Towards the simulation of bone-implant systems with a stratified material model

BACKGROUND

The clinical performance of medical devices is becoming increasingly important for the requirements of modern development processes and the associated regulations. However, the evidence for this performance can often only be obtained very late in the development process via clinical trials or studies.

OBJECTIVE

The purpose of the presented work is to show that the simulation of bone-implant-system has advanced in various aspects, including cloud-based execution, Virtual Clinical Trials and material modeling towards a point where and widespread utilization in healthcare for procedure planning and enhancing practices seems feasible. But this will only hold true if the virtual cohort data build from clinical Computer Tomography data are collected and analysed with care.

METHODS

An overview of the principal steps necessary to perfor Finite Element Method-based structural mechanical simulations of bone-implant systems based on clinical imaging data is presented. Since these data form the baseline for virtual cohort construction, we present an enhancement method to make them more accurate and reliable.

RESULTS

The findings of our work comprise the initial step towards a virtual cohort for the evaluation of proximal femur implants. In addition, results of our proposed enhancement methodology for clinical Computer Tomography data that demonstrate the necessity for the usage of multiple image reconstructions are presented.

CONCLUSION

Simulation methodologies and pipelines nowadays are mature and have turnaround times that allow for a day-to-day use. However, small changes in the imaging and the pre-processing of data can have a significant impact on the obtaind results. Consequently, first steps towards virtual clinical trials, like collecting bone samples, are done, but the reliability of the input data remains subject to further research and development.

Osmotic regulation of aquaporin-8 expression in retinal pigment epithelial cells in vitro: Dependence on KATP channel activation

PURPOSE

The expression of aquaporin-8 (AQP8), which plays a crucial role in the maintenance of the cellular fluid and electrolyte balance, was shown to be increased in RPE cells under hyperosmotic conditions. The aim of the present study was to investigate the mechanisms of hyperosmotic AQP8 gene expression and the localization of AQP8 in cultured human RPE cells.

METHODS

Hyperosmolarity was produced with the addition of 100 mM NaCl or 200 mM sucrose. Hypoxia was induced by cell culture in a 0.2% O₂ atmosphere or the addition of the hypoxia mimetic CoCl₂. Oxidative stress was induced by the addition of H₂O₂. Gene expression was determined with real-time RT-PCR analysis. AQP8 protein localization and secretion of VEGF were evaluated with immunocytochemistry, western blotting, and enzyme-linked immunosorbent assay (ELISA).

RESULTS

Immunocytochemical and western blot data suggest that the AQP8 protein is mainly located in the mitochondria. Extracellular hyperosmolarity, hypoxia, and oxidative stress induced increases in AQP8 gene expression. Hyperosmotic AQP8 gene expression was reduced by inhibitors of the p38 MAPK and PI3K signal transduction pathways, and by JAK2 and PLA₂ inhibitors, and was in part mediated by the transcriptional activity of CREB. Hyperosmotic AQP8 gene expression was also reduced by autocrine/paracrine interleukin-1 signaling, the sulfonylureas glibenclamide and glipizide, which are known inhibitors of K_ATP channel activation, and a pannexin-blocking peptide. The K_ATP channel opener pinacidil increased the expression of AQP8 under control conditions. The cells contained Kir6.1 and SUR2B gene transcripts and displayed Kir6.1 immunoreactivity. siRNA-mediated knockdown of AQP8 caused increases in hypoxic VEGF gene expression and secretion and decreased cell viability under control, hyperosmotic, and hypoxic conditions.

CONCLUSIONS

The data indicate that hyperosmotic expression of AQP8 in RPE cells is dependent on the activation of K_ATP channels. The data suggest that AQP8 activity decreases the hypoxic VEGF expression and improves the viability of RPE cells which may have impact for ischemic retinal diseases like diabetic retinopathy and age-related macular degeneration.

Helper T cells (CD3 + /CD4 + ) within the autologous peripheral blood stem cell graft positively correlate with event free survival of multiple myeloma patients

BACKGROUND

The microenvironment in the bone marrow - including lymphocytes - is part of the pathophysiology of multiple myeloma (MM). High dose chemotherapy followed by autologous stem cell transplantation is standard of care for younger patients.

AIM

To determine the influence of reinfused lymphocyte subsets on event free survival (EFS) and overall survival (OS).

METHODS

In peripheral blood (PB) and aphaeresis products (AP) of 41 MM patients lymphocyte subsets were determined by flow cytometry and were correlated with clinical outcome.

RESULTS

PB lymphocyte subsets did not influence EFS or OS. Residual plasma cells in the AP were not correlated with poor outcome, whereas a high percentage of B cells (CD19+) showed a trend towards reduced EFS (P = 0.051). A high amount of CD4 cells and an increased CD4/CD8 ratio were significantly associated with prolonged EFS. In contrast, high percentage of HLA-DR positive lymphocytes showed negative impact on EFS and OS (P = 0.03 and 0.02, respectively).

CONCLUSION

Obtained data suggest the non-activated (HLA-DR negative) helper CD4+ T cells in the AP to be tumour protective.

Correlation of residual leukocyte subsets with neutropenic fever during severe leukopenia after high-dose chemotherapy and autologous stem cell transplantation

BACKGROUND

High-dose chemotherapy with autologous stem cell transplantation is the standard treatment of eligible patients with multiple myeloma. However, this treatment is associated with a substantial risk of infectious complications during leukopenia. The aim of our pilot study was to determine the residual leukocyte subsets during severe cytopenia after high-dose melphalan and to correlate this with the occurrence of neutropenic fever.

METHODS

Residual leukocyte subsets in the peripheral blood on days 4-7 following autologous stem cell transplantation were analyzed by three-color flow cytometry in 20 patients with multiple myeloma. In addition, we determined the number of T cells that were transfused with the autografts.

RESULTS

Absolute numbers of lymphocytes (mean 25/microL) and monocytes (mean 4/microL) were strongly reduced but rather constant during the period of severe neutropenia. Neutrophil engraftment and duration of neutropenia were very similar in patients with and without neutropenic fever. Low absolute lymphocyte counts and absolute CD4+ T-cell counts on days 4-7 after stem cell transplantation correlated with neutropenic fever. Furthermore, T-cell numbers in the autologous stem cell grafts that the patients received were significantly lower in patients with neutropenic fever.

DISCUSSION

These observations suggest that the number of T cells, and in particular CD4+ T cells, in the blood during severe cytopenia is playing a role in defense of infection. T-cell numbers in the graft could provide a predictive factor for the risk of infection in the post-transplant period. However, this needs to be confirmed in a larger study.

Peripheral blood monoclonal B-cells predict the event free survival in multiple myeloma

Reinfusion of myeloma progenitor cells may contribute to relapse of multiple myeloma after autologous stem cell transplantation. The aim of our study was to investigate whether monoclonal B-cells are present in the apheresis product and to evaluate the clinical relevance of these cells. Leukapheresis products of 55 patients were purged with anti-B-cell-Monoclonal antibodies (MoAbs) and immunobeads. Monoclonal B-cells were found in 85% of patients within the B-cell population. In one third of all myeloma patients, the majority of B-cells was represented by monoclonal myeloma progenitor B-cells, whereas in two thirds of patients monoclonal cells only represented a small part of the entire B-cell population. As shown by sequence analysis, monoclonal precursor B-cells and malignant plasma cells had the identical genetic CDR III sequence. The purging efficacy, using a negative selection system, was a median of 3 logs (range 1,5-3,5). No statistical difference in the purging efficacy was found when 3, 4 or 5 MoAbs against B-cells antigens were used. However, a tumor specific signal could be detected in the purged harvest of all patients, when the highly sensitive ASO-PCR approach was used. Furthermore, we found a direct correlation between the amount of remaining monoclonal cells after negative selection and the event free survival of myeloma patients. 10/15 patients with a median of 20 x 10(3) monoclonal cells in the purged product relapsed at a median of 1,4 years, whereas only 6/24 patients with an oligoclonal pattern including a low number of remaining monoclonal cells relapsed at a median of 2,2 years. The event free survival (EFS) was statistically different between the two groups (p = 0,014).

PCR-restriction enzyme analysis of a bone marrow isolate from a human immunodeficiency virus-positive patient discloses polyclonal infection with two Mycobacterium avium strains

Polyclonal infection by Mycobacterium avium was detected by hsp65 PCR-restriction enzyme analysis (PRA) in a bone marrow isolate from an AIDS patient. Two M. avium strains, differing in colony morphology, PRA HaeIII digestion pattern, insertion element (IS) 1245 amplification, and restriction fragment length polymorphism fingerprints with IS1245 and IS1311 probes, were isolated.

In situ tolerance within the central nervous system as a mechanism for preventing autoimmunity

Multiple sclerosis (MS) is believed to be an autoimmune disease in which autoreactive T cells infiltrate the central nervous system (CNS). Animal models of MS have shown that CNS-specific T cells are present in the peripheral T cell repertoire of healthy mice and cause autoimmune disease only when they are activated by immunization. T cell entry into the CNS is thought to require some form of peripheral activation because the blood-brain barrier prohibits trafficking of this tissue by naive cells. We report here that naive T cells can traffic to the CNS without prior activation. Comparable numbers of T cells are found in the CNS of both healthy recombinase activating gene (Rag)(-/)- T cell receptor (TCR) transgenic mice and nontransgenic mice even when the transgenic TCR is specific for a CNS antigen. Transgenic T cells isolated from the CNS that are specific for non-CNS antigens are phenotypically naive and proliferate robustly to antigenic stimulation in vitro. Strikingly, transgenic T cells isolated from the CNS that are specific for myelin basic protein (MBP) are also primarily phenotypically naive but are unresponsive to antigenic stimulation in vitro. Mononuclear cells from the CNS of MBP TCR transgenic but not nontransgenic mice can suppress the response of peripheral MBP-specific T cells in vitro. These results indicate that naive MBP-specific T cells can traffic to the CNS but do not trigger autoimmunity because they undergo tolerance induction in situ.

High-efficiency dielectric reflection gratings: design, fabrication, and analysis

We report on reflection gratings produced entirely of dielectric materials. This gives the opportunity to enhance the laser damage threshold over that occurring in conventional metal gratings used for chirped-pulse-amplification, high-power lasers. The design of the system combines a dielectric mirror and a well-defined corrugated top layer to obtain optimum results. The rules that have to be considered for the design optimization are described. We optimized the parameters of a dielectric grating with a binary structure and theoretically obtained 100% reflectivity for the -1 order in the Littrow mounting for a 45 degrees angle of incidence. Subsequently we fabricated gratings by structuring a low-refractive-index top layer of a multilayer stack with electron-beam lithography. The multilayer system was fabricated by conventional sputtering techniques onto a flat fused-silica substrate. The parameters of the device were measured and controlled by light scatterometer equipment. We measured 97% diffraction efficiency in the -1 order and damage thresholds of 4.4 and 0.18 J/cm(2) with 5-ns and 1-ps laser pulses, respectively, at a wavelength of 532 nm in working conditions.

Polarization multiplexing of diffractive elements with metal-stripe grating pixels

Diffractive elements with polarization multiplexing for the visible spectral region are demonstrated. The polarization-multiplexing property of the element is based on the polarization-dependent transmission characteristics of metal-stripe subwavelength period gratings. The proper dimensions of these gratings are estimated by rigorous calculations. The principle of polarization multiplexing by use of metal-stripe subwavelength period gratings is described for a diffractive element that has a binary amplitude transmission per polarization channel and is demonstrated by experimental results.

Efficient coupling into polymer waveguides by gratings

Investigations of highly efficient grating couplers for polymer slab and strip waveguides fabricated by electron-beam lithography are reported. A maximum input efficiency of 67% is achieved. The electron-beam direct-writing technique allows one to replicate the original gratings into polymer substrates by embossing. An all-polymeric optical chip with efficient grating couplers is demonstrated. Waveguide grating couplers with blazed profile and variable grating depth are investigated. Thus, the intensity distribution of the outcoupled light is matched to a Gaussian-like profile. A focusing blazed grating that couples the light with an efficiency of 42% into a polymer strip waveguide is reported. A curvature correction of the grating lines allows one to improve the focusing properties.

The bcl-2/JH gene rearrangement is undetectable in Hodgkin's lymphomas: results from the German Hodgkin trial

Ninety-one Hodgkin's lymphomas (HD), 52 non-Hodgkin lymphomas (NHL) and 33 specimens of non-neoplastic lymphatic tissues were investigated by polymerase chain reaction (PCR) for the presence of the bcl-2/JH gene rearrangement. The majority of the HD cases were drawn from the files of the German Hodgkin trial where diagnoses are established by a panel of four independent histopathologists. Using the very sensitive PCR method which detected 1 positive among 10000 negative cells, the bcl-2/JH gene rearrangement was found in 7/52 NHL and 3/16 tonsils with follicular hyperplasia, but in none of the 91 HD. The bcl-2 protein, however, was expressed by malignant cells of B and T cell lymphomas and by the giant tumour cells in 2/13 HD lymphocyte predominant, 11/28 HD nodular sclerosing I, 14/17 HD nodular sclerosing II, 10/27 HD mixed cellularity and 3/3 HD lymphocyte depleted. The bcl-2/JH rearrangement is thus independent of protein over-expression, the latter being found in all types of lymphomas. Our results do not confirm the findings of others who have detected the bcl-2/JH rearrangement in HD. These discrepancies may be explained by differences in choice of material, the gene rearrangement actually occurring in bystander cells but not in Reed-Sternberg or Hodgkin cells, or by contamination.

DNA isolation by a rapid method from human blood samples: effects of MgCl2, EDTA, storage time, and temperature on DNA yield and quality

The isolation of DNA from whole blood by a modified rapid method (RM) was tested using various detergents and buffer conditions. Extraction of DNA with either NP-40 or Triton X-100 gave a high yield of undegraded DNA in less than an hour. The concentration of magnesium ion in the buffers was critical to obtaining intact, high molecular weight (HMW) DNA. Greater than 10 mM MgCl2 led to degradation. Addition of EDTA to the buffer inhibits this degradation. Preparation of DNA from blood stored at room temperature or incubated at 37 degrees C for 24 hr resulted in the same amount and quality of DNA as from samples frozen at -70 degrees C. DNA from blood samples that had undergone more than four freeze-thaw cycles was found to be partially degraded. The modified RM can be applied to extract DNA from as little as 10 microliters of blood (340 ng of DNA) and from dried blood samples. DNA samples remained intact and undegraded for longer times when DNA was dissolved in higher concentrations of EDTA.