Real-time assessment of liver fat content using a filter-based Raman system operating under ambient light through lock-in amplification.

During liver procurement, surgeons mostly rely on their subjective visual inspection of the liver to assess the degree of fatty infiltration, for which misclassification is common. We developed a Raman system, which consists of a 1064 nm laser, a handheld probe, optical filters, photodiodes, and a lock-in amplifier for real-time assessment of liver fat contents. The system performs consistently in normal and strong ambient light, and the excitation incident light penetrates at least 1 mm into duck fat phantoms and duck liver samples. The signal intensity is linearly correlated with MRI-calibrated fat contents of the phantoms and the liver samples.

Chlorin e6-EGF conjugated gold nanoparticles as a nanomedicine based therapeutic agent for triple negative breast cancer.

To develop a treatment modality for triple-negative breast cancer, we investigated the efficacy of a bifunctional theranostic nanoprobes (BN) during Photodynamic Therapy (PDT) on human breast carcinoma and normal human cells. The BN is a 21 nm gold nanoparticles functionalized with Chlorin e6 (Ce6) and Epidermal Growth Factor (EGF). Attachment to gold nanoparticle stabilizes Ce6 while EGF acts as a cancer cell targeting agent. Fluorescence Spectroscopy and Confocal Fluorescence Microscopy revealed a gradual uptake of nanoprobes into cancer cells at an average rate of 63 BN/min. Cell viability assays showed that 0.2 µg/mL BN concentration was highly cytotoxic to cancer cells (86 %), but not normal cells. At this concentration, 58 % cancer cells were necrotic and 38 % apoptotic, while the reactive oxygen species (ROS) was 9-fold higher in cancer cells compared to normal. Overall, results suggest that BN mediated PDT can achieve targeted cancer cell death with high efficiency.

Process for Delivering Timely Antibiotics to Febrile Bone Marrow Transplant Patients in the Emergency Department.

PURPOSE: Patients with a history of a bone marrow transplant (BMT) have a higher risk of infectious complications because of an immunocompromised state. It has been shown that giving timely antibiotics in 1 hour or less from presentation to the emergency department (ED) decreases morbidity and mortality in this patient population. We hypothesize that a quality improvement (QI) process, termed BMT Fever, will improve timely administration of antibiotics for this population presenting to the ED. METHODS: This is a QI process designed to improve the administration of antibiotics to BMT patients with a subjective or objective fever presenting to the ED. The percent of patients receiving antibiotics within 1 hour or less was compared pre- and post-intervention. RESULTS: Upon implementation of the BMT Fever QI process, the percentage of patients with febrile BMT receiving antibiotics within 1 hour or less per fiscal quarter significantly improved from six out of 28 patients (21%) to 147 out of 173 patients (85%), P value < .05. CONCLUSION: By implementing a QI process that addresses five structural obstacles, we were able to improve our timely administration of antibiotics to patients with febrile BMT presenting to the ED.

Unfractionated Heparin in SARS-CoV-2 Pneumonia: Ischemic Stroke Case Report.

Thromboembolism is a known phenomenon in patients with Coronavirus disease 2019 (COVID-19). Recent investigations have revealed that a significant proportion of those hospitalized with severe COVID-19 demonstrate clinical and laboratory markers compatible with hypercoagulability, which is differentiated from disseminated intravascular coagulation (DIC), termed COVID-associated coagulopathy. Additionally, there is increasing concern for development of acute ischemic stroke because of this hypercoagulable state. We present a patient with COVID-19 pneumonia who was managed with unfractionated heparin (UFH) infusion and developed a large ischemic infarct shortly after cessation of the infusion. In retrospect, the patient's coagulation parameters were consistent with overt DIC, although some of these parameters are easily masked by the effects of UFH. These findings emphasize the importance of anticoagulation as well as its careful discontinuation, as failure to do so may result in a significant thromboembolic event.

Pineal glioblastoma: Case report and literature review of an exceedingly rare etiology for pineal region mass.

Pineal glioblastoma is an exceedingly rare potential etiology for a pineal region mass. The presentation, imaging appearance, and changes in treatment have been documented in a select number of cases since its first description in 1954. Through these cases, changes in treatment have shown to improve outcomes in select patients, some of which have had survival times over two or three years. We present a case of a 39 year old female with biopsy proven pineal glioblastoma who demonstrates improvement on imaging and survival >12 months after treatment with radiation therapy and chemotherapy. Our case and the prior reported cases enable future research into improving treatment, classification, and imaging recognition for this unlikely disease.

Continuous-Wave Coherent Raman Spectroscopy via Plasmonic Enhancement.

In this paper, we report a successful combination of stimulated Raman spectroscopy (SRS) and surface-enhanced Raman scattering (SERS) using cw laser sources and gold/silica nanoparticles with embedded reporter molecules. We describe the preparation method for our gold/silica nanoparticles as well as the effect of probe wavelength, pump and probe power, polarization and sample concentration on the cwSESRS signal. Altogether, a stable ~12 orders of magnitude enhancement in the stimulated Raman signal is achieved because of the amplification of both pump and probe beams, leading to the detection of pico-molar nanoparticle concentrations, comparable to those of SERS. The coherent Raman spectra matches the incoherent conventional Raman spectra of the reporter molecules. Unlike conventional incoherent SERS this approach generates a coherent stimulated signal of microwatt intensities, opening the field to applications requiring a coherent beam, such as Molecular Holography.

Spontaneous intracranial hypotension in a patient with systemic lupus erythematosus.

Spontaneous intracranial hypotension (SIH) associated with cerebrospinal fluid leak classically presents with postural headache. It is most commonly caused by the spontaneous dehiscence of a meningeal diverticulum or as a consequence of dural tears. The association between connective tissue disease and SIH is well known. However, the occurrence of SIH associated with systemic lupus erythematosus has rarely been reported. We present a 53 years old female with a history of systemic lupus erythematosus who was diagnosed with SIH. The patient was worked up with Magnetic resonance imaging and Computed tomographic myelography, and successfully treated with a nontargeted epidural blood patch. Furthermore, we review the current literature and focus on the various imaging techniques that can be used in the workup of a cerebrospinal fluid leak.

A ventriculoperitoneal shunt incidentally found in the stomach.

We report a case of a ventriculoperitoneal shunt incidentally found within the stomach while the patient was undergoing a percutaneous endoscopic gastrostomy (PEG) tube placement. Among the complications of ventriculoperitoneal shunt placement, bowel perforation is rare a complication found in 0.01%-0.07% of cases, and typically occurs in premature infants and neonates [1]. To date, less than 100 such cases have been recorded of which only a few have appeared in the radiological literature. Here we discuss the current literature, the radiological features, clinical presentations and the management.

Severe malaria presenting to the ED: A collaborative approach utilizing exchange transfusion and artesunate.

We describe the case of a previously healthy 33year-old male pilot recently arrived to the United States from Africa. The patient presented to our ED febrile and disoriented, with projectile coffee-ground emesis. He was later found to have severe malaria and cerebral parasitemia. Due to the severity of his illness, the patient received the anti-malarial medication Artesunate as well as several exchange transfusions. Within 48h his parasitic load was reduced from 42% to 0.4%. The following is an account of a collaborative effort that spans the specialties of emergency medicine, infectious disease, and critical care medicine.

Adjunct Analgesic Use for Acute Pain in the Emergency Department.

Purpose: Multimodal analgesia is common practice in the postoperative setting, but the utility of adjunctive analgesia in the emergency department (ED) is less understood. The primary objective of this study was to analyze ED prescriber ordering habits for adjunct nonopioid pain medication for opioid-naïve patients who require intravenous (IV) morphine or hydromorphone for acute pain. Secondary objectives were to assess initial and total opioid consumption in morphine equivalent units (MEU), pain scores, and ED length of stay (LOS) between groups. Methods: A retrospective chart review of adult patients who presented to the ED at a large academic medical center and received IV morphine or hydromorphone for acute pain was conducted. Patients were analyzed according to initial opioid received and presence or absence of adjunct nonopioid analgesics. Results: A total of 102 patient charts were analyzed. Adjunctive nonopioid analgesics were ordered on 38% of patients. Patients who received an adjunct nonopioid analgesic received a smaller mean initial opioid dose than those who did not (4.73 vs 5.48 MEU, p = .08). Initial pain score reduction on the 11-point Numeric Rating Scale (NRS) did not differ between patients who received adjunct analgesics versus those who did not (3 vs 4, p = .75). Patients who received adjunct analgesics were associated with a decreased ED LOS (294 vs 342 minutes, p = .04). Conclusion: A small proportion of patients with acute pain received a nonopioid analgesic in conjunction to IV opioids. Further studies are warranted to assess the impact of adjunct analgesics for patients with acute pain.

Epidermal Growth Factor Receptor-Specific Nanoprobe Biodistribution in Mouse Models.

Nanotechnology offers a targeted approach to both imaging and treatment of cancer, the leading cause of death worldwide. Previous studies have found that nanoparticles with a wide variety of coatings initiate an immune response leading to sequestration in the liver and spleen. In an effort to find a nanoparticle platform which does not elicit an immune response, we created 43 nm and 44 nm of gold and silver nanoparticles coated with biomolecules normally produced by the body, α-lipoic acid and the epidermal growth factor (EGF), and have used mass spectroscopy to determine their biodistribution in mouse models, 24 h after tail vein injection. Relative to controls, mouse EGF (mEGF)-coated silver and gold nanoprobes are found at background levels in all organs including the liver and spleen. The lack of sequestration of mEGF-coated nanoprobes in the liver and spleen and the corresponding uptake of control nanoprobes at elevated levels in these organs suggest that the former are not recognized by the immune system. Further studies of cytokine and interleukin levels in the blood are required to confirm avoidance of an immune response.

Accurate assessment of liver steatosis in animal models using a high throughput Raman fiber optic probe.

Due to the shortage of healthy donor organs, steatotic livers are commonly used for transplantation, placing patients at higher risk for graft dysfunction and lower survival rates. Raman Spectroscopy is a technique which has shown the ability to rapidly detect the vibration state of C-H bonds in triglycerides. The aim of this study is to determine whether conventional Raman spectroscopy can reliably detect and quantify fat in an animal model of liver steatosis. Mice and rats fed a methionine and choline-deficient (MCD) and control diets were sacrificed on one, two, three and four weeks' time points. A confocal Raman microscope, a commercial Raman (iRaman) fiber optic probe and a highly sensitive Raman fiber optic probe system, the latter utilizing a 785 nm excitation laser, were used to detect changes in the Raman spectra of steatotic mouse livers. Thin layer chromatography was used to assess the triglyceride content of liver specimens, and sections were scored blindly for fat content using histological examination. Principal component analysis (PCA) of Raman spectra was used to extract the principal components responsible for spectroscopic differences with MCD week (time on MCD diet). Confocal Raman microscopy revealed the presence of saturated fats in mice liver sections. A commercially available handheld Raman spectroscopy probe could not distinguish the presence of fat in the liver whereas our specially designed, high throughput Raman system could clearly distinguish lobe-specific changes in fat content. In the left lobe in particular, the Raman PC scores exhibited a significant correlation (R(2) = 0.96) with the gold standard, blinded scoring by histological examination. The specially designed, high throughput Raman system can be used for clinical purposes. Its application to the field of transplantation would enable surgeons to determine the hepatic fat content of the donor's liver in the field prior to proceeding with organ retrieval. Next steps include validating these results in a prospective analysis of human liver transplantation implant biopsies.

A Novel Cause of Free Intraperitoneal Air in the Emergency Department.

Although all emergency physicians are familiar with catastrophic causes of free intraperitoneal air, we describe the case of a healthy 26-year-old woman who presented to our emergency department (ED) with a nonsurgical and previously unreported cause of pneumoperitoneum. The patient presented to our ED with complaints of shoulder and neck pain several hours after having undergone FemVue ultrasonography (Femasys, Suwanee, GA) for infertility evaluation. The technique uses an air and saline solution mixture injected into the uterine cavity to assess for tubal patency and uterine cavity morphology. Although the cause of her free air and pain was determined to be iatrogenic and ultimately benign, this complication is previously unreported and, without complaints of abdominal pain, presented a diagnostic challenge.

Surface-sensitive Raman spectroscopy of collagen I fibrils.

Collagen fibrils are the main constituent of the extracellular matrix surrounding eukaryotic cells. Although the assembly and structure of collagen fibrils is well characterized, very little appears to be known about one of the key determinants of their biological function-namely, the physico-chemical properties of their surface. One way to obtain surface-sensitive structural and chemical data is to take advantage of the near-field nature of surface- and tip-enhanced Raman spectroscopy. Using Ag and Au nanoparticles bound to Collagen type-I fibrils, as well as tips coated with a thin layer of Ag, we obtained Raman spectra characteristic to the first layer of collagen molecules at the surface of the fibrils. The most frequent Raman peaks were attributed to aromatic residues such as phenylalanine and tyrosine. In several instances, we also observed Amide I bands with a full width at half-maximum of 10-30 cm(-1). The assignment of these Amide I band positions suggests the presence of 3(10)-helices as well as α- and ß-sheets at the fibril's surface.