puncture the vascular wall. Then a 0.014-inch guide wire was advanced into the extravascular space. With the curved needle of the re-entry catheter, the guide wire was steered on a course parallel to the vessel wall in the extravascular space for 5-10?cm. At the desired reentry site, the re-entry catheter was used to puncture the vascular wall again in order to regain access to the endovascular space. Once the tip of the guide wire had safely been placed in the vascular lumen, a self-expandable stent graft (VIABAHN^® GORE^®) was deployed to complete the extraluminal bypass.

Results: Endovascular placement of an extraluminal bypass was successfully achieved in 20 attempts. The mean duration of the procedure amounted to 14:58 (minutes: seconds) (SD?±?3:56).

Conclusions: This in-vitro study suggests that endovascular placement of an extraluminal arterial bypass graft is technically feasible.     

Mandible reconstruction with patient-specific pre-bent reconstruction plates: comparison of a transfer key method to the standard method—results of an in vitro study

Purpose  

Patient-specific mandible reconstruction plates may be pre-bent to facilitate the surgical procedure. A method using transfer keys (TK) for repositioning pre-bent plates was compared with the standard method on mandibular models to evaluate its feasibility.     

The meanings given to gender in studies on multimodal rehabilitation for patients with chronic musculoskeletal pain – a literature review

Purpose: The purpose of this study is to assess and describe the meanings given to “gender” in scientific publications that evaluate multidisciplinary, interdisciplinary or multimodal rehabilitation for patients with chronic musculoskeletal pain.

Method: A systematic literature search for papers evaluating multimodal rehabilitation was conducted. The PubMed and EBSCO databases were searched from 1995 to 2015. Two or three researchers independently read each paper, performed a quality assessment and coded meanings of gender using qualitative content analysis.

Results: Twenty-seven papers were included in the review. Gender was used very differently in the MMR studies investigated but primarily it referred to factual differences between men and women. Only one paper provided a definition of the concept of gender and how it had been used in that study. In the content analysis, the meaning of gender formed three categories: “Gender as a factual difference”, “The man is the ideal” and “Gender as a result of social role expectations”.

Conclusions: The meaning of the concept of gender in multimodal rehabilitation is undefined and needs to be developed further. The way the concept is used should be defined in the design and evaluation of multimodal rehabilitation in future studies.

• Implications for rehabilitation

• Healthcare professionals should reflect on gender relations in encounters with patients, selection of patients into rehabilitation programs and design of programs.

• In rehabilitation for chronic pain the patients’ social circumstances and cultural context should be given the same consideration as biological sex and pain symptoms.

     

Team communications in surgery – creating a culture of safety

Abstract

As a key department within a healthcare organisation, the operating room is a hazardous environment, where the consequences of errors are high, despite the relatively low rates of occurrence. Team performance in surgery is increasingly being considered crucial for a culture of safety. The aim of this study was to describe team communication and the ways it fostered or threatened safety culture in surgery. Ethnography was used, and involved a 6-month fieldwork period of observation and 19 interviews with 24 informants from nursing, anaesthesia and surgery. Data were collected during 2009 in the operating rooms of a tertiary care facility in Queensland, Australia. Through analysis of the textual data, three themes that exemplified teamwork culture in surgery were generated: “building shared understandings through open communication”; “managing contextual stressors in a hierarchical environment” and “intermittent membership influences team performance”. In creating a safety culture in a healthcare organisation, a team’s optimal performance relies on the open discussion of teamwork and team expectation, and significantly depends on how the organisational culture promotes such discussions.     

Potential pharmacobezoar formation of large size extended-release tablets and their dissolution – an in vitro study

Objective: Extended release (ER) tablets/capsules in massive ingestion overdoses are prone to form pharmacobezoars potentially increasing the risk of late-appearing toxic effects and prolonged symptoms. Oral activated charcoal is often sufficient to prevent drug absorption, but in a recent massive ingestion of highly toxic substances, prior orogastric lavage might be considered. The disintegration characteristics of ER preparations in overdose situations is valuable to understand if the time line and course of the intoxication might be prolonged, but information on these characteristics are unavailable. Slow disintegration and/or pharmacobezoar formation, and the large size makes ER preparation impossible to evacuate using a 30F orogastric lavage tube. This study evaluates the disintegration and pharmacobezoar formation of a simulated massive ER tablet ingestion in an in vitro model, using a selection of extended release tablets, with different disintegrating characteristics when present in therapeutic numbers. Furthermore, the sizes of the formed pharmacobezoars were compared with the dimensions of a 30F orogastric lavage tube.

Method: A standardized model mimicking the physical effects on pharmaceutical preparations in simulated gastric fluid (SGF) was developed and tested on three mono-depot ER tablets (quetiapine/Seroquel^®XR 50?mg, paracetamol/Pinex^®Retard 500?mg, verapamil/Isoptin^®Retard 240?mg), one poly-depot ER tablet (carbamazepine/Tegretol^®Retard 200?mg), and one immediate-release tablet (paracetamol/Panodil^® 500mg). Thirty tablets were placed in polyamide mesh bags, either together in one bag or in separate bags, immersed in 1?L SGF, and incubated at 37?°C for 48?h. Released drugs were quantified at 0.5–48?h.

Results: Visual inspection showed that Seroquel^®XR, Pinex^®Retard, and Isoptin^®Retard tablets formed firm pharmacobezoars stable for more than 4?h and intact fractions remained for up to 24?h. Drug releases were reduced by 53%, 40%, and 31%, respectively, for up to 8?h compared to separated tablets. Light microscopy showed that contact with SGF transformed the coating of Seroquel^®XR and Pinex^®Retard to a diffusion-controlled swelled gel-layer, and the Isoptin^®Retard tablets into a rigid and slow-releasing matrix. Tegretol^®Retard disintegrated into microspheres within 30?min, and Panodil^® disintegrated within minutes.

Discussion: The developed pharmacobezoars of mono-depot ER tablets demonstrated prolonged drug release. Neither the formed pharmacobezoars, nor the single tablets of the tested mono-depot ER preparations, would pass through the lumen of a standard orogastric lavage tube, rendering this modality ineffective for tablet removal in gastrointestinal decontamination.     

Development of a model for organisation of and cooperation on home-based rehabilitation – an action research project

Abstract

Purpose: To use general policy guidelines and staff experience of rehabilitation work in two boroughs in Oslo to develop a model for organisation and cooperation in home-based rehabilitation. Method: The project was conducted as a collaboration between researchers and employees in the two boroughs. It was a practice-oriented study designed as an action research project combining knowledge generation and improvement of practice. Data were collected at seven meetings, and individual, qualitative interviews with a total of 24 persons were conducted in the period February 2010 to June 2011. Results: Home-based rehabilitation occurred rarely in the boroughs, and this field received little attention. However, this project provided a broad discussion of rehabilitation involving all parts of the organisation of both boroughs. In the course of the project, researchers and borough staff together developed a model for the organisation of and cooperation on rehabilitation including a coordinating unit assigned the paramount responsibility for the rehabilitation and an interdisciplinary team organising the collaboration on the practical level. Conclusions: When implementing a model like this in primary health services, we recommend involving several levels and service locations of the borough staff in order to legitimise the model in the organisation.

• Implications for Rehabilitation

• An increasing number of older people with chronic diseases in the Western world have caused increasing emphasis on rehabilitation in primary health care in patients’ homes.

• This study has elucidated challenging framework conditions for rehabilitation work in two Norwegian boroughs.

• To reduce municipal challenges we propose a rehabilitation model with a coordinating unit with the paramount responsibility for rehabilitation, and an interdisciplinary team constituting a suitable structure for collaboration.

     

Microsystems in medicine – results of an international survey

The utilization of microsystems technology (MST) in medical applications is instrumental in opening up new market segments, in the creation of novel, more effective diagnosis and therapy options in medicine, as well as in the further development of MST. However, the players in the healthcare industry are faced with technical and non‐technical difficulties. The present study analyzes this emerging field from the viewpoint of medicine, market, and MST. It identifies applications of medical devices with microsystems components and analyzes their potentials in great detail. Thus, especially the creation of new market segments is expected from a broad use of MST in medicine. Furthermore, problems and conditions during the entry of microsystems into medical products are illuminated, in particular considering the specific market features of the healthcare industry. The high expenditure necessary for establishing this technology in healthcare industry is the most significant obstacle, since this market is dominated by small and medium‐sized enterprises (SMEs). But there are non‐technical difficulties as well. This article presents selected results of the study, which was carried out in the scope of the EU project netMED (virtual institute on micromechatronics for biomedical industry).     

Curative effect analysis of therapeutic ultrasonic in vitro on hyperlipemia

Objective:to observe the effects of therapeutic ultrasoud in vitro on hyperlipemia.Methods :Comparing clinical effects of only ultrasound treatment,only administration of Geminifbrozip and combination of these two therapies.Theses patientswere divided into three groups and the follow-up observation was 3 months.Result Curative effect of the ultrasound group was better than that of drug group(P&;lt;0.05).Curative effect of the combined therapy group was the best(P&;lt;0.01),Result of follow-up suggested that servum glyceryl trioleate and cholesterol replapse rate of ultrasonic group was lower than that of drug goup.Serum glyceryl trioleate and cholesterol relapse rate of combined therapy group was the lowest.Conclusion:Combination of ultrasound treatment in vitro and administration of Geminifbrozip is the best way to treat hyperlipemia,and it is not easy to relapse.     

Growth of yeast cultures as in vitro model for investigating homœopathic medicines: Some further studies

o

1. 1The question of a sensitive response in the growth of yeast cell cultures to treatments with homœopathic dilutions (potencies), has been raised in a number of recent publications,^1,2,3. A further set of growth trials with this model performed at our Institute are reported here.
2. 2The actions of 8x to 16x decimal potencies of AgNO₃, CuSO₄, HgCl₂, and NaCl on the growth of cell cultures of Schizosaccharomyces pombe were investigated. This included a set of trials with experimental poisoning of the cells by toxic levels of CuSO₄ and subsequent study of the remedial action by potencies of the same substance.
3. 3.Yeast cells were grown in batch culture in a glucose/malt extract medium. Growth was interrupted shortly before the end of the exponential growth phase and total cell concentrations were assessed by means of a Coulter Counter. The obtained data were subjected to statistical analysis. Each treatment range was tested in three separate trials.
4. 4The results obtained failed to indicate any response in the growth rate of Sch. pombe to the potency treatments.

     

Interprofessional education day – an evaluation of an introductory experience for first-year students

Interprofessional health care teams have been shown to improve patient safety and reduce medical errors, among other benefits. Introducing interprofessional concepts to students in full day events is an established model that allows students to learn together. Our group developed an academic day for first-year students devoted to an introductory interprofessional education (IPE) experience, ‘IPE Day’. In total, 438 students representing medicine, dentistry, pharmacy and optometry gathered together, along with 25 facilitators, for IPE Day. Following the day’s program, students completed the evaluation consisting of the Interprofessional Collaborative Competencies Attainment Survey and open-ended questions. Narrative responses were analyzed for content and coded using the Canadian Interprofessional Health Collaborative competency domains. Three hundred and eight evaluations were completed. Students reported increased self-ratings of competency across all 20 items (p < 0.05). Their comments were organized into the six domains: interprofessional communication, collaborative leadership, role clarification, patient-centred care, conflict resolution, and team functioning. Based on these findings, we suggest that this IPE activity may be useful for improving learner perceptions about their interprofessional collaborative practice competence.     

Nondrug costs of therapy in acute care – are they important?

Drug acquisition costs are only a proportion of the total costs associated with drug therapy. The relevance of these costs are often not appreciated. However, they impact on the Intensive Care Unit via resources and quality of care. Increased indirect care by medical and nursing staff has the potential to adversely affect patient outcome. Redirecting staff to their primary role and reducing indirect patient activities will increase quality and allow more patients to be treated. Costs and resources are increasingly important in health care provision.