Effects of short heat exposure on human red and white blood cells

SOI MEMS Electro-Thermal Actuators for Biomedical Applications: Operation in 0.9% NaCl Solution

In recent years, the immense potential for MEMS devices in the biomedical industry has been understood. It has been determined that, among their many plausible functions, their use may also extend to single human red blood cell diagnostics, whereby biomarkers of quantifiable magnitudes may be detected. Without a doubt, the mechanical and thermal specifications by which potential devices must be able to function are very strict. Among them is the ability to operate while fully submerged in aqueous solutions. In this work, six devices were modelled numerically in deionised (DI) water and 0.9 wt% NaCl solution, the results of which were validated experimentally. The mechanical performance of the different devices when fully submerged in 0.9 wt% NaCl solution is hereby discussed. With the exception of one, all the devices in their current configuration are confirmed to be suitable candidates for biomedical applications.

Thermo-Mechanical Fluid-Structure Interaction Numerical Modelling and Experimental Validation of MEMS Electrothermal Actuators for Aqueous Biomedical Applications

Recent developments in MEMS technologies have made such devices attractive for use in applications that involve precision engineering and scalability. In the biomedical industry, MEMS devices have gained popularity in recent years for use as single-cell manipulation and characterisation tools. A niche application is the mechanical characterisation of single human red blood cells, which may exhibit certain pathological conditions that impart biomarkers of quantifiable magnitude that are potentially detectable via MEMS devices. Such applications come with stringent thermal and structural specifications wherein the potential device candidates must be able to function with no exceptions. This work presents a state-of-the-art numerical modelling methodology that is capable of accurately predicting MEMS device performance in various media, including aqueous ones. The method is strongly coupled in nature, whereby thermal as well as structural degrees of freedom are transferred to and from finite element and finite volume solvers at every iteration. This method therefore provides MEMS design engineers with a reliable tool that can be used in design and development stages and helps to avoid total reliability on experimental testing. The proposed numerical model is validated via a series of physical experiments. Four MEMS electrothermal actuators with cascaded V-shaped drivers are presented. With the use of the newly proposed numerical model as well as the experimental testing, the MEMS devices' suitability for biomedical applications is confirmed.

Hematology and coagulation preanalytics for clinical chemists: Factors intrinsic to the sample and extrinsic to the patient

In hematology and coagulation, diligence in the preanalytical phase of testing is of critical importance to obtaining reliable test results. If the sample used for testing is unsuitable, even outstanding analytical procedures and technology cannot produce a clinically-reliable result. Therefore, the intent of this manuscript is to review preanalytical factors intrinsic to the sample that affect the hematology and coagulation testing. Factors intrinsic to the sample (excluding in vivo anomalies) can be controlled, theoretically, by phlebotomists (including nurses) and laboratorians in the preanalytical phase of testing. Furthermore, the management and prevention of such factors is highlighted. Erroneous control of preanalytical factors can produce laboratory errors.

Characterization of the temperature rise in a single cell during photoacoustic tomography at the nanoscale

We are developing a label-free nanoscale photoacoustic tomography (nPAT) for imaging a single living cell. nPAT uses a laser-induced acoustic pulse to generate a nanometer-scale image. The primary motivation behind this imaging technique is the imaging of biological cells in the context of diagnosis without fluorescent tagging. During this procedure, thermal damage due to the laser pulse is a potential risk that may damage the cells. A physical model is built to estimate the temperature rise and thermal relaxation during the imaging procedure. Through simulations using finite element methods, two lasers (532 nm at 5 ps pulse duration and 830 nm at 0.2 ps pulse duration) were simulated for imaging red blood cells (RBCs). We demonstrate that a single 5-ps pulse laser with a 400-Hz repetition rate will generate a steady state temperature rise of less than a Kelvin on the surface of the RBCs. All the simulation results show that there is no significant temperature rise in an RBC in either single pulse or multiple pulse illumination with a 532-nm laser with 219 W fluence. Therefore, our simulation results demonstrate the thermal safety of an nPAT system. The photoacoustic signal generated by this laser is on the order of 2.5 kPa, so it should still be large enough to generate high-resolution images with nPAT. Frequency analysis of this signal shows a peak at 1.47 GHz, with frequencies as high as 3.5 GHz still being present in the spectrum. We believe that nPAT will open an avenue for disease diagnosis and cell biology studies at the nanometer-level.

Enhanced nucleic acid amplification with blood in situ by wire-guided droplet manipulation (WDM)

There are many challenges facing the use of molecular biology to provide pertinent information in a timely, cost effective manner. Wire-guided droplet manipulation (WDM) is an emerging format for conducting molecular biology with unique characteristics to address these challenges. To demonstrate the use of WDM, an apparatus was designed and assembled to automate polymerase chain reaction (PCR) on a reprogrammable platform. WDM minimizes thermal resistance by convective heat transfer to a constantly moving droplet in direct contact with heated silicone oil. PCR amplification of the GAPDH gene was demonstrated at a speed of 8.67 s/cycle. Conventional PCR was shown to be inhibited by the presence of blood. WDM PCR utilizes molecular partitioning of nucleic acids and other PCR reagents from blood components, within the water-in-oil droplet, to increase PCR reaction efficiency with blood in situ. The ability to amplify nucleic acids in the presence of blood simplifies pre-treatment protocols towards true point-of-care diagnostic use. The 16s rRNA hypervariable regions V3 and V6 were amplified from Klebsiella pneumoniae genomic DNA with blood in situ. The detection limit of WDM PCR was 1 ng/μL or 10(5)genomes/μL with blood in situ. The application of WDM for rapid, automated detection of bacterial DNA from whole blood may have an enormous impact on the clinical diagnosis of infections in bloodstream or chronic wound/ulcer, and patient safety and morbidity.

Exercising in Environmental Extremes

Athletes, military personnel, fire fighters, mountaineers and astronauts may be required to perform in environmental extremes (e.g. heat, cold, high altitude and microgravity). Exercising in hot versus thermoneutral conditions (where core temperature is > or = 1 degrees C higher in hot conditions) augments circulating stress hormones, catecholamines and cytokines with associated increases in circulating leukocytes. Studies that have clamped the rise in core temperature during exercise (by exercising in cool water) demonstrate a large contribution of the rise in core temperature in the leukocytosis and cytokinaemia of exercise. However, with the exception of lowered stimulated lymphocyte responses after exercise in the heat, and in exertional heat illness patients (core temperature > 40 degrees C), recent laboratory studies show a limited effect of exercise in the heat on neutrophil function, monocyte function, natural killer cell activity and mucosal immunity. Therefore, most of the available evidence does not support the contention that exercising in the heat poses a greater threat to immune function (vs thermoneutral conditions). From a critical standpoint, due to ethical committee restrictions, most laboratory studies have evoked modest core temperature responses (< 39 degrees C). Given that core temperature during exercise in the field often exceeds levels associated with fever and hyperthermia (approximately 39.5 degrees C) field studies may provide an opportunity to determine the effects of severe heat stress on immunity. Field studies may also provide insight into the possible involvement of immune modulation in the aetiology of exertional heat stroke (core temperature > 40.6 degrees C) and identify the effects of acclimatisation on neuroendocrine and immune responses to exercise-heat stress. Laboratory studies can provide useful information by, for example, applying the thermal clamp model to examine the involvement of the rise in core temperature in the functional immune modifications associated with prolonged exercise. Studies investigating the effects of cold, high altitude and microgravity on immunity and infection incidence are often hindered by extraneous stressors (e.g. isolation). Nevertheless, the available evidence does not support the popular belief that short- or long-term cold exposure, with or without exercise, suppresses immunity and increases infection incidence. In fact, controlled laboratory studies indicate immuno-stimulatory effects of cold exposure. Although some evidence shows that ascent to high altitude increases infection incidence, clear conclusions are difficult to make because of some overlap with the symptoms of acute mountain sickness. Studies have reported suppressed cell-mediated immunity in mountaineers at high altitude and in astronauts after re-entering the normal gravity environment; however, the impact of this finding on resistance to infection remains unclear.

[Evaluation of a new insulating system for infusion solutions in preclinical trauma therapy: a prospective, randomized study]

OBJECTIVE

Infusion of cold fluids in a patient leads to a reduction of core temperature and subsequently worsens hypothermia. We evaluated the efficacy of a newly developed self-warming insulation device for use in pre-hospital rescue.

METHODS

We studied 50 trauma patients with a rescue time of more than one hour. They were randomly assigned to either infusions taken directly from a warming box in the ambulance (Group A, n = 25) or infusions taken from the warming box and packed in an insulation device (Group B, n = 25). We recorded ambient temperatures, infusion temperatures in five-minute-steps and transport duration of the infusions from the ambulance to the site of accident.

RESULTS

Ambient temperatures and transport duration did not differ significantly between both groups. In Group A the infusion temperature decreased from 36.0 +/- 6.4 degrees C to 19.8 +/- 6.8 degrees C during the transport from the ambulance to the site of accident. In Group B infusion temperature decreased only about 1 degree C. In Group A the temperature of the infusion continued to decrease until the end of measurements. In contrast in Group B the infusion temperature even increased by 0.5 degree C over the measurement period. These differences between the two groups were statistically significant.

CONCLUSIONS

Our data show that even pre-warmed infusions from a warming box cool down considerably before they can be given to the patient. A self-warming insulation device can stabilize infusion temperature even under extreme conditions of prehospital trauma care.

Initial experience with a novel heat-exchanging catheter in neurosurgical patients

Even mild hypothermia provides marked protection against cerebral ischemia in animal models. Hypothermia may be of therapeutic value during neurosurgical procedures. However, current cooling systems often fail to induce sufficient hypothermia before the dura is opened. Furthermore, they usually fail to restore normothermia by the end of surgery, thus delaying extubation. We evaluated a new internal heat-exchanging catheter. Eight ASA physical status II-IV patients (29-72 yr) undergoing craniotomy were enrolled. After the induction of general anesthesia, we introduced the SetPoint catheter into the inferior vena cava via a femoral vein. The target core body temperature was 34 degrees C-34.5 degrees C. After reaching the target, core temperature was maintained until the dura was closed. Target core temperature was then set to 37.0 degrees C, and the patient was rewarmed as quickly as possible. Seven patients had a tumor resection, and one had an aneurysm clipped. The core-cooling rate was 3.9 degrees C +/- 1.6 degrees C/h, and the rewarming rate was 2.0 degrees C +/- 0.5 degrees C/h; core temperature was 35.9 degrees C +/- 0.2 degrees C by the end of surgery. Patients were subsequently kept normothermic for 3 h before the catheter was removed. No thrombus or other particulate material was identified on the extracted catheters. None of the patients suffered any complications that could be attributed to the SetPoint system or thermal management.

IMPLICATIONS

Because current systems for inducing therapeutic hypothermia are too slow, we tested an internal counter-current thermal management system during hypothermic neurosurgery. The SetPoint catheter cooled at 3.9 degrees C +/- 1.6 degrees C/h and rewarmed at 2.0 degrees C +/- 0.5 degrees C/h. Catheter-based internal thermal management thus seems to be rapid and effective.

Protection of innate immunity by C5aR antagonist in septic mice

Innate immune functions are known to be compromised during sepsis, often with lethal consequences. There is also evidence in rats that sepsis is associated with excessive complement activation and generation of the potent anaphylatoxin C5a. In the presence of a cyclic peptide antagonist (C5aRa) to the C5a receptor (C5aR), the binding of murine 125I-C5a to murine neutrophils was reduced, the in vitro chemotactic responses of mouse neutrophils to mouse C5a were markedly diminished, the acquired defect in hydrogen peroxide (H2O2) production of C5a-exposed neutrophils was reversed, and the lung permeability index (extravascular leakage of albumin) in mice after intrapulmonary deposition of IgG immune complexes was markedly diminished. Mice that developed sepsis after cecal ligation/puncture (CLP) and were treated with C5aRa had greatly improved survival rates. These data suggest that C5aRa interferes with neutrophil responses to C5a, preventing C5a-induced compromise of innate immunity during sepsis, with greatly improved survival rates after CLP.

Avoiding hypothermia in the trauma patient

Hypothermia may be encountered during the management of severely injured patients, and with exception of deliberate hypothermia for neuroprotection, has been associated with increased morbidity and mortality. This review examines the recent literature with regard to risk factors for developing hypothermia, significance of hypothermia, therapeutic use of hypothermia, and invasive and noninvasive methods to prevent and treat hypothermia.