Martin Baumann

In vivo MRI visualization of mesh shrinkage using surgical implants loaded with superparamagnetic iron oxides.

BackgroundProsthetic mesh implants are widely used in hernia surgery. To show long-term mesh-related complications such as shrinkage or adhesions, a precise visualization of meshes and their vicinity in vivo is important. By supplementing mesh fibers with ferro particles, magnetic resonance imaging (MRI) can help to delineate the mesh itself. This study aimed to demonstrate and quantify time-dependent mesh shrinkage in vivo by MRI.MethodsPolyvinylidenfluoride (PVDF) meshes with incorporated superparamagnetic iron oxides (SPIOs) were implanted as an abdominal wall replacement in 30 rats. On days 1, 7, 14, or 21, MRI was performed using a gradient echo sequence with repetition time (TR)/echo time (TE) of 50/4.6 and a flip angle of 20°. The length, width, and area of the device were measured on axial, coronal, and sagittal images, and geometric deformations were assessed by surgical explantation.ResultsIn all cases, the meshes were visualized and their area estimated by measuring the length and width of the mesh. The MRI presented a mean area shrinkage in vivo of 13% on day 7, 23% on day 14, and 23% on day 21. Postmortem measurements differed statistically from MRI, with a mean area shrinkage of 23% on day 7, 28% on day 14, and 30% on day 21. Ex vivo measurements of shrinkage showed in vivo measurements to be overestimated approximately 8%. Delineation of the mesh helped to show folding or adhesions close to the intestine.ConclusionLoading of surgical meshes with SPIOs allows their precise visualization during MRI and guarantees an accurate in vivo assessment of their shrinkage. The authors’ observation clearly indicates that shrinkage in vivo is remarkably less than that shown by illustrated explantation measurements. The use of MRI with such meshes could be a reliable technique for checking on proper operation of implanted meshes and showing related complications, obviating the need for exploratory open surgical revision.

A Concept for Magnetic Resonance Visualization of Surgical Textile Implants

Purpose:To develop a method for visualizing surgical textile implant (STI) with superparamagnetic iron oxides (SPIO), using magnetic resonance imaging (MRI). Therefore, positive-contrast inversion-recovery with on-resonant water suppression (IRON) was applied and its properties were evaluated in vitro. Materials and Methods:STI with different concentrations of SPIO integrated into the base material were produced. Imaging was performed on a clinical 1.5 Tesla scanner, using conventional balanced gradient echo sequences (SSFP), T2*-weighted sequences, and IRON-imaging. In vitro experiments were conducted in an agarose phantom. On MR-images, contrast-to-noise-ratios, and the dimensions of the implant were assessed. Results:Conventional MRI exhibited SPIO-loaded STI as signal voids. Using IRON, the mesh was clearly exhibited hyperintensely with suppression of on-resonant background signals with a distinct differentiation to other sources of off-resonances. Concentrations of approximately 9 mg/g led to best positive contrast and highest contrast-to-noise-ratios using IRON. Depending on B0-orientation, phase encoding direction and the STIs SPIO-load, the IRON-signal showed a characteristic pattern and an overestimation of STI size up to 4.6 mm. Conclusion:The integration of SPIOs into the base material combined with IRON is a feasible approach to visualize STI with MRI. This method could help to identify mesh-related problems in time and to reduce the need for surgical revision.

Blended learning in radiology: is self-determined learning really more effective?

OBJECTIVE To investigate whether there are differences in learning outcomes after the application of self-determined (intrinsic motivation) or mandatory (extrinsic motivation) use of e-learning units in an undergraduate radiology internship. METHODS 96 medical students undergoing a one-week radiology internship were included in this study. Ten electronic cases (e-cases) were created for a blended learning approach. The e-learning environment was accessed on a self-determined (group B; n=32) or a mandatory basis (group C; n=32). A group without access to the e-learning environment served as control group (group A; n=32). Usage parameters of the e-cases were recorded. Results of a pre- and post-course assessment were used to quantitatively analyze learning outcomes. RESULTS In group B 19/32 (59%) students processed at least one e-case, while in group C all students processed at least one e-case. There was a trend towards a higher improvement in knowledge in students exposed to a blended learning approach (group B: 13.7%; group C: 15.4%) than in the control group (group A: 8.5%; p=0.5356). Group C processed (p=0.0093) and passed (p=0.0078) significantly more e-cases, than with group B. There were no significant differences in the mean time per e-case and the total time on e-cases between both groups. CONCLUSION Extrinsic motivation results in a more extensive use of e-learning units in an undergraduate radiology internship when compared with intrinsic motivation. The choice of the teaching strategy has a bigger influence on learning outcomes than the type of motivation, highlighting the need for qualified medical teachers.

Local membrane curvature affects spontaneous membrane fluctuation characteristics

Mechanical fluctuations on erythrocyte cell membranes wee measured by phase-contrast optics at the cell centre and cel rim. Intensity changes were digitized by a linear charge-coupled device array and both frequency spectra and autocorrelation functions were calculated to detect fluctuation characteristics at these areas. Validation was performed with glutaraldehydetreated cells. The influence of viscosity and membrane elasticity changes was evaluated by testing cells in solution of different osmolarities (239-392 mosmol I(-1)), and cells at different stages of diamide treatment (0.5-5.0 mmol I(-1)). The calculated membrane bending modulus of 1.4 E-19 J is in accordance with other findings. Despite an increase of endoplasmic viscosity, no homogeneous attenuation of the fluctuation amplitudes was observed, but a frequency shift was observed. Spectrin linkage caused by diamide has no effect on membrane fluctuations at the cell centre but it influences fluctuations at the cell rim, which can be explained by the higher membrane curvature at the cell rim compared with the lower, or even negative, membrane curvature at the cell centre.

Characteristics of the osmotically induced membrane rupture

The phenomenon of reciprocating mechanical oscillations of electrofused erythrocytes was used to investigate the mechanical characteristics of ruptures induced in erythrocyte membranes by colloid osmotic pressure. The rupture characteristics follow an exponentially decaying time function. Time constants determined for opening times of ruptures decreased from 5.5 ms at 10 degrees C to 3.8 ms and 2.0 ms at 40 degrees C for the first and the last observable rupture, respectively. Evidence is given that the diameter of the membrane rupture exceeds the size of a haemoglobin molecule. With repetitive membrane rupturing, the ability of the membrane bilayer and associated structures to heal decreases, owing to the reduced ability to withstand pressure gradients. This change allows oscillating doublets to be classified according to one of three groups: group A showing no development in response to swell times, group B showing a continuous decrease in response to swell times, and group C showing a spontaneous decrease in response to swell times. These results suggest that oscillations cease as a result of defects of membrane healing. Calculations of respective temperature ranges are in agreement with temperature ranges for spectrin denaturation. Thus, conclusions obtained from this study suggest that the spectrin network plays a key role in membrane healing processes after mechanical membrane rupture.

Early stage shape change of human erythrocytes after application of electric field pulses.

Erythrocytes which receive electric field pulses are subject to poration, fusion and shape changes due to electrodynamic forces, aminophospholipid perturbation and influences on the normal flip-flop process. The shape change characteristics of cells suspended in different media were analysed after application of rectangular electric field pulses from t=11-44 micros and from E=4-8 kV/cm. Albumin is shown to decelerate the echinocyte shape change within the first few seconds after pulse application. The addition of fluoride and vanadate accelerates the shape change due to their inhibiting influence on the aminophospholipid translocase. For both the duration of the field pulse and its field strength, there exist lower threshold values under which no early stage shape change is observable. The activation energy calculated from the dissipative influence of the electric field alone is smaller than expected, indicating the electrodynamic influence on the flip-flop process. Cell shapes were additionally analysed by contour tracing to focus on the echinocyte spicule distribution after pulse application. This image analysis revealed that, with an increase of both pulse duration and field strength, the shape change velocity and the shape change intensity increase.

Mapping of proton relaxation near superparamagnetic iron oxide particle-loaded polymer threads for magnetic susceptibility difference quantification.

ObjectivesConventional radiological methods, including magnetic resonance imaging (MRI), fail to visualize polymeric surgical mesh implants because of small thread dimensions and material characteristics. For MRI delineation of such meshes, superparamagnetic iron oxide particles (SPIOs) are integrated in the mesh polymer. Usually, if SPIOs are used as an intravenous contrast agent, they increase the R1 and R2 of adjacent protons. It can be assumed that embedding SPIOs in polymers alters their molecular dynamics. The aim of this study was to investigate the influence of SPIO integration in polymer on the relaxation of adjacent protons. Materials and MethodsPolymer threads were placed in an agarose phantom. At 1.5 T, R1, R2, and R2* maps were calculated from multi inversion-recovery spin echo, multi–spin echo, and multi–gradient echo images, respectively. The threads were aligned parallel or orthogonal to B0. ResultsNo impact of SPIO on proton R1 and R2 was observed. R2* was increased by the SPIO-loaded threads. R1 and R2 amplitude maps showed a magnetic susceptibility difference of 0.97 ppm/(mg SPIO/g polymer) around SPIO-loaded threads. ConclusionsIn contrast to SPIO in aqueous solutions, polymer-embedded SPIO do not affect proton R1 and R2. However, embedded SPIO generate strong local static magnetic field gradients. Thus, SPIO integration is suitable to control the magnetic susceptibility of polymer threads. This can be exploited to visualize implanted polymer-based meshes in MRI using R2* susceptible sequences. Because no impact on R1 and R2 of adjacent protons by SPIO embedded in mesh threads was observed, structures adjacent to implanted meshes will be observable in R1 and R2 maps.

Standardized ultrasound as a new method to induce platelet aggregation. Evaluation, influence of lipoproteins and of glycoprotein IIb/IIIa antagonist tirofiban

Most of the published studies concerning platelet aggregation were performed with chemical stimulation procedures, however, mechanical stimulation might be a better simulation of physiological activation of platelets. In order to evaluate the influence of ultrasound on platelet aggregation in vitro, we developed an ultrasound device in a standardized set-up, and we evaluated the influence of lipoproteins and the glycoprotein IIb/IIIa inhibitor tirofiban on ultrasound induced platelet aggregation. A cylindrical shaped plastic test tube with 1 ml of platelet-rich plasma was placed in an ultrasound bath (35 kHz) for 5 s. The ultrasound energy transfer into the sample (Delta W=3.77 J) was calculated using the average temperature increase (averaged by 0.935 degrees C) of the sample. Platelet aggregation was quantified immediately after stimulation with ultrasound or adenosine diphosphate (ADP 2.1 and 4.2 microM) by the Myrenne Aggregometer PA2 at low (40 s(-1)) and afterwards at high (2500 s(-1)) shear. To evaluate the influence of lipoproteins, seven healthy male volunteers were investigated before and after a fat load (50 g fat per m(2) body surface), and 11 patients suffering from hypercholesterolemia and atherosclerotic disease before and after a single low-density lipoprotein (LDL) apheresis. Platelet aggregation after ultrasound stimulation was well correlated with platelet aggregation after ADP (r between 0.50 and 0.95). However, when exposed to high shear, the low shear-induced platelet aggregates were more stable after ultrasound stimulation compared with ADP stimulation either with or without tirofiban. After the fat load triglyceride concentration increased from 0.86+/-0.39 to 2.10+/-1.10 mmol l(-1) (P<0.05) resulting in a reduced formation of platelet aggregates after weak (ADP 2.1 microM) but not after strong (ADP 4.2 microM or ultrasound) stimuli. After a single LDL apheresis LDL cholesterol dropped from 3.99+/-0.90 to 1.06+/-0.55 mmol l(-1) (P<0.005). No changes in platelet aggregation were observed with the exception of a lower aggregation when exposed to high shear after stimulation with 2.1 microM ADP. In conclusion, we found the ultrasound stimulation of platelet-rich plasma easy to perform. The platelet aggregation after ultrasound stimulation correlated well with stimulation after ADP. While a reduction in LDL cholesterol concentration had only slight effects on platelet aggregation, an increase in triglyceride concentration resulted in a reduced formation of platelet aggregates after weak stimulation.

Optimization of magnetic drug targeting by mathematical modeling and simulation of magnetic fields

Magnetic drug targeting is a method of transporting drugs to specific locations within the human body. For this purpose superparamagnetic nanoparticles (MNP) are combined with chemotherapeutic agents, injected into the circulatory system and guided to a target site using an external magnetic field that acts on the MNP.

Agglomeration of magnetic nanoparticles and its effects on magnetic hyperthermia

Abstract Magnetic fluid hyperthermia (MFH) is a promising approach for organ-confined tumor treatment. In MFH, magnetic nanoparticles (MNP) are magnetically targeted at the tumor site and heated in an alternating magnetic field. The heat produced by the MNP is used to cause tumor cell death. At the tumor site, MNP bind to the cell membrane and form agglomerates before they are internalized into the intracellular compartments. Intracellular immobilization and the formation of agglomerates influence heating properties of MNP making it difficult to control the local heating inside the tumor. In this study, we investigated MNP agglomerated samples for their heating efficiency. We found an increase in heating of 22 % upon agglomeration. If MNP are additionally immobilized, however, the heating decreases by 30 %. Consequently, due to the binding of bigger MNP agglomerates at cellular level, heating efficiency inside tumors is assumed to decrease.