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Sharma A, Kumar R, Varadwaj P. Smelling the Disease: Diagnostic Potential of Breath Analysis. Mol Diagn Ther 2023; 27:321-347. [PMID: 36729362 PMCID: PMC9893210 DOI: 10.1007/s40291-023-00640-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 02/03/2023]
Abstract
Breath analysis is a relatively recent field of research with much promise in scientific and clinical studies. Breath contains endogenously produced volatile organic components (VOCs) resulting from metabolites of ingested precursors, gut and air-passage bacteria, environmental contacts, etc. Numerous recent studies have suggested changes in breath composition during the course of many diseases, and breath analysis may lead to the diagnosis of such diseases. Therefore, it is important to identify the disease-specific variations in the concentration of breath to diagnose the diseases. In this review, we explore methods that are used to detect VOCs in laboratory settings, VOC constituents in exhaled air and other body fluids (e.g., sweat, saliva, skin, urine, blood, fecal matter, vaginal secretions, etc.), VOC identification in various diseases, and recently developed electronic (E)-nose-based sensors to detect VOCs. Identifying such VOCs and applying them as disease-specific biomarkers to obtain accurate, reproducible, and fast disease diagnosis could serve as an alternative to traditional invasive diagnosis methods. However, the success of VOC-based identification of diseases is limited to laboratory settings. Large-scale clinical data are warranted for establishing the robustness of disease diagnosis. Also, to identify specific VOCs associated with illness states, extensive clinical trials must be performed using both analytical instruments and electronic noses equipped with stable and precise sensors.
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Affiliation(s)
- Anju Sharma
- Systems Biology Lab, Indian Institute of Information Technology, Allahabad, Uttar Pradesh, India
| | - Rajnish Kumar
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Uttar Pradesh, Lucknow Campus, Lucknow, India
| | - Pritish Varadwaj
- Systems Biology Lab, Indian Institute of Information Technology, Allahabad, Uttar Pradesh, India.
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2
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Kiss H, Örlős Z, Gellért Á, Megyesfalvi Z, Mikáczó A, Sárközi A, Vaskó A, Miklós Z, Horváth I. Exhaled Biomarkers for Point-of-Care Diagnosis: Recent Advances and New Challenges in Breathomics. MICROMACHINES 2023; 14:391. [PMID: 36838091 PMCID: PMC9964519 DOI: 10.3390/mi14020391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Cancers, chronic diseases and respiratory infections are major causes of mortality and present diagnostic and therapeutic challenges for health care. There is an unmet medical need for non-invasive, easy-to-use biomarkers for the early diagnosis, phenotyping, predicting and monitoring of the therapeutic responses of these disorders. Exhaled breath sampling is an attractive choice that has gained attention in recent years. Exhaled nitric oxide measurement used as a predictive biomarker of the response to anti-eosinophil therapy in severe asthma has paved the way for other exhaled breath biomarkers. Advances in laser and nanosensor technologies and spectrometry together with widespread use of algorithms and artificial intelligence have facilitated research on volatile organic compounds and artificial olfaction systems to develop new exhaled biomarkers. We aim to provide an overview of the recent advances in and challenges of exhaled biomarker measurements with an emphasis on the applicability of their measurement as a non-invasive, point-of-care diagnostic and monitoring tool.
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Affiliation(s)
- Helga Kiss
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
| | - Zoltán Örlős
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
| | - Áron Gellért
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
| | - Zsolt Megyesfalvi
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
| | - Angéla Mikáczó
- Department of Pulmonology, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, Hungary
| | - Anna Sárközi
- Department of Pulmonology, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, Hungary
| | - Attila Vaskó
- Department of Pulmonology, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, Hungary
| | - Zsuzsanna Miklós
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
| | - Ildikó Horváth
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
- Department of Pulmonology, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, Hungary
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Ali AS, Jacinto JGP, Mϋnchemyer W, Walte A, Kuhla B, Gentile A, Abdu MS, Kamel MM, Ghallab AM. Study on the Discrimination of Possible Error Sources That Might Affect the Quality of Volatile Organic Compounds Signature in Dairy Cattle Using an Electronic Nose. Vet Sci 2022; 9:vetsci9090461. [PMID: 36136677 PMCID: PMC9502780 DOI: 10.3390/vetsci9090461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary In recent decades, remarkable progress in the development of electronic nose (EN) technologies, particularly for disease detection, has been accomplished through the disclosure of novel methods and associated devices, mainly for the detection of volatile organic compounds (VOCs). Herein, we assessed the ability of a novel EN technology (MENT-EGAS prototype) to respond to direct sampling and to evaluate the influence of possible error sources that might affect the quality of VOC signatures. Principal Component Analyses (PCA) evidenced the presence in the analyzed samples of sufficient information to consent the discrimination of different environmental backgrounds, feed headspaces and exhalated breath between two groups of cows fed with two different types of feed. Moreover, discrimination was also observed within the same group between exhalated breaths sampled before and after feed intake. Based on these findings, we provided evidence that the MENT-EGAS prototype can identify error sources with accuracy. Livestock precision farming technologies are powerful tools for monitoring animal health and welfare parameters in a continuous and automated way. Abstract Electronic nose devices (EN) have been developed for detecting volatile organic compounds (VOCs). This study aimed to assess the ability of the MENT-EGAS prototype-based EN to respond to direct sampling and to evaluate the influence of possible error sources that might affect the quality of VOC signatures. This study was performed on a dairy farm using 11 (n = 11) multiparous Holstein-Friesian cows. The cows were divided into two groups housed in two different barns: group I included six lactating cows fed with a lactating diet (LD), and group II included 5 non-lactating late pregnant cows fed with a far-off diet (FD). Each group was offered 250 g of their respective diet; 10 min later, exhalated breath was collected for VOC determination. After this sampling, 4 cows from each group were offered 250 g of pellet concentrates. Ten minutes later, the exhalated breath was collected once more. VOCs were also measured directly from the feed’s headspace, as well as from the environmental backgrounds of each. Principal component analyses (PCA) were performed and revealed clear discrimination between the two different environmental backgrounds, the two different feed headspaces, the exhalated breath of groups I and II cows, and the exhalated breath within the same group of cows before and after the feed intake. Based on these findings, we concluded that the MENT-EGAS prototype can recognize several error sources with accuracy, providing a novel EN technology that could be used in the future in precision livestock farming.
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Affiliation(s)
- Asmaa S. Ali
- Department of Theriogenology, Faculty of Veterinary Medicine, Cairo University, Giza P.O. Box 12211, Egypt
- Correspondence:
| | - Joana G. P. Jacinto
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, 40064 Bologna, Italy
| | | | | | - Björn Kuhla
- Research Institute for Farm Animal Biology (FBN), Institute of Nutritional Physiology ‘Oskar Kellner’, 18196 Dummerstorf, Germany
| | - Arcangelo Gentile
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, 40064 Bologna, Italy
| | - Mohamed S. Abdu
- Department of Theriogenology, Faculty of Veterinary Medicine, Cairo University, Giza P.O. Box 12211, Egypt
| | - Mervat M. Kamel
- Department of Animal Management and Behavior, Faculty of Veterinary Medicine, Cairo University, Giza P.O. Box 12211, Egypt
| | - Abdelrauf Morsy Ghallab
- Department of Theriogenology, Faculty of Veterinary Medicine, Cairo University, Giza P.O. Box 12211, Egypt
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Kim C, Lee KK, Kang MS, Shin DM, Oh JW, Lee CS, Han DW. Artificial olfactory sensor technology that mimics the olfactory mechanism: a comprehensive review. Biomater Res 2022; 26:40. [PMID: 35986395 PMCID: PMC9392354 DOI: 10.1186/s40824-022-00287-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/13/2022] [Indexed: 11/19/2022] Open
Abstract
Artificial olfactory sensors that recognize patterns transmitted by olfactory receptors are emerging as a technology for monitoring volatile organic compounds. Advances in statistical processing methods and data processing technology have made it possible to classify patterns in sensor arrays. Moreover, biomimetic olfactory recognition sensors in the form of pattern recognition have been developed. Deep learning and artificial intelligence technologies have enabled the classification of pattern data from more sensor arrays, and improved artificial olfactory sensor technology is being developed with the introduction of artificial neural networks. An example of an artificial olfactory sensor is the electronic nose. It is an array of various types of sensors, such as metal oxides, electrochemical sensors, surface acoustic waves, quartz crystal microbalances, organic dyes, colorimetric sensors, conductive polymers, and mass spectrometers. It can be tailored depending on the operating environment and the performance requirements of the artificial olfactory sensor. This review compiles artificial olfactory sensor technology based on olfactory mechanisms. We introduce the mechanisms of artificial olfactory sensors and examples used in food quality and stability assessment, environmental monitoring, and diagnostics. Although current artificial olfactory sensor technology has several limitations and there is limited commercialization owing to reliability and standardization issues, there is considerable potential for developing this technology. Artificial olfactory sensors are expected to be widely used in advanced pattern recognition and learning technologies, along with advanced sensor technology in the future.
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Breath Sensor Technology for the Use in Mechanical Lung Ventilation Equipment for Monitoring Critically Ill Patients. Diagnostics (Basel) 2022; 12:diagnostics12020430. [PMID: 35204521 PMCID: PMC8870831 DOI: 10.3390/diagnostics12020430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/05/2022] [Accepted: 02/06/2022] [Indexed: 12/31/2022] Open
Abstract
Background: The need for mechanical lung ventilation is common in critically ill patients, either with COVID-19 infection or due to other causes. Monitoring of patients being ventilated is essential for timely and improved management. We here propose the use of a novel breath volatile organic compound sensor technology to be used in a mechanical lung ventilation machine for this purpose; the technology was evaluated in critically ill COVID-19 patients on mechanical lung ventilation. Methods: Based on the consistency results of our study data, the breath sensor device with metal oxide gas sensors and environment-controlling sensors was mounted on the ventilation exhaust port of the ventilation machine; this allowed to ensure additional safety since the device was placed outside the contour between the patient and equipment. Results: The sensors allowed stable registration of the signals for up to several weeks for 10 patients in total, depending on the storage amount; a proportion of patients were intubated or received tracheostoma during the evaluation period. Future studies are on the way to correlate sensor readings to other parameters characterizing the severity of the patient condition and outcome. Conclusions: We suppose that such technology will allow patient monitoring in real-time for timely identification of deterioration, potentially requiring some change of management. The obtained results are preliminary and further studies are needed to examine their clinical significance.
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Wojnowski W, Kalinowska K. Machine Learning and Electronic Noses for Medical Diagnostics. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
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Yang HY, Chen WC, Tsai RC. Accuracy of the Electronic Nose Breath Tests in Clinical Application: A Systematic Review and Meta-Analysis. BIOSENSORS 2021; 11:bios11110469. [PMID: 34821685 PMCID: PMC8615633 DOI: 10.3390/bios11110469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 11/20/2021] [Accepted: 11/20/2021] [Indexed: 05/25/2023]
Abstract
(1) Background: An electronic nose applies a sensor array to detect volatile biomarkers in exhaled breath to diagnose diseases. The overall diagnostic accuracy remains unknown. The objective of this review was to provide an estimate of the diagnostic accuracy of sensor-based breath tests for the diagnosis of diseases. (2) Methods: We searched the PubMed and Web of Science databases for studies published between 1 January 2010 and 14 October 2021. The search was limited to human studies published in the English language. Clinical trials were not included in this review. (3) Results: Of the 2418 records identified, 44 publications were eligible, and 5728 patients were included in the final analyses. The pooled sensitivity was 90.0% (95% CI, 86.3-92.8%, I2 = 47.7%), the specificity was 88.4% (95% CI, 87.1-89.5%, I2 = 81.4%), and the pooled area under the curve was 0.93 (95% CI 0.91-0.95). (4) Conclusion: The findings of our review suggest that a standardized report of diagnostic accuracy and a report of the accuracy in a test set are needed. Sensor array systems of electronic noses have the potential for noninvasiveness at the point-of-care in hospitals. Nevertheless, the procedure for reporting the accuracy of a diagnostic test must be standardized.
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Affiliation(s)
- Hsiao-Yu Yang
- Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei 10055, Taiwan; (W.-C.C.); (R.-C.T.)
- Department of Public Health, National Taiwan University College of Public Health, Taipei 10055, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Wan-Chin Chen
- Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei 10055, Taiwan; (W.-C.C.); (R.-C.T.)
- Department of Family Medicine, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Rodger-Chen Tsai
- Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei 10055, Taiwan; (W.-C.C.); (R.-C.T.)
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Diagnostic and prognostic prediction models in ventilator-associated pneumonia: Systematic review and meta-analysis of prediction modelling studies. J Crit Care 2021; 67:44-56. [PMID: 34673331 DOI: 10.1016/j.jcrc.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/23/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Existing expert systems have not improved the diagnostic accuracy of ventilator-associated pneumonia (VAP). The aim of this systematic literature review was to review and summarize state-of-the-art prediction models detecting or predicting VAP from exhaled breath, patient reports and demographic and clinical characteristics. METHODS Both diagnostic and prognostic prediction models were searched from a representative list of multidisciplinary databases. An extensive list of validated search terms was added to the search to cover papers failing to mention predictive research in their title or abstract. Two authors independently selected studies, while three authors extracted data using predefined criteria and data extraction forms. The Prediction Model Risk of Bias Assessment Tool was used to assess both the risk of bias and the applicability of the prediction modelling studies. Technology readiness was also assessed. RESULTS Out of 2052 identified studies, 20 were included. Fourteen (70%) studies reported the predictive performance of diagnostic models to detect VAP from exhaled human breath with a high degree of sensitivity and a moderate specificity. In addition, the majority of them were validated on a realistic dataset. The rest of the studies reported the predictive performance of diagnostic and prognostic prediction models to detect VAP from unstructured narratives [2 (10%)] as well as baseline demographics and clinical characteristics [4 (20%)]. All studies, however, had either a high or unclear risk of bias without significant improvements in applicability. CONCLUSIONS The development and deployment of prediction modelling studies are limited in VAP and related outcomes. More computational, translational, and clinical research is needed to bring these tools from the bench to the bedside. REGISTRATION PROSPERO CRD42020180218, registered on 05-07-2020.
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van der Sar IG, Wijbenga N, Nakshbandi G, Aerts JGJV, Manintveld OC, Wijsenbeek MS, Hellemons ME, Moor CC. The smell of lung disease: a review of the current status of electronic nose technology. Respir Res 2021; 22:246. [PMID: 34535144 PMCID: PMC8448171 DOI: 10.1186/s12931-021-01835-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/26/2021] [Indexed: 02/08/2023] Open
Abstract
There is a need for timely, accurate diagnosis, and personalised management in lung diseases. Exhaled breath reflects inflammatory and metabolic processes in the human body, especially in the lungs. The analysis of exhaled breath using electronic nose (eNose) technology has gained increasing attention in the past years. This technique has great potential to be used in clinical practice as a real-time non-invasive diagnostic tool, and for monitoring disease course and therapeutic effects. To date, multiple eNoses have been developed and evaluated in clinical studies across a wide spectrum of lung diseases, mainly for diagnostic purposes. Heterogeneity in study design, analysis techniques, and differences between eNose devices currently hamper generalization and comparison of study results. Moreover, many pilot studies have been performed, while validation and implementation studies are scarce. These studies are needed before implementation in clinical practice can be realised. This review summarises the technical aspects of available eNose devices and the available evidence for clinical application of eNose technology in different lung diseases. Furthermore, recommendations for future research to pave the way for clinical implementation of eNose technology are provided.
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Affiliation(s)
- I G van der Sar
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - N Wijbenga
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - G Nakshbandi
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J G J V Aerts
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - O C Manintveld
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M S Wijsenbeek
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M E Hellemons
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - C C Moor
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Giang C, Calvert J, Rahmani K, Barnes G, Siefkas A, Green-Saxena A, Hoffman J, Mao Q, Das R. Predicting ventilator-associated pneumonia with machine learning. Medicine (Baltimore) 2021; 100:e26246. [PMID: 34115013 PMCID: PMC8202554 DOI: 10.1097/md.0000000000026246] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/02/2021] [Indexed: 01/04/2023] Open
Abstract
Ventilator-associated pneumonia (VAP) is the most common and fatal nosocomial infection in intensive care units (ICUs). Existing methods for identifying VAP display low accuracy, and their use may delay antimicrobial therapy. VAP diagnostics derived from machine learning (ML) methods that utilize electronic health record (EHR) data have not yet been explored. The objective of this study is to compare the performance of a variety of ML models trained to predict whether VAP will be diagnosed during the patient stay.A retrospective study examined data from 6126 adult ICU encounters lasting at least 48 hours following the initiation of mechanical ventilation. The gold standard was the presence of a diagnostic code for VAP. Five different ML models were trained to predict VAP 48 hours after initiation of mechanical ventilation. Model performance was evaluated with regard to the area under the receiver operating characteristic (AUROC) curve on a 20% hold-out test set. Feature importance was measured in terms of Shapley values.The highest performing model achieved an AUROC value of 0.854. The most important features for the best-performing model were the length of time on mechanical ventilation, the presence of antibiotics, sputum test frequency, and the most recent Glasgow Coma Scale assessment.Supervised ML using patient EHR data is promising for VAP diagnosis and warrants further validation. This tool has the potential to aid the timely diagnosis of VAP.
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Snitz K, Andelman-Gur M, Pinchover L, Weissgross R, Weissbrod A, Mishor E, Zoller R, Linetsky V, Medhanie A, Shushan S, Jaffe E, Sobel N. Proof of concept for real-time detection of SARS CoV-2 infection with an electronic nose. PLoS One 2021; 16:e0252121. [PMID: 34077435 PMCID: PMC8172018 DOI: 10.1371/journal.pone.0252121] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/10/2021] [Indexed: 01/12/2023] Open
Abstract
Rapid diagnosis is key to curtailing the Covid-19 pandemic. One path to such rapid diagnosis may rely on identifying volatile organic compounds (VOCs) emitted by the infected body, or in other words, identifying the smell of the infection. Consistent with this rationale, dogs can use their nose to identify Covid-19 patients. Given the scale of the pandemic, however, animal deployment is a challenging solution. In contrast, electronic noses (eNoses) are machines aimed at mimicking animal olfaction, and these can be deployed at scale. To test the hypothesis that SARS CoV-2 infection is associated with a body-odor detectable by an eNose, we placed a generic eNose in-line at a drive-through testing station. We applied a deep learning classifier to the eNose measurements, and achieved real-time detection of SARS CoV-2 infection at a level significantly better than chance, for both symptomatic and non-symptomatic participants. This proof of concept with a generic eNose implies that an optimized eNose may allow effective real-time diagnosis, which would provide for extensive relief in the Covid-19 pandemic.
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Affiliation(s)
- Kobi Snitz
- Department of Neurobiology and Azrieli Center for Human Brain Imaging and Research, Weizmann Institute of Science, Rehovot, Israel
- * E-mail: (NS); (KS)
| | - Michal Andelman-Gur
- Department of Neurobiology and Azrieli Center for Human Brain Imaging and Research, Weizmann Institute of Science, Rehovot, Israel
| | - Liron Pinchover
- Department of Neurobiology and Azrieli Center for Human Brain Imaging and Research, Weizmann Institute of Science, Rehovot, Israel
| | - Reut Weissgross
- Department of Neurobiology and Azrieli Center for Human Brain Imaging and Research, Weizmann Institute of Science, Rehovot, Israel
| | - Aharon Weissbrod
- Department of Neurobiology and Azrieli Center for Human Brain Imaging and Research, Weizmann Institute of Science, Rehovot, Israel
| | - Eva Mishor
- Department of Neurobiology and Azrieli Center for Human Brain Imaging and Research, Weizmann Institute of Science, Rehovot, Israel
| | - Roni Zoller
- Department of Neurobiology and Azrieli Center for Human Brain Imaging and Research, Weizmann Institute of Science, Rehovot, Israel
| | - Vera Linetsky
- Department of Neurobiology and Azrieli Center for Human Brain Imaging and Research, Weizmann Institute of Science, Rehovot, Israel
| | - Abebe Medhanie
- Department of Neurobiology and Azrieli Center for Human Brain Imaging and Research, Weizmann Institute of Science, Rehovot, Israel
| | - Sagit Shushan
- Department of Neurobiology and Azrieli Center for Human Brain Imaging and Research, Weizmann Institute of Science, Rehovot, Israel
- Department of Otolaryngology & Head and Neck Surgery, Edith Wolfson Medical Center, Holon, Israel
| | - Eli Jaffe
- Magen David Adom in Israel and Department of Emergency Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Noam Sobel
- Department of Neurobiology and Azrieli Center for Human Brain Imaging and Research, Weizmann Institute of Science, Rehovot, Israel
- * E-mail: (NS); (KS)
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Xu E, Pérez-Torres D, Fragkou PC, Zahar JR, Koulenti D. Nosocomial Pneumonia in the Era of Multidrug-Resistance: Updates in Diagnosis and Management. Microorganisms 2021; 9:534. [PMID: 33807623 PMCID: PMC8001201 DOI: 10.3390/microorganisms9030534] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 12/11/2022] Open
Abstract
Nosocomial pneumonia (NP), including hospital-acquired pneumonia in non-intubated patients and ventilator-associated pneumonia, is one of the most frequent hospital-acquired infections, especially in the intensive care unit. NP has a significant impact on morbidity, mortality and health care costs, especially when the implicated pathogens are multidrug-resistant ones. This narrative review aims to critically review what is new in the field of NP, specifically, diagnosis and antibiotic treatment. Regarding novel imaging modalities, the current role of lung ultrasound and low radiation computed tomography are discussed, while regarding etiological diagnosis, recent developments in rapid microbiological confirmation, such as syndromic rapid multiplex Polymerase Chain Reaction panels are presented and compared with conventional cultures. Additionally, the volatile compounds/electronic nose, a promising diagnostic tool for the future is briefly presented. With respect to NP management, antibiotics approved for the indication of NP during the last decade are discussed, namely, ceftobiprole medocaril, telavancin, ceftolozane/tazobactam, ceftazidime/avibactam, and meropenem/vaborbactam.
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Affiliation(s)
- Elena Xu
- Burns, Trauma and Critical Care Research Centre, University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia;
| | - David Pérez-Torres
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, 47012 Valladolid, Spain;
| | - Paraskevi C. Fragkou
- Fourth Department of Internal Medicine, Attikon University Hospital, 12462 Athens, Greece;
| | - Jean-Ralph Zahar
- Microbiology Department, Infection Control Unit, Hospital Avicenne, 93000 Bobigny, France;
| | - Despoina Koulenti
- Burns, Trauma and Critical Care Research Centre, University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia;
- Second Critical Care Department, Attikon University Hospital, 12462 Athens, Greece
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Machine Learning and Electronic Noses for Medical Diagnostics. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_329-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Grassin-Delyle S, Roquencourt C, Moine P, Saffroy G, Carn S, Heming N, Fleuriet J, Salvator H, Naline E, Couderc LJ, Devillier P, Thévenot EA, Annane D. Metabolomics of exhaled breath in critically ill COVID-19 patients: A pilot study. EBioMedicine 2021; 63:103154. [PMID: 33279860 PMCID: PMC7714658 DOI: 10.1016/j.ebiom.2020.103154] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/06/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Early diagnosis of coronavirus disease 2019 (COVID-19) is of the utmost importance but remains challenging. The objective of the current study was to characterize exhaled breath from mechanically ventilated adults with COVID-19. METHODS In this prospective observational study, we used real-time, online, proton transfer reaction time-of-flight mass spectrometry to perform a metabolomic analysis of expired air from adults undergoing invasive mechanical ventilation in the intensive care unit due to severe COVID-19 or non-COVID-19 acute respiratory distress syndrome (ARDS). FINDINGS Between March 25th and June 25th, 2020, we included 40 patients with ARDS, of whom 28 had proven COVID-19. In a multivariate analysis, we identified a characteristic breathprint for COVID-19. We could differentiate between COVID-19 and non-COVID-19 ARDS with accuracy of 93% (sensitivity: 90%, specificity: 94%, area under the receiver operating characteristic curve: 0·94-0·98, after cross-validation). The four most prominent volatile compounds in COVID-19 patients were methylpent-2-enal, 2,4-octadiene 1-chloroheptane, and nonanal. INTERPRETATION The real-time, non-invasive detection of methylpent-2-enal, 2,4-octadiene 1-chloroheptane, and nonanal in exhaled breath may identify ARDS patients with COVID-19. FUNDING The study was funded by Agence Nationale de la Recherche (SoftwAiR, ANR-18-CE45-0017 and RHU4 RECORDS, Programme d'Investissements d'Avenir, ANR-18-RHUS-0004), Région Île de France (SESAME 2016), and Fondation Foch.
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Affiliation(s)
- Stanislas Grassin-Delyle
- Hôpital Foch, Exhalomics®, Département des maladies des voies respiratoires, Suresnes, France (S.G.D., H.S., E.N., L-J.C., P.D.); Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation, Montigny le Bretonneux, France (S.G.D., P.M., N.H., D.A.); FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis) (S.G.D., H.S., E.N., L-J.C., P.D., E.T., D.A.)..
| | - Camille Roquencourt
- CEA, LIST, Laboratoire Sciences des Données et de la Décision, Gif-sur-Yvette, France (C.R.)
| | - Pierre Moine
- Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation, Montigny le Bretonneux, France (S.G.D., P.M., N.H., D.A.); Intensive Care Unit, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris, Garches, France (P.M., G.S., S.C., N.H., J.F., D.A.)
| | - Gabriel Saffroy
- Intensive Care Unit, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris, Garches, France (P.M., G.S., S.C., N.H., J.F., D.A.)
| | - Stanislas Carn
- Intensive Care Unit, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris, Garches, France (P.M., G.S., S.C., N.H., J.F., D.A.)
| | - Nicholas Heming
- Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation, Montigny le Bretonneux, France (S.G.D., P.M., N.H., D.A.); Intensive Care Unit, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris, Garches, France (P.M., G.S., S.C., N.H., J.F., D.A.)
| | - Jérôme Fleuriet
- Intensive Care Unit, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris, Garches, France (P.M., G.S., S.C., N.H., J.F., D.A.)
| | - Hélène Salvator
- Hôpital Foch, Exhalomics®, Département des maladies des voies respiratoires, Suresnes, France (S.G.D., H.S., E.N., L-J.C., P.D.); FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis) (S.G.D., H.S., E.N., L-J.C., P.D., E.T., D.A.)
| | - Emmanuel Naline
- Hôpital Foch, Exhalomics®, Département des maladies des voies respiratoires, Suresnes, France (S.G.D., H.S., E.N., L-J.C., P.D.); FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis) (S.G.D., H.S., E.N., L-J.C., P.D., E.T., D.A.)
| | - Louis-Jean Couderc
- Hôpital Foch, Exhalomics®, Département des maladies des voies respiratoires, Suresnes, France (S.G.D., H.S., E.N., L-J.C., P.D.); FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis) (S.G.D., H.S., E.N., L-J.C., P.D., E.T., D.A.)
| | - Philippe Devillier
- Hôpital Foch, Exhalomics®, Département des maladies des voies respiratoires, Suresnes, France (S.G.D., H.S., E.N., L-J.C., P.D.); FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis) (S.G.D., H.S., E.N., L-J.C., P.D., E.T., D.A.)
| | - Etienne A Thévenot
- Département Médicaments et Technologies pour la Santé (DMTS), Université Paris-Saclay, CEA, INRAE, MetaboHUB, Gif-sur-Yvette, France (E.T.); FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis) (S.G.D., H.S., E.N., L-J.C., P.D., E.T., D.A.)
| | - Djillali Annane
- Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation, Montigny le Bretonneux, France (S.G.D., P.M., N.H., D.A.); Intensive Care Unit, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris, Garches, France (P.M., G.S., S.C., N.H., J.F., D.A.); FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis) (S.G.D., H.S., E.N., L-J.C., P.D., E.T., D.A.)
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Chen CY, Lin WC, Yang HY. Diagnosis of ventilator-associated pneumonia using electronic nose sensor array signals: solutions to improve the application of machine learning in respiratory research. Respir Res 2020; 21:45. [PMID: 32033607 PMCID: PMC7006122 DOI: 10.1186/s12931-020-1285-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/07/2020] [Indexed: 01/07/2023] Open
Abstract
Background Ventilator-associated pneumonia (VAP) is a significant cause of mortality in the intensive care unit. Early diagnosis of VAP is important to provide appropriate treatment and reduce mortality. Developing a noninvasive and highly accurate diagnostic method is important. The invention of electronic sensors has been applied to analyze the volatile organic compounds in breath to detect VAP using a machine learning technique. However, the process of building an algorithm is usually unclear and prevents physicians from applying the artificial intelligence technique in clinical practice. Clear processes of model building and assessing accuracy are warranted. The objective of this study was to develop a breath test for VAP with a standardized protocol for a machine learning technique. Methods We conducted a case-control study. This study enrolled subjects in an intensive care unit of a hospital in southern Taiwan from February 2017 to June 2019. We recruited patients with VAP as the case group and ventilated patients without pneumonia as the control group. We collected exhaled breath and analyzed the electric resistance changes of 32 sensor arrays of an electronic nose. We split the data into a set for training algorithms and a set for testing. We applied eight machine learning algorithms to build prediction models, improving model performance and providing an estimated diagnostic accuracy. Results A total of 33 cases and 26 controls were used in the final analysis. Using eight machine learning algorithms, the mean accuracy in the testing set was 0.81 ± 0.04, the sensitivity was 0.79 ± 0.08, the specificity was 0.83 ± 0.00, the positive predictive value was 0.85 ± 0.02, the negative predictive value was 0.77 ± 0.06, and the area under the receiver operator characteristic curves was 0.85 ± 0.04. The mean kappa value in the testing set was 0.62 ± 0.08, which suggested good agreement. Conclusions There was good accuracy in detecting VAP by sensor array and machine learning techniques. Artificial intelligence has the potential to assist the physician in making a clinical diagnosis. Clear protocols for data processing and the modeling procedure needed to increase generalizability.
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Affiliation(s)
- Chung-Yu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliu, Taiwan
| | - Wei-Chi Lin
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Hsiao-Yu Yang
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan. .,Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan. .,Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan. .,Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan.
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A Low-Cost Breath Analyzer Module in Domiciliary Non-Invasive Mechanical Ventilation for Remote COPD Patient Monitoring. SENSORS 2020; 20:s20030653. [PMID: 31991608 PMCID: PMC7038329 DOI: 10.3390/s20030653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/14/2020] [Accepted: 01/17/2020] [Indexed: 02/07/2023]
Abstract
Smart Breath Analyzers were developed as sensing terminals of a telemedicine architecture devoted to remote monitoring of patients suffering from Chronic Obstructive Pulmonary Disease (COPD) and home-assisted by non-invasive mechanical ventilation via respiratory face mask. The devices based on different sensors (CO2/O2 and Volatile Organic Compounds (VOCs), relative humidity and temperature (R.H. & T) sensors) monitor the breath air exhaled into the expiratory line of the bi-tube patient breathing circuit during a noninvasive ventilo-therapy session; the sensor raw signals are transmitted pseudonymized to National Health Service units by TCP/IP communication through a cloud remote platform. The work is a proof-of-concept of a sensors-based IoT system with the perspective to check continuously the effectiveness of therapy and/or any state of exacerbation of the disease requiring healthcare. Lab tests in controlled experimental conditions by a gas-mixing bench towards CO2/O2 concentrations and exhaled breath collected in a sampling bag were carried out to test the realized prototypes. The Smart Breath Analyzers were also tested in real conditions both on a healthy volunteer subject and a COPD suffering patient.
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Abstract
In this paper, we report on an in-house developed electronic nose (E-nose) for use with breath analysis. The unit consists of an array of 10 micro-electro-mechanical systems (MEMS) metal oxide (MOX) gas sensors produced by seven manufacturers. Breath sampling of end-tidal breath is achieved using a heated sample tube, capable of monitoring sampling-related parameters, such as carbon dioxide (CO2), humidity, and temperature. A simple mobile app was developed to receive real-time data from the device, using Wi-Fi communication. The system has been tested using chemical standards and exhaled breath samples from healthy volunteers, before and after taking a peppermint capsule. Results from chemical testing indicate that we can separate chemical standards (acetone, isopropanol and 1-propanol) and different concentrations of isobutylene. The analysis of exhaled breath samples demonstrate that we can distinguish between pre- and post-consumption of peppermint capsules; area under the curve (AUC): 0.81, sensitivity: 0.83 (0.59–0.96), specificity: 0.72 (0.47–0.90), p-value: <0.001. The functionality of the developed device has been demonstrated with the testing of chemical standards and a simplified breath study using peppermint capsules. It is our intention to deploy this system in a UK hospital in an upcoming breath research study.
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Astuti SD, Mukhammad Y, Duli SAJ, Putra AP, Setiawatie EM, Triyana K. Gas Sensor Array System Properties for Detecting Bacterial Biofilms. JOURNAL OF MEDICAL SIGNALS & SENSORS 2019; 9:158-164. [PMID: 31544055 PMCID: PMC6743245 DOI: 10.4103/jmss.jmss_60_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Gas sensor array system is a device that mimics the work of how the nose smells using the gas sensors that could give response toward specific odors. It is used for characterizing the different blended gas that is suited with the biological working nose principle. Thus, it could be used to detect the dental and oral diseases. Periodontitis is one of the diseases caused by the damage on the teeth due to the chronic infection on the gingival structure marked with bacterial plaque and calculus. This study aims to develop an electric nose for odor detection application on the periodontal bacterial biofilm as early detection device for dental and oral disease. Methods: This device is designed as a portable device to ease the data acquisition. The measured data were stored at a database system connected to a real-time computer. A gas array sensor system with six gas sensors (TGS 826, TGS 2602, TGS 2600, TGS 2611, TGS 2612, and TGS 2620) has been assembled for the early detection application for dental and oral disease excreted by the bacterial biofilm that caused dental and oral disease, including Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Streptococcus mutans, and Enterococcus faecalis. Results: TGS 826 and TGS 2602 sensor had the best response showed by the high ADC delta value. Conclusion: GS 826 and TGS 2602 sensor could be used as a candidate for early detection device for dental and oral disease.
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Affiliation(s)
- Suryani Dyah Astuti
- Biomedical Engineering, Postgraduate School, Universitas Airlangga, Surabaya, Indonesia.,Department of Physics, Faculty of Science and Technology, Universitas Airlangga, Surabaya, Indonesia
| | - Yanuar Mukhammad
- Biomedical Engineering, Postgraduate School, Universitas Airlangga, Surabaya, Indonesia
| | | | - Alfian Pramudita Putra
- Department of Physics, Faculty of Science and Technology, Universitas Airlangga, Surabaya, Indonesia
| | | | - Kuwat Triyana
- Department of Physics, Faculty of Mathematics and Natural Science, Gadjah Mada University, Yogyakarta, Indonesia
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The electronic nose technology in clinical diagnosis: A systematic review. Porto Biomed J 2019; 4:e42. [PMID: 31930178 PMCID: PMC6924976 DOI: 10.1097/j.pbj.0000000000000042] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 06/06/2019] [Indexed: 12/13/2022] Open
Abstract
Supplemental Digital Content is available in the text Background: Volatile organic compounds (VOC) are end products of human metabolism (normal and disease-associated) that can be mainly excreted in breath, urine, and feces. Therefore, VOC can be very useful as markers of diseases and helpful for clinicians since its sampling is noninvasive, inexpensive, and painless. Electronic noses, or eNoses, provide an easy and inexpensive way to analyze gas samples. Thus, this device may be used for diagnosis, monitoring or phenotyping diseases according to specific breathprints (breath profile). Objective: In this review, we summarize data showing the ability of eNose to be used as a noninvasive tool to improve diagnosis in clinical settings. Methods: A PRISMA-oriented search was performed in PubMed and Cochrane Library. Only studies performed in humans and published since 2000 were included. Results: A total of 48 original articles, 21 reviews, and 7 other documents were eligible and fully analyzed. The quality assessment of the selected studies was conducted according to the Standards for Reporting of Diagnostic Accuracy. Airway obstructive diseases were the most studied and Cyranose 320 was the most used eNose. Conclusions: Several case–control studies were performed to test this technology in diverse fields. More than a half of the selected studies showed good accuracy. However, there are some limitations regarding sampling methodology, analysis, reproducibility, and external validation that need to be standardized. Additionally, it is urgent to test this technology in intend-to-treat populations. Thus, it is possible to think in the contribution of VOC analysis by eNoses in a clinical setting.
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20
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Biomarkers in Pneumonia-Beyond Procalcitonin. Int J Mol Sci 2019; 20:ijms20082004. [PMID: 31022834 PMCID: PMC6514895 DOI: 10.3390/ijms20082004] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 01/10/2023] Open
Abstract
Pneumonia is the leading infectious cause of mortality worldwide and one of the most common lower respiratory tract infections that is contributing significantly to the burden of antibiotic consumption. Due to the complexity of its pathophysiology, it is widely accepted that clinical diagnosis and prognosis are inadequate for the accurate assessment of the severity of the disease. The most challenging task for a physician is the risk stratification of patients with community-acquired pneumonia. Herein, early diagnosis is essential in order to reduce hospitalization and mortality. Procalcitonin and C-reactive protein remain the most widely used biomarkers, while interleukin 6 has been of particular interest in the literature. However, none of them appear to be ideal, and the search for novel biomarkers that will most sufficiently predict the severity and treatment response in pneumonia has lately intensified. Although our insight has significantly increased over the last years, a translational approach with the application of genomics, metabolomics, microbiomics, and proteomics is required to better understand the disease. In this review, we discuss this rapidly evolving area and summarize the application of novel biomarkers that appear to be promising for the accurate diagnosis and risk stratification of pneumonia.
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Machine Learning Methods Applied to Predict Ventilator-Associated Pneumonia with Pseudomonas aeruginosa Infection via Sensor Array of Electronic Nose in Intensive Care Unit. SENSORS 2019; 19:s19081866. [PMID: 31003541 PMCID: PMC6514817 DOI: 10.3390/s19081866] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 12/17/2022]
Abstract
One concern to the patients is the off-line detection of pneumonia infection status after using the ventilator in the intensive care unit. Hence, machine learning methods for ventilator-associated pneumonia (VAP) rapid diagnose are proposed. A popular device, Cyranose 320 e-nose, is usually used in research on lung disease, which is a highly integrated system and sensor comprising 32 array using polymer and carbon black materials. In this study, a total of 24 subjects were involved, including 12 subjects who are infected with pneumonia, and the rest are non-infected. Three layers of back propagation artificial neural network and support vector machine (SVM) methods were applied to patients’ data to predict whether they are infected with VAP with Pseudomonas aeruginosa infection. Furthermore, in order to improve the accuracy and the generalization of the prediction models, the ensemble neural networks (ENN) method was applied. In this study, ENN and SVM prediction models were trained and tested. In order to evaluate the models’ performance, a fivefold cross-validation method was applied. The results showed that both ENN and SVM models have high recognition rates of VAP with Pseudomonas aeruginosa infection, with 0.9479 ± 0.0135 and 0.8686 ± 0.0422 accuracies, 0.9714 ± 0.0131, 0.9250 ± 0.0423 sensitivities, and 0.9288 ± 0.0306, 0.8639 ± 0.0276 positive predictive values, respectively. The ENN model showed better performance compared to SVM in the recognition of VAP with Pseudomonas aeruginosa infection. The areas under the receiver operating characteristic curve of the two models were 0.9842 ± 0.0058 and 0.9410 ± 0.0301, respectively, showing that both models are very stable and accurate classifiers. This study aims to assist the physician in providing a scientific and effective reference for performing early detection in Pseudomonas aeruginosa infection or other diseases.
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Wojnowski W, Dymerski T, Gębicki J, Namieśnik J. Electronic Noses in Medical Diagnostics. Curr Med Chem 2019; 26:197-215. [PMID: 28982314 DOI: 10.2174/0929867324666171004164636] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 05/24/2016] [Accepted: 09/05/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Electronic nose technology is being developed in order to analyse complex mixtures of volatiles in a way parallel to biologic olfaction. When applied in the field of medicine, the use of such devices should enable the identification and discrimination between different diseases. In this review, a comprehensive summary of research in medical diagnostics using electronic noses is presented. A special attention has been paid to the application of these devices and sensor technologies, in response to current trends in medicine. METHODS Peer-reviewed research literature pertaining to the subject matter was identified based on a search of bibliographic databases. The quality and relevance of retrieved papers was assessed using standard tools. Their content was critically reviewed and certain information contained therein was compiled in tabularized form. RESULTS The majority of reviewed studies show promising results, often surpassing the accuracy and sensitivity of established diagnostic methods. However, only a relatively small number of devices have been field tested. The methods used for sample collection and data processing in various studies were listed in a table, together with electronic nose models used in these investigations. CONCLUSION Despite the fact that devices equipped with arrays of chemical sensors are not routinely used in everyday medical practice, their prospective use would solve some established issues in medical diagnostics, as well as lead to developments in prophylactics by facilitating a widespread use of non-invasive screening tests.
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Affiliation(s)
- Wojciech Wojnowski
- Department of Analytical Chemistry, Chemical Faculty, Gdansk University of Technology, Gdansk, Poland
| | - Tomasz Dymerski
- Department of Analytical Chemistry, Chemical Faculty, Gdansk University of Technology, Gdansk, Poland
| | - Jacek Gębicki
- Department of Chemical and Process Engineering, Chemical Faculty, Gdansk University of Technology, Gdansk, Poland
| | - Jacek Namieśnik
- Department of Analytical Chemistry, Chemical Faculty, Gdansk University of Technology, Gdansk, Poland
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Sánchez C, Santos JP, Lozano J. Use of Electronic Noses for Diagnosis of Digestive and Respiratory Diseases through the Breath. BIOSENSORS 2019; 9:E35. [PMID: 30823459 PMCID: PMC6468564 DOI: 10.3390/bios9010035] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
Abstract
The increased occurrence of chronic diseases related to lifestyle or environmental conditions may have a detrimental effect on long-term health if not diagnosed and controlled in time. For this reason, it is important to develop new noninvasive early diagnosis equipment that allows improvement of the current diagnostic methods. This, in turn, has led to an exponential development of technology applied to the medical sector, such as the electronic nose. In addition, the appearance of this type of technology has allowed the possibility of studying diseases from another point of view, such as through breath analysis. This paper presents a bibliographic review of past and recent studies, selecting those investigations in which a patient population was studied with electronic nose technology, in order to identify potential applications of this technology in the detection of respiratory and digestive diseases through the analysis of volatile organic compounds present in the breath.
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Affiliation(s)
- Carlos Sánchez
- Institute of Physics Technology and Information (CSIC), 28006 Madrid, Spain.
- Up Devices and Technologies, 28021 Madrid, Spain.
| | - J Pedro Santos
- Institute of Physics Technology and Information (CSIC), 28006 Madrid, Spain.
| | - Jesús Lozano
- Industrial Engineering School, University of Extremadura, 06006 Badajoz, Spain.
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Maugeri G, Lychko I, Sobral R, Roque ACA. Identification and Antibiotic-Susceptibility Profiling of Infectious Bacterial Agents: A Review of Current and Future Trends. Biotechnol J 2019; 14:e1700750. [PMID: 30024110 PMCID: PMC6330097 DOI: 10.1002/biot.201700750] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/06/2018] [Indexed: 12/16/2022]
Abstract
Antimicrobial resistance is one of the most worrying threats to humankind with extremely high healthcare costs associated. The current technologies used in clinical microbiology to identify the bacterial agent and profile antimicrobial susceptibility are time-consuming and frequently expensive. As a result, physicians prescribe empirical antimicrobial therapies. This scenario is often the cause of therapeutic failures, causing higher mortality rates and healthcare costs, as well as the emergence and spread of antibiotic resistant bacteria. As such, new technologies for rapid identification of the pathogen and antimicrobial susceptibility testing are needed. This review summarizes the current technologies, and the promising emerging and future alternatives for the identification and profiling of antimicrobial resistance bacterial agents, which are expected to revolutionize the field of clinical diagnostics.
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Affiliation(s)
- Gaetano Maugeri
- UCIBIO, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2819-516, Caparica, Portugal
| | - Iana Lychko
- UCIBIO, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2819-516, Caparica, Portugal
| | - Rita Sobral
- UCIBIO, Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2819-516, Caparica, Portugal
| | - Ana C A Roque
- UCIBIO, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2819-516, Caparica, Portugal
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Finamore P, Scarlata S, Incalzi RA. Breath analysis in respiratory diseases: state-of-the-art and future perspectives. Expert Rev Mol Diagn 2018; 19:47-61. [PMID: 30575423 DOI: 10.1080/14737159.2019.1559052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The vast majority of respiratory diseases are associated with the production of volatile organic compounds (VOCs), the analysis of which might improve our knowledge about these disorders and their clinical management. The aim of this narrative review is to provide a comprehensive summary of current evidence supporting the application of breath analysis in the field of respiratory diseases, as well as suggesting potential applications available in the near future. Areas covered: A computerized literature search was performed to identify relevant articles reporting original data on the clinical use of breath analysis in respiratory diseases. Papers focusing on diseases other than respiratory, technical issues of VOC sampling and analysis, in vitro experiments or exogenous compounds were excluded. Expert commentary: Currently available evidence on the application of breath analysis in respiratory diseases is encouraging; however, it is mostly based on single-center studies without external validation. The standardization of the technique, together with multicenter clinical trials with external validation, will ensure it is ready for clinical use. Current and new applications in respiratory diseases may represent a major breakthrough in the field, so much so as to deserve further efforts in outlining the most effective way to apply VOC analysis for clinical purposes.
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Affiliation(s)
| | - Simone Scarlata
- a Unit of Geriatrics , Campus Bio-Medico University, Rome, Italy
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Tirzïte M, Bukovskis M, Strazda G, Jurka N, Taivans I. Detection of lung cancer with electronic nose and logistic regression analysis. J Breath Res 2018; 13:016006. [PMID: 30221629 DOI: 10.1088/1752-7163/aae1b8] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Lung cancer is a very common malignancy with a low five-year survival rate. Artificial olfactory sensor (electronic nose) is a tool that recently has been studied as a probable optimal screening tool for early detection of lung cancer, but still no statistical method has been put forward as the preferable one. The aim of the study was to explore the use of logistic regression analysis (LRA) to analyse patients' exhaled breath samples with electronic nose in order to differentiate lung cancer patients (regardless of the stage of the cancer) from patients with other lung diseases and healthy individuals. Patients with histologically or cytologically verified, untreated lung cancer, patients with other lung diseases such as benign lung tumors, chronic obstructive pulmonary disease, asthma, pneumonia, etc, and healthy volunteers were enrolled in the study, in total 252 cancer patients and 223 patients without cancer. Breath sample collection and analysis were performed with Cyranose 320 sensor device and data further analysed using LRA. The LRA correctly differentiated lung cancer patients from no-cancer patients. The overall sensitivity in detecting patients having cancer was 95.8% for smokers and 96.2% for non-smokers and the overall specificity was 90.6% for non-smokers and 92.3% for smokers. Exhaled breath analysis by electronic nose using LRA is able to discriminate lung cancer patients from patients with other lung diseases and from healthy individuals.
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Affiliation(s)
- Madara Tirzïte
- Faculty of Medicine, University of Latvia, Raina Blv. 19, Riga, Latvia
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Monitoring of n-butanol vapors biofiltration process using an electronic nose combined with calibration models. MONATSHEFTE FUR CHEMIE 2018; 149:1693-1699. [PMID: 30174352 PMCID: PMC6105205 DOI: 10.1007/s00706-018-2243-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/23/2018] [Indexed: 11/17/2022]
Abstract
Abstract Malodorous odors, by definition, are unpleasant, irritating smells being a mixture of volatile chemical compounds that can be sensed at low concentrations. Due to the increasing problem of odor nuisance associated with odor sensations, and thus the need to remove them from the air, deodorization techniques are commonly used. Biofiltration is one of the methods of reducing odorants in the air stream. In the paper, the possibility of using an electronic nose as an alternative method to gas chromatography for the online monitoring and evaluation of efficiency of the n-butanol vapors biofiltration process in a transient state was investigated. Three calibration models were used in the research, i.e., multiple linear regression, principal component regression, and partial least-square regression. The obtained results were compared with the theoretical values. Graphical abstract ![]()
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28
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Lubinska-Szczygeł M, Pudlak D, Dymerski T, Namieśnik J. Rapid assessment of the authenticity of limequat fruit using the electronic nose and gas chromatography coupled with mass spectrometry. MONATSHEFTE FUR CHEMIE 2018; 149:1605-1614. [PMID: 30174348 PMCID: PMC6105222 DOI: 10.1007/s00706-018-2242-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/23/2018] [Indexed: 11/30/2022]
Abstract
Abstract Citrus fruits are very popular food products. There are many species and varieties of them. There are also documented cases of some citrus fruits causing a severe allergic reaction. Some species of the citrus fruits, especially hybrid ones show a reduced allergenic effect due to the lack of seeds. There is a need for rapid methods for evaluation of citrus’ botanical origin. During research, the headspace of three citrus fruits Citrus Aurantifolia, Citrus japonica, and Citrus × floridana was analysed using electronic nose based on ultrafast gas chromatography and gas chromatography with mass spectrometry. In the paper, two approaches were compared. The usefulness of an electronic nose to control the quality of hybrids was demonstrated. The results obtained during ultrafast gas chromatography analyses were subjected to statistical analysis. Four chemometric methods namely: principal component analysis (PCA), discriminant function analysis (DFA), soft independent modeling of class analogies (SIMCA), statistical quality control (SQC) were used to distinguish between limequat and its parent fruits. Electronic nose combined with chemometrics is a novel analytical tool for hybrid fruits’ classification due to their botanical origin. It can supplement established techniques by providing results in a short time and at a low cost. Graphical abstract ![]()
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Affiliation(s)
- Martyna Lubinska-Szczygeł
- Department of Analytical Chemistry, Faculty of Chemistry, Gdańsk University of Technology, 11/12 G. Narutowicza Str., 80-233 Gdańsk, Poland
| | - Dominika Pudlak
- Department of Analytical Chemistry, Faculty of Chemistry, Gdańsk University of Technology, 11/12 G. Narutowicza Str., 80-233 Gdańsk, Poland
| | - Tomasz Dymerski
- Department of Analytical Chemistry, Faculty of Chemistry, Gdańsk University of Technology, 11/12 G. Narutowicza Str., 80-233 Gdańsk, Poland
| | - Jacek Namieśnik
- Department of Analytical Chemistry, Faculty of Chemistry, Gdańsk University of Technology, 11/12 G. Narutowicza Str., 80-233 Gdańsk, Poland
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Vandana Kalwaje E, Rello J. Management of ventilator-associated pneumonia: Need for a personalized approach. Expert Rev Anti Infect Ther 2018; 16:641-653. [DOI: 10.1080/14787210.2018.1500899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Eshwara Vandana Kalwaje
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Jordi Rello
- Critical Care Department, Vall d’Hebron Barcelona Hospital Campus & Centro de Investigacion Biomedica en Red (CIBERES), Barcelona, Spain
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Abstract
PURPOSE OF REVIEW Nosocomial pneumonia is a frequent and severe nosocomial infection divided in two distinct groups: hospital-acquired pneumonia and ventilator-associated pneumonia (VAP). In this context, the VAP is notoriously difficult to diagnose clinically, resulting from the lack of a 'gold standard' method of diagnosis. RECENT FINDINGS The use of biomarkers may potentially improve the early diagnosis of infections allowing earlier and better identification and treatment. An exhausting list of biomarkers has been studied and although far from perfect, procalcitonin (PCT) and C-reactive protein (CRP) are the most studied biomarkers used in clinical practice. Data coming from literature suggests the use of PCT for VAP prognosis and as a based algorithm tool for the reduction of duration of pneumonia therapy, as well as, the use of the CRP dynamics to the early prediction of VAP and the response to the antibiotics. SUMMARY The evidence for the use of biomarkers to diagnose nosocomial pneumonia as a stand-alone tool is low to moderate. Improved performance for both PCT and CRP can be obtained by using them in association with clinical features or scoring systems but prospective studies are still needed to validate this hypothesis.
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Study on Interference Suppression Algorithms for Electronic Noses: A Review. SENSORS 2018; 18:s18041179. [PMID: 29649152 PMCID: PMC5948617 DOI: 10.3390/s18041179] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 11/21/2022]
Abstract
Electronic noses (e-nose) are composed of an appropriate pattern recognition system and a gas sensor array with a certain degree of specificity and broad spectrum characteristics. The gas sensors have their own shortcomings of being highly sensitive to interferences which has an impact on the detection of target gases. When there are interferences, the performance of the e-nose will deteriorate. Therefore, it is urgent to study interference suppression techniques for e-noses. This paper summarizes the sources of interferences and reviews the advances made in recent years in interference suppression for e-noses. According to the factors which cause interference, interferences can be classified into two types: interference caused by changes of operating conditions and interference caused by hardware failures. The existing suppression methods were summarized and analyzed from these two aspects. Since the interferences of e-noses are uncertain and unstable, it can be found that some nonlinear methods have good effects for interference suppression, such as methods based on transfer learning, adaptive methods, etc.
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van Oort PM, Povoa P, Schnabel R, Dark P, Artigas A, Bergmans DCJJ, Felton T, Coelho L, Schultz MJ, Fowler SJ, Bos LD. The potential role of exhaled breath analysis in the diagnostic process of pneumonia-a systematic review. J Breath Res 2018; 12:024001. [PMID: 29292698 DOI: 10.1088/1752-7163/aaa499] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Diagnostic strategies currently used for pneumonia are time-consuming, lack accuracy and suffer from large inter-observer variability. Exhaled breath contains thousands of volatile organic compounds (VOCs), which include products of host and pathogen metabolism. In this systematic review we investigated the use of so-called 'breathomics' for diagnosing pneumonia. A Medline search yielded 18 manuscripts reporting on animal and human studies using organic and inorganic molecules in exhaled breath, that all could be used to answer whether analysis of VOC profiles could potentially improve the diagnostic process of pneumonia. Papers were categorised based on their specific aims; the exclusion of pneumonia; the detection of specific respiratory pathogens; and whether targeted or untargeted VOC analysis was used. Ten studies reported on the association between VOCs and presence of pneumonia. Eight studies demonstrated a difference in exhaled VOCs between pneumonia and controls; in the individual studies this discrimination was based on unique sets of VOCs. Eight studies reported on the accuracy of a breath test for a specific respiratory pathogen: five of these concerned pre-clinical studies in animals. All studies were valued as having a high risk of bias, except for one study that used an external validation cohort. The findings in the identified studies are promising. However, as yet no breath test has been shown to have sufficient diagnostic accuracy for pneumonia. We are in need of studies that further translate the knowledge from discovery studies to clinical practice.
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Affiliation(s)
- Pouline M van Oort
- Department of Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands
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Shi H, Zhang M, Adhikari B. Advances of electronic nose and its application in fresh foods: A review. Crit Rev Food Sci Nutr 2017; 58:2700-2710. [DOI: 10.1080/10408398.2017.1327419] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Hao Shi
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Min Zhang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
- Jiangsu Province Key Laboratory of Advanced Food Manufacturing Equipment and Technology, Jiangnan University, China
| | - Benu Adhikari
- School of Applied Sciences, RMIT University, Melbourne, VIC, Australia
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34
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Volatile Organic Compounds: Upcoming Role in Diagnosis of Invasive Mould Infections. CURRENT FUNGAL INFECTION REPORTS 2017. [DOI: 10.1007/s12281-017-0284-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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35
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Bassetti M, Poulakou G, Ruppe E, Bouza E, Van Hal SJ, Brink A. Antimicrobial resistance in the next 30 years, humankind, bugs and drugs: a visionary approach. Intensive Care Med 2017; 43:1464-1475. [PMID: 28733718 DOI: 10.1007/s00134-017-4878-x] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/24/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To describe the current standards of care and major recent advances with regard to antimicrobial resistance (AMR) and to give a prospective overview for the next 30 years in this field. METHODS Review of medical literature and expert opinion were used in the development of this review. RESULTS There is undoubtedly a large clinical and public health burden associated with AMR in ICU, but it is challenging to quantify the associated excess morbidity and mortality. In the last decade, antibiotic stewardship and infection prevention and control have been unable to prevent the rapid spread of resistant Gram-negative bacteria (GNB), in particular carbapenem-resistant Pseudomonas aeruginosa (and other non-fermenting GNB), extended-spectrum β-lactamase (ESBL)-producing and carbapenem-resistant Enterobacteriaceae (CRE). The situation appears more optimistic currently for Gram-positive, where Staphylococcus aureus, and particularly methicillin-resistant S. aureus (MRSA), remains a cardinal cause of healthcare-associated infections worldwide. Recent advancements in laboratory techniques allow for a rapid identification of the infecting pathogen and antibiotic susceptibility testing. Their impact can be particularly relevant in settings with prevalence of MDR, since they may guide fine-tuning of empirically selected regimen, facilitate de-escalation of unnecessary antimicrobials, and support infection control decisions. Currently, antibiotics are the primary anti-infective solution for patients with known or suspected MDR bacteria in intensive care. Numerous incentives have been provided to encourage researchers to work on alternative strategies to reverse this trend and to provide a means to treat these pathogens. Although some promising antibiotics currently in phase 2 and 3 of development will soon be licensed and utilized in ICU, the continuous development of an alternative generation of compounds is extremely important. There are currently several promising avenues available to fight antibiotic resistance, such as faecal microbiota, and phage therapy.
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Affiliation(s)
- Matteo Bassetti
- Department of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata, Piazzale S. Maria Della Misericordia 15, 33100, Udine, Italy.
| | - Garyphallia Poulakou
- Fourth Department of Internal Medicine, School of Medicine, Attikon University General Hospital, Athens National and Kapodistrian University, 1 Rimini St, 12462, Athens, Greece
| | - Etienne Ruppe
- Genomic Research Laboratory, Division of Infectious Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - Sebastian J Van Hal
- Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Adrian Brink
- Ampath National Laboratory Services, Department of Clinical Microbiology, Milpark Hospital, Johannesburg, South Africa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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36
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Dragonieri S, Pennazza G, Carratu P, Resta O. Electronic Nose Technology in Respiratory Diseases. Lung 2017; 195:157-165. [PMID: 28238110 DOI: 10.1007/s00408-017-9987-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/13/2017] [Indexed: 02/06/2023]
Abstract
Electronic noses (e-noses) are based on arrays of different sensor types that respond to specific features of an odorant molecule, mostly volatile organic compounds (VOCs). Differently from gas chromatography and mass spectrometry, e-noses can distinguish VOCs spectrum by pattern recognition. E-nose technology has successfully been used in commercial applications, including military, environmental, and food industry. Human-exhaled breath contains a mixture of over 3000 VOCs, which offers the postulate that e-nose technology can have medical applications. Based on the above hypothesis, an increasing number of studies have shown that breath profiling by e-nose could play a role in the diagnosis and/or screening of various respiratory and systemic diseases. The aim of the present study was to review the principal literature on the application of e-nose technology in respiratory diseases.
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Affiliation(s)
- Silvano Dragonieri
- Department of Respiratory Diseases, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Giorgio Pennazza
- Unit of Electronics for Sensor Systems, Center for Integrated Research, Campus Bio-Medico University, Rome, Italy
| | - Pierluigi Carratu
- Department of Respiratory Diseases, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Onofrio Resta
- Department of Respiratory Diseases, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
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37
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van Oort PMP, Nijsen T, Weda H, Knobel H, Dark P, Felton T, Rattray NJW, Lawal O, Ahmed W, Portsmouth C, Sterk PJ, Schultz MJ, Zakharkina T, Artigas A, Povoa P, Martin-Loeches I, Fowler SJ, Bos LDJ. BreathDx - molecular analysis of exhaled breath as a diagnostic test for ventilator-associated pneumonia: protocol for a European multicentre observational study. BMC Pulm Med 2017; 17:1. [PMID: 28049457 PMCID: PMC5210294 DOI: 10.1186/s12890-016-0353-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 12/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnosis of ventilator-associated pneumonia (VAP) remains time-consuming and costly, the clinical tools lack specificity and a bedside test to exclude infection in suspected patients is unavailable. Breath contains hundreds to thousands of volatile organic compounds (VOCs) that result from host and microbial metabolism as well as the environment. The present study aims to use breath VOC analysis to develop a model that can discriminate between patients who have positive cultures and who have negative cultures with a high sensitivity. METHODS/DESIGN The Molecular Analysis of Exhaled Breath as Diagnostic Test for Ventilator-Associated Pneumonia (BreathDx) study is a multicentre observational study. Breath and bronchial lavage samples will be collected from 100 and 53 intubated and ventilated patients suspected of VAP. Breath will be analysed using Thermal Desorption - Gas Chromatography - Mass Spectrometry (TD-GC-MS). The primary endpoint is the accuracy of cross-validated prediction for positive respiratory cultures in patients that are suspected of VAP, with a sensitivity of at least 99% (high negative predictive value). DISCUSSION To our knowledge, BreathDx is the first study powered to investigate whether molecular analysis of breath can be used to classify suspected VAP patients with and without positive microbiological cultures with 99% sensitivity. TRIAL REGISTRATION UKCRN ID number 19086, registered May 2015; as well as registration at www.trialregister.nl under the acronym 'BreathDx' with trial ID number NTR 6114 (retrospectively registered on 28 October 2016).
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Affiliation(s)
- Pouline M P van Oort
- Institute of Inflammation and Repair, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | | | - Hans Weda
- Philips Research, Eindhoven, The Netherlands
| | - Hugo Knobel
- Philips Research, Eindhoven, The Netherlands
| | - Paul Dark
- Salford Royal NHS Foundation Trust, Greater Manchester, UK
| | - Timothy Felton
- University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Nicholas J W Rattray
- Manchester Institute of Biotechnology (MIB), School of Chemistry, University of Manchester, Manchester, UK
| | - Oluwasola Lawal
- Institute of Inflammation and Repair, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Waqar Ahmed
- Institute of Inflammation and Repair, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Craig Portsmouth
- Manchester Institute of Biotechnology (MIB), School of Chemistry, University of Manchester, Manchester, UK
| | - Peter J Sterk
- Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcus J Schultz
- Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Tetyana Zakharkina
- Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Antonio Artigas
- Critical Care Department, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Sabadell, Spain
| | - Pedro Povoa
- Hospital de São Fransisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Ignacio Martin-Loeches
- Department of Clinical Medicine, St James's Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Dublin, Ireland
| | - Stephen J Fowler
- Institute of Inflammation and Repair, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Lieuwe D J Bos
- Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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38
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Hang Y, Chingin K, Liang J, Wang X, Hu L. Fast detection of volatile organic compounds from Staphylococcal blood cultures by CDI-MS. RSC Adv 2017. [DOI: 10.1039/c7ra01815k] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Rapid recognition of Staphylococcal bacteremia in humans is a serious challenge in clinical research.
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Affiliation(s)
- Yaping Hang
- Department of Clinical Laboratory
- The Second Affiliated Hospital of Nanchang University
- Nanchang 330006
- P. R. China
| | - Konstantin Chingin
- Jiangxi Key Laboratory for Mass Spectrometry and Instrumentation
- East China Institute of Technology
- Nanchang 330013
- P. R. China
| | - Juchao Liang
- Jiangxi Key Laboratory for Mass Spectrometry and Instrumentation
- East China Institute of Technology
- Nanchang 330013
- P. R. China
| | - Xiaozhong Wang
- Department of Clinical Laboratory
- The Second Affiliated Hospital of Nanchang University
- Nanchang 330006
- P. R. China
| | - Longhua Hu
- Department of Clinical Laboratory
- The Second Affiliated Hospital of Nanchang University
- Nanchang 330006
- P. R. China
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39
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Valdez LF, Gutiérrez JM. Chocolate Classification by an Electronic Nose with Pressure Controlled Generated Stimulation. SENSORS 2016; 16:s16101745. [PMID: 27775628 PMCID: PMC5087530 DOI: 10.3390/s16101745] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/04/2016] [Accepted: 10/13/2016] [Indexed: 11/20/2022]
Abstract
In this work, we will analyze the response of a Metal Oxide Gas Sensor (MOGS) array to a flow controlled stimulus generated in a pressure controlled canister produced by a homemade olfactometer to build an E-nose. The built E-nose is capable of chocolate identification between the 26 analyzed chocolate bar samples and four features recognition (chocolate type, extra ingredient, sweetener and expiration date status). The data analysis tools used were Principal Components Analysis (PCA) and Artificial Neural Networks (ANNs). The chocolate identification E-nose average classification rate was of 81.3% with 0.99 accuracy (Acc), 0.86 precision (Prc), 0.84 sensitivity (Sen) and 0.99 specificity (Spe) for test. The chocolate feature recognition E-nose gives a classification rate of 85.36% with 0.96 Acc, 0.86 Prc, 0.85 Sen and 0.96 Spe. In addition, a preliminary sample aging analysis was made. The results prove the pressure controlled generated stimulus is reliable for this type of studies.
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Affiliation(s)
- Luis F Valdez
- Bioelectronics Section, Department of Electrical Engineering, CINVESTAV, Mexico City 07360, Mexico.
| | - Juan Manuel Gutiérrez
- Bioelectronics Section, Department of Electrical Engineering, CINVESTAV, Mexico City 07360, Mexico.
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40
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Factors Influencing Continuous Breath Signal in Intubated and Mechanically-Ventilated Intensive Care Unit Patients Measured by an Electronic Nose. SENSORS 2016; 16:s16081337. [PMID: 27556467 PMCID: PMC5017501 DOI: 10.3390/s16081337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/15/2016] [Accepted: 08/17/2016] [Indexed: 01/21/2023]
Abstract
Introduction: Continuous breath analysis by electronic nose (eNose) technology in the intensive care unit (ICU) may be useful in monitoring (patho) physiological changes. However, the application of breath monitoring in a non-controlled clinical setting introduces noise into the data. We hypothesized that the sensor signal is influenced by: (1) humidity in the side-stream; (2) patient-ventilator disconnections and the nebulization of medication; and (3) changes in ventilator settings and the amount of exhaled CO2. We aimed to explore whether the aforementioned factors introduce noise into the signal, and discuss several approaches to reduce this noise. Methods: Study in mechanically-ventilated ICU patients. Exhaled breath was monitored using a continuous eNose with metal oxide sensors. Linear (mixed) models were used to study hypothesized associations. Results: In total, 1251 h of eNose data were collected. First, the initial 15 min of the signal was discarded. There was a negative association between humidity and Sensor 1 (Fixed-effect β: −0.05 ± 0.002) and a positive association with Sensors 2–4 (Fixed-effect β: 0.12 ± 0.001); the signal was corrected for this noise. Outliers were most likely due to noise and therefore removed. Sensor values were positively associated with end-tidal CO2, tidal volume and the pressure variables. The signal was corrected for changes in these ventilator variables after which the associations disappeared. Conclusion: Variations in humidity, ventilator disconnections, nebulization of medication and changes of ventilator settings indeed influenced exhaled breath signals measured in ventilated patients by continuous eNose analysis. We discussed several approaches to reduce the effects of these noise inducing variables.
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Pérez Antón A, Del Nogal Sánchez M, Crisolino Pozas ÁP, Pérez Pavón JL, Moreno Cordero B. Headspace-programmed temperature vaporizer-mass spectrometry and pattern recognition techniques for the analysis of volatiles in saliva samples. Talanta 2016; 160:21-27. [PMID: 27591583 DOI: 10.1016/j.talanta.2016.06.061] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/24/2016] [Accepted: 06/28/2016] [Indexed: 12/25/2022]
Abstract
A rapid method for the analysis of volatiles in saliva samples is proposed. The method is based on direct coupling of three components: a headspace sampler (HS), a programmable temperature vaporizer (PTV) and a quadrupole mass spectrometer (qMS). Several applications in the biomedical field have been proposed with electronic noses based on different sensors. However, few contributions have been developed using a mass spectrometry-based electronic nose in this field up to date. Samples of 23 patients with some type of cancer and 32 healthy volunteers were analyzed with HS-PTV-MS and the profile signals obtained were subjected to pattern recognition techniques with the aim of studying the possibilities of the methodology to differentiate patients with cancer from healthy controls. An initial inspection of the contained information in the data by means of principal components analysis (PCA) revealed a complex situation were an overlapped distribution of samples in the score plot was visualized instead of two groups of separated samples. Models using K-nearest neighbors (KNN) and Soft Independent Modeling of Class Analogy (SIMCA) showed poor discrimination, specially using SIMCA where a small distance between classes was obtained and no satisfactory results in the classification of the external validation samples were achieved. Good results were obtained when Mahalanobis discriminant analysis (DA) and support vector machines (SVM) were used obtaining 2 (false positives) and 0 samples misclassified in the external validation set, respectively. No false negatives were found using these techniques.
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Affiliation(s)
- Ana Pérez Antón
- Departamento de Química Analítica, Nutrición y Bromatología, Facultad de Ciencias Químicas, Universidad de Salamanca, 37008 Salamanca, Spain
| | - Miguel Del Nogal Sánchez
- Departamento de Química Analítica, Nutrición y Bromatología, Facultad de Ciencias Químicas, Universidad de Salamanca, 37008 Salamanca, Spain.
| | - Ángel Pedro Crisolino Pozas
- Servicio de Medicina Interna, Hospital Virgen de la Vega, Complejo Asistencial Universitario de Salamanca, 37007 Salamanca, Spain
| | - José Luis Pérez Pavón
- Departamento de Química Analítica, Nutrición y Bromatología, Facultad de Ciencias Químicas, Universidad de Salamanca, 37008 Salamanca, Spain
| | - Bernardo Moreno Cordero
- Departamento de Química Analítica, Nutrición y Bromatología, Facultad de Ciencias Químicas, Universidad de Salamanca, 37008 Salamanca, Spain
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van Geffen WH, Bruins M, Kerstjens HAM. Diagnosing viral and bacterial respiratory infections in acute COPD exacerbations by an electronic nose: a pilot study. J Breath Res 2016; 10:036001. [DOI: 10.1088/1752-7155/10/3/036001] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Enhancing Electronic Nose Performance Based on a Novel QPSO-KELM Model. SENSORS 2016; 16:s16040520. [PMID: 27077860 PMCID: PMC4851034 DOI: 10.3390/s16040520] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/27/2016] [Accepted: 04/07/2016] [Indexed: 01/08/2023]
Abstract
A novel multi-class classification method for bacteria detection termed quantum-behaved particle swarm optimization-based kernel extreme learning machine (QPSO-KELM) based on an electronic nose (E-nose) technology is proposed in this paper. Time and frequency domain features are extracted from E-nose signals used for detecting four different classes of wounds (uninfected and infected with Staphylococcu aureus, Escherichia coli and Pseudomonas aeruginosa) in this experiment. In addition, KELM is compared with five existing classification methods: Linear discriminant analysis (LDA), quadratic discriminant analysis (QDA), extreme learning machine (ELM), k-nearest neighbor (KNN) and support vector machine (SVM). Meanwhile, three traditional optimization methods including particle swarm optimization algorithm (PSO), genetic algorithm (GA) and grid search algorithm (GS) and four kernel functions (Gaussian kernel, linear kernel, polynomial kernel and wavelet kernel) for KELM are discussed in this experiment. Finally, the QPSO-KELM model is also used to deal with another two experimental E-nose datasets in the previous experiments. The experimental results demonstrate the superiority of QPSO-KELM in various E-nose applications.
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