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Jellyfish have emerged as a source of next generation collagen that is an attractive alternative to existing sources, such as bovine and porcine, due to a plentiful supply and providing a safer source through lack of bovine spongiform encephalopathy (BSE) transmission risk and potential viral vectors, both of which could be transmitted to humans. Here we compare collagen implantable sponges derived for the first time from the Rhizostoma pulmo jellyfish. A further novelty for the research was that there was a comparison for sponges that were either uncrosslinked or crosslinked using 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC), and an assessment on how this affected resorption, as well as their biocompatibility compared to bovine type I collagen sponges. The scaffolds were prepared and examined using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS PAGE) and scanning electron microscopy (SEM). The samples were implanted in adult male Wistar rats for in vivo experimentation. Both crosslinked and uncrosslinked jellyfish collagen sponges showed a significant reduction in histopathology scores over the course of the study, whereas the bovine collagen sponge scores were not significantly reduced. Both jellyfish collagen sponges and the bovine sponge were tolerated well by the hosts, and a recovery was visible in all samples, suggesting that R. pulmo jellyfish-derived collagen could offer compelling biocompatibility with wound healing applications. We also demonstrate that noncrosslinked samples could be safer with better resorption times than crosslinked samples. © 2017 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1524-1533, 2018., (© 2017 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc.)

The GABA(A) receptors (GABARs) are chloride-permeable ligand-gated ion channels responsible for fast inhibitory neurotransmission. These receptors are structurally heterogeneous, and in mammals can be formed from a combination of sixteen different subunit subtypes. Much of this variety comes from the six different alpha subunit subtypes. All neuronal GABARs contain an alpha subunit, and the identity of the alpha subtype affects the pharmacological properties of the receptors. The expression of each of the different alpha subtypes is regulated developmentally and regionally and changes with both normal physiological processes such development and synaptic plasticity, and pathological conditions such as epilepsy. In order to understand the functional significance of this structural heterogeneity, we examined the effect of the alpha subtype on the receptor's response to GABA. Each of the six alpha subtypes was transiently co-expressed with the beta3 and gamma2L subunits in mammalian cells. The sensitivity to GABA was measured with whole-cell recordings. We also determined the activation, deactivation, desensitization, and recovery kinetics for the six isoforms using rapid application recordings from excised macropatches. We found unique characteristics associated with each alpha subunit subtype. These properties would be expected to influence the post-synaptic response to GABA, creating functional diversity among neurons expressing different alpha subunits.

Purpose: In the presence of carotid occlusion, the external carotid artery (ECA) becomes an important source of cerebral blood flow, especially if the circle of Willis is incomplete. The contribution of the ECA to hemispheric blood flow in patients with severe ipsilateral carotid stenosis has never been previously investigated., Methods: One hundred eight patients were monitored during sequential cross-clamping of the external (ECA) and then ipsilateral internal carotid artery (ICA) during carotid endarterectomy using transcranial Doppler sonography (TCD) (Neuroguard CDS, Los Angeles, Calif), to measure middle cerebral artery blood flow velocity, and near-infrared spectroscopy, to measure regional cerebral oxygen saturation (CsO(2)) (Invos 3100A; Somanetics, Troy, Mich)., Results: On the ipsilateral ECA cross-clamp, the median fall in CsO(2) was 3% (interquartile range, 1%-4%; P <.0001). On addition of the ICA cross-clamp there was a further fall of 3% and a total fall of 6% (3%-9%; P <.0001). The median percentage fall in middle cerebral artery blood flow velocity on ECA clamping was 12% (4%-24%; P <.0001); on ICA clamping it was 48% (25%-74%; P <.0001). Falls in TCD on ECA clamping were greater with increasing severity of ipsilateral ICA stenosis. The correlation between CsO(2) and TCD on external clamping, although less strong than that on internal clamping, was statistically significant r = 0.32; P =.01; Spearman rank correlation)., Conclusions: The falls in TCD and CsO(2) were of a similar order of magnitude and must therefore reflect a fall in cerebral perfusion. The ipsilateral ECA contributes significantly to intracranial blood flow and oxygen saturation in severe carotid stenosis.

Objective: To investigate whether heparin reversal after carotid endarterectomy reduces the incidence of haemorrhagic complications., Design: A randomised prospective trial., Methods: Sixty-four patients randomised to reversal of heparin or no reversal, of whom 31 received protamine titrated to the residual circulating heparin at closure of arteriotomy. Measurements included serial activated clotting times (ACTs), wound drainage, neck swelling using duplex Doppler imaging to measure the depth from skin to carotid bifurcation, and the recording of all complications., Results: Wound drainage volumes were significantly reduced by protamine reversal (68.5 ml compared to 35 ml, p < 0.001), but neck swelling was not (72 mm compared to 70 mm, p = 0.77). Two patients who were not reversed developed neck haematomas requiring evacuation. More importantly, two patients receiving protamine, thrombosed the operated internal carotid artery (ICA) postoperatively and died despite urgent thrombectomy. A further patient who was not randomised in this study but who received protamine also developed ICA thrombosis within the same 3 month period., Conclusions: Reversing heparin with protamine reduces postoperative wound drainage after carotid surgery but may predispose to ICA thrombosis and stroke. This is in keeping with a previous retrospective study published during our trial.

Objectives: To study the effect of contralateral carotid stenosis on oxygen saturation (CsO2) of both cerebral hemispheres monitored by reflective near-infrared spectroscopy (NIRS) during carotid surgery., Methods: NIRS was compared to ipsilateral transcranial Doppler ultrasonography (TCD) of the middle cerebral artery and jugular bulb venous oxygen saturation (JvSO2) in 54 patients undergoing carotid endarterectomy., Results: Median operated side and contralateral CsO2 were 68(54-88)% and 69(55-85)% before carotid clamping falling to 63(44-80)% and 69(55-84)% respectively on clamping the carotid (p < 0.0001 and p = NS). JvSO2 fell from 78(38-98)% to 72(30-97)% on carotid clamping with a percentage fall in peak TCD of -28(0 to -100)% (p < 0.0001). Patients with a contralateral carotid artery occlusion experienced falls in ipsi and contralateral CsO2 of -8(-4 to -10)% and -3(2 to -7)% compared to -4(0 to -14)% and 0(-5 to 4)% in those with a lesser stenosis (p < 0.05). On declamping, median ipsilateral and contralateral CsO2 rose from 65(46-82)% and 67(52-87)% to 68(53-84)% respectively (p < 0.0001 and p = NS). JvSO2 increased from 75(33-95)% to 79(42-95)% (p < 0.0001) with an increase in median peak TCD of 35(-34 to 506)%., Conclusions: The greatest changes in CsO2 occurred in the operated side cerebral hemispheres in those with a contralateral carotid artery occlusion. However, a contralateral carotid artery occlusion does not reliably predict the need for a shunt and cerebral monitoring remains essential; although is only required on the operated side.

Study Objective: To evaluate two methods of augmenting venous filling as potential aids to i.v. cannulation., Design: Comparative study of cross-sectional areas of preselected antecubital fossa veins., Setting: Vascular laboratory of a British university teaching hospital., Participants: Thirty healthy, normotensive, adult volunteers., Interventions: Vessel cross-sectional areas measured noninvasively using a color flow duplex ultrasound scanner. Measurements were taken at rest, after application of a venous tourniquet, with tourniquet and Esmarch bandage, and with tourniquet and Rhys-Davies exsanguinator., Results: Mean (+/- SD) cross-sectional area at rest was 0.18 +/- 0.094 cm2 and after tourniquet was 0.28 +/- 0.14 cm2. Application of an Esmarch bandage produced an increase to 0.33 +/- 0.14 cm2, and Rhys-Davies exsanguinator produced an increase to 0.32 +/- 0.15 cm2 (P < .0001 for all comparisons except Rhys-Davies exsanguinator versus Esmarch bandage)., Conclusion: Application of either the Esmarch bandage or the Rhys-Davies exsanguinator caused significant filling of antecubital fossa veins in excess of that produced by a venous tourniquet alone in normovolemic, normotensive volunteers.

Near infrared spectroscopy is a relatively new technique for monitoring intracerebral oxygen saturation. Using the technique, three episodes of cerebral hypoxia were detected during elective carotid endarterectomy which were not reliably recorded by more standard monitoring of cerebral perfusion. In one case, cerebral hypoxia was related to slippage of the tracheal tube into the right main bronchus and in the other two to episodes of hypotension. Near infrared spectroscopy is a reliable indicator of peripheral cortical perfusion and provides continuous and noninvasive monitoring of intracerebral oxygen saturation.

Transcranial Doppler ultrasonography (TCD) of the middle cerebral artery (MCA), light-reflective cerebral oximetry and measurement of internal carotid artery stump pressure were compared as methods of monitoring cerebral perfusion during carotid surgery in 33 patients. Median cerebral oxygen saturation was 70 (range 62-85) per cent and TCD-measured mean blood velocity 42 (range 19-91) cm/s before carotid cross-clamping, falling to 68 (53-83) per cent and 16 (0-50) cm/s respectively on application of the clamps (P < 0.001). Stump pressure correlated closely with MCA blood velocity 30 s after the start of cross-clamping (rs = 0.58, P < 0.001), but not with cerebral oxygen saturation. A fall of 5 per cent or more in cerebral oxygen saturation following cross-clamp application was predicted by a decrease in mean MCA blood velocity of at least 60 per cent. Changes in cerebral oxygen saturation correlated significantly with systolic blood pressure throughout the perioperative period (rs = 0.41, P < 0.001). Significant falls in cerebral oxygenation were not predicted by low stump pressure but were associated with large reductions in the mean MCA blood velocity measured by TCD.