PAExM: label-free hyper-resolution photoacoustic expansion microscopy.

Reflection-mode ultraviolet photoacoustic microscopy (UV-PAM) is capable of imaging cell nuclei in thick tissue without complex preparation procedures, but it is challenging to distinguish adjacent nuclei due to the limited spatial resolution. Tissue expansion technology has recently been developed to exceed the diffraction-limited fluorescence microscopies, but it is accompanied by limitations including additional staining. Herein, photoacoustic expansion microscopy (PAExM) is presented, which is an advanced histologic imaging strategy combining advantages of fast label-free reflection-mode UV-PAM and the tissue expansion technology. Clustered cell nuclei in an enlarged volume of a mouse brain section can be visually resolved without staining, demonstrating a great potential of the system to be widely used for histologic applications throughout biomedical fields.

Changes of visualised Eustachian tube lengths by age and position: Radiologic study in sitting and supine positions using cone beam and conventional CT.

OBJECTIVES: Patulous eustachian tube (ET) has been characterised by the visualisation of full-length ET on computed tomography (CT) results. We wanted to investigate the changes of visualised ET lengths by age in supine and sitting positions. DESIGN: Retrospective study. SETTING: Tertiary care academic referral centre. PARTICIPANTS: One hundred subjects who underwent cone beam CT (CBCT) in a sitting position and conventional CT in a supine position for non-otitis-related or dental complaints. MAIN OUTCOME MEASURES: Visualised ET lengths from the nasopharyngeal orifice measured by different positions and ages. RESULTS: Subjects did not show visualisation of full-length ET throughout the study. The visualised ET lengths (9.0 ± 2.5 mm) of the CBCT group were significantly larger than those (6.8 ± 2.3 mm) of the conventional CT group (P < 0.0001).Women showed longer visualised ET lengths than men in CBCT group (P < 0.001). The visualised ET lengths of the CBCT group were consistent or slightly increasing as a function of age (P = 0.06); however, the visualised ET lengths of the conventional CT group decreased as a function of age (P = 0.001). The slopes of regression lines of the two groups were significantly different. CONCLUSIONS: When in the supine position, the ET lengths gradually shortened as the subjects got older, most likely due to venous engorgement and the collapse of surrounding tissues; this finding thus suggests that CT in a supine position is an inappropriate method to diagnose patulous ET. The visualised ET lengths by CBCT in a sitting position were consistent throughout the different ages of the subjects and may be used as a diagnostic test for patulous ET.

Deep learning-based virtual staining, segmentation, and classification in label-free photoacoustic histology of human specimens.

In pathological diagnostics, histological images highlight the oncological features of excised specimens, but they require laborious and costly staining procedures. Despite recent innovations in label-free microscopy that simplify complex staining procedures, technical limitations and inadequate histological visualization are still problems in clinical settings. Here, we demonstrate an interconnected deep learning (DL)-based framework for performing automated virtual staining, segmentation, and classification in label-free photoacoustic histology (PAH) of human specimens. The framework comprises three components: (1) an explainable contrastive unpaired translation (E-CUT) method for virtual H&E (VHE) staining, (2) an U-net architecture for feature segmentation, and (3) a DL-based stepwise feature fusion method (StepFF) for classification. The framework demonstrates promising performance at each step of its application to human liver cancers. In virtual staining, the E-CUT preserves the morphological aspects of the cell nucleus and cytoplasm, making VHE images highly similar to real H&E ones. In segmentation, various features (e.g., the cell area, number of cells, and the distance between cell nuclei) have been successfully segmented in VHE images. Finally, by using deep feature vectors from PAH, VHE, and segmented images, StepFF has achieved a 98.00% classification accuracy, compared to the 94.80% accuracy of conventional PAH classification. In particular, StepFF's classification reached a sensitivity of 100% based on the evaluation of three pathologists, demonstrating its applicability in real clinical settings. This series of DL methods for label-free PAH has great potential as a practical clinical strategy for digital pathology.

In vivo photoacoustic monitoring of vasoconstriction induced by acute hyperglycemia.

Postprandial hyperglycemia, blood glucose spikes, induces endothelial dysfunction, increasing cardiovascular risks. Endothelial dysfunction leads to vasoconstriction, and observation of this phenomenon is important for understanding acute hyperglycemia. However, high-resolution imaging of microvessels during acute hyperglycemia has not been fully developed. Here, we demonstrate that photoacoustic microscopy can noninvasively monitor morphological changes in blood vessels of live animals' extremities when blood glucose rises rapidly. As blood glucose level rose from 100 to 400 mg/dL following intraperitoneal glucose injection, heart/breath rate, and body temperature remained constant, but arterioles constricted by approximately -5.7 ± 1.1% within 20 min, and gradually recovered for another 40 min. In contrast, venular diameters remained within about 0.6 ± 1.5% during arteriolar constriction. Our results experimentally and statistically demonstrate that acute hyperglycemia produces transitory vasoconstriction in arterioles, with an opposite trend of change in blood glucose. These findings could help understanding vascular glucose homeostasis and the relationship between diabetes and cardiovascular diseases.

Examining MLKL phosphorylation to detect necroptosis in murine mammary tumors.

Necroptosis occurs predominantly in the center of late-stage tumors and necroptotic cells are dispersed and difficult to be detected by Western blotting of key markers without enrichment by microdissection. To overcome these obstacles, this protocol provides a detailed immunohistochemistry-oriented approach including the steps of tumor isolation from mouse mammary tumor models, necrotic region identification by H&E staining, and necroptosis detection through examining mixed lineage kinase domain-like protein (MLKL) phosphorylation. This protocol could be applied to other types of solid tumors. For complete details on the use and execution of this protocol, please refer to Baik et al. (2021).

Fully integrated photoacoustic microscopy and photoplethysmography of human in vivo.

Photoacoustic microscopy (PAM) is used to visualize blood vessels and to monitor their time-dependent changes. Photoplethysmography (PPG) measures hemodynamic time-series changes such as heart rate. However, PPG's limited visual access to the dynamic changes of blood vessels has prohibited further understanding of hemodynamics. Here, we propose a novel, fully integrated PAM and photoplethysmography (PAM-PPG) system to understand hemodynamic features in detail. Using the PAM-PPG system, we simultaneously acquire vascular images (by PAM) and changes in the blood volume (by PPG) from human fingers. Next, we determine the heart rate from changes in the PA signals, which match well with the PPG signals. These changes can be measured if the blood flow is not blocked. From the results, we believe that PAM-PPG could be a useful clinical tool in various clinical fields such as cardiology and endocrinology.

ZBP1 not RIPK1 mediates tumor necroptosis in breast cancer.

Tumor necrosis happens commonly in advanced solid tumors. We reported that necroptosis plays a major role in tumor necrosis. Although several key necroptosis regulators including receptor interacting protein kinase 1 (RIPK1) have been identified, the regulation of tumor necroptosis during tumor development remains elusive. Here, we report that Z-DNA-binding protein 1 (ZBP1), not RIPK1, mediates tumor necroptosis during tumor development in preclinical cancer models. We found that ZBP1 expression is dramatically elevated in necrotic tumors. Importantly, ZBP1, not RIPK1, deletion blocks tumor necroptosis during tumor development and inhibits metastasis. We showed that glucose deprivation triggers ZBP1-depedent necroptosis in tumor cells. Glucose deprivation causes mitochondrial DNA (mtDNA) release to the cytoplasm and the binding of mtDNA to ZBP1 to activate MLKL in a BCL-2 family protein, NOXA-dependent manner. Therefore, our study reveals ZBP1 as the key regulator of tumor necroptosis and provides a potential drug target for controlling tumor metastasis.

Super Wide-Field Photoacoustic Microscopy of Animals and Humans In Vivo.

Acoustic-resolution photoacoustic micro-scopy (AR-PAM) is an emerging biomedical imaging modality that combines superior optical sensitivity and fine ultrasonic resolution in an optical quasi-diffusive regime (~1-3 mm in tissues). AR-PAM has been explored for anatomical, functional, and molecular information in biological tissues. Heretofore, AR-PAM systems have suffered from a limited field-of-view (FOV) and/or slow imaging speed, which have precluded them from routine preclinical and clinical applications. Here, we demonstrate an advanced AR-PAM system that overcomes both limitations of previous AR-PAM systems. The new AR-PAM system demonstrates a super wide-field scanning that utilized a 1-axis water-proofing microelectromechanical systems (MEMS) scanner integrated with two linear stepper motor stages. We achieved an extended FOV of 36 ×80 mm2 by mosaicking multiple volumetric images of 36 ×2.5 mm2 with a total acquisition time of 224 seconds. For one volumetric data (i.e., 36 ×2.5 mm2), the B-scan imaging speed over the short axis (i.e., 2.5 mm) was 83 Hz in humans. The 3D volumetric image was also provided by using MEMS mirror scanning along the X-axis and stepper-motor scanning along the Y-axis. The super-wide FOV mosaic image was realized by registering and merging all individual volumetric images. Finally, we obtained multi-plane whole-body in-vivo PA images of small animals, illustrating distinct multi-layered structures including microvascular networks and internal organs. Importantly, we also visualized microvascular networks in human fingers, palm, and forearm successfully. This advanced MEMS-AR-PAM system could potentially enable hitherto not possible wide preclinical and clinical applications.

Versatile Single-Element Ultrasound Imaging Platform using a Water-Proofed MEMS Scanner for Animals and Humans.

Single-element transducer based ultrasound (US) imaging offers a compact and affordable solution for high-frequency preclinical and clinical imaging because of its low cost, low complexity, and high spatial resolution compared to array-based US imaging. To achieve B-mode imaging, conventional approaches adapt mechanical linear or sector scanning methods. However, due to its low scanning speed, mechanical linear scanning cannot achieve acceptable temporal resolution for real-time imaging, and the sector scanning method requires specialized low-load transducers that are small and lightweight. Here, we present a novel single-element US imaging system based on an acoustic mirror scanning method. Instead of physically moving the US transducer, the acoustic path is quickly steered by a water-proofed microelectromechanical (MEMS) scanner, achieving real-time imaging. Taking advantage of the low-cost and compact MEMS scanner, we implemented both a tabletop system for in vivo small animal imaging and a handheld system for in vivo human imaging. Notably, in combination with mechanical raster scanning, we could acquire the volumetric US images in live animals. This versatile US imaging system can be potentially used for various preclinical and clinical applications, including echocardiography, ophthalmic imaging, and ultrasound-guided catheterization.

Review on practical photoacoustic microscopy.

Photoacoustic imaging (PAI) has many interesting advantages, such as deep imaging depth, high image resolution, and high contrast to intrinsic and extrinsic chromophores, enabling morphological, functional, and molecular imaging of living subjects. Photoacoustic microscopy (PAM) is one form of the PAI inheriting its characteristics and is useful in both preclinical and clinical research. Over the years, PAM systems have been evolved in several forms and each form has its relative advantages and disadvantages. Thus, to maximize the benefits of PAM for a specific application, it is important to configure the PAM system optimally by targeting a specific application. In this review, we provide practical methods for implementing a PAM system to improve the resolution, signal-to-noise ratio (SNR), and imaging speed. In addition, we review the preclinical and the clinical applications of PAM and discuss the current challenges and the scope for future developments.

Super-resolution localization photoacoustic microscopy using intrinsic red blood cells as contrast absorbers.

Photoacoustic microscopy (PAM) has become a premier microscopy tool that can provide the anatomical, functional, and molecular information of animals and humans in vivo. However, conventional PAM systems suffer from limited temporal and/or spatial resolution. Here, we present a fast PAM system and an agent-free localization method based on a stable and commercial galvanometer scanner with a custom-made scanning mirror (L-PAM-GS). This novel hardware implementation enhances the temporal resolution significantly while maintaining a high signal-to-noise ratio (SNR). These improvements allow us to photoacoustically and noninvasively observe the microvasculatures of small animals and humans in vivo. Furthermore, the functional hemodynamics, namely, the blood flow rate in the microvasculature, is successfully monitored and quantified in vivo. More importantly, thanks to the high SNR and fast B-mode rate (500 Hz), by localizing photoacoustic signals from captured red blood cells without any contrast agent, unresolved microvessels are clearly distinguished, and the spatial resolution is improved by a factor of 2.5 in vivo. L-PAM-GS has great potential in various fields, such as neurology, oncology, and pathology.

Dental implant treatment after healing of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in the same region: a case report.

Although pathophysiology, incidence, and factors associated with the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ) and management strategies for patients treated with bisphosphonates or patients with BRONJ are well-established, few guidelines or recommendations are available for patients with a history of successfully healed BRONJ. We present a case of successful dental implant treatment after healing of BRONJ in the same region of the jaw, and speculate that implant placement is possible after healing of BRONJ surgery in select cases.