Auricular laser acupuncture as an adjunct for parental anxiety management during children's surgery: A randomized-controlled study.

BACKGROUND: Pediatric surgery is associated with high levels of anxiety for both children and parents/caregivers. To mitigate anxiety, auricular acupuncture has shown its potential in the perioperative setting. Accordingly, our team developed a wearable prototype auricular laser acupuncture system, AcuHealth V1.0, as a portable acupuncture device and conducted a proof-of-concept evaluation with parents of children undergoing surgery. AIMS: The primary aim of this study was to conduct feasibility testing of the AcuHealth V1.0 system in delivering auricular laser acupuncture. METHODS: Parents of children who were scheduled to undergo outpatient surgery were randomly assigned to one of three groups: authentic acupuncture (laser beams at known anxiolytic acupoints, n = 13), sham acupuncture (non-anxiolytic acupoints, n = 14), or a placebo control group (inactive laser, n = 14). Parent self-reported anxiety (0-10 numerical rating scale) was assessed at baseline, pre-intervention (once child was taken to the OR), post-intervention, and at 30 min after the intervention. Usability and acceptability data regarding the device were assessed after the intervention. RESULTS: Baseline data revealed no significant difference in anxiety between the three groups. Parent-reported anxiety level at 30-min post-intervention as compared to baseline in the authentic group was significantly decreased (delta mean ± std = -3.58 ± 2.07) compared to both the sham acupuncture (-1.35 ± 2.65) and placebo control group (0.54 ± 1.13). Evaluation of changes in parent-reported anxiety between groups over time using two-way repeated-measures analysis of variance (ANOVA) revealed a significant difference between the three groups (p = 0.001). Post hoc analysis with Scheffe test pairwise comparisons showed that at 30-min post-intervention compared to baseline, the authentic intervention group was significantly less anxious compared with both the sham group (p = 0.033) and the placebo control group (p = 0.001). Additionally, feedback regarding the usage of the device supported the acceptability and usability of the device with no adverse events. CONCLUSIONS: This pilot study administering laser auricular acupuncture via the AcuHealth V1.0 system decreased parental anxiety after 30 min in parents who received treatment immediately after their children were taken to the operating room with no adverse effect.

A machine-learning approach to predicting hypotensive events in ICU settings.

BACKGROUND: Predicting hypotension well in advance provides physicians with enough time to respond with proper therapeutic measures. However, the real-time prediction of hypotension with high positive predictive value (PPV) is a challenge. This is due to the dynamic changes in patients' physiological status following drug administration, which limits the quantity of useful data available for the algorithm. METHOD: To mimic real-time monitoring, we developed a machine-learning algorithm that uses most of the available data points from patients' records to train and test the algorithm. The algorithm predicts hypotension up to 30 min in advance based on the data from only 5 min of patient physiological history. A novel evaluation method is also proposed to assess the performance of the algorithm as a function of time at every timestamp within 30 min of hypotension onset. This evaluation approach provides statistical tools to find the best possible prediction window. RESULTS: During about 181,000 min of monitoring of 400 patients, the algorithm demonstrated 94% accuracy, 85% sensitivity and 96% specificity in predicting hypotension within 30 min of the events. A high PPV of 81% was obtained, and the algorithm predicted 80% of hypotensive events 25 min prior to onset. It was shown that choosing a classification threshold that maximizes the F1 score during the training phase contributes to a high PPV and sensitivity. CONCLUSIONS: This study demonstrates the promising potential of machine-learning algorithms in the real-time prediction of hypotensive events in ICU settings based on short-term physiological history.

Ureteral Access Sheath Deployment: How Much Force Is Too Much? Initial Studies with a Novel Ureteral Access Sheath Force Sensor in the Porcine Ureter.

Introduction and Objectives: Ureteral injuries can occur during ureteral access sheath (UAS) deployment. The force exerted during deployment and the amount of force that results in ureteral injury is yet to be accurately quantitated. In this feasibility study, we developed and then tested a novel force-sensing device in our animal laboratory to identify the threshold force that results in a porcine ureteral injury. Methods: With Institutional Animal Care and Use Committee approval, we measured ureteral dilator and UAS deployment force using our proprietary University of California, Irvine Ureteral Access Sheath Force Sensor (UAS-FS). The exerted force was measured during deployment from the moment that the tip of the UAS was passed into the urethral meatus until it reached the renal pelvis; progression of the UAS along the ureter was monitored with fluoroscopy. Ureteroscopic evaluation was performed after deployment of each catheter/sheath ≥8F to assess for ureteral injury using the Postureteroscopic Lesion Scale (PULS). Results: Six juvenile Yorkshire female pigs (12 ureters) were studied. No injuries were detected when the deployment force was <4 Newtons (N), which was the case when the catheter/access sheath was ≤13F. Increasing UAS size >13F resulted in greater peak forces. In five of the pigs, ureters selected for 14F UAS deployment without previous sequential dilation were injured (PULS ≥3) at a mean threshold force of 4.84 N. Serial dilation had a higher threshold for PULS ≥3 at 5.56 N. Overall, injury of PULS ≥3 was routinely noted when the force applied exceeded 8.1 N. Conclusions: The UAS-FS reliably measured forces while deploying a UAS. Significant ureteral injury can routinely be avoided if the applied force is <4.84 N; PULS ≥3 routinely occurred when forces exceeded 8.1 N. Serial dilation may allow safe passage at higher deployment forces, as much as 5.56 N.

Highly efficient cellular cloning using Ferro-core Micropallet Arrays.

Advancing knowledge of biological mechanisms has come to depend upon genetic manipulation of cells and organisms, relying upon cellular cloning methods that remain unchanged for decades, are labor and time intensive, often taking many months to come to fruition. Thus, there is a pressing need for more efficient processes. We have adapted a newly developed micropallet array platform, termed the "ferro-core micropallet array", to dramatically improve and accelerate the process of isolating clonal populations of adherent cells from heterogeneous mixtures retaining the flexibility of employing a wide range of cytometric parameters for identifying colonies and cells of interest. Using transfected (retroviral oncogene or fluorescent reporter construct) rat 208 F cells, we demonstrated the capacity to isolate and expand pure populations of genetically manipulated cells via laser release and magnetic recovery of single micropallets carrying adherent microcolonies derived from single cells. This platform can be broadly applied to biological research, across the spectrum of molecular biology to cellular biology, involving fields such as cancer, developmental, and stem cell biology. The ferro-core micropallet array platform provides significant advantages over alternative sorting and cloning methods by eliminating the necessity for repetitive purification steps and increasing throughput by dramatically shortening the time to obtain clonally expanded cell colonies.

Multicolor Immunofluorescent Imaging of Complex Cellular Mixtures on Micropallet Arrays Enables the Identification of Single Cells of Defined Phenotype.

A Micropallet-Array-based strategy allowing the identification of cells of defined phenotype in complex mixtures, such as would be obtained from a tissue biopsy, is presented. Following the distribution of single adherent cells from the mixture on individual pedestals, termed "micropallets", immunofluorescent confocal imaging is applied to interrogate the expression of five cell surface molecules.

Ferromagnetic micropallets for magnetic capture of single adherent cells.

We present a magnetic micropallet array and demonstrate its capacity to recover specific, individual adherent cells from large populations and deliver them for downstream single cell analysis. A ferromagnetic photopolymer was formulated, characterized, and used to fabricate magnetic micropallets, which are microscale pedestals that provide demarcated cell growth surfaces with preservation of biophysical properties including photopatternability, biocompatibility, and optical clarity. Each micropallet holds a single adherent cell in culture, and hundreds of thousands of micropallets comprise a single micropallet array. Any micropallet in the array can be recovered on demand, carrying the adhered cell with it. We used this platform to recover selectively single cells, which were subsequently analyzed using single-cell RT-qPCR.

Fabrication and biological evaluation of uniform extracellular matrix coatings on discontinuous photolithography generated micropallet arrays.

The recent identification of rare cell populations within tissues that are associated with specific biological behaviors, for example, progenitor cells, has illuminated a limitation of current technologies to study such adherent cells directly from primary tissues. The micropallet array is a recently developed technology designed to address this limitation by virtue of its capacity to isolate and recover single adherent cells on individual micropallets. The capacity to apply this technology to primary tissues and cells with restricted growth characteristics, particularly adhesion requirements, is critically dependent on the capacity to generate functional extracellular matrix (ECM) coatings. The discontinuous nature of the micropallet array surface provides specific constraints on the processes for generating the desired ECM coatings that are necessary to achieve the full functional capacity of the micropallet array. We have developed strategies, reported herein, to generate functional coatings with various ECM protein components: fibronectin, EHS tumor basement membrane extract, collagen, and laminin-5; confirmed by evaluation for rapid cellular adherence of four dissimilar cell types: fibroblast, breast epithelial, pancreatic epithelial, and myeloma. These findings are important for the dissemination and expanded use of micropallet arrays and similar microtechnologies requiring the integrated use of ECM protein coatings to promote cellular adherence.

A Vapor Based Microfluidic Flow Regulator.

We introduce a flow regulating technology that uses trapped air bubbles in a hydrophobic microfluidic channel. We present basic designs for flow regulators and flow valves using trapped air. Experiments have successfully demonstrated the capability of this technique for delivering constant and varying flow rate, and for on-off valving. This approach to valving provides a simple, yet effective way to monolithically integrate flow and valve control on polymer Lab-on-Chip devices.

Low-voltage polymer-based scanning cantilever for in vivo optical coherence tomography.

Novel hand-held optical coherence tomography (OCT) probes with polymer cantilevers have been developed for clinical oral and skin imaging. An electroactive ionic polymer-metal composite cantilever was used to generate 3-mm transverse scanning movement of an optical fiber with applied 2-V linear alternating voltage at 1 Hz. Low driving voltage ensures safety. Two different optical designs achieve both forward and sidewise scanning and make it possible to image everywhere within the human oral cavity. In vivo OCT imaging of the human tongue is demonstrated.