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Active microelectronic array system for DNA hybridization, genotyping and pharmacogenomic applications.

Microelectronic arrays have been developed for DNA hybridization analysis of point mutations, single nucleotide polymorphisms, short tandem repeats and gene expression. In addition to a variety of molecular biology and genomic research applications, such devices will also be used for infectious disease detection, genetic and cancer diagnostics, and pharmacogenomic applications. These microelectronic array devices are able to produce defined electric fields on their surfaces that allow charged molecules and other entities to be transported to or from any test site or micro-location on the planar surface of the device. These molecules and entities include DNA, RNA, proteins, enzymes, antibodies and cells. Electronic-based molecule addressing and hybridization can then be carried out, where the electric field is now used to greatly accelerate the hybridization reactions that occur on the selected test sites. When reversed, the electric field can be used to provide an additional parameter for improved hybridization. Special low-conductance buffers have been developed that provide for the rapid transport of the DNA molecules and facilitate the electronic hybridization reactions under conditions that do not support hybridization. Important to the device function is the permeation layer that overcoats the underlying microelectrodes. Generally composed of a porous hydrogel material impregnated with attachment chemistry, this permeation layer prevents the destruction of analytes at the active microelectrode surface, ameliorates the adverse effects of electrolysis products on the sensitive hybridization and affinity reactions, and serves as a support structure for attaching DNA probes and other molecules to the array. The microelectronic chip or array device is incorporated into a cartridge package (NanoChip trade mark cartridge) that provides the electronic, optical, and fluidic interfacing. A complete instrument system (NanoChip trade mark Molecular Biology Workstation) provides a chip loader, fluorescent reader, computer control interface and data display screen. The probe loader component allows DNA probes or target molecules (polymerase chain reactions amplicons, genomic DNA, RNA, etc.) to be selectively addressed to the array test sites, providing the end-user with 'make your own chip' capabilities. The electronic hybridization can then be carried out and the chip analyzed using a fluorescent detector system. In addition to carrying out rapid, accurate and highly reliable genotyping (point mutations, single nucleotide polymorphisms, short tandem repeats), other future applications include gene expression analysis, or on-chip amplification, immunoassays and cell separation and selection. Smaller and more compact systems are also being designed for portable sample to answer and point of care diagnostics.

DNA Probes↗

Short-wave infrared reflectance investigation of sites of paleobiological interest: applications for Mars exploration.

Rover missions to the rocky bodies of the Solar System and especially to Mars require lightweight, portable instruments that use minimal power, require no sample preparation, and provide suitably diagnostic mineralogical information to an Earth-based exploration team. Short-wave infrared (SWIR) spectroscopic instruments such as the Portable Infrared Mineral Analyser (PIMA, Integrated Spectronics Pty Ltd., Baulkham Hills, NSW, Australia) fulfill all these requirements. We describe an investigation of a possible Mars analogue site using a PIMA instrument. A survey was carried out on the Strelley Pool Chert, an outcrop of stromatolitic, silicified Archean carbonate and clastic succession in the Pilbara Craton, interpreted as being modified by hydrothermal processes. The results of this study demonstrate the capability of SWIR techniques to add significantly to the geological interpretation of such hydrothermally altered outcrops. Minerals identified include dolomite, white micas such as illite-muscovite, and chlorite. In addition, the detection of pyrophyllite in a bleached and altered unit directly beneath the succession suggests acidic, sulfur-rich hydrothermal activity may have interacted with the silicified sediments of the Strelley Pool Chert.

Australia↗

Role of portable sleep studies for diagnosis of obstructive sleep apnea.

PURPOSE OF REVIEW: There is growing awareness of the significance of obstructive sleep apnea in the general population and in the medical community and, as a result, there is a growing demand for diagnosis and treatment. Attended, in-laboratory polysomnography is resource intensive and not readily available in some communities. Alternate diagnostic strategies have been proposed including the use of home sleep studies. Although these portable systems have been in use for many years, only in the past few years have a significant number of studies been performed to evaluate these systems in the home setting. The use of actigraphy and peripheral arterial tonometry for diagnostic purposes has also recently been investigated. RECENT FINDINGS: In the laboratory setting, measurements of sleep-disordered breathing with specific portable sleep systems correspond well with measurements provided by standard polysomnography. In the home setting, portable systems demonstrate several important limitations including lost or inadequate data collection, logistic concerns, and mildly reduced diagnostic accuracy. Data regarding the potential cost benefit of home studies is inconclusive. SUMMARY: Home polysomnography is a viable option for evaluating patients with moderate or high clinical suspicion for sleep-disordered breathing. However, patients with failed or equivocal home studies and those with negative studies but persistent symptoms should undergo standard polysomnography. Further investigations are needed to compare long-term outcomes in patients evaluated using portable devices versus standard polysomnography.

Diagnostic Techniques, Cardiovascular↗

Clinical classification of glaucomatous visual field loss by frequency doubling perimetry.

PURPOSE: To determine whether the frequency doubling perimeter (FDP) can grade glaucomatous visual function loss in a clinically relevant manner. Sinusoidal gratings < 1 cpd that undergo counterphase flicker > 15 Hz appear to have twice as many bands of light, a phenomenon referred to as the "frequency doubling illusion." Evidence suggests that this psychophysical effect is mediated in part by large-diameter ganglion cells, which are reported to be lost early in the glaucomatous disease process. A portable, commercially available FDP has already demonstrated high diagnostic potential for glaucoma screening. METHODS: Sixty-four eyes of 42 glaucomatous patients and 22 eyes of 14 normal subjects were evaluated by means of both frequency doubling perimetry and Humphrey perimetry. A clinical scoring algorithm modeled after the Hodapp-Parrish-Anderson criteria for scoring Humphrey visual field defects was derived for the FDP at the halfway point of the study, and all participants were reassessed with this algorithm upon its completion. RESULTS: FDP mean and pattern deviation showed strong linear correlations with Humphrey 30-2 mean deviation (R = 0.75; P < .0001) and corrected pattern standard deviation values (R = 0.64; P < .0001). Despite this, neither global index could consistently categorize the graded glaucomatous visual fields in a manner consistent with the Hodapp-Parrish-Anderson criteria. The new FDP scoring algorithm did provide good segregation (73% precise parity, 93% parity within one Humphrey grade). CONCLUSIONS: Sixteen-zone frequency doubling perimetry can segregate glaucomatous visual field loss into pathologic categories approximating those obtained with Humphrey 30-2 perimetry by means of a formula modeled after the Hodapp-Parrish-Anderson criteria.

Algorithms↗

Stress echocardiography. Part I. Exercise echocardiography: techniques, implementation, clinical applications, and correlations.

OBJECTIVE: To describe the techniques and applications of exercise echocardiography. DESIGN: We review pertinent experimental and clinical studies from the literature and present our experience with the first 2,000 patients who underwent exercise echocardiography in our laboratory. MATERIAL AND METHODS: The indications for and contraindications to exercise echocardiography and the advantages, limitations, and accuracy of this procedure in comparison with other techniques for detecting coronary artery disease are discussed. RESULTS: Exercise echocardiography is increasingly used for the noninvasive evaluation of coronary artery disease because, in addition to its diagnostic capabilities, it offers attractive features such as portability, versatility, rapid availability of results, and relatively low cost. For accurate interpretation of the results, the workload achieved and the time between completion of exercise and image acquisition must be considered. The major limitation of exercise echocardiography is the high degree of operator dependence. For accurate interpretation of regional wall motion abnormalities and recognition of ischemic changes, specific training and extensive experience are necessary. CONCLUSION: Although exercise echocardiography has only relatively recently become a widely used technique, it has proved to have considerable accuracy in the diagnosis of coronary artery disease (mean sensitivity, 84%; mean specificity, 87%). In high-volume laboratories, feasibility studies have shown success rates between 90 and 99%; thus far, reproducibility has been satisfactory. Other applications of exercise echocardiography being studied are follow-up monitoring after revascularization, determination of prognosis, and assessment of valvular heart disease.

Contraindications↗

Three-dimensional echocardiography paves the way toward virtual reality.

The heart is a three-dimensional (3-D) object and, with the help of 3-D echocardiography (3-DE), it can be shown in a realistic fashion. This capability decreases variability in the interpretation of complex pathology among investigators. Therefore, it is likely that the method will become the standard echocardiography examination in the future. The availability of volumetric data sets allows retrieval of an infinite number of cardiac cross-sections. This results in more accurate and reproducible measurements of valve areas, cardiac mass and cavity volumes by obviating geometric assumptions. Typical 3-DE parameters, such as ejection fraction, flow jets, myocardial perfusion and LV wall curvature, may become important diagnostic parameters based on 3-DE. However, the freedom of an infinite number of cross-sections of the heart can result in an often-encountered problem of being "lost in space" when an observer works on a 3-DE image data set. Virtual reality computing techniques in the form of a virtual heart model can be useful by providing spatial "cardiac" information. With the recent introduction of relatively low cost portable echo devices, it is envisaged that use of diagnostic ultrasound (US) will be further boosted. This, in turn, will require further teaching facilities. Coupling of a cardiac model with true 3-D echo data in a virtual reality setting may be the answer.

Echocardiography, Three-Dimensional↗

A nanoscale optical biosensor: sensitivity and selectivity of an approach based on the localized surface plasmon resonance spectroscopy of triangular silver nanoparticles.

Triangular silver nanoparticles ( approximately 100 nm wide and 50 nm high) have remarkable optical properties. In particular, the peak extinction wavelength, lambda(max) of their localized surface plasmon resonance (LSPR) spectrum is unexpectedly sensitive to nanoparticle size, shape, and local ( approximately 10-30 nm) external dielectric environment. This sensitivity of the LSPR lambda(max) to the nanoenvironment has allowed us to develop a new class of nanoscale affinity biosensors. The essential characteristics and operational principles of these LSPR nanobiosensors will be illustrated using the well-studied biotin-streptavidin system. Exposure of biotin-functionalized Ag nanotriangles to 100 nM streptavidin (SA) caused a 27.0 nm red-shift in the LSPR lambda(max). The LSPR lambda(max) shift, DeltaR/DeltaR(max), versus [SA] response curve was measured over the concentration range 10(-)(15) M < [SA] < 10(-)(6) M. Comparison of the data with the theoretical normalized response expected for 1:1 binding of a ligand to a multivalent receptor with different sites but invariant affinities yielded approximate values for the saturation response, DeltaR(max) = 26.5 nm, and the surface-confined thermodynamic binding constant K(a,surf) = 10(11) M(-)(1). At present, the limit of detection (LOD) for the LSPR nanobiosensor is found to be in the low-picomolar to high-femtomolar region. A strategy to amplify the response of the LSPR nanobiosensor using biotinylated Au colloids and thereby further improve the LOD is demonstrated. Several control experiments were performed to define the LSPR nanobiosensor's response to nonspecific binding as well as to demonstrate its response to the specific binding of another protein. These include the following: (1) electrostatic binding of SA to a nonbiotinylated surface, (2) nonspecific interactions of prebiotinylated SA to a biotinylated surface, (3) nonspecific interactions of bovine serum albumin to a biotinylated surface, and (4) specific binding of anti-biotin to a biotinylated surface. The LSPR nanobiosensor provides a pathway to ultrasensitive biodetection experiments with extremely simple, small, light, robust, low-cost instrumentation that will greatly facilitate field-portable environmental or point-of-service medical diagnostic applications.

Biosensing Techniques↗

Culture-free genomics: a shift toward genome-wide applications in Chagas disease and leishmaniasis.

INTRODUCTION: Chagas disease and leishmaniasis remain major neglected tropical diseases, with diagnosis and surveillance constrained by low parasite burden, multiclonal infections, and complex parasite biology. Traditional culture-dependent and targeted molecular approaches fail to capture the full genomic diversity of Trypanosoma cruzi and Leishmania spp. limiting clinical and epidemiological utility. AREAS COVERED: We review the evolution from early sequencing to second- and third-generation platforms, highlighting culture-free detection and genomic surveillance. We discuss enrichment strategies (selective whole-genome amplification (SWGA) and capture-enrichment sequencing (CES)) addressing low parasite DNA abundance in complex samples, alongside metagenomics and portable sequencing for field-based surveillance and diagnostics. We further explore how direct-from-host data can improve diagnostics, enhance transmission surveillance, support treatment monitoring, and guide control strategies. EXPERT OPINION: Culture-free genomic approaches represent a transformative advance in kinetoplastid research, providing resolution that culture-dependent methods cannot deliver. Their diagnostic contribution is at present largely indirect, operating through the identification of improved molecular and serological targets rather than through sequencing as the assay itself. Persistent barriers of cost, infrastructure, standardization, and bioinformatics capacity, together with the absence of formal clinical validation, currently confine these methods to research and surveillance settings.

Capture-enrichment sequencing↗

Service program diagnostics and decision support technology for improving health technology service efficiency and productivity.

Our in-depth survey of both the state of the art and the results of application, implementation, and rollout of problem resolution diagnostics in control help desks and field service clearly shows the potential of online remote diagnostics technology (Figure 9) to improve service force productivity and efficiency and to make more effective use of service resources (people and parts). Our survey of the current and planned future expenditures for diagnostics used in field service clearly indicates that the overall service diagnostics market is currently sizable, in the range of $2 billion as of 1997, and is projected to grow to approximately $2.6 billion by 2000. This current expenditure and growth will occur primarily in the electronics arena, but there are still substantial development and application investments occurring in both electromechanical and mechanical areas. We believe that the pace of investment will fall off as the service industry shifts from development and experimental research to the application and rollout of standard off-the-shelf technology. Thus, the overall pattern of the diagnostics market indicates a continuing increase in expenditures by the field service industry for electronics-oriented service diagnostics and some increase with respect to use of this technology in electromechanical and mechanical applications. The application and use of diagnostics technology will also be affected by the ability of the field service management community to recognize the need to search for an optimum as opposed to a feasible solution to dispatch, assignment, call screening, call avoidance, and logistics deployment. The further rollout of affordable wireless communications technology such as Ardis and Ram mobile and the new cellular-based CPDP technology, coupled with the increased availability of inexpensive wireless-based laptops, portables, and CD-ROM-based problem resolution and diagnostics technology clearly shows the value of this technology in improving service productivity, efficiency, and profitability. As we move from very expensive academically and research and development-oriented diagnostics applications to the purchase and use of off-the-shelf software and predeveloped knowledge bases, it is clear that this technology will be broadly applied.

Cost-Benefit Analysis↗

[Comparison of echocardiographic studies made with new portable devices to conventional studies].

OBJECTIVES: The latest development in echocardiography is the hand-held ultrasound device. Previous studies have shown that portable ultrasound devices detect major cardiovascular pathology better than the physical examination, but their diagnostic accuracy is still not known. The purpose of this study was to compare the results of examinations made with portable devices to those obtained with higher-scale platforms. PATIENTS AND METHOD: 211 consecutive unselected patients were included in the study. Patients were randomly studied with a portable device and a standard platform (considered the gold standard for comparison) by cardiologists experienced in echocardiography. Parameters of cardiac morphology and function, and valvular regurgitation were compared and analyzed using the McNemar paired test. Differences of more than one grade were considered major differences. RESULTS: The subjective assessment of the studies made with the portable device was significantly worse. The correlation between estimates of left ventricular function (differences not statistically significant) was adequate, but significant differences were detected in the evaluation of left atrial enlargement, left ventricular hypertrophy, aortic root enlargement, and mitral and tricuspid regurgitation. CONCLUSIONS: Hand-held cardiac ultrasound devices do not satisfy criteria for a complete echocardiographic study. They provide accurate information about ventricular function but fail to adequately measure cardiac chambers or assess valve function.

Adult↗

Diagnostic and therapeutic use of chest sonography: value in critically ill patients.

OBJECTIVE: Portable chest radiography, used for critically ill patients, often fails to depict thoracic disease clearly. Chest sonography allows good characterization of pleural diseases, mediastinal lesions, and pulmonary consolidations, and provides accurate and safe guidance for interventional procedures. Accordingly, we evaluated its usefulness in the diagnosis and management of critically ill patients. SUBJECTS AND METHODS: Sonography was used prospectively to evaluate 41 critically ill patients, when portable chest radiographs were difficult to interpret and failed to explain the clinical findings. An initial diagnosis was made on the basis of clinical and radiologic information. The final diagnosis was confirmed by thoracentesis (n = 15), image-guided aspiration biopsy (n = 7), surgery (n = 3), and clinical follow-up (n = 16). All 41 sonographic examinations were performed by a sonographer who had no knowledge of the initial diagnosis. The sonographic findings were recorded and analyzed. The usefulness of sonography in diagnosis and management was then evaluated according to the following criteria: diagnostic value--(1) made diagnosis, (2) changed diagnosis, (3) additional information, (4) no benefit; and management aid--(1) affected decision, (2) affected decision and guided thoracentesis, (3) affected diagnosis and guided aspiration, (4) no benefit. RESULTS: Chest sonography was helpful in diagnosis in 27 (66%) of 41 patients and in treatment in 37 (90%) of 41 patients. A significant influence on treatment planning occurred in 17 (41%) of 41 patients. A diagnostic aspiration biopsy under sonographic detected sonographically. Thoracentesis were attempted in 25 of 29 patients with pleural effusion and were successful in 24 patients (96%); a minimal pneumothorax developed in one patient (4%). CONCLUSION: Chest sonography is a useful diagnostic tool for critically ill patients with chest diseases. This technique can be particularly helpful when CT is not available or when critically ill patients cannot be moved.

Aortic Aneurysm↗

Can hand-carried ultrasound devices be extended for use by the noncardiology medical community?

Echocardiography (echo) is a powerful, noninvasive, inexpensive diagnostic imaging technique that provides important information in a variety of cardiovascular diseases. Echo provides rapid information regarding ventricular and valvular function in the clinical management of patients. Smaller, relatively inexpensive hand-carried cardiac ultrasound (HCU) devices have become commercially available, which can be used for diagnostic cardiac imaging. Because of their relative ease of use, portability, and affordable cost, these new hand-held systems have made point-of-care (bedside) echocardiography available to all medical personnel. The rate-limiting step to the widespread use of this technology is the lack of personnel with echo training at the immediate contact point with patients. Although extensive training and experience are needed to acquire and interpret a complete echo, training medical personnel to perform and interpret a limited echo (defined as a brief, diagnosis focused exam) may fully exploit the potential of echo as a point-of-care diagnostic tool and may be accomplished in a short period of time. Presently there are guidelines for independent competency in echocardiography and HCU echo established by several professional organizations and as a result of these rigorous guidelines, other noncardiology medical professionals who could practically derive the greatest benefit are discouraged and virtually precluded from utilizing echo during the initial encounter with the patient. However, there is now a growing body of literature in a diverse group of noncardiology medical personnel that demonstrates that it is possible to quickly and effectively train them to perform and interpret limited echocardiograms. Medical students, medical residents, cardiology fellows with limited experience, emergency department physicians, and surgical intensive care unit staff have all been evaluated after only brief, focused training periods, and investigators found that HCU echo provided important new information, changed therapeutic management, and was vastly superior to the physical exam alone with an acceptable overall level of accuracy. The contribution of echocardiography to the field of cardiovascular disease since its invention has been significant and the newer compact, portable, ultrasound systems have the potential to revolutionize the utilization and availability of echocardiography. To maximize integration of echo into medical practice, physicians and physician extenders could be trained to perform and interpret limited echo to complement their clinical examination and improve their diagnostic skills. The challenge is to provide practical training programs to assure competency in performing point of care echocardiograms.

Emergency Service, Hospital↗

Clinical evaluation of a portable lactate meter in type I glycogen storage disease.

High lactate concentrations occur in type I glycogen storage disease (GSD) whenever glycogenolysis occurs. Not only does hyperlactataemia cause acute clinical deterioration, but chronic lactate elevations have also been associated with many of the long-term complications in GSD. A portable finger-stick blood lactate meter has recently been marketed as a training tool for high-performance athletes, but it has not been tested as a clinical diagnostic tool. This study was performed to assess the accuracy of the portable lactate meter in subjects with GSD I who are predisposed to high lactate concentrations. A total of 166 intravenous and 39 capillary samples from 13 subjects were tested concomitantly on three different lactate meters. The meter readings were compared with the lactate concentration determined by the laboratory gold-standard enzymatic colorimetric assay. Almost no inter-meter variability was found. The lactate meter values had outstanding correlation with the laboratory lactate determination, although the meters were found to run 0.5 mmol/L higher than the laboratory assay. The meter deviation was independent of lactate concentration. More variability was noted with finger-stick capillary lactate determinations, but monitoring of trends with capillary samples should prove valuable as a method for determining long-term control or acute deterioration. The portable lactate meter is a highly accurate tool for monitoring lactate concentrations, and should prove valuable for monitoring metabolic control in patients with GSD type I and other disorders associated with hyperlactataemia.

Adolescent↗

Two-electrode low supply voltage electrocardiogram signal amplifier.

Portable biomedical instrumentation has become an important part of diagnostic and treatment instrumentation, including telemedicine applications. Low-voltage and low-power design tendencies prevail. Modern battery cell voltages in the range of 3-3.6 V require appropriate circuit solutions. A two-electrode biopotential amplifier design is presented, with a high common-mode rejection ratio (CMRR), high input voltage tolerance and standard first-order high-pass characteristic. Most of these features are due to a high-gain first stage design. The circuit makes use of passive components of popular values and tolerances. Powered by a single 3 V source, the amplifier tolerates +/- 1 V common mode voltage, +/- 50 microA common mode current and 2 V input DC voltage, and its worst-case CMRR is 60 dB. The amplifier is intended for use in various applications, such as Holter-type monitors, defibrillators, ECG monitors, biotelemetry devices etc.

Amplifiers, Electronic↗

Principles of the surgical approach in human liver cystic echinococcosis.

Ultrasonography (USG) has recently contributed much to the diagnostic of hepatic cystic echinococcosis (CE). The use of portable ultrasonograph allowed us to perform a community survey among 9482 people living in a high risk area for CE in the Florida Department (Uruguay). Positive USG results were found in 123 asymptomatic patients. 48 out of 51 USG positive cases were surgically confirmed and 3 were found to be false positive. The results of this survey allowed us to propose a new classification of the echographic imaging based on the parasite's various evolutive and involutive stages. The Echinococcus granulosus cyst size was compared with the parasite's evolutive stages. The cyst's segmentary topography and the related risk of CE is evaluated. The importance of cystic-biliary communication is pointed out and its rational surgical treatment described. Finally, an algorithm is presented facilitating the choice of a rational treatment.

Adolescent↗

Use and implication of the DICOM standard in dentistry.

DICOM is an international imaging standard that was developed for medicine and has been extended to support dentistry among other professions. This standard can provide the basis of interoperability for digital system outputs, providing image portability and reducing the danger of obsolescence rendering valuable diagnostic information impossible to display. This paper presents a brief overview of the origins and components of the DICOM standard and reports an ongoing initiative to promote interoperability within the DICOM as the industry standard for digital imaging in dentistry.

Humans↗

Lung disease in premature neonates: impact of new treatments and technologies.

Advances in perinatal medicine and neonatology have dramatically changed clinical outcomes for premature neonates and have ushered in a new era of radiological complexity. "Portable" chest radiographs continue to be the mainstay in diagnostic imaging of fragile newborns, but radiologists may be confronted with new and unexpected radiological expressions of once-familiar disease processes. Familiarity with the radiological impact of emerging treatments in premature neonates is essential for accurate film interpretation.

Bronchopulmonary Dysplasia↗

High-order kinetic energy focusing in an end cap reflectron time-of-flight mass spectrometer.

A reflectron is described which provides high-order kinetic energy focusing using a simple geometry that does not require a set of resistively coupled lens elements. The reflectron is implemented in an approximately 2.0 in (overall length) mass analyzer as part of an effort to provide highly miniaturized mass spectrometers that may be utilized as field-portable instruments for environmental analysis, biological agent detection, or diagnostics.

Bradykinin↗