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Wang Z, Jiang N, Jiang Z, Wang H, Guo Y, Zhong F, Gui B, Chen Y, Deng Q, Zhou Q, Hu B. Dual-mode nanoprobe strategy integrating ultrasound and near-infrared light for targeted and synergistic arterial thrombolysis. J Nanobiotechnology 2024; 22:311. [PMID: 38831332 PMCID: PMC11145811 DOI: 10.1186/s12951-024-02562-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024] Open
Abstract
Efficient thrombolysis in time is crucial for prognostic improvement of patients with acute arterial thromboembolic disease, while limitations and complications still exist in conventional thrombolytic treatment methods. Herein, our study sought to investigate a novel dual-mode strategy that integrated ultrasound (US) and near-infrared light (NIR) with establishment of hollow mesoporous silica nanoprobe (HMSN) which contains Arginine-glycine-aspartate (RGD) peptide (thrombus targeting), perfluoropentane (PFP) (thrombolysis with phase-change and stable cavitation) and indocyanine green (ICG) (thrombolysis with photothermal conversion). HMSN is used as the carrier, the surface is coupled with targeted RGD to achieve high targeting and permeability of thrombus, PFP and ICG are loaded to achieve the collaborative diagnosis and treatment of thrombus by US and NIR, so as to provide a new strategy for the integration of diagnosis and treatment of arterial thrombus. From the in vitro and in vivo evaluation, RGD/ICG/PFP@HMSN can aggregate and penetrate at the site of thrombus, and finally establish the dual-mode directional development and thrombolytic treatment under the synergistic effect of US and NIR, providing strong technical support for the accurate diagnosis and treatment of arterial thrombosis.
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Affiliation(s)
- Zhiwen Wang
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, 238# Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China
| | - Nan Jiang
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, 238# Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China
| | - Zhixin Jiang
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, 238# Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China
| | - Hao Wang
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, 238# Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China
| | - Yuxin Guo
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, 238# Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China
| | - Fanglu Zhong
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, 238# Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China
| | - Bin Gui
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, 238# Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China
| | - Yueying Chen
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, 238# Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China
| | - Qing Deng
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, 238# Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China
| | - Qing Zhou
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, 238# Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China.
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China.
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.
| | - Bo Hu
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, 238# Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China.
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China.
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.
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Yuan R, Yang N, Huang Y, Li W, Zeng Y, Liu Z, Tan X, Feng F, Zhang Q, Su S, Chu C, Liu L, Ge L. Layer-by-Layer Microneedle-Mediated rhEGF Transdermal Delivery for Enhanced Wound Epidermal Regeneration and Angiogenesis. ACS APPLIED MATERIALS & INTERFACES 2023; 15:21929-21940. [PMID: 37126734 DOI: 10.1021/acsami.3c02254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Appropriate treatments for acute traumas tend to avoid hemorrhages, vascular damage, and infections. However, in the homeostasis-imbalanced wound microenvironment, currently developed therapies could not precisely and controllably deliver biomacromolecular drugs, which are confronted with challenges due to large molecular weight, poor biomembrane permeability, low dosage, rapid degradation, and bioactivity loss. To conquer this, we construct a simple and effective layer-by-layer (LBL) self-assembly transdermal delivery patch, bearing microneedles (MN) coated with recombinant human epidermal growth factor (LBL MN-rhEGF) for a sustained release to wound bed driven by typical electrostatic force. Pyramidal LBL MN-rhEGF patches hold so enough mechanical strength to penetrate the stratum corneum, and generated microchannels allow rhEGF direct delivery in situ. The administrable delivery of biomacromolecular rhEGF through hierarchically coated MN arrays follows the diffusion mechanism of Fick's second law. Numerous efforts further have illustrated that finger-pressing LBL MN-rhEGF patches could not only promote cell proliferation of normal human dermal fibroblasts (NHDF) and human umbilical vein endothelial cells (HUVEC) in vitro but also take significant effects (regenerative epidermis: ∼144 μm; pro-angiogenesis: higher CD31 expression) in accelerating wound healing of mechanically injured rats, compared to the traditional dressing, which relies on passive diffusion. Our proof-of-concept features novel LBL biomacromolecular drug-delivery systems and self-administrated precision medicine modes at the point of care.
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Affiliation(s)
- Renqiang Yuan
- State Key Laboratory of Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Nanjing University of Posts and Telecommunications, Nanjing 210023, P.R. China
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P.R. China
| | - Ning Yang
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P.R. China
| | - Yueru Huang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, P.R. China
| | - Weikun Li
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P.R. China
| | - Yi Zeng
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P.R. China
| | - Zonghao Liu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P.R. China
| | - Xin Tan
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P.R. China
| | - Fang Feng
- Jiangsu Yuyue Medical Equipment & Supply Co., Ltd., Development Zone, Danyang 212310, P.R. China
| | - Qianli Zhang
- School of Chemistry and Life Science, Suzhou University of Science and Technology, Suzhou 215009, P.R. China
| | - Shao Su
- State Key Laboratory of Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Nanjing University of Posts and Telecommunications, Nanjing 210023, P.R. China
| | - Cuilin Chu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, P.R. China
| | - Ling Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, P.R. China
| | - Liqin Ge
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P.R. China
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Tran MH, Fei B. Compact and ultracompact spectral imagers: technology and applications in biomedical imaging. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:040901. [PMID: 37035031 PMCID: PMC10075274 DOI: 10.1117/1.jbo.28.4.040901] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/27/2023] [Indexed: 05/18/2023]
Abstract
Significance Spectral imaging, which includes hyperspectral and multispectral imaging, can provide images in numerous wavelength bands within and beyond the visible light spectrum. Emerging technologies that enable compact, portable spectral imaging cameras can facilitate new applications in biomedical imaging. Aim With this review paper, researchers will (1) understand the technological trends of upcoming spectral cameras, (2) understand new specific applications that portable spectral imaging unlocked, and (3) evaluate proper spectral imaging systems for their specific applications. Approach We performed a comprehensive literature review in three databases (Scopus, PubMed, and Web of Science). We included only fully realized systems with definable dimensions. To best accommodate many different definitions of "compact," we included a table of dimensions and weights for systems that met our definition. Results There is a wide variety of contributions from industry, academic, and hobbyist spaces. A variety of new engineering approaches, such as Fabry-Perot interferometers, spectrally resolved detector array (mosaic array), microelectro-mechanical systems, 3D printing, light-emitting diodes, and smartphones, were used in the construction of compact spectral imaging cameras. In bioimaging applications, these compact devices were used for in vivo and ex vivo diagnosis and surgical settings. Conclusions Compact and ultracompact spectral imagers are the future of spectral imaging systems. Researchers in the bioimaging fields are building systems that are low-cost, fast in acquisition time, and mobile enough to be handheld.
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Affiliation(s)
- Minh H. Tran
- University of Texas at Dallas, Department of Bioengineering, Richardson, Texas, United States
| | - Baowei Fei
- University of Texas at Dallas, Department of Bioengineering, Richardson, Texas, United States
- University of Texas Southwestern Medical Center, Department of Radiology, Dallas, Texas, United States
- University of Texas at Dallas, Center for Imaging and Surgical Innovation, Richardson, Texas, United States
- Address all correspondence to Baowei Fei,
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Kabir A, Sarkar A, Barui A. Acute and Chronic Wound Management: Assessment, Therapy and Monitoring Strategies. Regen Med 2023. [DOI: 10.1007/978-981-19-6008-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Pantoja JL, Ali F, Baril DT, Farley SM, Boynton S, Finn JP, Hu P, Lawrence PF. Arterial spin labeling magnetic resonance imaging quantifies tissue perfusion around foot ulcers. J Vasc Surg Cases Innov Tech 2022; 8:817-824. [PMID: 36510629 PMCID: PMC9735268 DOI: 10.1016/j.jvscit.2022.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Objective Tools that quantify tissue perfusion of the foot are deficient, contributing to the uncertainty in predicting ulcer healing potential. This pilot study aims to quantify peri-wound foot perfusion at various tissue depths using a novel application of pseudo-continuous arterial spin labeling magnetic resonance imaging. Methods Ten diabetic patients with neuropathic wounds and 20 healthy volunteers without wounds were recruited. Wounds were graded according to the Wound, Ischemia, Foot Infection (WIfI) system. All subjects underwent a noncontrasted ASL MRI of the foot for perfusion measurements. For healthy volunteers, perfusion was compared at rest and during sustained toe flexion between four regions: lateral plantar, medial plantar, lateral calcaneal, and medial calcaneal. Evaluations of diabetic volunteers compared perfusion between four zones: wound, near border, far border, and remote. Remote zone perfusion in diabetics was compared with perfusion in the plantar foot of healthy volunteers. Results There were 11 wounds, which were located over the metatarsal heads in five, the stump of a transmetatarsal amputation in three, the heel in two, and the mid foot in one. The median WIfI stage was 2. One patient had a WIfI ischemia grade of 1; the remaining patients' grades were 0. The mean ankle-brachial index was 1.0 ± 0.3. There were two patients with a WIfI foot infection grade of 1; the remaining patients' grades were 0. In healthy volunteers, plantar foot perfusion with sustained toe flexion was 43.9 ± 1.7 mL/100g/min and significantly higher than perfusion at rest (27.3 ± 2.7 mL/100g/min; P < .001). In diabetic patients, perfusion at the wound, near border, far border, and remote regions was 96.1 ± 10.7, 92.7 ± 9.4, 73.4 ± 8.2, and 62.8 ± 2.7 mL/100g/min. Although this perfusion pattern persisted throughout the depth of the wound, perfusion decreased with tissue depth. In the near border, perfusion at 20% of the wound depth was 124.0 ± 35.6 mL/100g/min and 69.9 ± 10.1 mL/100g/min at 100% (P = .006). Lastly, remote perfusion in diabetics was 2.3 times the plantar perfusion in healthy volunteers (27.3 ± 2.7 mL/100g/min; P < .001). Conclusions The pattern of resting tissue perfusion around nonischemic diabetic foot ulcers was successfully quantified with arterial spin labeling magnetic resonance imaging. Diabetic patients with wounds were hyperemic compared with healthy volunteers. There was a 1.5-fold increase in peri-wound tissue perfusion relative to the rest of the foot. This study is the first step in developing a tool to assess the perfusion deficit in ischemic wounds.
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Affiliation(s)
- Joe Luis Pantoja
- Division of Vascular and Endovascular Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Correspondence: Dr Joe Luis Pantoja, MD, Division of Vascular and Endovascular Surgery, David Geffen School of Medicine, University of California Los Angeles, Medical Plaza Driveway, Ste 530, Los Angeles, CA 90095
| | - Fadil Ali
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Donald T. Baril
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Steven M. Farley
- Division of Vascular and Endovascular Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Scott Boynton
- Division of Vascular and Endovascular Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - J. Paul Finn
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Peng Hu
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Peter F. Lawrence
- Division of Vascular and Endovascular Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Lucas Y, Niri R, Treuillet S, Douzi H, Castaneda B. Wound Size Imaging: Ready for Smart Assessment and Monitoring. Adv Wound Care (New Rochelle) 2021; 10:641-661. [PMID: 32320356 PMCID: PMC8392100 DOI: 10.1089/wound.2018.0937] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 01/02/2023] Open
Abstract
Significance: We introduce and evaluate emerging devices and modalities for wound size imaging and also promising image processing tools for smart wound assessment and monitoring. Recent Advances: Some commercial devices are available for optical wound assessment but with limited possibilities compared to the power of multimodal imaging. With new low-cost devices and machine learning, wound assessment has become more robust and accurate. Wound size imaging not only provides area and volume but also the proportion of each tissue on the wound bed. Near-infrared and thermal spectral bands also enhance the classical visual assessment. Critical Issues: The ability to embed advanced imaging technology in portable devices such as smartphones and tablets with tissue analysis software tools will significantly improve wound care. As wound care and measurement are performed by nurses, the equipment needs to remain user-friendly, enable quick measurements, provide advanced monitoring, and be connected to the patient data management system. Future Directions: Combining several image modalities and machine learning, optical wound assessment will be smart enough to enable real wound monitoring, to provide clinicians with relevant indications to adapt the treatments and to improve healing rates and speed. Sharing the wound care histories of a number of patients on databases and through telemedicine practice could induce a better knowledge of the healing process and thus a better efficiency when the recorded clinical experience has been converted into knowledge through deep learning.
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Affiliation(s)
- Yves Lucas
- PRISME Laboratory, Orléans University, Orléans, France
| | - Rania Niri
- PRISME Laboratory, Orléans University, Orléans, France
- IRF-SIC Laboratory, Ibn Zohr University, Agadir, Morocco
| | | | - Hassan Douzi
- IRF-SIC Laboratory, Ibn Zohr University, Agadir, Morocco
| | - Benjamin Castaneda
- Laboratorio de Imagenes Medicas, Pontificia Universidad Catholica del Peru, Lima, Peru
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Abstract
OBJECTIVE Oxygen is essential to wound healing; therefore, accurate monitoring can guide clinical decisions. Clinical wound assessment is often subjective, and tools to monitor wound oxygen are typically expensive, indirect, and highly variable. This study demonstrates the utility of a novel, low-cost oxygen-sensing thin film for serial assessment of wound oxygenation. DESIGN Dual-layer films were fabricated with boron oxygen-sensing nanoparticles (BNPs) impregnated into a chitosan-polycaprolactone layer for direct wound bed contact with a relatively oxygen impermeable calcium alginate surface layer. The BNPs are a dual-emissive difluoroboron β-diketonate dye incorporated into poly(lactic acid) nanoparticles. Under UV excitation, the BNPs emit fluorescence based on concentration and oxygen-sensitive phosphorescence. The fluorescence/phosphorescence ratio is directly proportional to oxygen concentration. METHODS A series of in vitro oxygen challenges and in vivo murine and porcine wound healing models were used to validate the utility of the film in sensing wound oxygenation. MAIN RESULTS In vitro testing demonstrated the oxygen-sensing capability of the BNP film and its ability to shield ambient oxygen to isolate wound oxygen. In vivo testing demonstrated the ability of the film to accurately monitor relative oxygen changes in a murine wound over time, measuring a 22% fluorescence/phosphorescence increase during acute healing. CONCLUSIONS This study presents a low-cost, noninvasive, direct, and serial oxygen mapping technology to detect spatial differences in wound oxygenation. Clinical use of the films has the potential to monitor wound healing trajectories and guide wound care decisions.
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Schmidt A, Niesner F, von Woedtke T, Bekeschus S. Hyperspectral Imaging of Wounds Reveals Augmented Tissue Oxygenation Following Cold Physical Plasma Treatment in Vivo. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2021. [DOI: 10.1109/trpms.2020.3009913] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Saiko G, Lombardi P, Au Y, Queen D, Armstrong D, Harding K. Hyperspectral imaging in wound care: A systematic review. Int Wound J 2020; 17:1840-1856. [PMID: 32830443 PMCID: PMC7949456 DOI: 10.1111/iwj.13474] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 01/18/2023] Open
Abstract
Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real-time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label-free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non-invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.
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Affiliation(s)
| | | | | | | | - David Armstrong
- Keck School of MedicineUniversity of Southern California, Los AngelesCaliforniaCaliforniaCanada
| | - Keith Harding
- School of MedicineCardiff UniversityWalesUK
- A*STARSingapore
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Murphy GA, Singh-Moon RP, Mazhar A, Cuccia DJ, Rowe VL, Armstrong DG. Quantifying dermal microcirculatory changes of neuropathic and neuroischemic diabetic foot ulcers using spatial frequency domain imaging: a shade of things to come? BMJ Open Diabetes Res Care 2020; 8:8/2/e001815. [PMID: 33219118 PMCID: PMC7682192 DOI: 10.1136/bmjdrc-2020-001815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/06/2020] [Accepted: 11/03/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The use of non-invasive vascular and perfusion diagnostics are an important part of assessing lower extremity ulceration and amputation risk in patients with diabetes mellitus. Methods for detecting impaired microvascular vasodilatory function in patients with diabetes may have the potential to identify sites at risk of ulceration prior to clinically identifiable signs. Spatial frequency domain imaging (SFDI) uses patterned near-infrared and visible light spectroscopy to determine tissue oxygen saturation and hemoglobin distribution within the superficial and deep dermis, showing distinct microcirculatory and oxygenation changes that occur prior to neuropathic and neuroischemic ulceration. RESEARCH DESIGNS AND METHODS 35 patients with diabetes mellitus and a history of diabetic foot ulceration were recruited for monthly imaging with SFDI. Two patients who ulcerated during the year-long longitudinal study were selected for presentation of their clinical course alongside the dermal microcirculation biomarkers from SFDI. RESULTS Patient 1 developed a neuropathic ulcer portended by a focal increase in tissue oxygen saturation and decrease in superficial papillary hemoglobin concentration 3 months prior. Patient 2 developed bilateral neuroischemic ulcers showing decreased tissue oxygen saturation and increased superficial papillary and deep dermal reticular hemoglobin concentrations. CONCLUSIONS Wounds of different etiology show unique dermal microcirculatory changes prior to gross ulceration. Before predictive models can be developed from SFDI, biomarker data must be correlated with the clinical course of patients who ulcerate while being followed longitudinally. TRIAL REGISTRATION NUMBER NCT03341559.
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Affiliation(s)
- Grant A Murphy
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | | | - Amaan Mazhar
- Department of Research and Development, Modulim, Irvine, California, USA
| | - David J Cuccia
- Department of Research and Development, Modulim, Irvine, California, USA
| | - Vincent L Rowe
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - David G Armstrong
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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Saiko G, Lombardi P, Au Y, Queen D, Armstrong D, Harding K. Hyperspectral imaging in wound care: A systematic review. Int Wound J 2020. [PMID: 32830443 DOI: 10.1111/iwj.13474.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real-time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label-free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non-invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.
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Affiliation(s)
| | | | | | | | - David Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, California, California, Canada
| | - Keith Harding
- School of Medicine, Cardiff University, Wales, UK.,A*STAR, Singapore
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Longobardi P, Hartwig V, Santarella L, Hoxha K, Campos J, Laurino M, Salvo P, Trivella MG, Coceani F, Rocco M, L'Abbate A. Potential markers of healing from near infrared spectroscopy imaging of venous leg ulcer. A randomized controlled clinical trial comparing conventional with hyperbaric oxygen treatment. Wound Repair Regen 2020; 28:856-866. [DOI: 10.1111/wrr.12853] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/19/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Flavio Coceani
- Istituto Scienze della Vita, Scuola Superiore Sant'Anna Pisa Italy
| | - Monica Rocco
- Dipartimento di Scienze Medico‐Chirurgiche e di Medicina Traslazionale Università degli Studi di Roma “La Sapienza” Roma Italy
| | - Antonio L'Abbate
- Istituto di Fisiologia Clinica‐CNR Pisa Italy
- Istituto Scienze della Vita, Scuola Superiore Sant'Anna Pisa Italy
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Schulz T, Marotz J, Stukenberg A, Reumuth G, Houschyar KS, Siemers F. [Hyperspectral imaging for postoperative flap monitoring of pedicled flaps]. HANDCHIR MIKROCHIR P 2020; 52:316-324. [PMID: 32823364 DOI: 10.1055/a-1167-3089] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Since pedicle flaps were first described by the Indian physician Sushruta Samhita in the 6th century B. C., they have become an integral part of reconstructive surgery. As more and more research has been conducted into the underlying physical principles, flap monitoring has developed steadily in the last few decades. Hyperspectral Imaging (HSI) is a new quantitative measuring method for assessing the perfusion of the underlying tissue. OBJECTIVE This study aims to evaluate HSI as a monitoring method for pedicle flaps. PATIENTS AND METHODS In 16 patients who had undergone reconstructive surgery, oxygen saturation, haemoglobin and water concentration of the locoregional flap, necrotic flap areas as well as intact skin were measured on postoperative days 1 to 7. Subsequently, the data were statistically described and graphically illustrated. RESULTS HSI revealed increased haemoglobin concentration and decreased oxygen and water concentration in necrotic flap areas compared with the monitor island and healthy skin. The distribution of the values collected from the vital skin areas and the monitor island was almost identical. CONCLUSION HSI allows for safe, immediate, non-contact measurement of tissue perfusion of transferred tissue areas in patients after pedicle flap surgery. The use of HSI may improve postoperative flap monitoring.
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Affiliation(s)
- Torsten Schulz
- BG Klinikum Bergmannstrost Halle Handchirurgie, Plastische Chirurgie, Brandverletztenzentrum
| | - Jörg Marotz
- BG Klinikum Bergmannstrost Halle Handchirurgie, Plastische Chirurgie, Brandverletztenzentrum
| | - Anna Stukenberg
- BG Klinikum Bergmannstrost Halle Handchirurgie, Plastische Chirurgie, Brandverletztenzentrum
| | - Georg Reumuth
- BG Klinikum Bergmannstrost Halle Handchirurgie, Plastische Chirurgie, Brandverletztenzentrum
| | | | - Frank Siemers
- BG Klinikum Bergmannstrost Halle Handchirurgie, Plastische Chirurgie, Brandverletztenzentrum
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Abazari M, Ghaffari A, Rashidzadeh H, Badeleh SM, Maleki Y. A Systematic Review on Classification, Identification, and Healing Process of Burn Wound Healing. INT J LOW EXTR WOUND 2020; 21:18-30. [PMID: 32524874 DOI: 10.1177/1534734620924857] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Because of the intrinsic complexity, the classification of wounds is important for the diagnosis, management, and choosing the correct treatment based on wound type. Generally, burn injuries are classified as a class of wounds in which injury is caused by heat, cold, electricity, chemicals, friction, or radiation. On the other hand, wound healing is a complex process, and understanding the biological trend of this process and differences in the healing process of different wounds could reduce the possible risk in many cases and greatly reduce the future damage to the injured tissue and other organs. The aim of this review is to provide a general perspective for the burn wound location among the other types of injuries and summarizing as well as highlighting the differences of these types of wounds with emphasizing on factors affecting thereof.
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Affiliation(s)
| | | | | | | | - Yaser Maleki
- Institute for Advanced Studies in Basic Sciences. Zanjan, Iran
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Marotz J, Kulcke A, Siemers F, Cruz D, Aljowder A, Promny D, Daeschlein G, Wild T. Extended Perfusion Parameter Estimation from Hyperspectral Imaging Data for Bedside Diagnostic in Medicine. Molecules 2019; 24:molecules24224164. [PMID: 31744187 PMCID: PMC6891704 DOI: 10.3390/molecules24224164] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/30/2019] [Accepted: 11/14/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Hyperspectral Imaging (HSI) has a strong potential to be established as a new contact-free measuring method in medicine. Hyperspectral cameras and data processing have to fulfill requirements concerning practicability and validity to be integrated in clinical routine processes. Methods: Calculating physiological parameters which are of significant clinical value from recorded remission spectra is a complex challenge. We present a data processing method for HSI remission spectra based on a five-layer model of perfused tissue that generates perfusion parameters for every layer and presents them as depth profiles. The modeling of the radiation transport and the solution of the inverse problem are based on familiar approximations, but use partially heuristic methods for efficiency and to fulfill practical clinical requirements. Results: The parameter determination process is consistent, as the measured spectrum is practically completely reproducible by the modeling sequence; in other words, the whole spectral information is transformed into model parameters which are easily accessible for physiological interpretation. The method is flexible enough to be applicable on a wide spectrum of skin and wounds. Examples of advanced procedures utilizing extended perfusion representation in clinical application areas (flap control, burn diagnosis) are presented.
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Affiliation(s)
- Jörg Marotz
- Klinik für Plastische und Handchirurgie und Brandverletztenzentrum, BG-Klinikum Bergmannstrost, D-06002 Halle (Saale), Germany;
- Institute of Applied Bioscience and Process Management, University of Applied Science Anhalt, D-06366 Köthen (Anhalt), Germany;
- Correspondence: ; Tel.: +49-17696526456
| | - Axel Kulcke
- Diaspective Vision GmbH, D-18233 Am Salzhaff, Germany;
| | - Frank Siemers
- Klinik für Plastische und Handchirurgie und Brandverletztenzentrum, BG-Klinikum Bergmannstrost, D-06002 Halle (Saale), Germany;
| | - Diogo Cruz
- Clinic of Plastic, Hand and Aesthetic Surgery, Medical Center Dessau, University of Applied Science Anhalt, D-06847 Dessau, Germany;
| | - Ahmed Aljowder
- Clinic of Dermatology, Immunology and Allergology, Medical Center Dessau, Medical University Brandenburg “Theodor Fontane“ Medical Center Dessau, D-06847 Dessau, Germany;
| | - Dominik Promny
- Klinik für Plastische, Wiederherstellende und Handchirurgie, Zentrum für Schwerbrandverletzte, Klinikum Nürnberg, D-90471 Nürnberg, Germany;
| | - Georg Daeschlein
- Klinik und Poliklinik für Hautkrankheiten, Universitätsmedizin Greifswald, D-17475 Greifswald, Germany;
| | - Thomas Wild
- Institute of Applied Bioscience and Process Management, University of Applied Science Anhalt, D-06366 Köthen (Anhalt), Germany;
- Clinic of Plastic, Hand and Aesthetic Surgery, Medical Center Dessau, University of Applied Science Anhalt, D-06847 Dessau, Germany;
- Clinic of Dermatology, Immunology and Allergology, Medical Center Dessau, Medical University Brandenburg “Theodor Fontane“ Medical Center Dessau, D-06847 Dessau, Germany;
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Kulcke A, Holmer A, Wahl P, Siemers F, Wild T, Daeschlein G. A compact hyperspectral camera for measurement of perfusion parameters in medicine. ACTA ACUST UNITED AC 2019. [PMID: 29522415 DOI: 10.1515/bmt-2017-0145] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Worldwide, chronic wounds are still a major and increasing problem area in medicine with protracted suffering of patients and enormous costs. Beside conventional wound treatment, for instance kinds of oxygen therapy and cold plasma technology have been tested, providing an improvement in the perfusion of wounds and their healing potential, but these methods are unfortunately not sufficiently validated and accepted for clinical practice to date. Using hyperspectral imaging technology in the visible (VIS) and near infrared (NIR) region with high spectral and spatial resolution, perfusion parameters of tissue and wounds can be determined. We present a new compact hyperspectral camera which can be used in clinical practice. From hyperspectral data the hemoglobin oxygenation (StO2), the relative concentration of hemoglobin [tissue hemoglobin index (THI)] and the so-called NIR-perfusion index can be determined. The first two parameters are calculated from the VIS-part of the spectrum and represent the perfusion of superficial tissue layers, whereas the NIR-perfusion index is calculated from the NIR-part representing the perfusion in deeper layers. First clinical measurements of transplanted flaps and chronic ulcer wounds show, that the perfusion level can be determined quantitatively allowing sensitive evaluation and monitoring for an optimization of the wound treatment planning and for validation of new treatment methods.
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Affiliation(s)
- Axel Kulcke
- Diaspective Vision GmbH, Strandstraße 15, D-18233 Am Salzhaff, Germany
| | - Amadeus Holmer
- Diaspective Vision GmbH, Strandstrasse 13, D-18233 Am Salzhaff, Germany
| | - Philip Wahl
- Diaspective Vision GmbH, Strandstrasse 13, D-18233 Am Salzhaff, Germany
| | - Frank Siemers
- Department of Plastic and Hand Surgery and Burn Unit, BG Klinikum Bergmannstrost, Merseburger Strasse 165, 06002 Halle (Saale), Germany
| | - Thomas Wild
- Department of Plastic, Aesthetic and Hand Surgery, Interdisciplinary Center for Treatment of Chronic Wounds, Auenweg 38, 06847 Dessau, Germany.,Department of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodore Fontane, Auenweg 38, 06847 Dessau, Germany
| | - Georg Daeschlein
- Department of Dermatology, University Medicine Greifswald, Sauerbruchstr., 17475 Greifswald, Germany
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Wang Y, Zhan Y, Harris LM, Khan S, Xia J. A portable three-dimensional photoacoustic tomography system for imaging of chronic foot ulcers. Quant Imaging Med Surg 2019; 9:799-806. [PMID: 31281775 DOI: 10.21037/qims.2019.05.02] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Chronic leg ulcers affect approximately 6.5 million Americans and the disorder is associated with a range of serious complications. Since many chronic ulcers have underlying vascular insufficiency, accurate assessment of tissue perfusion is critical to treatment planning and post-surgical monitoring. However, existing clinical tests fail to meet this need in practice due to their low sensitivity or accuracy. Methods In this paper, we introduce a portable photoacoustic tomography (PAT) system for wound assessment. Since hemoglobin serves as the major endogenous contrast at near-infrared wavelengths, PAT provides label-free, three-dimensional (3D) imaging of hemoglobin distribution, which is closely related to blood perfusion. The proposed system consists of a 128-element linear transducer array, a data acquisition (DAQ) system, and a pulsed Nd:YAG laser source, all mounted on a portable cart for easy clinical testing. Results We validated our system through both phantom and human imaging studies. The phantom imaging results indicate that the system's spatial resolution ranges from 0.5 mm along the axial direction to 1.3 mm along the elevational direction. The healthy volunteer result shows clear foot vasculature, indicating good perfusion. The preliminary patient imaging results agree very well with the clinical test, demonstrating that PAT has a high potential for assessing the circulation around the wound. Conclusions We believe that our technique will be a valuable tool for assessing tissue perfusion and guiding wound treatment in vascular clinics.
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Affiliation(s)
- Yuehang Wang
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Ye Zhan
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Linda M Harris
- Department of Surgery, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Sikandar Khan
- Department of Surgery, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Jun Xia
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA
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Weinkauf C, Mazhar A, Vaishnav K, Hamadani AA, Cuccia DJ, Armstrong DG. Near-instant noninvasive optical imaging of tissue perfusion for vascular assessment. J Vasc Surg 2018; 69:555-562. [PMID: 30292608 DOI: 10.1016/j.jvs.2018.06.202] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/01/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Noninvasive vascular tests are critical for identifying patients who may benefit from surgical revascularization, but current tests have significant limitations in people with diabetes. This study aimed to evaluate the ability of spatial frequency domain imaging (SFDI), an optical imaging method capable of measuring tissue oxygen saturation (StO2) and tissue hemoglobin, to assess lower extremity blood supply. METHODS Ankle-brachial index, toe-brachial index, pedal Doppler waveforms, and SFDI images were prospectively evaluated in 47 consecutive patients with and without diabetes in whom there was concern for peripheral artery disease (PAD). SFDI is a noncontact optical imaging technology that uses structured illumination to quantify subsurface (2-3 mm in depth) StO2 and tissue hemoglobin in the dermal microcirculation (HbT1) and macrocirculation (HbT2) over a large field of view (15 × 20 cm) within 10 seconds. RESULTS This demonstrates the ability of SFDI to capture reliable clinical measurements of perfusion in plantar aspects of the feet. SFDI StO2 values differentiate nondiabetic patients with and without arterial disease, defined as ankle-brachial index <0.9 (P = .06), but are limited in those with diabetes (P = .43). An elevated StO2 and reduced HbT1 are observed in people with diabetes compared with nondiabetic patients (P < .05). An SFDI-derived HbT2/HbT1 index differentiates diabetics with PAD vs no PAD (P < .01) using toe-brachial index <0.7 as a cutoff for PAD in diabetes. CONCLUSIONS SFDI is a feasible, rapid, and easy to use widefield measurement of perfusion in a clinical setting. This first-of-use study suggests that the technology has potential to evaluate lower extremity perfusion in people with and without diabetes. Further studies with increased numbers of patients and end points including wound healing will need to be designed to fully evaluate the applicability of this new technology.
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Affiliation(s)
- Craig Weinkauf
- Division of Vascular Surgery, University of Arizona, Tucson, Ariz.
| | | | - Kairavi Vaishnav
- Division of Vascular Surgery, University of Arizona, Tucson, Ariz
| | - Auon A Hamadani
- Department of Medicine, Icahn School of Medicine, New York, NY
| | | | - David G Armstrong
- Vascular Surgery Division, Department of Surgery, University of Southern California, Los Angeles, Calif
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Radowsky JS, Neely R, Forsberg JA, Lisboa FA, Dente CJ, Elster EA, Crane NJ. Preclosure spectroscopic differences between healed and dehisced traumatic wounds. PLoS One 2018; 13:e0204453. [PMID: 30261011 PMCID: PMC6160065 DOI: 10.1371/journal.pone.0204453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/07/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The complexity and severity of traumatic wounds in military and civilian trauma demands improved wound assessment, before, during, and after treatment. Here, we explore the potential of 3 charge-coupled device (3CCD) imaging values to distinguish between traumatic wounds that heal following closure and those that fail. Previous studies demonstrate that normalized 3CCD imaging values exhibit a high correlation with oxygen saturation and allow for comparison of values between diverse clinical settings, including utilizing different equipment and lighting. METHODS We screened 119 patients at Walter Reed National Military Medical Center and at Grady Memorial Hospital with at least one traumatic extremity wound of ≥ 75 cm2. We collected images of each wound during each débridement surgery for a total of 66 patients. An in-house written computer application selected a region of interest in the images, separated the pixel color values, calculated relative values, and normalized them. We followed patients until the enrolled wounds were surgically closed, quantifying the number of wounds that dehisced (defined as wound failure or infection requiring return to the operating room after closure) or healed. RESULTS Wound failure occurred in 20% (19 of 96) of traumatic wounds. Normalized intensity values for patients with wounds that healed successfully were, on average, significantly different from values for patients with wounds that failed (p ≤ 0.05). Simple thresholding models and partial least squares discriminant analysis models performed poorly. However, a hierarchical cluster analysis model created with 17 variables including 3CCD data, wound surface area, and time from injury predicts wound failure with 76.9% sensitivity, 76.5% specificity, 76.6% accuracy, and a diagnostic odds ratio of 10.8 (95% confidence interval: 2.6-45.9). CONCLUSIONS Imaging using 3CCD technology may provide a non-invasive and cost-effective method of aiding surgeons in deciding if wounds are ready for closure and could potentially decrease the number of required débridements and hospital days. The process may be automated to provide real-time feedback in the operating room and clinic. The low cost and small size of the cameras makes this technology attractive for austere and shipboard environments where space and weight are at a premium.
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Affiliation(s)
- Jason S. Radowsky
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (USUHS-Walter Reed Surgery), Bethesda, Maryland, United States of America
- * E-mail:
| | - Romon Neely
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (USUHS-Walter Reed Surgery), Bethesda, Maryland, United States of America
| | - Jonathan A. Forsberg
- Orthopaedics, USUHS-Walter Reed Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Orthopaedics, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Felipe A. Lisboa
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (USUHS-Walter Reed Surgery), Bethesda, Maryland, United States of America
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, United States of America
- Surgical Critical Care Initiative, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Christopher J. Dente
- Surgical Critical Care Initiative, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Trauma/Surgical Critical Care, Grady Memorial Hospital, Atlanta, Georgia, United States of America
| | - Eric A. Elster
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (USUHS-Walter Reed Surgery), Bethesda, Maryland, United States of America
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, United States of America
- Surgical Critical Care Initiative, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Nicole J. Crane
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (USUHS-Walter Reed Surgery), Bethesda, Maryland, United States of America
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, United States of America
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Holmer A, Tetschke F, Marotz J, Malberg H, Markgraf W, Thiele C, Kulcke A. Oxygenation and perfusion monitoring with a hyperspectral camera system for chemical based tissue analysis of skin and organs. Physiol Meas 2016; 37:2064-2078. [DOI: 10.1088/0967-3334/37/11/2064] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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