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Tai Y, Tonmoy TI, Win S, Brinkley NT, Park BH, Nam J. Enhanced peripheral nerve regeneration by mechano-electrical stimulation. NPJ Regen Med 2023; 8:57. [PMID: 37848428 PMCID: PMC10582163 DOI: 10.1038/s41536-023-00334-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
To address limitations in current approaches for treating large peripheral nerve defects, the presented study evaluated the feasibility of functional material-mediated physical stimuli on peripheral nerve regeneration. Electrospun piezoelectric poly(vinylidene fluoride-trifluoroethylene) nanofibers were utilized to deliver mechanical actuation-activated electrical stimulation to nerve cells/tissues in a non-invasive manner. Using morphologically and piezoelectrically optimized nanofibers for neurite extension and Schwann cell maturation based on in vitro experiments, piezoelectric nerve conduits were synthesized and implanted in a rat sciatic nerve transection model to bridge a critical-sized sciatic nerve defect (15 mm). A therapeutic shockwave system was utilized to periodically activate the piezoelectric effect of the implanted nerve conduit on demand. The piezoelectric nerve conduit-mediated mechano-electrical stimulation (MES) induced enhanced peripheral nerve regeneration, resulting in full axon reconnection with myelin regeneration from the proximal to the distal ends over the critical-sized nerve gap. In comparison, a control group, in which the implanted piezoelectric conduits were not activated in vivo, failed to exhibit such nerve regeneration. In addition, at both proximal and distal ends of the implanted conduits, a decreased number of damaged myelination (ovoids), an increased number of myelinated nerves, and a larger axonal diameter were observed under the MES condition as compared to the control condition. Furthermore, unlike the control group, the MES condition exhibited a superior functional nerve recovery, assessed by walking track analysis and polarization-sensitive optical coherence tomography, demonstrating the significant potential of the piezoelectric conduit-based physical stimulation approach for the treatment of peripheral nerve injury.
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Affiliation(s)
- Youyi Tai
- Department of Bioengineering, University of California, Riverside, CA, 92521, USA
| | | | - Shwe Win
- Department of Bioengineering, University of California, Riverside, CA, 92521, USA
| | - Natasha T Brinkley
- Department of Bioengineering, University of California, Riverside, CA, 92521, USA
| | - B Hyle Park
- Department of Bioengineering, University of California, Riverside, CA, 92521, USA
| | - Jin Nam
- Department of Bioengineering, University of California, Riverside, CA, 92521, USA.
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Monroy GL, Erfanzadeh M, Tao M, DePaoli DT, Saytashev I, Nam SA, Rafi H, Kwong KC, Shea K, Vakoc BJ, Vasudevan S, Hammer DX. Development of polarization-sensitive optical coherence tomography imaging platform and metrics to quantify electrostimulation-induced peripheral nerve injury in vivo in a small animal model. NEUROPHOTONICS 2023; 10:025004. [PMID: 37077218 PMCID: PMC10109528 DOI: 10.1117/1.nph.10.2.025004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/28/2023] [Indexed: 05/03/2023]
Abstract
Significance Neuromodulation devices are rapidly evolving for the treatment of neurological diseases and conditions. Injury from implantation or long-term use without obvious functional losses is often only detectable through terminal histology. New technologies are needed that assess the peripheral nervous system (PNS) under normal and diseased or injured conditions. Aim We aim to demonstrate an imaging and stimulation platform that can elucidate the biological mechanisms and impacts of neurostimulation in the PNS and apply it to the sciatic nerve to extract imaging metrics indicating electrical overstimulation. Approach A sciatic nerve injury model in a 15-rat cohort was observed using a newly developed imaging and stimulation platform that can detect electrical overstimulation effects with polarization-sensitive optical coherence tomography. The sciatic nerve was electrically stimulated using a custom-developed nerve holder with embedded electrodes for 1 h, followed by a 1-h recovery period, delivered at above-threshold Shannon model k -values in experimental groups: sham control (SC, n = 5 , 0.0 mA / 0 Hz ), stimulation level 1 (SL1, n = 5 , 3.4 mA / 50 Hz , and k = 2.57 ), and stimulation level 2 (SL2, n = 5 , 6.8 mA / 100 Hz , and k = 3.17 ). Results The stimulation and imaging system successfully captured study data across the cohort. When compared to a SC after a 1-week recovery, the fascicle closest to the stimulation lead showed an average change of + 4 % / - 309 % (SL1/SL2) in phase retardation and - 79 % / - 148 % in optical attenuation relative to SC. Analysis of immunohistochemistry (IHC) shows a + 1 % / - 36 % difference in myelin pixel counts and - 13 % / + 29 % difference in axon pixel counts, and an overall increase in cell nuclei pixel count of + 20 % / + 35 % . These metrics were consistent with IHC and hematoxylin/eosin tissue section analysis. Conclusions The poststimulation changes observed in our study are manifestations of nerve injury and repair, specifically degeneration and angiogenesis. Optical imaging metrics quantify these processes and may help evaluate the safety and efficacy of neuromodulation devices.
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Affiliation(s)
- Guillermo L. Monroy
- U. S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biomedical Physics, Silver Spring, Maryland, United States
| | - Mohsen Erfanzadeh
- Massachusetts General Hospital, Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Michael Tao
- U. S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biomedical Physics, Silver Spring, Maryland, United States
| | - Damon T. DePaoli
- Massachusetts General Hospital, Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Ilyas Saytashev
- U. S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biomedical Physics, Silver Spring, Maryland, United States
| | - Stephanie A. Nam
- Massachusetts General Hospital, Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Harmain Rafi
- U. S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biomedical Physics, Silver Spring, Maryland, United States
| | - Kasey C. Kwong
- Massachusetts General Hospital, Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Katherine Shea
- U. S. Food and Drug Administration, Center for Drug Evaluation and Research, Office of Clinical Pharmacology, Office of Translational Science, Division of Applied Regulatory Science, Silver Spring, Maryland, United States
| | - Benjamin J. Vakoc
- Massachusetts General Hospital, Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
- Massachusetts Institute of Technology, Division of Health Science and Technology, Cambridge, Massachusetts, United States
| | - Srikanth Vasudevan
- U. S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biomedical Physics, Silver Spring, Maryland, United States
- Address all correspondence to Srikanth Vasudevan, ; Daniel X. Hammer,
| | - Daniel X. Hammer
- U. S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biomedical Physics, Silver Spring, Maryland, United States
- Address all correspondence to Srikanth Vasudevan, ; Daniel X. Hammer,
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3
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Saytashev I, Yoon YC, Vakoc BJ, Vasudevan S, Hammer DX. Improved in vivo optical coherence tomography imaging of animal peripheral nerves using a prism nerve holder. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:026002. [PMID: 36785561 PMCID: PMC9921515 DOI: 10.1117/1.jbo.28.2.026002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/20/2023] [Indexed: 06/01/2023]
Abstract
Significance Modern optical volumetric imaging modalities, such as optical coherence tomography (OCT), provide enormous information about the structure, function, and physiology of living tissue. Although optical imaging achieves lateral resolution on the order of the wavelength of light used, and OCT achieves axial resolution on a similar micron scale, tissue optical properties, particularly high scattering and absorption, limit light penetration to only a few millimeters. In addition, in vivo imaging modalities are susceptible to significant motion artifacts due to cardiac and respiratory function. These effects limit access to artifact-free optical measurements during peripheral neurosurgery to only a portion of the exposed nerve without further modification to the procedure. Aim We aim to improve in vivo OCT imaging during peripheral neurosurgery in small and large animals by increasing the amount of visualized nerve volume as well as suppressing motion of the imaged area. Approach We designed a nerve holder with embedded mirror prisms for peripheral nerve volumetric imaging as well as a specific beam steering strategy to acquire prism and direct view volumes in one session with minimal motion artifacts. Results The axially imaged volumes from mirror prisms increased the OCT signal intensity by > 22 dB over a 1.25-mm imaging depth in tissue-mimicking phantoms. We then demonstrated the new imaging capabilities in visualizing peripheral nerves from direct and side views in living rats and minipigs using a polarization-sensitive OCT system. Prism views have shown nerve fascicles and vasculature from the bottom half of the imaged nerve which was not visible in direct view. Conclusions We demonstrated improved OCT imaging during neurosurgery in small and large animals by combining the use of a prism nerve holder with a specifically designed beam scanning protocol. Our strategy can be applied to existing OCT imaging systems with minimal hardware modification, increasing the nerve tissue volume visualized. Enhanced imaging depth techniques may lead to a greater adoption of structural and functional optical biomarkers in preclinical and clinical medicine.
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Affiliation(s)
- Ilyas Saytashev
- U. S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Silver Spring, Maryland, United States
| | - Yong-Chul Yoon
- Massachusetts General Hospital, Wellman Center for Photomedicine, Boston, Massachusetts, United States
| | - Benjamin J. Vakoc
- Massachusetts General Hospital, Wellman Center for Photomedicine, Boston, Massachusetts, United States
| | - Srikanth Vasudevan
- U. S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Silver Spring, Maryland, United States
| | - Daniel X. Hammer
- U. S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Silver Spring, Maryland, United States
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Wang A, Qi W, Gao T, Tang X. Molecular Contrast Optical Coherence Tomography and Its Applications in Medicine. Int J Mol Sci 2022; 23:ijms23063038. [PMID: 35328454 PMCID: PMC8949853 DOI: 10.3390/ijms23063038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 12/28/2022] Open
Abstract
The growing need to understand the molecular mechanisms of diseases has prompted the revolution in molecular imaging techniques along with nanomedicine development. Conventional optical coherence tomography (OCT) is a low-cost in vivo imaging modality that provides unique high spatial and temporal resolution anatomic images but little molecular information. However, given the widespread adoption of OCT in research and clinical practice, its robust molecular imaging extensions are strongly desired to combine with anatomical images. A range of relevant approaches has been reported already. In this article, we review the recent advances of molecular contrast OCT imaging techniques, the corresponding contrast agents, especially the nanoparticle-based ones, and their applications. We also summarize the properties, design criteria, merit, and demerit of those contrast agents. In the end, the prospects and challenges for further research and development in this field are outlined.
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5
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OCT-Guided Surgery for Gliomas: Current Concept and Future Perspectives. Diagnostics (Basel) 2022; 12:diagnostics12020335. [PMID: 35204427 PMCID: PMC8871129 DOI: 10.3390/diagnostics12020335] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023] Open
Abstract
Optical coherence tomography (OCT) has been recently suggested as a promising method to obtain in vivo and real-time high-resolution images of tissue structure in brain tumor surgery. This review focuses on the basics of OCT imaging, types of OCT images and currently suggested OCT scanner devices and the results of their application in neurosurgery. OCT can assist in achieving intraoperative precision identification of tumor infiltration within surrounding brain parenchyma by using qualitative or quantitative OCT image analysis of scanned tissue. OCT is able to identify tumorous tissue and blood vessels detection during stereotactic biopsy procedures. The combination of OCT with traditional imaging such as MRI, ultrasound and 5-ALA fluorescence has the potential to increase the safety and accuracy of the resection. OCT can improve the extent of resection by offering the direct visualization of tumor with cellular resolution when using microscopic OCT contact probes. The theranostic implementation of OCT as a part of intelligent optical diagnosis and automated lesion localization and ablation could achieve high precision, automation and intelligence in brain tumor surgery. We present this review for the increase of knowledge and formation of critical opinion in the field of OCT implementation in brain tumor surgery.
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Chang S, Varadarajan D, Yang J, Chen IA, Kura S, Magnain C, Augustinack JC, Fischl B, Greve DN, Boas DA, Wang H. Scalable mapping of myelin and neuron density in the human brain with micrometer resolution. Sci Rep 2022; 12:363. [PMID: 35013441 PMCID: PMC8748995 DOI: 10.1038/s41598-021-04093-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/03/2021] [Indexed: 12/23/2022] Open
Abstract
Optical coherence tomography (OCT) is an emerging 3D imaging technique that allows quantification of intrinsic optical properties such as scattering coefficient and back-scattering coefficient, and has proved useful in distinguishing delicate microstructures in the human brain. The origins of scattering in brain tissues are contributed by the myelin content, neuron size and density primarily; however, no quantitative relationships between them have been reported, which hampers the use of OCT in fundamental studies of architectonic areas in the human brain and the pathological evaluations of diseases. Here, we built a generalized linear model based on Mie scattering theory that quantitatively links tissue scattering to myelin content and neuron density in the human brain. We report a strong linear relationship between scattering coefficient and the myelin content that is retained across different regions of the brain. Neuronal cell body turns out to be a secondary contribution to the overall scattering. The optical property of OCT provides a label-free solution for quantifying volumetric myelin content and neuron cells in the human brain.
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Affiliation(s)
- Shuaibin Chang
- Department of Electrical and Computer Engineering, Boston University, 8 St Mary's St, Boston, 02215, USA
| | - Divya Varadarajan
- Department of Radiology, Massachusetts General Hospital, A.A. Martinos Center for Biomedical Imaging, 13th Street, Boston, 02129, USA
| | - Jiarui Yang
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, 02215, USA
| | - Ichun Anderson Chen
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, 02215, USA
| | - Sreekanth Kura
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, 02215, USA
| | - Caroline Magnain
- Department of Radiology, Massachusetts General Hospital, A.A. Martinos Center for Biomedical Imaging, 13th Street, Boston, 02129, USA
| | - Jean C Augustinack
- Department of Radiology, Massachusetts General Hospital, A.A. Martinos Center for Biomedical Imaging, 13th Street, Boston, 02129, USA
| | - Bruce Fischl
- Department of Radiology, Massachusetts General Hospital, A.A. Martinos Center for Biomedical Imaging, 13th Street, Boston, 02129, USA
| | - Douglas N Greve
- Department of Radiology, Massachusetts General Hospital, A.A. Martinos Center for Biomedical Imaging, 13th Street, Boston, 02129, USA
| | - David A Boas
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, 02215, USA
- Department of Electrical and Computer Engineering, Boston University, 8 St Mary's St, Boston, 02215, USA
| | - Hui Wang
- Department of Radiology, Massachusetts General Hospital, A.A. Martinos Center for Biomedical Imaging, 13th Street, Boston, 02129, USA.
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7
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Lee MW, Jang N, Choi N, Yang S, Jeong J, Nam HS, Oh S, Kim K, Hwang D. In Vivo Cellular-Level 3D Imaging of Peripheral Nerves Using a Dual-Focusing Technique for Intra-Neural Interface Implantation. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2102876. [PMID: 34845862 PMCID: PMC8787432 DOI: 10.1002/advs.202102876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/09/2021] [Indexed: 06/13/2023]
Abstract
In vivo volumetric imaging of the microstructural changes of peripheral nerves with an inserted electrode could be key for solving the chronic implantation failure of an intra-neural interface necessary to provide amputated patients with natural motion and sensation. Thus far, no imaging devices can provide a cellular-level three-dimensional (3D) structural images of a peripheral nerve in vivo. In this study, an optical coherence tomography-based peripheral nerve imaging platform that employs a newly proposed depth of focus extension technique is reported. A point spread function with the finest transverse resolution of 1.27 µm enables the cellular-level volumetric visualization of the metal wire and microstructural changes in a rat sciatic nerve with the metal wire inserted in vivo. Further, the feasibility of applying the imaging platform to large animals for a preclinical study is confirmed through in vivo rabbit sciatic nerve imaging. It is expected that new possibilities for the successful chronic implantation of an intra-neural interface will open up by providing the 3D microstructural changes of nerves around the inserted electrode.
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Affiliation(s)
- Min Woo Lee
- Center for Intelligent and Interactive RoboticsKorea Institute of Science and TechnologySeoul02792Republic of Korea
| | - Namseon Jang
- Center for Intelligent and Interactive RoboticsKorea Institute of Science and TechnologySeoul02792Republic of Korea
| | - Nara Choi
- Center for Intelligent and Interactive RoboticsKorea Institute of Science and TechnologySeoul02792Republic of Korea
| | - Sungwook Yang
- Center for Intelligent and Interactive RoboticsKorea Institute of Science and TechnologySeoul02792Republic of Korea
| | - Jinwoo Jeong
- Center for Intelligent and Interactive RoboticsKorea Institute of Science and TechnologySeoul02792Republic of Korea
| | - Hyeong Soo Nam
- Department of Mechanical EngineeringKorea Advanced Institute of Science and TechnologyDaejeon34141Republic of Korea
| | - Sang‐Rok Oh
- Center for Intelligent and Interactive RoboticsKorea Institute of Science and TechnologySeoul02792Republic of Korea
| | - Keehoon Kim
- Department of Mechanical EngineeringPohang University of Science and TechnologyGyeongbuk37673Republic of Korea
| | - Donghyun Hwang
- Center for Intelligent and Interactive RoboticsKorea Institute of Science and TechnologySeoul02792Republic of Korea
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8
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Luzhansky ID, Sudlow LC, Brogan DM, Wood MD, Berezin MY. Imaging in the repair of peripheral nerve injury. Nanomedicine (Lond) 2019; 14:2659-2677. [PMID: 31612779 PMCID: PMC6886568 DOI: 10.2217/nnm-2019-0115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022] Open
Abstract
Surgical intervention followed by physical therapy remains the major way to repair damaged nerves and restore function. Imaging constitutes promising, yet underutilized, approaches to improve surgical and postoperative techniques. Dedicated methods for imaging nerve regeneration will potentially provide surgical guidance, enable recovery monitoring and postrepair intervention, elucidate failure mechanisms and optimize preclinical procedures. Herein, we present an outline of promising innovations in imaging-based tracking of in vivo peripheral nerve regeneration. We emphasize optical imaging because of its cost, versatility, relatively low toxicity and sensitivity. We discuss the use of targeted probes and contrast agents (small molecules and nanoparticles) to facilitate nerve regeneration imaging and the engineering of grafts that could be used to track nerve repair. We also discuss how new imaging methods might overcome the most significant challenges in nerve injury treatment.
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Affiliation(s)
- Igor D Luzhansky
- Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
- The Institute of Materials Science & Engineering, Washington University, St Louis, MO 63130, USA
| | - Leland C Sudlow
- Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - David M Brogan
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Matthew D Wood
- Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Mikhail Y Berezin
- Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
- The Institute of Materials Science & Engineering, Washington University, St Louis, MO 63130, USA
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9
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Demidov V, Matveev LA, Demidova O, Matveyev AL, Zaitsev VY, Flueraru C, Vitkin IA. Analysis of low-scattering regions in optical coherence tomography: applications to neurography and lymphangiography. BIOMEDICAL OPTICS EXPRESS 2019; 10:4207-4219. [PMID: 31453005 PMCID: PMC6701530 DOI: 10.1364/boe.10.004207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/24/2019] [Accepted: 07/17/2019] [Indexed: 05/19/2023]
Abstract
Analysis of semi-transparent low scattering biological structures in optical coherence tomography (OCT) has been actively pursued in the context of lymphatic imaging, with most approaches relying on the relative absence of signal as a means of detection. Here we present an alternate methodology based on spatial speckle statistics, utilizing the similarity of a distribution of given voxel intensities to the power distribution function of pure noise, to visualize the low-scattering biological structures of interest. In a human tumor xenograft murine model, we show that these correspond to lymphatic vessels and nerves; extensive histopathologic validation studies are reported to unequivocally establish this correspondence. The emerging possibility of OCT lymphangiography and neurography is novel and potentially impactful (especially the latter), although further methodology refinement is needed to distinguish between the visualized lymphatics and nerves.
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Affiliation(s)
- Valentin Demidov
- Department of Medical Biophysics, University of Toronto, 101 College St., Toronto, M5G 1L7, Canada
| | - Lev A. Matveev
- Institute of Applied Physics Russian Academy of Sciences, 46 Ulyanov Street, Nizhniy Novgorod, 603950, Russia
| | - Olga Demidova
- Department of Arts and Science, Seneca College, 1750 Finch Avenue East, Toronto, M2J 2X5, Canada
| | - Alexander L. Matveyev
- Institute of Applied Physics Russian Academy of Sciences, 46 Ulyanov Street, Nizhniy Novgorod, 603950, Russia
| | - Vladimir Y. Zaitsev
- Institute of Applied Physics Russian Academy of Sciences, 46 Ulyanov Street, Nizhniy Novgorod, 603950, Russia
| | - Costel Flueraru
- National Research Council Canada, Information Communication Technology, 1200 Montreal Rd, Ottawa, K1A0R6, Canada
| | - I. Alex Vitkin
- Department of Medical Biophysics, University of Toronto, 101 College St., Toronto, M5G 1L7, Canada
- University Health Network, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada
- University of Toronto, Department of Radiation Oncology, 150 College St, Toronto, M5S 3E2, Canada
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10
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Hill RA, Grutzendler J. Uncovering the biology of myelin with optical imaging of the live brain. Glia 2019; 67:2008-2019. [PMID: 31033062 DOI: 10.1002/glia.23635] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/26/2019] [Accepted: 04/11/2019] [Indexed: 12/31/2022]
Abstract
Myelin has traditionally been considered a static structure that is produced and assembled during early developmental stages. While this characterization is accurate in some contexts, recent studies have revealed that oligodendrocyte generation and patterns of myelination are dynamic and potentially modifiable throughout life. Unique structural and biochemical properties of the myelin sheath provide opportunities for the development and implementation of multimodal label-free and fluorescence optical imaging approaches. When combined with genetically encoded fluorescent tags targeted to distinct cells and subcellular structures, these techniques offer a powerful methodological toolbox for uncovering mechanisms of myelin generation and plasticity in the live brain. Here, we discuss recent advances in these approaches that have allowed the discovery of several forms of myelin plasticity in developing and adult nervous systems. Using these techniques, long-standing questions related to myelin generation, remodeling, and degeneration can now be addressed.
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Affiliation(s)
- Robert A Hill
- Department of Biological Sciences, Dartmouth College, Hanover, New Hampshire
| | - Jaime Grutzendler
- Departments of Neurology and Neuroscience, Yale School of Medicine, New Haven, Connecticut
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11
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Hope J, Braeuer B, Amirapu S, McDaid A, Vanholsbeeck F. Extracting morphometric information from rat sciatic nerve using optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-14. [PMID: 30392195 DOI: 10.1117/1.jbo.23.11.116001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/15/2018] [Indexed: 06/08/2023]
Abstract
We apply three optical coherence tomography (OCT) image analysis techniques to extract morphometric information from OCT images obtained on peripheral nerves of rat. The accuracy of each technique is evaluated against histological measurements accurate to + / - 1 μm. The three OCT techniques are: (1) average depth-resolved profile (ADRP), (2) autoregressive spectral estimation (AR-SE), and (3) correlation of the derivative spectral estimation (CoD-SE). We introduce a scanning window to the ADRP technique, which provides transverse resolution and improves epineurium thickness estimates-with the number of analyzed images showing agreement with histology increasing from 2 / 10 to 5 / 10 (Kruskal-Wallis test, α = 0.05). A method of estimating epineurium thickness, using the AR-SE technique, showed agreement with histology in 6 / 10 analyzed images (Kruskal-Wallis test, α = 0.05). Using a tissue sample in which histology identified two fascicles with an estimated difference in mean fiber diameter of 4 μm, the AR-SE and CoD-SE techniques both correctly identified the fascicle with larger fiber diameter distribution but incorrectly estimated the magnitude of this difference as 0.5 μm. The ability of the OCT signal analysis techniques to extract accurate morphometric details from peripheral nerves is promising but restricted in depth by scattering in adipose and neural tissues.
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Affiliation(s)
- James Hope
- The Dodd Walls Centre for Photonic and Quantum Technologies, New Zealand
- University of Auckland, Department of Mechanical Engineering, Auckland, New Zealand
| | - Bastian Braeuer
- The Dodd Walls Centre for Photonic and Quantum Technologies, New Zealand
- University of Auckland, Department of Physics, Auckland, New Zealand
| | - Satya Amirapu
- University of Auckland, Anatomy and Medical Imaging, Auckland, New Zealand
| | - Andrew McDaid
- University of Auckland, Department of Mechanical Engineering, Auckland, New Zealand
| | - Frédérique Vanholsbeeck
- The Dodd Walls Centre for Photonic and Quantum Technologies, New Zealand
- University of Auckland, Department of Physics, Auckland, New Zealand
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12
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Wide-Field Functional Microscopy of Peripheral Nerve Injury and Regeneration. Sci Rep 2018; 8:14004. [PMID: 30228335 PMCID: PMC6143548 DOI: 10.1038/s41598-018-32346-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/31/2018] [Indexed: 12/14/2022] Open
Abstract
Severe peripheral nerve injuries often result in partial repair and lifelong disabilities in patients. New surgical techniques and better graft tissues are being studied to accelerate regeneration and improve functional recovery. Currently, limited tools are available to provide in vivo monitoring of changes in nerve physiology such as myelination and vascularization, and this has impeded the development of new therapeutic options. We have developed a wide-field and label-free functional microscopy platform based on angiographic and vectorial birefringence methods in optical coherence tomography (OCT). By incorporating the directionality of the birefringence, which was neglected in the previously reported polarization-sensitive OCT techniques for nerve imaging, vectorial birefringence contrast reveals internal nerve microanatomy and allows for quantification of local myelination with superior sensitivity. Advanced OCT angiography is applied in parallel to image the three-dimensional vascular networks within the nerve over wide-fields. Furthermore, by combining vectorial birefringence and angiography, intraneural vessels can be discriminated from those of the surrounding tissues. The technique is used to provide longitudinal imaging of myelination and revascularization in the rodent sciatic nerve model, i.e. imaged at certain sequential time-points during regeneration. The animals were exposed to either crush or transection injuries, and in the case of transection, were repaired using an autologous nerve graft or acellular nerve allograft. Such label-free functional imaging by the platform can provide new insights into the mechanisms that limit regeneration and functional recovery, and may ultimately provide intraoperative assessment in human subjects.
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Fan Y, Xia Y, Zhang X, Sun Y, Tang J, Zhang L, Liao H. Optical coherence tomography for precision brain imaging, neurosurgical guidance and minimally invasive theranostics. Biosci Trends 2018; 12:12-23. [PMID: 29332928 DOI: 10.5582/bst.2017.01258] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This review focuses on optical coherence tomography (OCT)-based neurosurgical application for imaging and treatment of brain tumors. OCT has emerged as one of the most innovative and successful translational biomedical-diagnostic techniques. It is a useful imaging tool for noninvasive, in vivo, in situ and real-time imaging in soft biological tissues, such as brain tumor imaging. OCT can detect the structure of biological tissue in a micrometer scale, and functional OCT has some clinical researches and applications, such as nerve fiber tracts and neurovascular imaging. OCT is able to identify tumor margins, and it gives intraoperative precision identification and resection guidance. OCT-based theranostics is introduced into preclinical neurosurgical resection, such as the integration of OCT and laser ablation. We discuss the challenges and opportunities of OCT-based system in the field of combination of intraoperative structural and functional imaging, neurosurgical guidance and minimally invasive theranostics. We point out that OCT and laser ablation-based theranostics can give more precision and intelligence for intraoperative diagnosis and therapeutics in clinical applications. The theranostics can precisely locate, or specifically target cancerous tissues, and then as much as possiblly eliminate them.
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Affiliation(s)
- Yingwei Fan
- Department of Biomedical Engineering, School of Medicine, Tsinghua University
| | - Yan Xia
- Department of Biomedical Engineering, School of Medicine, Tsinghua University
| | - Xinran Zhang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University
| | - Yu Sun
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Jie Tang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Hongen Liao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University
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Siddiqui M, Nam AS, Tozburun S, Lippok N, Blatter C, Vakoc BJ. High-speed optical coherence tomography by circular interferometric ranging. NATURE PHOTONICS 2018; 12:111-116. [PMID: 29657576 PMCID: PMC5894866 DOI: 10.1038/s41566-017-0088-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 12/18/2017] [Indexed: 05/17/2023]
Abstract
Existing three-dimensional optical imaging methods excel in controlled environments but are difficult to deploy over large, irregular and dynamic fields. This has limited imaging in areas such as material inspection and medicine. To better address these applications, we developed methods in optical coherence tomography (OCT) to efficiently interrogate sparse scattering fields, i.e., those in which most locations (voxels) do not generate meaningful signal. Frequency comb sources are used to superimpose reflected signals from equispaced locations through optical subsampling. This results in circular ranging, and reduces the number of measurements required to interrogate large volumetric fields. As a result, signal acquisition barriers that have limited speed and field in OCT are avoided. With a new ultrafast, time-stretched frequency comb laser design operating with 7.6 MHz to 18.9 MHz repetition rates, we achieved imaging of multi-cm3 fields at up to 7.5 volumes per second.
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Affiliation(s)
- Meena Siddiqui
- Harvard Medical School, Boston, Massachusetts 02115, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Harvard-MIT Health Sciences & Technology (HST), Cambridge, Massachusetts 02139, USA
| | - Ahhyun S. Nam
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts 02139, USA
| | - Serhat Tozburun
- Harvard Medical School, Boston, Massachusetts 02115, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Norman Lippok
- Harvard Medical School, Boston, Massachusetts 02115, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Cedric Blatter
- Harvard Medical School, Boston, Massachusetts 02115, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Benjamin J. Vakoc
- Harvard Medical School, Boston, Massachusetts 02115, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Harvard-MIT Health Sciences & Technology (HST), Cambridge, Massachusetts 02139, USA
- Correspondence to: Benjamin J. Vakoc
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15
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Polarization Sensitive Optical Coherence Tomography: A Review of Technology and Applications. APPLIED SCIENCES-BASEL 2017. [DOI: 10.3390/app7050474] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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de Boer JF, Hitzenberger CK, Yasuno Y. Polarization sensitive optical coherence tomography - a review [Invited]. BIOMEDICAL OPTICS EXPRESS 2017; 8:1838-1873. [PMID: 28663869 PMCID: PMC5480584 DOI: 10.1364/boe.8.001838] [Citation(s) in RCA: 196] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/16/2017] [Accepted: 02/16/2017] [Indexed: 05/18/2023]
Abstract
Optical coherence tomography (OCT) is now a well-established modality for high-resolution cross-sectional and three-dimensional imaging of transparent and translucent samples and tissues. Conventional, intensity based OCT, however, does not provide a tissue-specific contrast, causing an ambiguity with image interpretation in several cases. Polarization sensitive (PS) OCT draws advantage from the fact that several materials and tissues can change the light's polarization state, adding an additional contrast channel and providing quantitative information. In this paper, we review basic and advanced methods of PS-OCT and demonstrate its use in selected biomedical applications.
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Affiliation(s)
- Johannes F. de Boer
- Department of Physics and Astronomy, LaserLaB Amsterdam, VU University, Amsterdam, The Netherlands
- Authors were listed in alphabetical order and contributed equally to the manuscript
| | - Christoph K. Hitzenberger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
- Authors were listed in alphabetical order and contributed equally to the manuscript
| | - Yoshiaki Yasuno
- Computational Optics Group, University of Tsukuba, Tsukuba, Japan
- Authors were listed in alphabetical order and contributed equally to the manuscript
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Rougon G, Brasselet S, Debarbieux F. Advances in Intravital Non-Linear Optical Imaging of the Central Nervous System in Rodents. Brain Plast 2016; 2:31-48. [PMID: 29765847 PMCID: PMC5928564 DOI: 10.3233/bpl-160028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose of review: Highly coordinated cellular interactions occur in the healthy or pathologic adult rodent central nervous system (CNS). Until recently, technical challenges have restricted the analysis of these events to largely static modes of study such as immuno-fluorescence and electron microscopy on fixed tissues. The development of intravital imaging with subcellular resolution is required to probe the dynamics of these events in their natural context, the living brain. Recent findings: This review focuses on the recently developed live non-linear optical imaging modalities, the core principles involved, the identified technical challenges that limit their use and the scope of their applications. We highlight some practical applications for these modalities with a specific attention given to Experimental Autoimmune Encephalomyelitis (EAE), a rodent model of a chronic inflammatory disease of the CNS characterized by the formation of disseminated demyelinating lesions accompanied by axonal degeneration. Summary: We conclude that label-free nonlinear optical imaging combined to two photon imaging will continue to contribute richly to comprehend brain function and pathogenesis and to develop effective therapeutic strategies.
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Affiliation(s)
- Geneviève Rougon
- Aix-Marseille Université, CNRS, Institut des Neurosciences de la Timone, UMR 7289, Marseille, France
| | - Sophie Brasselet
- Aix-Marseille Université, CNRS, Centrale Marseille, Institut Fresnel, UMR 7249, Marseille, France
| | - Franck Debarbieux
- Aix-Marseille Université, CNRS, Institut des Neurosciences de la Timone, UMR 7289, Marseille, France
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Yoon Y, Jeon SH, Park YH, Jang WH, Lee JY, Kim KH. Visualization of prostatic nerves by polarization-sensitive optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2016; 7:3170-3183. [PMID: 27699090 PMCID: PMC5030002 DOI: 10.1364/boe.7.003170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/23/2016] [Accepted: 07/26/2016] [Indexed: 05/03/2023]
Abstract
Preservation of prostatic nerves is critical to recovery of a man's sexual potency after radical prostatectomy. A real-time imaging method of prostatic nerves will be helpful for nerve-sparing radical prostatectomy (NSRP). Polarization-sensitive optical coherence tomography (PS-OCT), which provides both structural and birefringent information of tissue, was applied for detection of prostatic nerves in both rat and human prostate specimens, ex vivo. PS-OCT imaging of rat prostate specimens visualized highly scattering and birefringent fibrous structures superficially, and these birefringent structures were confirmed to be nerves by histology or multiphoton microscopy (MPM). PS-OCT could easily distinguish these birefringent structures from surrounding other tissue compartments such as prostatic glands and fats. PS-OCT imaging of human prostatectomy specimens visualized two different birefringent structures, appearing fibrous and sheet-like. The fibrous ones were confirmed to be nerves by histology, and the sheet-like ones were considered to be fascias surrounding the human prostate. PS-OCT imaging of human prostatectomy specimens along the perimeter showed spatial variation in the amount of birefringent fibrous structures which was consistent with anatomy. These results demonstrate the feasibility of PS-OCT for detection of prostatic nerves, and this study will provide a basis for intraoperative use of PS-OCT.
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Affiliation(s)
- Yeoreum Yoon
- Department of Mechanical Engineering, Pohang University of Science and Technology, San 31, Hyoja-dong, Nam-gu, Pohang, Gyeongbuk 790-784, South Korea
| | - Seung Hwan Jeon
- Department of Urology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137–040, South Korea
| | - Yong Hyun Park
- Department of Urology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137–040, South Korea
| | - Won Hyuk Jang
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, San 31, Hyoja-dong, Nam-gu, Pohang, Gyeongbuk 790-784, South Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137–040, South Korea
| | - Ki Hean Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology, San 31, Hyoja-dong, Nam-gu, Pohang, Gyeongbuk 790-784, South Korea
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, San 31, Hyoja-dong, Nam-gu, Pohang, Gyeongbuk 790-784, South Korea
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19
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Villiger M, Lorenser D, McLaughlin RA, Quirk BC, Kirk RW, Bouma BE, Sampson DD. Deep tissue volume imaging of birefringence through fibre-optic needle probes for the delineation of breast tumour. Sci Rep 2016; 6:28771. [PMID: 27364229 PMCID: PMC4929466 DOI: 10.1038/srep28771] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/10/2016] [Indexed: 01/13/2023] Open
Abstract
Identifying tumour margins during breast-conserving surgeries is a persistent challenge. We have previously developed miniature needle probes that could enable intraoperative volume imaging with optical coherence tomography. In many situations, however, scattering contrast alone is insufficient to clearly identify and delineate malignant regions. Additional polarization-sensitive measurements provide the means to assess birefringence, which is elevated in oriented collagen fibres and may offer an intrinsic biomarker to differentiate tumour from benign tissue. Here, we performed polarization-sensitive optical coherence tomography through miniature imaging needles and developed an algorithm to efficiently reconstruct images of the depth-resolved tissue birefringence free of artefacts. First ex vivo imaging of breast tumour samples revealed excellent contrast between lowly birefringent malignant regions, and stromal tissue, which is rich in oriented collagen and exhibits higher birefringence, as confirmed with co-located histology. The ability to clearly differentiate between tumour and uninvolved stroma based on intrinsic contrast could prove decisive for the intraoperative assessment of tumour margins.
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Affiliation(s)
- Martin Villiger
- Harvard Medical School and Massachusetts General Hospital, Wellman Center for Photomedicine, Boston, MA USA
| | - Dirk Lorenser
- Optical+Biomedical Engineering Laboratory, The University of Western Australia, Perth, WA 6009, Australia
| | - Robert A. McLaughlin
- Optical+Biomedical Engineering Laboratory, The University of Western Australia, Perth, WA 6009, Australia
| | - Bryden C. Quirk
- Optical+Biomedical Engineering Laboratory, The University of Western Australia, Perth, WA 6009, Australia
| | - Rodney W. Kirk
- Optical+Biomedical Engineering Laboratory, The University of Western Australia, Perth, WA 6009, Australia
| | - Brett E. Bouma
- Harvard Medical School and Massachusetts General Hospital, Wellman Center for Photomedicine, Boston, MA USA
- Harvard-Massachusetts Institute of Technology, Program in Health Sciences and Technology, Cambridge, MA 02142, USA
| | - David D. Sampson
- Optical+Biomedical Engineering Laboratory, The University of Western Australia, Perth, WA 6009, Australia
- Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, Perth, WA 6009, Australia
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Lee HS, Shin SW, Bae JK, Jung WG, Kim SW, Oak C, Chun BK, Ahn YC, Lee BJ, Lee KD. Preliminary study of optical coherence tomography imaging to identify microscopic extrathyroidal extension in patients with papillary thyroid carcinoma. Lasers Surg Med 2015; 48:371-6. [PMID: 26718751 DOI: 10.1002/lsm.22466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES We evaluated the feasibility of using optical coherence tomography (OCT), to identify microscopic extrathyroidal extension (mETE) in ex vivo thyroidectomy specimens of patients who underwent thyroidectomy for the treatment of papillary thyroid carcinoma (PTC). METHODS A total of 170 ex vivo OCT images of the tumor, were acquired just after completion of thyroidectomy in 17 patients. The OCT images of each patient were separately evaluated by two blinded investigators, and the outcomes were compared with the histopathology reports. RESULTS The sensitivity and specificity of mETE identification from the OCT images were 81.4% and 86.0%, respectively, for the first investigator, and 82.9% and 87.0%, respectively, for the second investigator. Substantial agreement between the investigators was verified by Cohen's κ (Cohen's κ = 0.772). CONCLUSION In this preliminary study of a limited series of ex vivo thyroidectomy specimens, we verified the feasibility of OCT as a method of identifying mETE in patients with PTC.
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Affiliation(s)
- Hyoung Shin Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, South Korea.,Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, Korea
| | - Sung Won Shin
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Korea
| | - Jung Kweon Bae
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Korea
| | - Woong Gyu Jung
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, South Korea.,Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, Korea
| | - Chulho Oak
- Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, Korea.,Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Bong Kwon Chun
- Department of Pathology, Kosin University College of Medicine, Busan, South Korea
| | - Yeh-Chan Ahn
- Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, Korea.,Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology, Pukyong National University, Busan, South Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine and Medical Research Institute, Busan, South Korea
| | - Kang Dae Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, South Korea
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