AIMTo investigate viability assessment of segmental small bowel ischemia/reperfusion in a porcine model.METHODSIn 15 pigs, five or six 30-cm segments of jejunum were simultaneously made ischemic by clamping the mesenteric arteries and veins for 1 to 16 h. Reperfusion was initiated after different intervals of ischemia (1-8 h) and subsequently monitored for 5-15 h. The intestinal segments were regularly photographed and assessed visually and by palpation. Intraluminal lactate and glycerol concentrations were measured by microdialysis, and samples were collected for light microscopy and transmission electron microscopy. The histological changes were described and graded.RESULTSUsing light microscopy, the jejunum was considered as viable until 6 h of ischemia, while with transmission electron microscopy the ischemic muscularis propria was considered viable until 5 h of ischemia. However, following ≥ 1 h of reperfusion, only segments that had been ischemic for ≤ 3 h appeared viable, suggesting a possible upper limit for viability in the porcine mesenteric occlusion model. Although intraluminal microdialysis allowed us to closely monitor the onset and duration of ischemia and the onset of reperfusion, we were unable to find sufficient level of association between tissue viability and metabolic markers to conclude that microdialysis is clinically relevant for viability assessment. Evaluation of color and motility appears to be poor indicators of intestinal viability.CONCLUSIONThree hours of total ischemia of the small bowel followed by reperfusion appears to be the upper limit for viability in this porcine mesenteric ischemia model.

Tools such as Simpleware ScanIP+FE and COMSOL Multiphysics allow us to gain a better understanding of bioimpedance measurements without actually doing the measurements. This tutorial will cover the steps needed to go from a 3D voxel data set to a model that can be used to simulate a transfer impedance measurement. Geometrical input data used in this tutorial are from MRI scan of a human thigh, which are converted to a mesh using Simpleware ScanIP+FE. The mesh is merged with electrical properties for the relevant tissues, and a simulation is done in COMSOL Multiphysics. Available numerical output data are transfer impedance, contribution from different tissues to final transfer impedance, and voltages at electrodes. Available volume output data are normal and reciprocal current densities, potential, sensitivity, and volume impedance sensitivity. The output data are presented as both numbers and graphs. The tutorial will be useful even if data from other sources such as VOXEL-MAN or CT scans are used.

The standard clinical method for the assessment of viability in ischemic small intestine is still visual inspection and palpation. This method is non-specific and unreliable, and requires a high level of clinical experience. Consequently, viable tissue might be removed, or irreversibly damaged tissue might be left in the body, which may both slow down patient recovery. Impedance spectroscopy has been used to measure changes in electrical parameters during ischemia in various tissues. The physical changes in the tissue at the cellular and structural levels after the onset of ischemia lead to time-variant changes in the electrical properties. We aimed to investigate the use of bioimpedance measurement to assess if the tissue is ischemic, and to assess the ischemic time duration. Measurements were performed on pigs (n = 7) using a novel two-electrode setup, with a Solartron 1260/1294 impedance gain-phase analyser. After induction of anaesthesia, an ischemic model with warm, full mesenteric arterial and venous occlusion on 30 cm of the jejunum was implemented. Electrodes were placed on the serosal surface of the ischemic jejunum, applying a constant voltage, and measuring the resulting electrical admittance. As a control, measurements were done on a fully perfused part of the jejunum in the same porcine model. The changes in tan δ (dielectric parameter), measured within a 6 h period of warm, full mesenteric occlusion ischemia in seven pigs, correlates with the onset and duration of ischemia. Tan δ measured in the ischemic part of the jejunum differed significantly from the control tissue, allowing us to determine if the tissue was ischemic or not (P < 0.0001, F = (1,75.13) 188.19). We also found that we could use tan δ to predict ischemic duration. This opens up the possibility of real-time monitoring and assessment of the presence and duration of small intestinal ischemia.

In coronary artery bypass grafting there is a risk of graft occlusion which may result in myocardial infarction. A three-axis acceleration sensor may give additional information about heart function during surgery and the first postoperative days. This paper describes the assembly and packaging of a three-axis micro acceleration sensor for use in clinical trials. The sensor was connected to a cable for power supply and signal output and moulded in silicone. Testing of the encapsulation showed leakage currents well below the 10 muA limit for direct cardiac applications. A hydrogen peroxide gas plasma method was used for sterilization. In animal experiments the sensor was sutured to the heart and no fatigue failures ensued due to the cycling strain forces from the heart. The sensor has been qualified for clinical trials.