Reference Standards for Digital Infrared Thermography Measuring Surface Temperature of the Upper Limbs

(1) Background: although digital infrared thermographic imaging (DITI) is used for diverse medical conditions of the upper limbs, no reference standards have been established. This study aims to establish reference standards by analyzing DITI results of the upper limbs. (2) Methods: we recruited 905 healthy Korean adults and conducted thermography on six regions (dorsal arm, ventral arm, lateral arm, medial arm, dorsal hand, and ventral hand region). We analyzed the data based on the proximity of regions of interest (ROIs), sex, and age. (3) Results: the average temperature (°C) and temperature discrepancy between the right and the left sides (ΔT) of each ROI varied significantly (p < 0.001), ranging from 28.45 ± 5.71 to 29.74 ± 5.14 and from 0.01 ± 0.49 to 0.15 ± 0.62, respectively. The temperature decreased towards the distal ROIs compared to proximal ROIs. The average temperatures of the same ROIs were significantly higher for men than women in all regions (p < 0.001). Across all regions, except the dorsal hand region, average temperatures tended to increase with age, particularly in individuals in their 30s and older (p < 0.001). (4) Conclusions: these data could be used as DITI reference standards to identify skin temperature abnormalities of the upper limbs. However, it is important to consider various confounding factors, and further research is required to validate the accuracy of our results under pathological conditions.

Clinical Accuracy of Non-Contact Forehead Infrared Thermometer Measurement in Children: An Observational Study

We evaluated the clinical reliability and utility of temperature measurements using no-contact forehead infrared thermometers (NCFITs) by comparing their temperature measurements with those obtained using infrared tympanic thermometers (IRTTs) in children. In this observational, prospective, and cross-sectional study, we enrolled 255 children (aged 1 month to 18 years) from the pediatric surgery ward at a tertiary medical center in Korea. The mean age of the children was 9.05 ± 5.39 years, and 54.9% were boys. The incidence rate of fever, defined as an IRTT reading of ≥38.0 °C, was 15.7%. The ICC coefficient for the assessment of agreement between temperatures recorded by the NCFIT and IRTT was 0.87, and the κ-coefficient was 0.83. The bias and 95% limits of agreement were 0.15 °C (−0.43 to 0.73). For an accurate diagnosis of fever (≥38 °C), the false-negative rate was much lower, but the false-positive rate was higher, especially in 6-year-old children. Therefore, NCFITs can be used to screen children for fever. However, a secondary check is required using another thermometer when the child’s temperature is >38 °C. NCFITs are proposed for screening but not for measuring the temperature. For the latter, an accurate and reliable thermometer shall be used.

Evaluation of carbon nanotubes-hydroxyapatite nanocomposites as bioactive implant coats radiated by near infrared laser

This study aimed to evaluate carbon nanotubes-hydroxyapatite nanocomposites as bioactive titanium implant coats and to assess the effect of near-infrared radiation on these nanocomposites. Carbon nanotubes were acid-functionalized, and hydroxyapatite was prepared by the wet-chemical precipitation method. Both precursors were used to prepare the carbon nanotubes-hydroxyapatite nanocomposites in two concentrations of hydroxyapatite (0.5 and 1 wt.%). The formed nanocomposites were characterized and used to coat silanized titanium discs and cylinders. Half the specimens of each group were radiated by near-infrared laser, then wettability and shear bond strength were tested for all specimens. Bioactivity was tested by monitoring the formation of calcium phosphate compounds after soaking in simulated body fluid. A significant increase in wettability and bond strength was found in the radiated coats compared to the non-radiated ones with the 1% hydroxyapatite group showing the highest values followed by 0.5% hydroxyapatite then the carbon nanotubes group. The two-way ANOVA test showed that both the difference in material and the laser treatment have had a statistically significant contribution to the increase in wettability and bond strength. The radiated groups also contributed to the formation of more calcium phosphate crystals of larger sizes and higher degrees of crystallinity.

Diagnostic accuracy of non-contact infrared thermometers and thermal scanners: a systematic review and meta-analysis

Infrared thermal screening, via the use of handheld non-contact infrared thermometers (NCITs) and thermal scanners, has been widely implemented all over the world. We performed a systematic review and meta-analysis to investigate its diagnostic accuracy for the detection of fever. We searched PubMed, Embase, the Cochrane Library, medRxiv, bioRxiv, ClinicalTrials.gov, COVID-19 Open Research Dataset, COVID-19 research database, Epistemonikos, EPPI-Centre, World Health Organization International Clinical Trials Registry Platform, Scopus and Web of Science databases for studies where a non-contact infrared device was used to detect fever against a reference standard of conventional thermometers. Forest plots and Hierarchical Summary Receiver Operating Characteristics curves were used to describe the pooled summary estimates of sensitivity, specificity and diagnostic odds ratio. From a total of 1063 results, 30 studies were included in the qualitative synthesis, of which 19 were included in the meta-analysis. The pooled sensitivity and specificity were 0.808 (95%CI 0.656-0.903) and 0.920 (95%CI 0.769-0.975), respectively, for the NCITs (using forehead as the site of measurement), and 0.818 (95%CI 0.758-0.866) and 0.923 (95%CI 0.823-0.969), respectively, for thermal scanners. The sensitivity of NCITs increased on use of rectal temperature as the reference. The sensitivity of thermal scanners decreased in a disease outbreak/pandemic setting. Changes approaching statistical significance were also observed on the exclusion of neonates from the analysis. Thermal screening had a low positive predictive value, especially at the initial stage of an outbreak, whereas the negative predictive value (NPV) continued to be high even at later stages. Thermal screening has reasonable diagnostic accuracy in the detection of fever, although it may vary with changes in subject characteristics, setting, index test and the reference standard used. Thermal screening has a good NPV even during a pandemic. The policymakers must take into consideration the factors surrounding the screening strategy while forming ad-hoc guidelines.

Comparison of Thermal Foot Maps between Diabetic Patients with Neuropathic, Vascular, Neurovascular, and No Complications

BACKGROUND

Diabetes mellitus is a public health problem worldwide. The diabetic foot has a degenerate vascular structure, and its patients present neurological problems, which require the earliest possible identification.

INTRODUCTION

The objective of the research was to use infrared thermography to analyze the temperature difference of the feet of users with diabetes mellitus with neuropathy, vasculopathy, neurovascular disease, or none of them, segmenting the sole of the foot in four areas for the study.

METHODS

A type of descriptive, cross-sectional and observational study was developed in a group of 277 patients with diabetic pathology (138 men and 139 women), with an average age of 63.41 ± 17.69 years and a body mass index of 29.08 ± 5.86, delimited in four groups: 22 (7.94%) with neuropathy, 32 (11.55%) with vasculopathy, 83 (29.96%) with neurovasculopathy and 140 (50.54%) without previous pathology. Thus, almost half of the sample (49.46%) presented some type of complication (neuropathic, vasculopathic or both). The photographic images were made with an infrared camera model FLIR E60bx®. The data obtained were analyzed using the IBM SPSS Statistics 22 statistical program.

RESULTS

There were lower temperatures under the 1st metatarsal head, the 5th metatarsal head, the heel, and pulp of the big toe of both left and right feet of the patients in the neuropathy, vasculopathy, and neurovasculopathy groups relative to the group with neither pathology.

CONCLUSION

Infrared thermography can be useful in assessing the foot at risk to reveal the variability of temperature according to the study area, which may be useful for medical judgment and the predisposition to identify lesions in compromised regions of the foot.

The microcirculation and its measurement in sepsis

The microcirculation describes the smallest elements of the cardiovascular conducting system and is pivotal in the maintenance of homeostasis. Microcirculatory dysfunction is present early in the pathophysiology of sepsis, with the extent of microcirculatory derangement relating to disease severity and prognosis in ICU patients. However, at present microcirculatory function is not routinely monitored at the bedside. This article describes the pathophysiology of microcirculatory derangements in sepsis, methods of its measurement and evidence to support their clinical use.

Evaluating NIR vascular imaging to support intravenous cannulation in awake children difficult to cannulate; a randomized clinical trial

BACKGROUND

Recently, various near-infrared vascular imaging devices aimed at facilitating peripheral intravenous cannulation (PIC) were introduced, all claiming to increase success rate of PIC. We evaluated the clinical utility of a near-infrared vascular imaging device (VascuLuminator(®)) in pediatric patients who were referred to the anesthesiologist because of difficult cannulation.

METHODS

There were 226 consecutive children referred to pediatric anesthesiologists by the treating pediatrician of the in- and outpatient clinic, because of difficulties with intravenous cannulation, were included in this cluster randomized clinical trial. The presence and use of the near-infrared vascular imaging device for PIC was randomized in clusters of 1 week. Success at first attempt (Fisher exact test) and time to successful cannulation (Log-rank test) were assessed to evaluate differences between groups.

RESULTS

Success at first attempt in the group with the VascuLuminator(®) (59%) was not significantly different from the control group (54%, P = 0.41), neither was the median time to successful cannulation: 246 s and 300 s, respectively (P = 0.54).

CONCLUSIONS

Visualization of blood vessels with near-infrared light and with near-infrared vascular imaging device did not improve success of PIC in pediatric patients who are known difficult to cannulate.

Application of infrared laser to the zebrafish vascular system: gene induction, tracing, and ablation of single endothelial cells

OBJECTIVE

Infrared laser-evoked gene operator is a new microscopic method optimized to heat cells in living organisms without causing photochemical damage. By combining the promoter system for the heat shock response, infrared laser-evoked gene operator enables laser-mediated gene induction in targeted cells. We applied this method to the vascular system in zebrafish embryos and demonstrated its usability to investigate mechanisms of vascular morphogenesis in vivo.

APPROACH AND RESULTS

We used double-transgenic zebrafish with fli1:nEGFP to identify the endothelial cells, and with hsp:mCherry to carry out single-cell labeling. Optimizing the irradiation conditions, we finally succeeded in inducing the expression of the mCherry gene in single targeted endothelial cells, at a maximum efficiency rate of 60%. In addition, we indicated that this system could be used for laser ablation under certain conditions. To evaluate infrared laser-evoked gene operator, we applied this system to the endothelial cells of the first intersegmental arteries, and captured images of the connection between the vascular systems of the brain and spinal cord.

CONCLUSIONS

Our results suggest that the infrared laser-evoked gene operator system will contribute to the elucidation of the mechanisms underlying vascular morphogenesis by controlling spatiotemporal gene activation in single endothelial cells, by labeling or deleting individual vessels in living embryos.

Shoulder motion analysis using simultaneous skin shape registration

A new non-invasive approach is proposed to study joint motions. It is based on dynamic tracking of the skin shape. A robust simultaneous registration algorithm (Iterative Median Closest Point) is used to follow the evolving shape and compute the rigid motion of the underlying bone structures. This new method relies on the differentiation of the rigid and elastic parts of the shape motion. A skin marker network is tracked by a set of infrared cameras. Unlike usual techniques, the algorithm tracks the instantaneous polyhedral shape embedding this network. This innovating approach is expected to minimize bias effect of skin sweeps and give some new information about the underlying soft tissue activities. Current application addresses the motion of the shoulder complex (humerus, clavicle and scapula). It is compared with two marker-based methods published in the literature. Preliminary results show significant differences between these three approaches. The new approach measurements give rise to greater rotations.