In vivo assessment of muscle mitochondrial function in healthy, young males in relation to parameters of aerobic fitness.

PURPOSE: The recovery of muscle oxygen consumption (m[Formula: see text]O2) after exercise provides a measure of skeletal muscle mitochondrial capacity, as more and better-functioning mitochondria will be able to restore m[Formula: see text]O2 faster to the pre-exercise state. The aim was to measure muscle mitochondrial capacity using near-infrared spectroscopy (NIRS) within a healthy, normally active population and relate this to parameters of aerobic fitness, investigating the applicability and relevance of using NIRS to assess muscle mitochondrial capacity non-invasively. METHODS: Mitochondrial capacity was analysed in the gastrocnemius and flexor digitorum superficialis (FDS) muscles of eight relatively high-aerobic fitness ([Formula: see text]O2peak ≥ 57 mL/kg/min) and eight relatively low-aerobic fitness male subjects ([Formula: see text]O2peak ≤ 47 mL/kg/min). Recovery of whole body [Formula: see text]O2, i.e. excess post-exercise oxygen consumption (EPOC) was analysed after a cycling protocol. RESULTS: Mitochondrial capacity, as analysed using NIRS, was significantly higher in high-fitness individuals compared to low-fitness individuals in the gastrocnemius, but not in the FDS (p = 0.0036 and p = 0.20, respectively). Mitochondrial capacity in the gastrocnemius was significantly correlated with [Formula: see text]O2peak (R2 = 0.57, p = 0.0019). Whole body [Formula: see text]O2 recovery was significantly faster in the high-fitness individuals (p = 0.0048), and correlated significantly with mitochondrial capacity in the gastrocnemius (R2 = 0.34, p = 0.028). CONCLUSION: NIRS measurements can be used to assess differences in mitochondrial muscle oxygen consumption within a relatively normal, healthy population. Furthermore, mitochondrial capacity correlated with parameters of aerobic fitness ([Formula: see text]O2peak and EPOC), emphasising the physiological relevance of the NIRS measurements.

Evaluation of the performance of three hand-held near-infrared spectrometer through investigation of total antioxidant capacity in gluten-free grains.

The performance of three portable NIR spectrometers was compared by analysing the total antioxidant capacity (TAC) of different species of gluten-free grains. TAC is often used to evaluate the quality of foods and was determined using Folin-Ciocalteu measurements and used as reference data for establishing PLS-R models with NIR data. NIRS enables fast and non-invasive measurements. The microPhazir RX and the MicroNIR 2200 are broadly used in chemical and pharmaceutical industries, whereas SCiO is a pocket-sized, consumer-oriented spectrometer. The devices work in different regions of the NIR spectrum and their performances was compared using statistical parameters. 77 samples were measured and analysed using the software The Unscrambler X, as well as SCiO-Lab. All models established were cross- and test set validated. The multivariate data processing using The Unscrambler X yielded similar results as SCiO-Lab. The best model was established for non-milled samples measured with the MicroNIR 2200 and analysed using The Unscrambler X.

Near-infrared spectroscopy in vegetables and humans: An observational study.

BACKGROUND: Cerebral near-infrared spectroscopy (NIRS) of tissue oxygen saturation is claimed to be a surrogate marker for global cerebral perfusion. Increasingly, NIRS target-based therapy has been used during cardiac surgery in the hope of decreasing the incidence of adverse neurological outcome. OBJECTIVES: We report NIRS values for some common vegetables and faculty at a world-class medical institution. DESIGN: Observational nonblinded study. SETTING: Single tertiary care institution and local urban vegetable market. PARTICIPANTS: Five yams (Dioscorea cayenensis), five courgettes (Cucurbita pepo) and five butternut squashes (Cucurbita moschata) were studied. Five cardiothoracic surgeons and anaesthesiologists were the control group. INTERVENTIONS: None. MAIN OUTCOME MEASURES: NIRS value of each species. RESULTS: Mean NIRS value for the control group was 71% [95% confidence interval (CI) 68 to 74] and was similar to that of the yellow squashes [75% (95% CI 74 to 76)]. These values were significantly greater than the NIRS measurements of both the butternut squash and yam [63% (95% CI 62 to 64) and 64% (95% CI 63 to 65), respectively, P < 0.01]. CONCLUSION: Commonly eaten vegetables have NIRS measurements similar to those seen in healthy humans.

Identification Performance of Different Types of Handheld Near-Infrared (NIR) Spectrometers for the Recycling of Polymer Commodities.

For sustainable utilization of raw materials and environmental protection, the recycling of the most common polymers-polyethylene (PE), polypropylene (PP), polyethylene terephthalate (PET), polyvinyl chloride (PVC), and polystyrene (PS)-is an extremely important issue. In the present communication, the discrimination performance of the above polymer commodities based on their near-infrared (NIR) spectra measured with four real handheld (<200 g) spectrometers based on different monochromator principles were investigated. From a total of 43 polymer samples, the diffuse reflection spectra were measured with the handheld instruments. After the original spectra were pretreated by second derivative and standard normal variate (SNV), principal component analysis (PCA) was applied and unknown samples were tested by soft independent modeling of class analogies (SIMCA). The results show that the five polymer commodities cluster in the score plots of their first three principal components (PCs) and, furthermore, samples in calibration and test sets can be correctly identified by SICMA. Thus, it was concluded that on the basis of the NIR spectra measured with the handheld spectrometers the SIMCA analysis provides a suitable analytical tool for the correct assignment of the type of polymer. Because the mean distance between clusters in the score plot reflects the discrimination capability for each polymer pair the variation of this parameter for the spectra measured with the different handheld spectrometers was used to rank the identification performance of the five polymer commodities.

Reliability of muscle blood flow and oxygen consumption response from exercise using near-infrared spectroscopy.

NEW FINDINGS: What is the central question of this study? Continuous-wave near-infrared spectroscopy, coupled with venous and arterial occlusions, offers an economical, non-invasive alternative to measuring skeletal muscle blood flow and oxygen consumption, but its reliability during exercise has not been established. What is the main finding and its importance? Continuous-wave near-infrared spectroscopy devices can reliably assess local skeletal muscle blood flow and oxygen consumption from the vastus lateralis in healthy, physically active adults. The patterns of response exhibited during exercise of varying intensity agree with other published results using similar methodologies, meriting potential applications in clinical diagnosis and therapeutic assessment. Near-infrared spectroscopy (NIRS), coupled with rapid venous and arterial occlusions, can be used for the non-invasive estimation of resting local skeletal muscle blood flow (mBF) and oxygen consumption (mV̇O2), respectively. However, the day-to-day reliability of mBF and mV̇O2 responses to stressors such as incremental dynamic exercise has not been established. The aim of this study was to determine the reliability of NIRS-derived mBF and mV̇O2 responses from incremental dynamic exercise. Measurements of mBF and mV̇O2 were collected in the vastus lateralis of 12 healthy, physically active adults [seven men and five women; 25 (SD 6) years old] during three non-consecutive visits within 10 days. After 10 min rest, participants performed 3 min of rhythmic isotonic knee extension (one extension every 4 s) at 5, 10, 15, 20, 25 and 30% of maximal voluntary contraction (MVC), before four venous occlusions and then two arterial occlusions. The mBF and mV̇O2 increased proportionally with intensity [from 0.55 to 7.68 ml min-1  (100 ml)-1 and from 0.05 to 1.86 ml O2  min-1  (100 g)-1 , respectively] up to 25% MVC, where they began to plateau at 30% MVC. Moreover, an mBF/mV̇O2 muscle oxygen consumption ratio of ∼5 was consistent for all exercise stages. The intraclass correlation coefficient for mBF indicated high to very high reliability for 10-30% MVC (0.82-0.9). There was very high reliability for mV̇O2 across all exercise stages (intraclass correlation coefficient 0.91-0.96). In conclusion, NIRS can reliably assess muscle blood flow and oxygen consumption responses to low- to moderate-intensity exercise, meriting potential applications in clinical diagnosis and therapeutic assessment.

Indocyanine green fluorescence in second near-infrared (NIR-II) window.

Indocyanine green (ICG), a FDA approved near infrared (NIR) fluorescent agent, is used in the clinic for a variety of applications including lymphangiography, intra-operative lymph node identification, tumor imaging, superficial vascular imaging, and marking ischemic tissues. These applications operate in the so-called "NIR-I" window (700-900 nm). Recently, imaging in the "NIR-II" window (1000-1700 nm) has attracted attention since, at longer wavelengths, photon absorption, and scattering effects by tissue components are reduced, making it possible to image deeper into the underlying tissue. Agents for NIR-II imaging are, however, still in pre-clinical development. In this study, we investigated ICG as a NIR-II dye. The absorbance and NIR-II fluorescence emission of ICG were measured in different media (PBS, plasma and ethanol) for a range of ICG concentrations. In vitro and in vivo testing were performed using a custom-built spectral NIR assembly to facilitate simultaneous imaging in NIR-I and NIR-II window. In vitro studies using ICG were performed using capillary tubes (as a simulation of blood vessels) embedded in Intralipid solution and tissue phantoms to evaluate depth of tissue penetration in NIR-I and NIR-II window. In vivo imaging using ICG was performed in nude mice to evaluate vascular visualization in the hind limb in the NIR-I and II windows. Contrast-to-noise ratios (CNR) were calculated for comparison of image quality in NIR-I and NIR-II window. ICG exhibited significant fluorescence emission in the NIR-II window and this emission (similar to the absorption profile) is substantially affected by the environment of the ICG molecules. In vivo imaging further confirmed the utility of ICG as a fluorescent dye in the NIR-II domain, with the CNR values being ~2 times those in the NIR-I window. The availability of an FDA approved imaging agent could accelerate the clinical translation of NIR-II imaging technology.

Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature, and Cerebral Blood Flow Monitoring in Patients with Aneurysmal Subarachnoid Hemorrhage.

OBJECTIVE: To evaluate an intraparenchymal probe for intracranial pressure (ICP) and temperature (TEMP) monitoring as well as determination of cerebral hemodynamics using a near-infrared spectroscopy (NIRS) and indocyanine green (ICG) dye dilution method (NIRS-ICP probe). METHODS: The NIRS-ICP probe was applied after aneurysmal subarachnoid hemorrhage if multimodal monitoring was established due to poor neurological condition. ICP and TEMP values were obtained from ventricular catheters and systemic temperature sensors. Repeated NIRS-ICG measurements (2 injections within 30 min) were performed daily for determination of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time of ICG (mttICG). Secondary neurologic dysfunction was defined as brain tissue oxygen tension <20 mmHg and/or lactate/pyruvate ratio >35 obtained from cerebral probing. RESULTS: A total of 128 NIRS-ICG measurements were performed in ten patients. The correlation coefficients between ICP and TEMP values obtained with the NIRS-ICP probe and values from routine monitoring were r = 0.72 and r = 0.96, respectively. The mean values were 30.3 ± 13.6 ml/100 g/min for CBF, 3.3 ± 1.2 ml/100 g for CBV, and 6.8 ± 1.6 s for mttICG. The coefficients of variation from repeated NIRS-ICG measurements were 10.9 % for CBF, 11.7 % for CBV, and 3.8 % for mttICG. The sensitivity for detection of secondary neurologic dysfunction was 85 % and the specificity 83 % using a CBF-threshold of 25 ml/100 g/min. CONCLUSION: Multimodal monitoring using the NIRS-ICP probe is feasible with high reproducibility of measurement values and the ability to detect secondary neurologic dysfunction. No safety concerns exist for the routine clinical use of the NIRS-ICP probe.

Acousto-Optic Cerebral Blood Flow Monitoring During Induction of Anesthesia in Humans.

BACKGROUND: Past transcranial Doppler (TCD) studies have documented the effects of the sequence of anesthesia induction followed by intubation on cerebral blood flow (CBF) velocity. The purpose of this study was to determine whether acousto-optic CBF monitoring would detect changes in CBF which are known to occur with propofol and subsequent endotracheal intubation. METHODS: Seventy-two patients scheduled for elective non-intracranial surgery were evaluated. A Cerox 3215F (Ornim Medical) acousto-optic CBF monitor was used. The acousto-optic transducers were applied bifrontally prior to induction. Baseline cerebral flow index (CFI) values were obtained for at least 2 min prior to induction, set to a unitless value of 100. Subsequent relative changes in CFI from baseline were determined at the lowest value over 3 min after propofol injection but before laryngoscopy; and the highest value over 5 min after the start of laryngoscopy. CFI data were evaluated using Friedman's test. RESULTS: The median dose of propofol [interquartile range] given was 200 mg [160-250]. CFI decreased to 84 % of baseline after propofol and increased to 147 % of baseline after endotracheal intubation (both p < 0.001); MAP decreased after intravenous induction of anesthesia from 103 ± 15 to 86 ± 15 mmHg (p < 0.001) and then returned following endotracheal intubation to 104 ± 20 mmHg. CONCLUSIONS: Our data are congruent with previous observations made with TCD under similar experimental conditions. Such observations support the notion that acousto-optic monitoring yields valid real-time measures of changes in CBF in humans. Further validation against other quantitative measures of CBF would be appropriate.

Should Cerebral Near-infrared Spectroscopy be Standard of Care in Adult Cardiac Surgery?

Near-infrared spectroscopy (NIRS) is non-invasive, easy to use, and offers real-time monitoring of the oxygen content of cerebral tissue. An effective and user-friendly method of cerebral monitoring stands to offer a significant advance in patient care during adult cardiac surgery, particularly for surgery in which the continuity of cerebral vessels may be compromised. While the current evidence does not definitively show improvement in neurological outcomes, it can be argued that the overall risk to benefit ratio falls on the side of NIRS. NIRS also gives information about the oxygenation of systemic tissues. It may be that in surgery that does not involve the aortic arch, the value of NIRS will be in increased individualisation of patient management and improved systemic perfusion, impacting general outcomes as much as neurological outcomes. This review will summarise the need for neuromonitoring and the principles of NIRS. It will examine the thresholds used to define desaturation, the evidence for clinical benefit from NIRS, and the criticisms and limitations of NIRS. It will also discuss the uses of NIRS beyond improving neurological outcomes alone.

Standardization of near infrared spectra measured on multi-instrument.

Calibration model transfer is essential for practical applications of near infrared (NIR) spectroscopy because the measurements of the spectra may be performed on different instruments and the difference between the instruments must be corrected. An approach for calibration transfer based on alternating trilinear decomposition (ATLD) algorithm is proposed in this work. From the three-way spectral matrix measured on different instruments, the relative intensity of concentration, spectrum and instrument is obtained using trilinear decomposition. Because the relative intensity of instrument is a reflection of the spectral difference between instruments, the spectra measured on different instruments can be standardized by a correction of the coefficients in the relative intensity. Two NIR datasets of corn and tobacco leaf samples measured with three instruments are used to test the performance of the method. The results show that, for both the datasets, the spectra measured on one instrument can be correctly predicted using the partial least squares (PLS) models built with the spectra measured on the other instruments.

NIR imaging spectroscopy for quantification of constituents in polymers thin films loaded with paracetamol.

Thin films loaded with the drug paracetamol were produced from polymer blends formed by hydroxypropylmethylcellulose (HPMC), polyvinylpyrrolidone (PVP) and polyethyleneglycol (PEG), at various mass ratios of polymers and drug defined by a D-optimal experimental design. NIR hyperspectral images were obtained from each thin film formulation and the pixel-to-pixel quantification of the constituents were carried out by partial least square (PLS) and multivariate curve resolution-alternating least square (MCR-ALS) with three different calibration/validation strategies. These strategies differ in the way to construct the calibration and validation matrices and they had to be carried out to suppress the bias on the quantification of the constituents in the polymer blend. The errors of prediction in the models from MCR-ALS were influenced by the calibration/validation strategy employed, but they were similar to the ones from PLS model. Concentration distribution maps were built after pixel-to-pixel predictions and their characteristics were analyzed.

Non-invasive identification of melanoma with near-infrared and skin impedance spectroscopy.

BACKGROUND/PURPOSE: An early diagnosis of cutaneous malignant melanoma is of high importance for good prognosis. An objective, non-invasive instrument could improve the diagnostic accuracy of melanoma and decrease unnecessary biopsies. The aim of this study was to investigate the use of Near-infrared and skin impedance spectroscopy in combination as a tool to distinguish between malignant and benign skin tumours. METHODS: Near-infrared and skin impedance spectra were collected in vivo on 50 naevi or suspect melanomas prior to excision. Received data were analysed using multivariate techniques and the results were compared to histopathology analyses of the tumours. A total of 12 cutaneous malignant melanomas, 19 dysplastic naevi and 19 benign naevi were included in the study. RESULTS: The observed sensitivity and specificity of the proposed method were 83% and 95%, respectively, for malignant melanoma. CONCLUSION: The results indicate that the combination of near-infrared and skin impedance spectroscopy is a promising tool for non-invasive diagnosis of suspect cutaneous malignant melanomas.

Validation of a stand-alone near-infrared spectroscopy system for monitoring cerebral autoregulation during cardiac surgery.

BACKGROUND: Individualizing arterial blood pressure (ABP) targets during cardiopulmonary bypass (CPB) based on cerebral blood flow (CBF) autoregulation monitoring may provide a more effective means for preventing cerebral hypoperfusion than the current standard of care. Autoregulation can be monitored in real time with transcranial Doppler (TCD). We have previously demonstrated that near-infrared spectroscopy (NIRS)-derived regional cerebral oxygen saturation (rS(c)O(2)) provides a clinically suitable surrogate of CBF for autoregulation monitoring. The purpose of this study was to determine the accuracy of a stand-alone "plug-and-play" investigational system for autoregulation monitoring that uses a commercially available NIRS monitor with TCD methods. METHODS: TCD monitoring of middle cerebral artery CBF velocity and NIRS monitoring were performed in 70 patients during CPB. Indices of autoregulation were computed by both a personal computer-based system and an investigational prototype NIRS-based monitor. A moving linear correlation coefficient between slow waves of ABP and CBF velocity (mean velocity index [Mx]) and between ABP and rS(c)O(2) (cerebral oximetry index [COx]) were calculated. When CBF is autoregulated, there is no correlation between CBF and ABP; when CBF is dysregulated, Mx and COx approach 1 (i.e., CBF and ABP are correlated). Linear regression and bias analysis were performed between time-averaged values of Mx and COx derived from the personal computer-based system and from COx measured with the prototype monitor. Values for Mx and COx were categorized in 5 mm Hg bins of ABP for each patient. The lower limit of CBF autoregulation was defined as the ABP where Mx incrementally increased to ≥0.4. RESULTS: There was correlation and good agreement between COx derived from the prototype monitor and Mx (r = 0.510; 95% confidence interval, 0.414-0.595; P < 0.001; bias, -0.07 ± 0.19). The correlation and bias between the personal computer-based COx and the COx from the prototype NIRS monitor were r = 0.957 (95% confidence interval, 0.945-0.966; P < 0.001 and 0.06 ± 0.06, respectively). The average ABP at the lower limit of autoregulation was 63 ± 11 mm Hg (95% prediction interval, 52-74 mm Hg). Although the mean ABP at the COx-determined lower limit of autoregulation determined with the prototype monitor was statistically different from that determined by Mx (59 ± 9 mm Hg; 95% prediction interval, 50-68 mm Hg; P = 0.026), the difference was not likely clinically meaningful. CONCLUSIONS: Monitoring CBF autoregulation with an investigational stand-alone NIRS monitor is correlated and in good agreement with TCD-based methods. The availability of such a device would allow widespread autoregulation monitoring as a means of individualizing ABP targets during CPB.

Evaluation of anticancer drug-loaded nanoparticle characteristics by nondestructive methodologies.

The purpose of this study was to utilize near-infrared (NIR) spectroscopy and near-infrared chemical imaging (NIR-CI) as non-invasive techniques to evaluate the drug loading in letrozole-loaded PLGA nanoparticle formulations prepared by the emulsification-solvent evaporation method. A Plackett-Burman design was applied to evaluate the main effects of amount of drug (X(1)), amount of polymer (X(2)), stirring rate (X(3)), emulsifier concentration (X(4)), organic to aqueous phase volume ratio (X(5)), type of organic solvent (X(6)), and homogenization time (X(7)) on drug entrapment efficiency. The influence of three different spectral pretreatment methods (multiplicative scatter correction, standard normal variate, and Savitzky-Golay second derivative transformation with third-order polynomial) and two different regression methods (PLS regression and principal component regression (PCR)) on model prediction ability were compared. PLS of spectra that were pretreated with Savitzky-Golay second derivative transformation provided better model prediction than PCR as it revealed better linear correlation (correlation coefficient of 0.991) for both calibration and prediction models. Relatively low values of root mean square errors of calibration (RMSEC = 0.748) and prediction (RMSEP = 0.786) and low standard errors of calibration (SEC = 0.758) and prediction (SEP = 0.589) suggested good predictability for estimation of the loading of letrozole in PLGA nanoparticles. NIR-CI analysis also revealed mutual homogenous distribution of both polymer and drug and was capable of clearly distinguishing the 12 formulations both quantitatively and qualitatively. In conclusion, NIR and NIR-CI could be potentially used to characterize anticancer drug-loaded nanoparticulate matrix.

Can noninvasive evaluation of benign prostatic obstruction be optimized?

PURPOSE OF REVIEW: Lower urinary tract symptoms caused by benign prostatic obstruction is a common disorder and the incidence is increasing with higher life expectancy. The present article focuses on recently published methods to diagnose bladder outlet obstruction and differ between benign obstruction and prostate cancer in lower urinary tract symptoms patients. RECENT FINDINGS: Several new ultrasound imaging techniques have been reported. Resistive index in the prostatic artery, detrusor wall thickness and prostatic urethral angle all may correlate with obstruction, but more studies are needed to establish their place in clinical practice. Intravesical prostatic protrusion can predict obstruction and may be considered for clinical use. Near infrared spectroscopy has to be studied more to clarify its usefulness in clinical practice. There has been a rapid development of novel serum and urine-based biomarkers for prostate cancer in the last decade to differentiate between benign prostatic hyperplasia and prostate cancer. The recent studies with the use of prostate-specific antigen and urine prostate cancer gene 3 look promising. SUMMARY: Among promising new techniques in the investigation of prostatic obstruction, intravesical prostatic protrusion may be considered for clinical use. None of the methods described in recent studies can fully replace urodynamic investigation. Novel biomarkers in the future may help the clinicians to differentiate benign prostatic hyperplasia from prostate cancer.

Translation of near-infrared fluorescence imaging technologies: emerging clinical applications.

Technical developments in near-infrared fluorescence (NIRF) imaging and tomography have enabled recent translation into investigational human studies. Noninvasive imaging of the lymphatic vasculature for diagnosis and assessment of function has been uniquely accomplished with NIR using indocyanine green (ICG), a nonspecific dye that has comparatively poor fluorescent properties compared to emerging dyes. Adjunct use of NIRF-ICG for (a) intraoperative sentinel lymph node mapping for cancer staging, (b) video-angiography during surgery, and (c) discrimination of malignant from benign breast lesions detected by mammography and ultrasongraphy also evidences the clinical utility of NIRF. Future NIRF imaging agents that consist of bright fluorescent dyes conjugated to disease-targeting moieties promise molecular imaging and image-guided surgery. In this review, emerging NIRF imaging is described within the context of nuclear imaging technologies that remain the "gold standard" of molecular imaging.

Detection and quantification of adulteration in sandalwood oil through near infrared spectroscopy.

The confirmation of authenticity of essential oils and the detection of adulteration are problems of increasing importance in the perfumes, pharmaceutical, flavor and fragrance industries. This is especially true for 'value added' products like sandalwood oil. A methodical study is conducted here to demonstrate the potential use of Near Infrared (NIR) spectroscopy along with multivariate calibration models like principal component regression (PCR) and partial least square regression (PLSR) as rapid analytical techniques for the qualitative and quantitative determination of adulterants in sandalwood oil. After suitable pre-processing of the NIR raw spectral data, the models are built-up by cross-validation. The lowest Root Mean Square Error of Cross-Validation and Calibration (RMSECV and RMSEC % v/v) are used as a decision supporting system to fix the optimal number of factors. The coefficient of determination (R(2)) and the Root Mean Square Error of Prediction (RMSEP % v/v) in the prediction sets are used as the evaluation parameters (R(2) = 0.9999 and RMSEP = 0.01355). The overall result leads to the conclusion that NIR spectroscopy with chemometric techniques could be successfully used as a rapid, simple, instant and non-destructive method for the detection of adulterants, even 1% of the low-grade oils, in the high quality form of sandalwood oil.

Diagnostic performance of a novel device for real-time margin assessment in lumpectomy specimens.

BACKGROUND: Margin status in breast lumpectomy procedures is a prognostic factor for local recurrence and the need to obtain clear margins is often a cause for repeated surgical procedures. A recently developed device for real-time intraoperative margin assessment (MarginProbe; Dune Medical Devices, Caesarea, Israel), was clinically tested. The work presented here looks at the diagnostic performance of the device. METHODS: The device was applied to freshly excised lumpectomy and mastectomy specimens at specific tissue measurement sites. These measurement sites were accurately marked, cut out, and sent for histopathologic analysis. Device readings (positive or negative) were compared with histology findings (namely malignant, containing any microscopically detected tumor, or nonmalignant) on a per measurement site basis. The sensitivity and specificity of the device was computed for the full dataset and for additional relevant subgroups. RESULTS: A total of 869 tissue measurement sites were obtained from 76 patients, 753 were analyzed, of which 165 were cancerous and 588 were nonmalignant. Device performance on relatively homogeneous sites was: sensitivity 1.00 (95% CI: 0.85-1), specificity 0.87 (95% CI: 0.83-0.90). Performance for the full dataset was: sensitivity 0.70 (95% CI: 0.63-0.77), specificity 0.70 (95% CI: 0.67-0.74). Device sensitivity was estimated to change from 56% to 97% as the cancer feature size increased from 0.7 mm to 6.6 mm. Detection rate of samples containing pure DCIS clusters was not different from rates of samples containing IDC. CONCLUSIONS: The device has high sensitivity and specificity in distinguishing between normal and cancer tissue even down to small cancer features.

Standardized management improves outcomes after the Norwood procedure.

BACKGROUND: In the past decade, many advances in the care of patients undergoing the Norwood procedure (NP) have been reported, but management remains nonstandardized at many institutions. We studied the impact of a standardized management protocol for neonates undergoing NP. METHODS: Care of NP patients has been protocol-driven at our institution since 2005, with routine use of regional low flow perfusion; near infrared spectroscopy; phenoxybenzamine with cardiopulmonary bypass; delayed sternal closure; peritoneal drainage; gastrostomy tubes; postoperative vocal cord assessment; and a home surveillance program of daily weight and oxygen saturation measurement. Patients undergoing NP from 2001 to 2004 (n = 40, group 1), in whom these interventions were only selectively employed, were retrospectively compared with those receiving standardized management from 2005 to 2007 (n = 40, group 2), with endpoints of survival in-hospital and to stage 2 palliation (S2P). Effect of protocol elements on outcome was evaluated by univariate and multivariate analyses. RESULTS: Hospital survival (95% vs. 70%, P= .003) and survival to S2P (85% vs. 58%, P= .006) was better in group 2. By univariate analysis, regional low flow perfusion, gastrostomy usage, and near infrared spectroscopy were associated with improved hospital and survival to S2P. In multivariable analysis, gastrostomy usage was associated with improved hospital survival (P= .027) and survival to S2P (P= .049), while our home surveillance program was a predictor of survival to S2P (P= .016). CONCLUSION: Protocol-driven management of NP patients was associated with better hospital survival and survival to S2P. Among protocol elements, gastrostomy usage was linked to both improved hospital survival and survival to S2P. Home surveillance was associated with increased survival to S2P.