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Urbanska M, Guck J. Single-Cell Mechanics: Structural Determinants and Functional Relevance. Annu Rev Biophys 2024; 53:367-395. [PMID: 38382116 DOI: 10.1146/annurev-biophys-030822-030629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
The mechanical phenotype of a cell determines its ability to deform under force and is therefore relevant to cellular functions that require changes in cell shape, such as migration or circulation through the microvasculature. On the practical level, the mechanical phenotype can be used as a global readout of the cell's functional state, a marker for disease diagnostics, or an input for tissue modeling. We focus our review on the current knowledge of structural components that contribute to the determination of the cellular mechanical properties and highlight the physiological processes in which the mechanical phenotype of the cells is of critical relevance. The ongoing efforts to understand how to efficiently measure and control the mechanical properties of cells will define the progress in the field and drive mechanical phenotyping toward clinical applications.
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Affiliation(s)
- Marta Urbanska
- Max Planck Institute for the Science of Light, Erlangen, Germany; ,
- Max-Planck-Zentrum für Physik und Medizin, Erlangen, Germany
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Jochen Guck
- Max Planck Institute for the Science of Light, Erlangen, Germany; ,
- Max-Planck-Zentrum für Physik und Medizin, Erlangen, Germany
- Department of Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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2
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O'Neal HR, Sheybani R, Kraus CK, Self WH, Shah AM, Thomas CB, Tse HTK, Scoggins R. Cellular host response sepsis test for risk stratification of patients in the emergency department: A pooled analysis. Acad Emerg Med 2024. [PMID: 38643433 DOI: 10.1111/acem.14923] [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: 12/04/2023] [Revised: 03/06/2024] [Accepted: 03/31/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVES Sepsis is one of the most common, costly, and misdiagnosed conditions in U.S. emergency departments (EDs). ED providers often treat on nonspecific signs, subjective suspicion, or presumption of infection, resulting in over- and undertreatment. An increased understanding of host response has opened a new direction for sepsis diagnostics. The IntelliSep test is a U.S. Food and Drug Administration-cleared cellular host response diagnostic that could help distinguish sepsis in ED settings. Our objective was to evaluate the potential of the cellular host response test to expedite appropriate care for patients who present with signs of infection. METHODS We performed a pooled analysis of five adult (≥18 years) cohorts enrolled at seven geographically diverse U.S. sites in separate studies. Structured blinded adjudication was used to classify presence or absence of sepsis, and only patients with high confidence in the adjudicated label were included (n = 1002), defined as patients for whom there was consensus in the determination of sepsis per the Sepsis-3 and severe sepsis per the Sepsis-2 definitions between both the independent adjudication panel and the site-level physician. RESULTS Among patients with signs or suspicion of infection, the test achieved similar or better performance compared to other indicators in identifying patients at high risk for sepsis (specificity > 83%) and significantly superior performance in identifying those at low risk (sensitivity > 92%; 0% sepsis-associated mortality). The test also stratified severity of illness, as shown by 30-day in-hospital mortality (p < 0.001), hospital length of stay (p < 0.01), and use of hospital resources (p < 0.001). CONCLUSIONS Our data suggest that the cellular host response test provides clinically actionable results for patients at both high and low risk for sepsis and provides a rapid, objective means for risk stratification of patients with signs of infection. If integrated into standard of care, the test may help improve outcomes and reduce unnecessary antibiotic use.
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Affiliation(s)
- Hollis R O'Neal
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA
| | | | - Chadd K Kraus
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt Institute for Clinical and Translational Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ajay M Shah
- Cytovale, Inc., San Francisco, California, USA
| | - Christopher B Thomas
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Franciscan Missionaries of Our Lady Health System, Baton Rouge, Louisiana, USA
| | | | - Robert Scoggins
- Cytovale, Inc., San Francisco, California, USA
- Pulmonary & Critical Care, Kootenai Health, Coeur d'Alene, Idaho, USA
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3
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Marin MJ, van Wijk XMR, Chambliss AB. Advances in sepsis biomarkers. Adv Clin Chem 2024; 119:117-166. [PMID: 38514209 DOI: 10.1016/bs.acc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Sepsis, a dysregulated host immune response to an infectious agent, significantly increases morbidity and mortality for hospitalized patients worldwide. This chapter reviews (1) the basic principles of infectious diseases, pathophysiology and current definition of sepsis, (2) established sepsis biomarkers such lactate, procalcitonin and C-reactive protein, (3) novel, newly regulatory-cleared/approved biomarkers, such as assays that evaluate white blood cell properties and immune response molecules, and (4) emerging biomarkers and biomarker panels to highlight future directions and opportunities in the diagnosis and management of sepsis.
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Affiliation(s)
- Maximo J Marin
- Department of Pathology, Immunology & Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Allison B Chambliss
- Department of Pathology & Laboratory Medicine, University of California Los Angeles, Los Angeles, California, USA
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4
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O'Neal HR, Sheybani R, Janz DR, Scoggins R, Jagneaux T, Walker JE, Henning DJ, Rosenman E, Mahler SA, Regunath H, Sampson CS, Files DC, Fremont RD, Noto MJ, Schneider EE, Shealey WR, Berlinger MS, Carver TC, Walker MK, Ledeboer NA, Shah AM, Tse HTK, DiCarlo D, Rice TW, Thomas CB. Validation of a Novel, Rapid Sepsis Diagnostic for Emergency Department Use. Crit Care Explor 2024; 6:e1026. [PMID: 38333076 PMCID: PMC10852401 DOI: 10.1097/cce.0000000000001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES To assess the in vitro IntelliSep test, a microfluidic assay that quantifies the state of immune activation by evaluating the biophysical properties of leukocytes, as a rapid diagnostic for sepsis. DESIGN Prospective cohort study. SETTING Five emergency departments (EDs) in Louisiana, Missouri, North Carolina, and Washington. PATIENTS Adult patients presenting to the ED with signs (two of four Systemic Inflammatory Response Syndrome criteria, where one must be temperature or WBC count) or suspicion (provider-ordered culture) of infection. INTERVENTIONS All patients underwent testing with the IntelliSep using ethylene diamine tetraacetic acid-anticoagulated whole blood followed by retrospective adjudication for sepsis by sepsis-3 criteria by a blinded panel of physicians. MEASUREMENTS AND MAIN RESULTS Of 599 patients enrolled, 572 patients were included in the final analysis. The result of the IntelliSep test is reported as the IntelliSep Index (ISI), ranging from 0.1 to 10.0, divided into three interpretation bands for the risk of sepsis: band 1 (low) to band 3 (high). The median turnaround time for ISI results was 7.2 minutes. The ISI resulted band 1 in 252 (44.1%), band 2 in 160 (28.0%), and band 3 in 160 (28.0%). Sepsis occurred in 26.6% (152 of 572 patients). Sepsis prevalence was 11.1% (95% CI, 7.5-15.7%) in band 1, 28.1% (95% CI, 21.3-35.8%) in band 2, and 49.4% (95% CI, 41.4-57.4%) in band 3. The Positive Percent Agreement of band 1 was 81.6% and the Negative Percent Agreement of band 3 was 80.7%, with an area under the receiver operating characteristic curve of 0.74. Compared with band 1, band 3 correlated with adverse clinical outcomes, including mortality, and resource utilization. CONCLUSIONS Increasing ISI interpretation band is associated with increasing probability of sepsis in patients presenting to the ED with suspected infection.
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Affiliation(s)
- Hollis R O'Neal
- Pulmonary and Critical Care, Louisiana State University Health Sciences Center, Baton Rouge, LA
- Pulmonary & Critical Care, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
| | | | - David R Janz
- Pulmonary & Critical Care, University Medical Center, New Orleans, LA
| | - Robert Scoggins
- Pulmonary and Critical Care, Kootenai Health, Coeur d'Alene, ID
| | - Tonya Jagneaux
- Pulmonary and Critical Care, Louisiana State University Health Sciences Center, Baton Rouge, LA
- Pulmonary & Critical Care, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
| | - James E Walker
- Pulmonary and Critical Care, Louisiana State University Health Sciences Center, Baton Rouge, LA
- Pulmonary & Critical Care, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
| | - Daniel J Henning
- Department of Emergency Medicine, University of Washington, Seattle, WA
| | | | - Simon A Mahler
- Departments of Emergency Medicine, Epidemiology and Prevention, and Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Hariharan Regunath
- Critical Care Medicine and Infectious Diseases, University of Maryland-Baltimore Washington Medical Center, Glen Burnie, MD
- Division of Infectious Diseases, Department of Medicine, University of Missouri School of Medicine, Columbia, MO
| | - Christopher S Sampson
- Department of Emergency Medicine, University of Missouri School of Medicine, Columbia, MO
| | - D Clark Files
- Pulmonary and Critical Care Medicine, Wake Forest University School of Medicine, Winston Salem, NC
| | | | - Michael J Noto
- Allergy, Pulmonary, and Critical Care Medicine, Emory University School of Medicine, Atlanta, GA
| | - Erica E Schneider
- Pulmonary and Critical Care, Bon Secours Mercy Health System, Richmond, VA
| | - Wesley R Shealey
- Department of Medicine, Infectious Disease, Creighton University School of Medicine, Phoenix, AZ
| | - Matthew S Berlinger
- Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thomas C Carver
- Division of Trauma, Critical Care, and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Morgan K Walker
- Critical Care Medicine, National Institutes of Health, Bethesda, MD
| | - Nathan A Ledeboer
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Henry T K Tse
- Pulmonary & Critical Care, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
| | - Dino DiCarlo
- Department of Bioengineering and Biomedical Engineering, University of California, Los Angeles, CA
| | - Todd W Rice
- Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Christopher B Thomas
- Pulmonary and Critical Care, Louisiana State University Health Sciences Center, Baton Rouge, LA
- Pulmonary & Critical Care, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
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Markova O, Clanet C, Husson J. Quantifying both viscoelasticity and surface tension: Why sharp tips overestimate cell stiffness. Biophys J 2024; 123:210-220. [PMID: 38087780 PMCID: PMC10808041 DOI: 10.1016/j.bpj.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 09/10/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Quantifying the mechanical properties of cells is important to better understand how mechanics constrain cellular processes. Furthermore, because pathologies are usually paralleled by altered cell mechanical properties, mechanical parameters can be used as a novel way to characterize the pathological state of cells. Key features used in models are cell tension, cell viscoelasticity (representing the average of the cell bulk), or a combination of both. It is unclear which of these features is the most relevant or whether both should be included. To clarify this, we performed microindentation experiments on cells with microindenters of various tip radii, including micrometer-sized microneedles. We obtained different cell-indenter contact radii and measured the corresponding contact stiffness. We derived a model predicting that this contact stiffness should be an affine function of the contact radius and that, at vanishing contact radius, the cell stiffness should be equal to the cell tension multiplied by a constant. When microindenting leukocytes and both adherent and trypsinized adherent cells, the contact stiffness was indeed an affine function of the contact radius. For leukocytes, the deduced surface tension was consistent with that measured using micropipette aspiration. For detached endothelial cells, agreement between microindentation and micropipette aspiration was better when considering these as only viscoelastic when analyzing micropipette aspiration experiments. This work suggests that indenting cells with sharp tips but neglecting the presence of surface tension leads to an effective elastic modulus whose origin is in fact surface tension. Accordingly, using sharp tips when microindenting a cell is a good way to directly measure its surface tension without the need to let the viscoelastic modulus relax.
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Affiliation(s)
- Olga Markova
- Laboratoire d'Hydrodynamique (LadHyX), CNRS, École Polytechnique, Institut Polytechnique de Paris, Palaiseau, France
| | - Christophe Clanet
- Laboratoire d'Hydrodynamique (LadHyX), CNRS, École Polytechnique, Institut Polytechnique de Paris, Palaiseau, France
| | - Julien Husson
- Laboratoire d'Hydrodynamique (LadHyX), CNRS, École Polytechnique, Institut Polytechnique de Paris, Palaiseau, France.
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Di Carlo D. Rapid deformability cytometry for tissue biopsies. Nat Biomed Eng 2023; 7:1337-1339. [PMID: 37903902 DOI: 10.1038/s41551-023-01110-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Affiliation(s)
- Dino Di Carlo
- Departments of Bioengineering and Mechanical & Aerospace Engineering, University of California Los Angeles, Los Angeles, CA, USA.
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7
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Soteriou D, Kubánková M, Schweitzer C, López-Posadas R, Pradhan R, Thoma OM, Györfi AH, Matei AE, Waldner M, Distler JHW, Scheuermann S, Langejürgen J, Eckstein M, Schneider-Stock R, Atreya R, Neurath MF, Hartmann A, Guck J. Rapid single-cell physical phenotyping of mechanically dissociated tissue biopsies. Nat Biomed Eng 2023; 7:1392-1403. [PMID: 37024677 PMCID: PMC10651479 DOI: 10.1038/s41551-023-01015-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/22/2023] [Indexed: 04/08/2023]
Abstract
During surgery, rapid and accurate histopathological diagnosis is essential for clinical decision making. Yet the prevalent method of intra-operative consultation pathology is intensive in time, labour and costs, and requires the expertise of trained pathologists. Here we show that biopsy samples can be analysed within 30 min by sequentially assessing the physical phenotypes of singularized suspended cells dissociated from the tissues. The diagnostic method combines the enzyme-free mechanical dissociation of tissues, real-time deformability cytometry at rates of 100-1,000 cells s-1 and data analysis by unsupervised dimensionality reduction and logistic regression. Physical phenotype parameters extracted from brightfield images of single cells distinguished cell subpopulations in various tissues, enhancing or even substituting measurements of molecular markers. We used the method to quantify the degree of colon inflammation and to accurately discriminate healthy and tumorous tissue in biopsy samples of mouse and human colons. This fast and label-free approach may aid the intra-operative detection of pathological changes in solid biopsies.
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Affiliation(s)
- Despina Soteriou
- Max Planck Institute for the Science of Light and Max-Planck-Zentrum für Physik und Medizin, Erlangen, Germany
| | - Markéta Kubánková
- Max Planck Institute for the Science of Light and Max-Planck-Zentrum für Physik und Medizin, Erlangen, Germany
| | - Christine Schweitzer
- Max Planck Institute for the Science of Light and Max-Planck-Zentrum für Physik und Medizin, Erlangen, Germany
| | - Rocío López-Posadas
- Department of Medicine 1-Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
| | - Rashmita Pradhan
- Department of Medicine 1-Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
| | - Oana-Maria Thoma
- Department of Medicine 1-Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Andrea-Hermina Györfi
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
| | - Alexandru-Emil Matei
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
| | - Maximilian Waldner
- Department of Medicine 1-Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Jörg H W Distler
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
| | | | | | - Markus Eckstein
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Regine Schneider-Stock
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Raja Atreya
- Department of Medicine 1-Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Markus F Neurath
- Department of Medicine 1-Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Arndt Hartmann
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jochen Guck
- Max Planck Institute for the Science of Light and Max-Planck-Zentrum für Physik und Medizin, Erlangen, Germany.
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Kechagidis K, Owen B, Guillou L, Tse H, Di Carlo D, Krüger T. Numerical investigation of the dynamics of a rigid spherical particle in a vortical cross-slot flow at moderate inertia. MICROSYSTEMS & NANOENGINEERING 2023; 9:100. [PMID: 37519826 PMCID: PMC10372015 DOI: 10.1038/s41378-023-00541-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/22/2023] [Accepted: 04/25/2023] [Indexed: 08/01/2023]
Abstract
The study of flow and particle dynamics in microfluidic cross-slot channels is of high relevance for lab-on-a-chip applications. In this work, we investigate the dynamics of a rigid spherical particle in a cross-slot junction for a channel height-to-width ratio of 0.6 and at a Reynolds number of 120 for which a steady vortex exists in the junction area. Using an in-house immersed-boundary-lattice-Boltzmann code, we analyse the effect of the entry position of the particle in the junction and the particle size on the dynamics and trajectory shape of the particle. We find that the dynamics of the particle depend strongly on its lateral entry position in the junction and weakly on its vertical entry position; particles that enter close to the centre show trajectory oscillations. Larger particles have longer residence times in the junction and tend to oscillate less due to their confinement. Our work contributes to the understanding of particle dynamics in intersecting flows and enables the design of optimised geometries for cytometry and particle manipulation.
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Affiliation(s)
- Konstantinos Kechagidis
- School of Engineering, Institute for Multiscale Thermofluids, University of Edinburgh, W Mains Rd, Edinburgh, EH9 3JW Scotland UK
| | - Benjamin Owen
- School of Engineering, Institute for Multiscale Thermofluids, University of Edinburgh, W Mains Rd, Edinburgh, EH9 3JW Scotland UK
| | - Lionel Guillou
- Cytovale, Inc., Executive Park Blvd., San Fransisco, CA 90095 CA USA
| | - Henry Tse
- Cytovale, Inc., Executive Park Blvd., San Fransisco, CA 90095 CA USA
| | - Dino Di Carlo
- Department of Bioengineering, University of California, Westwood Plaza, Los Angeles, 610101 CA USA
| | - Timm Krüger
- School of Engineering, Institute for Multiscale Thermofluids, University of Edinburgh, W Mains Rd, Edinburgh, EH9 3JW Scotland UK
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9
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Hollenbeak CS, Henning DJ, Geeting GK, Ledeboer NA, Faruqi IA, Pierce CG, Thomas CB, O'Neal HR. Costs and Consequences of a Novel Emergency Department Sepsis Diagnostic Test: The IntelliSep Index. Crit Care Explor 2023; 5:e0942. [PMID: 37465702 PMCID: PMC10351935 DOI: 10.1097/cce.0000000000000942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Sepsis causes 270,000 deaths and costs $38 billion annually in the United States. Most cases of sepsis present in the emergency department (ED), where rapid diagnosis remains challenging. The IntelliSep Index (ISI) is a novel diagnostic test that analyzes characteristics of WBC structure and provides a reliable early signal for sepsis. This study performs a cost-consequence analysis of the ISI relative to procalcitonin for early sepsis diagnosis in the ED. PERSPECTIVE U.S. healthcare system. SETTING Community hospital ED. METHODS A decision tree analysis was performed comparing ISI with procalcitonin. Model parameters included prevalence of sepsis, sensitivity and specificity of diagnostic tests (both ISI and procalcitonin), costs of hospitalization, and mortality rate stratified by diagnostic test result. Mortality and prevalence of sepsis were estimated from best available literature. Costs were estimated based on an analysis of a large, national discharge dataset, and adjusted to 2018 U.S. dollars. Outcomes included expected costs and survival. RESULTS Assuming a confirmed sepsis prevalence of 16.9% (adjudicated to Sepsis-3), the ISI strategy had an expected cost per patient of $3,849 and expected survival rate of 95.08%, whereas the procalcitonin strategy had an expected cost of $4,656 per patient and an expected survival of 94.98%. ISI was both less costly and more effective than procalcitonin, primarily because of fewer false-negative results. These results were robust in sensitivity analyses. CONCLUSIONS ISI was both less costly and more effective in preventing mortality than procalcitonin, primarily because of fewer false-negative results. The ISI may provide health systems with a higher-value diagnostic test in ED sepsis evaluation. Additional work is needed to validate these results in clinical practice.
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Affiliation(s)
- Christopher S Hollenbeak
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA
| | - Daniel J Henning
- Department of Emergency Medicine, University of Washington, Seattle, WA
| | - Glenn K Geeting
- Department of Emergency Medicine, Grant Memorial Hospital, Petersburg, WV
| | - Nathan A Ledeboer
- Department of Clinical Microbiology and Molecular Diagnostics, Medical College of Wisconsin, Milwaukee, WI
| | - Imran A Faruqi
- Department of Clinical Medicine, School of Medicine, Louisiana State University Health Sciences Center, Baton Rouge, LA
| | | | - Christopher B Thomas
- Department of Clinical Medicine, School of Medicine, Louisiana State University Health Sciences Center, Baton Rouge, LA
| | - Hollis R O'Neal
- Department of Clinical Medicine, School of Medicine, Louisiana State University Health Sciences Center, Baton Rouge, LA
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10
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Kraus CK, Nguyen HB, Jacobsen RC, Ledeboer NA, May LS, O'Neal HR, Puskarich MA, Rice TW, Self WH, Rothman RE. Rapid identification of sepsis in the emergency department. J Am Coll Emerg Physicians Open 2023; 4:e12984. [PMID: 37284425 PMCID: PMC10239543 DOI: 10.1002/emp2.12984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023] Open
Abstract
Objectives Recent research has helped define the complex pathways in sepsis, affording new opportunities for advancing diagnostics tests. Given significant advances in the field, a group of academic investigators from emergency medicine, intensive care, pathology, and pharmacology assembled to develop consensus around key gaps and potential future use for emerging rapid host response diagnostics assays in the emergency department (ED) setting. Methods A modified Delphi study was conducted that included 26 panelists (expert consensus panel) from multiple specialties. A smaller steering committee first defined a list of Delphi statements related to the need for and future potential use of a hypothetical sepsis diagnostic test in the ED. Likert scoring was used to assess panelists agreement or disagreement with statements. Two successive rounds of surveys were conducted and consensus for statements was operationally defined as achieving agreement or disagreement of 75% or greater. Results Significant gaps were identified related to current tools for assessing risk of sepsis in the ED. Strong consensus indicated the need for a test providing an indication of the severity of dysregulated host immune response, which would be helpful even if it did not identify the specific pathogen. Although there was a relatively high degree of uncertainty regarding which patients would most benefit from the test, the panel agreed that an ideal host response sepsis test should aim to be integrated into ED triage and thus should produce results in less than 30 minutes. The panel also agreed that such a test would be most valuable for improving sepsis outcomes and reducing rates of unnecessary antibiotic use. Conclusion The expert consensus panel expressed strong consensus regarding gaps in sepsis diagnostics in the ED and the potential for new rapid host response tests to help fill these gaps. These finding provide a baseline framework for assessing key attributes of evolving host response diagnostic tests for sepsis in the ED.
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Affiliation(s)
- Chadd K. Kraus
- Department of Emergency MedicineGeisinger Medical CenterDanvillePennsylvaniaUSA
| | - H. Bryant Nguyen
- Department of MedicinePulmonary and Critical Care DivisionLoma Linda UniversityLoma LindaCaliforniaUSA
| | - Ryan C. Jacobsen
- Department of Emergency MedicineUniversity of Kansas HospitalKansas CityKansasUSA
| | - Nathan A. Ledeboer
- Department of Pathology & Laboratory MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Larissa S. May
- Department of Emergency MedicineUC Davis HealthDavisCaliforniaUSA
| | - Hollis R. O'Neal
- Department of Critical Care MedicineLouisiana State UniversityBaton RougeLouisianaUSA
| | - Michael A. Puskarich
- Department of Emergency MedicineHennepin County Medical CenterUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Todd W. Rice
- Vanderbilt Institute for Clinical and Translational Sciences and Division of AllergyPulmonary and Critical Care MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Wesley H. Self
- Vanderbilt Institute for Clinical and Translational Sciences and Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Richard E. Rothman
- Department of Emergency MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
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11
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Lu N, Tay HM, Petchakup C, He L, Gong L, Maw KK, Leong SY, Lok WW, Ong HB, Guo R, Li KHH, Hou HW. Label-free microfluidic cell sorting and detection for rapid blood analysis. LAB ON A CHIP 2023; 23:1226-1257. [PMID: 36655549 DOI: 10.1039/d2lc00904h] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Blood tests are considered as standard clinical procedures to screen for markers of diseases and health conditions. However, the complex cellular background (>99.9% RBCs) and biomolecular composition often pose significant technical challenges for accurate blood analysis. An emerging approach for point-of-care blood diagnostics is utilizing "label-free" microfluidic technologies that rely on intrinsic cell properties for blood fractionation and disease detection without any antibody binding. A growing body of clinical evidence has also reported that cellular dysfunction and their biophysical phenotypes are complementary to standard hematoanalyzer analysis (complete blood count) and can provide a more comprehensive health profiling. In this review, we will summarize recent advances in microfluidic label-free separation of different blood cell components including circulating tumor cells, leukocytes, platelets and nanoscale extracellular vesicles. Label-free single cell analysis of intrinsic cell morphology, spectrochemical properties, dielectric parameters and biophysical characteristics as novel blood-based biomarkers will also be presented. Next, we will highlight research efforts that combine label-free microfluidics with machine learning approaches to enhance detection sensitivity and specificity in clinical studies, as well as innovative microfluidic solutions which are capable of fully integrated and label-free blood cell sorting and analysis. Lastly, we will envisage the current challenges and future outlook of label-free microfluidics platforms for high throughput multi-dimensional blood cell analysis to identify non-traditional circulating biomarkers for clinical diagnostics.
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Affiliation(s)
- Nan Lu
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Blk N3, Level 2, Room 86 (N3-02c-86), 639798, Singapore.
- HP-NTU Digital Manufacturing Corporate Lab, Nanyang Technological University, 65 Nanyang Drive, Block N3, 637460, Singapore
| | - Hui Min Tay
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Blk N3, Level 2, Room 86 (N3-02c-86), 639798, Singapore.
| | - Chayakorn Petchakup
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Blk N3, Level 2, Room 86 (N3-02c-86), 639798, Singapore.
| | - Linwei He
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Blk N3, Level 2, Room 86 (N3-02c-86), 639798, Singapore.
| | - Lingyan Gong
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Blk N3, Level 2, Room 86 (N3-02c-86), 639798, Singapore.
| | - Kay Khine Maw
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Blk N3, Level 2, Room 86 (N3-02c-86), 639798, Singapore.
| | - Sheng Yuan Leong
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Blk N3, Level 2, Room 86 (N3-02c-86), 639798, Singapore.
| | - Wan Wei Lok
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Blk N3, Level 2, Room 86 (N3-02c-86), 639798, Singapore.
| | - Hong Boon Ong
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Blk N3, Level 2, Room 86 (N3-02c-86), 639798, Singapore.
| | - Ruya Guo
- Key Laboratory of Agricultural Information Acquisition Technology, Ministry of Agriculture and Rural Affairs, China Agricultural University, Beijing, 100083, China
| | - King Ho Holden Li
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Blk N3, Level 2, Room 86 (N3-02c-86), 639798, Singapore.
- HP-NTU Digital Manufacturing Corporate Lab, Nanyang Technological University, 65 Nanyang Drive, Block N3, 637460, Singapore
| | - Han Wei Hou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Blk N3, Level 2, Room 86 (N3-02c-86), 639798, Singapore.
- HP-NTU Digital Manufacturing Corporate Lab, Nanyang Technological University, 65 Nanyang Drive, Block N3, 637460, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Clinical Sciences Building, 308232, Singapore
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12
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Measuring Cell Mechanical Properties Using Microindentation. Methods Mol Biol 2023; 2600:3-23. [PMID: 36587087 DOI: 10.1007/978-1-0716-2851-5_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Quantifying cell mechanical properties is of interest to better understand both physiological and pathological cellular processes. Cell mechanical properties are quantified by a finite set of parameters such as the effective Young's modulus or the effective viscosity. These parameters can be extracted by applying controlled forces to a cell and by quantifying the resulting deformation of the cell.Microindentation consists in pressing a cell with a calibrated spring terminated by a rigid tip and by measuring the resulting indentation of the cell. We have developed a microindentation technique that uses a flexible micropipette as a spring. The micropipette has a microbead at its tip, and this spherical geometry allows using analytical models to extract cell mechanical properties from microindentation experiments. We use another micropipette to hold the cell to be indented, which makes this technique well suited to study nonadherent cells, but we also describe how to use this technique on adherent cells.
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13
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Komorowski M, Green A, Tatham KC, Seymour C, Antcliffe D. Sepsis biomarkers and diagnostic tools with a focus on machine learning. EBioMedicine 2022; 86:104394. [PMID: 36470834 PMCID: PMC9783125 DOI: 10.1016/j.ebiom.2022.104394] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
Over the last years, there have been advances in the use of data-driven techniques to improve the definition, early recognition, subtypes characterisation, prognostication and treatment personalisation of sepsis. Some of those involve the discovery or evaluation of biomarkers or digital signatures of sepsis or sepsis sub-phenotypes. It is hoped that their identification may improve timeliness and accuracy of diagnosis, suggest physiological pathways and therapeutic targets, inform targeted recruitment into clinical trials, and optimise clinical management. Given the complexities of the sepsis response, panels of biomarkers or models combining biomarkers and clinical data are necessary, as well as specific data analysis methods, which broadly fall under the scope of machine learning. This narrative review gives a brief overview of the main machine learning techniques (mainly in the realms of supervised and unsupervised methods) and published applications that have been used to create sepsis diagnostic tools and identify biomarkers.
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Affiliation(s)
- Matthieu Komorowski
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, United Kingdom,Corresponding author.
| | - Ashleigh Green
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Kate C. Tatham
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, United Kingdom,Anaesthetics, Perioperative Medicine and Pain Department, Royal Marsden NHS Foundation Trust, 203 Fulham Rd, London, SW3 6JJ, United Kingdom
| | - Christopher Seymour
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Antcliffe
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, United Kingdom
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14
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Li Y, Wong IY, Guo M. Reciprocity of Cell Mechanics with Extracellular Stimuli: Emerging Opportunities for Translational Medicine. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2022; 18:e2107305. [PMID: 35319155 PMCID: PMC9463119 DOI: 10.1002/smll.202107305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/20/2022] [Indexed: 06/14/2023]
Abstract
Human cells encounter dynamic mechanical cues in healthy and diseased tissues, which regulate their molecular and biophysical phenotype, including intracellular mechanics as well as force generation. Recent developments in bio/nanomaterials and microfluidics permit exquisitely sensitive measurements of cell mechanics, as well as spatiotemporal control over external mechanical stimuli to regulate cell behavior. In this review, the mechanobiology of cells interacting bidirectionally with their surrounding microenvironment, and the potential relevance for translational medicine are considered. Key fundamental concepts underlying the mechanics of living cells as well as the extracelluar matrix are first introduced. Then the authors consider case studies based on 1) microfluidic measurements of nonadherent cell deformability, 2) cell migration on micro/nano-topographies, 3) traction measurements of cells in three-dimensional (3D) matrix, 4) mechanical programming of organoid morphogenesis, as well as 5) active mechanical stimuli for potential therapeutics. These examples highlight the promise of disease diagnosis using mechanical measurements, a systems-level understanding linking molecular with biophysical phenotype, as well as therapies based on mechanical perturbations. This review concludes with a critical discussion of these emerging technologies and future directions at the interface of engineering, biology, and medicine.
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Affiliation(s)
- Yiwei Li
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, 1037 Luoyu Road, Wuhan, Hubei, 430074, China
| | - Ian Y Wong
- School of Engineering, Center for Biomedical Engineering, Joint Program in Cancer Biology, Brown University, 184 Hope St Box D, Providence, RI, 02912, USA
| | - Ming Guo
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
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15
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O’Neal HR, Sheybani R, Caffery TS, Hamer D, Laperouse LM, Musso MW, O’Neal CS, Tse HTK, Shah AM, Thomas CB. Assessment of a cellular host response test to risk-stratify suspected COVID-19 patients in the Emergency Department setting. PLoS One 2022; 17:e0264220. [PMID: 35294441 PMCID: PMC8926179 DOI: 10.1371/journal.pone.0264220] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/04/2022] [Indexed: 01/08/2023] Open
Abstract
Objective Assess the IntelliSep Index (ISI) for risk stratification of patients presenting to the Emergency Department (ED) with respiratory symptoms suspected of COVID-19 during the pandemic. Methods An observational single-center study of prospective cohort of patients presenting to the ED during the early COVID-19 pandemic with respiratory symptoms and a CBC drawn within 4.5 hours of initial vital signs. A sample of this blood was aliquoted for performance of the ISI, and patients were followed for clinical outcomes. The study required no patient-centered activity beyond standard of care and treating clinicians were unaware of study enrollment and ISI test results. Main findings 282 patients were included. The ISI ranges 0.1 to 10.0, with three interpretation bands indicating risk of adverse outcome: low (green), 0.1–4.9; intermediate (yellow), 5.0–6.2; and high (red), 6.3–10.0. Of 193 (68.4%) tested for SARS-CoV-2, 96 (49.7%) were positive. The ISI resulted in 182 (64.5%) green, 54 (18.1%) yellow, and 46 (15.6%) red band patients. Green band patients had a 1.1% (n = 2) 3-day mortality, while yellow and red band had 3.7% (n = 2, p > .05) and 10.9% (n = 5, p < .05) 3-day mortalities, respectively. Fewer green band patients required admission (96 [52.7%]) vs yellow (44 [81.5%]) and red (43 [93.5%]). Green band patients had more hospital free days (median 23 (Q1-Q3 20–25) than yellow (median 22 [Q1-Q3 0–23], p < 0.05) and red (median 21 [Q1-Q3 0–24], p < 0.01). SOFA increased with interpretation band: green (2, [Q1-Q3 0–4]) vs yellow (4, [Q1-Q3 2–5], p < 0.001) and red (5, [Q1-Q3 3–6]) p < 0.001). Conclusions The ISI rapidly risk-stratifies patients presenting to the ED during the early COVID-19 pandemic with signs or suspicion of respiratory infection.
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Affiliation(s)
- Hollis R. O’Neal
- Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States of America
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States of America
| | - Roya Sheybani
- Cytovale, Inc., San Francisco, California, United States of America
- * E-mail:
| | - Terrell S. Caffery
- Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States of America
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States of America
| | - Diana Hamer
- Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States of America
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States of America
| | - L. Mark Laperouse
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States of America
| | - Mandi W. Musso
- Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States of America
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States of America
| | - Catherine S. O’Neal
- Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States of America
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States of America
| | - Henry T. K. Tse
- Cytovale, Inc., San Francisco, California, United States of America
| | - Ajay M. Shah
- Cytovale, Inc., San Francisco, California, United States of America
| | - Christopher B. Thomas
- Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States of America
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States of America
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16
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O'Neal CS, Hamer D, Musso MW, Caffery TS, Walker MK, Lavie KW, Berlinger MS, Thomas CB, Alwood SM, Jagneaux T, Sanchez MA, O'Neal HR. Retrospective Identification of Infection in the Emergency Department: A Significant Challenge in Sepsis Clinical Trials. Am J Med Sci 2022; 364:163-167. [PMID: 35300978 DOI: 10.1016/j.amjms.2022.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/27/2021] [Accepted: 02/28/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND This study examined three methods for retrospectively identifying infection in emergency department (ED) patients: modified objective definitions of infection (MODI) from the CDC/NHSN, physician adjudication determination of infection, and ED treating physician behavior. METHOD This study used a subset of data from a prospective sepsis trial. We used Fleiss's Kappa to compare agreement between two physicians retrospectively adjudicating infection based on the patient's medical record, modified infection definition from the CDC/NHSN, and ED treating physician behavior. RESULTS Overall, there was similar agreement between physician adjudication of infection and MODI criteria (Kappa=0.59) compared to having two physicians independently identify infection through retrospective chart review (Kappa=0.58). ED treating physician behavior was a poorer proxy for infection when compared to the MODI criteria (0.41) and physician adjudication (Kappa = 0.50). CONCLUSION Retrospective identification of infection poses a significant challenge in sepsis clinical trials. Using modified definitions of infection provides a standardized, less time consuming, and equally effective means of identifying infection compared to having multiple physicians adjudicate a patient's chart.
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Affiliation(s)
- Catherine S O'Neal
- Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808
| | - Diana Hamer
- Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808
| | - Mandi W Musso
- Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808; Louisiana State University Health Sciences Center, Emergency Medicine Residency Program 5246 Brittany Dr., Baton Rouge, LA, USA 70808
| | - Terrell S Caffery
- Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808; Louisiana State University Health Sciences Center, Emergency Medicine Residency Program 5246 Brittany Dr., Baton Rouge, LA, USA 70808
| | - Morgan K Walker
- Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808
| | - Katherine W Lavie
- Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808
| | - Matthew S Berlinger
- Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808
| | - Christopher B Thomas
- Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808; Baton Rouge General Medical Center, 8585 Picardy Ave., Baton Rouge, LA, USA 70809
| | - Shannon M Alwood
- Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808; Louisiana State University Health Sciences Center, Emergency Medicine Residency Program 5246 Brittany Dr., Baton Rouge, LA, USA 70808
| | - Tonya Jagneaux
- Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808; Baton Rouge General Medical Center, 8585 Picardy Ave., Baton Rouge, LA, USA 70809
| | - Michael A Sanchez
- Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Baton Rouge General Medical Center, 8585 Picardy Ave., Baton Rouge, LA, USA 70809
| | - Hollis R O'Neal
- Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808; Baton Rouge General Medical Center, 8585 Picardy Ave., Baton Rouge, LA, USA 70809
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17
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Zak A, Dupré-Crochet S, Hudik E, Babataheri A, Barakat AI, Nüsse O, Husson J. Distinct timing of neutrophil spreading and stiffening during phagocytosis. Biophys J 2022; 121:1381-1394. [PMID: 35318004 PMCID: PMC9072703 DOI: 10.1016/j.bpj.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/29/2021] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
Phagocytic cells form the first line of defense in an organism, engulfing microbial pathogens. Phagocytosis involves cell mechanical changes that are not yet well understood. Understanding these mechanical modifications promises to shed light on the immune processes that trigger pathological complications. Previous studies showed that phagocytes undergo a sequence of spreading events around their target followed by an increase in cell tension. Seemingly in contradiction, other studies observed an increase in cell tension concomitant with membrane expansion. Even though phagocytes are viscoelastic, few studies have quantified viscous changes during phagocytosis. It is also unclear whether cell lines behave mechanically similarly to primary neutrophils. We addressed the question of simultaneous versus sequential spreading and mechanical changes during phagocytosis by using immunoglobulin-G-coated 8- and 20-μm-diameter beads as targets. We used a micropipette-based single-cell rheometer to monitor viscoelastic properties during phagocytosis by both neutrophil-like PLB cells and primary human neutrophils. We show that the faster expansion of PLB cells on larger beads is a geometrical effect reflecting a constant advancing speed of the phagocytic cup. Cells become stiffer on 20- than on 8-μm beads, and the relative timing of spreading and stiffening of PLB cells depends on target size: on larger beads, stiffening starts before maximal spreading area is reached but ends after reaching maximal area. On smaller beads, the stiffness begins to increase after cells have engulfed the bead. Similar to PLB cells, primary cells become stiffer on larger beads but start spreading and stiffen faster, and the stiffening begins before the end of spreading on both bead sizes. Our results show that mechanical changes in phagocytes are not a direct consequence of cell spreading and that models of phagocytosis should be amended to account for causes of cell stiffening other than membrane expansion.
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Affiliation(s)
- Alexandra Zak
- LadHyX, CNRS, École polytechnique, Institut Polytechnique de Paris, Palaiseau, France; Institut de Chimie Physique, CNRS UMR 8000, Université Paris-Saclay, Orsay, France
| | - Sophie Dupré-Crochet
- Institut de Chimie Physique, CNRS UMR 8000, Université Paris-Saclay, Orsay, France
| | - Elodie Hudik
- Institut de Chimie Physique, CNRS UMR 8000, Université Paris-Saclay, Orsay, France
| | - Avin Babataheri
- LadHyX, CNRS, École polytechnique, Institut Polytechnique de Paris, Palaiseau, France
| | - Abdul I Barakat
- LadHyX, CNRS, École polytechnique, Institut Polytechnique de Paris, Palaiseau, France
| | - Oliver Nüsse
- Institut de Chimie Physique, CNRS UMR 8000, Université Paris-Saclay, Orsay, France
| | - Julien Husson
- LadHyX, CNRS, École polytechnique, Institut Polytechnique de Paris, Palaiseau, France.
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Battat S, Weitz DA, Whitesides GM. An outlook on microfluidics: the promise and the challenge. LAB ON A CHIP 2022; 22:530-536. [PMID: 35048918 DOI: 10.1039/d1lc00731a] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This perspective considers ways in which the field of microfluidics can increase its impact by improving existing technologies and enabling new functionalities. We highlight applications where microfluidics has made or can make important contributions, including diagnostics, food safety, and the production of materials. The success of microfluidics assumes several forms, including fundamental innovations in fluid mechanics that enable the precise manipulation of fluids at small scales and the development of portable microfluidic chips for commercial purposes. We identify outstanding technical challenges whose resolution could increase the accessibility of microfluidics to users with both scientific and non-technical backgrounds. They include the simplification of procedures for sample preparation, the identification of materials for the production of microfluidic devices in both laboratory and commercial settings, and the replacement of auxiliary equipment with automated components for the operation of microfluidic devices.
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Affiliation(s)
- Sarah Battat
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02138, USA.
| | - David A Weitz
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02138, USA.
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - George M Whitesides
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, USA.
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Assessment of a Cellular Host Response Test as a Sepsis Diagnostic for Those With Suspected Infection in the Emergency Department. Crit Care Explor 2021; 3:e0460. [PMID: 34151282 PMCID: PMC8208428 DOI: 10.1097/cce.0000000000000460] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: Sepsis is a common cause of morbidity and mortality. A reliable, rapid, and early indicator can help improve efficiency of care and outcomes. To assess the IntelliSep test, a novel in vitro diagnostic that quantifies the state of immune activation by measuring the biophysical properties of leukocytes, as a rapid diagnostic for sepsis and a measure of severity of illness, as defined by Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation-II scores and the need for hospitalization. Design, Setting, SUBJECTS: Adult patients presenting to two emergency departments in Baton Rouge, LA, with signs of infection (two of four systemic inflammatory response syndrome criteria, with at least one being aberration of temperature or WBC count) or suspicion of infection (a clinician order for culture of a body fluid), were prospectively enrolled. Sepsis status, per Sepsis-3 criteria, was determined through a 3-tiered retrospective and blinded adjudication process consisting of objective review, site-level clinician review, and final determination by independent physician adjudicators. MEASUREMENTS AND MAIN RESULTS: Of 266 patients in the final analysis, those with sepsis had higher IntelliSep Index (median = 6.9; interquartile range, 6.1–7.6) than those adjudicated as not septic (median = 4.7; interquartile range, 3.7–5.9; p < 0.001), with an area under the receiver operating characteristic curve of 0.89 and 0.83 when compared with unanimous and forced adjudication standards, respectively. Patients with higher IntelliSep Index had higher Sequential Organ Failure Assessment (3 [interquartile range, 1–5] vs 1 [interquartile range, 0–2]; p < 0.001) and Acute Physiology and Chronic Health Evaluation-II (7 [interquartile range, 3.5–11.5] vs 5 [interquartile range, 2–9]; p < 0.05) and were more likely to be admitted to the hospital (83.6% vs 48.3%; p < 0.001) compared with those with lower IntelliSep Index. CONCLUSIONS: In patients presenting to the emergency department with signs or suspicion of infection, the IntelliSep Index is a promising tool for the rapid diagnosis and risk stratification for sepsis.
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