Quantifying the Concentration of Glucose, Urea, and Lactic Acid in Mixture by Confocal Raman Microscopy

Raman spectroscopy has numerous applications in the field of biology. One such application is the simultaneously measurement of the concentration of multiple biochemical components in low volume aqueous mixtures, for example, a single drop of blood serum. Over twenty years ago, it was shown for the first time that it was possible to estimate the concentration of glucose, urea, and lactic acid in mixture by combining Raman Spectroscopy with Partial Least Squares Regression analysis. This was followed by numerous contributions in the literature designed to increase the number of components and reduce the limits of concentration that could be simultaneously measured using Raman spectroscopy, by developing various optical architectures to maximise the signal to noise ratio. The aim of this paper is to demonstrate the potential of a confocal Raman microscopy system for multicomponent analysis for the case of physiologically relevant mixtures of glucose, urea, and lactic acid

Does patient self-management education of primary care professionals improve patient outcomes : a systematic review

Background: Patient self-management support is recognised as a key component of chronic care. Education and training for health professionals has been shown in the literature to be associated with better uptake, implementation and effectiveness of self-management programs, however, there is no clear evidence regarding whether this training results in improved health outcomes for patients with chronic conditions. Methods: A systematic review was undertaken using the PRISMA guidelines using the Cochrane Library, PubMEd, ERIC, EMBASE, CINAHL, PsycINFO, Web searches, Hand searches and Bibliographies. Articles published from inception to September 1st, 2013 were included. Systematic reviews, Meta-analysis, Randomized controlled trials (RCTs), Controlled clinical trials, Interrupted time series and Controlled before and after studies, which reported on primary care health professionals' continuing education or evidence-based medicine/education on patient self-management for any chronic condition, were included. A minimum of two reviewers participated independently at each stage of review. Results: From 7533 abstracts found, only two papers provided evidence on the effectiveness of self-management education for primary healthcare professionals in terms of measured outcomes in patients. These two articles show improvement in patient outcomes for chronic back pain and diabetes based on RCTs. The educational interventions with health professionals spanned a range of techniques and modalities but both RCTs included a motivational interviewing component. Conclusions: Before and up to 2 years after the incorporation of patient empowerment for self-management into the WONCA Europe definition of general practice, there was a scarcity of high quality evidence showing improved outcomes for patients as a result of educating health professionals in patient self-management of chronic conditions.Peer reviewe

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Proton MRS can determine the pathology of human cancers with a high level of accuracy

The first report of a high-resolution proton (1H) magnetic resonance spectrum from intact viable cancer cells was made by Block and colleagues in 1973,1 who suggested 1H magnetic resonance spectroscopy (MRS) might lead to pathologically relevant information. However, at this time 1H was not the favored nucleus since adequate water suppression was difficult and small resonances were swamped by a much larger water signal. Carbon-13 (13C) MRS2 and phosphorus-31 (31P MRS3 were the preferred methods for monitoring cellular metabolism and intact viable cells and organs..

In vivo spectroscopy and imaging of the ovary in vivo at 3 tesla and spectroscopy on biopsy at 8.5 tesla

In vivo spectroscopy and imaging of the ovary at 3T can provide diagnostic information preoperatively on patients with ovarian masses. Here is the first report of a case where the in vivo MRI and MRS at 3T were undertaken on a patient with an ovarian mass distinguishing the malignant from the cystic component. Spectroscopy on biopsies obtained intraoperatively and recorded at 8.5T provided a diagnosis of poorly differentiated malignant tumor. The MR studies were undertaken blind and the diagnosis subsequently confirmed histologically

Quantifying the concentration of glucose, urea, and lactic acid in aqueous mixtures by confocal Raman microscopy

Raman spectroscopy has numerous applications in the field of biology. One such application is the simultaneously measurement of the concentration of multiple biochemical components in low volume aqueous mixtures, for example, a single drop of blood serum. Over twenty years ago, it was shown for the first time that it was possible to estimate the concentration of glucose, urea, and lactic acid in mixture by combining Raman Spectroscopy with Partial Least Squares Regression analysis. This was followed by numerous contributions in the literature designed to increase the number of components and reduce the limits of concentration that could be simultaneously measured using Raman spectroscopy, by developing various optical architectures to maximise the signal to noise ratio. The aim of this paper is to demonstrate the potential of a confocal Raman microscopy system for multicomponent analysis for the case of physiologically relevant mixtures of glucose, urea, and lactic acid

Multicomponent analysis using a confocal Raman microscope

Measuring the concentration of multiple chemical components in a low-volume aqueous mixture by Raman spectroscopy has received significant interest in the literature. All of the contributions to date focus on the design of optical systems that facilitate the recording of spectra with high signal-to-noise ratio by collecting as many Raman scattered photons as possible. In this study, the confocal Raman microscope setup is investigated for multicomponent analysis. Partial least-squares regression is used to quantify physiologically relevant aqueous mixtures of glucose, lactic acid, and urea. The predicted error is 17.81 mg/dL for glucose, 10.6 mg/dL for lactic acid, and 7.6 mg/dL for urea, although this can be improved with increased acquisition times. A theoretical analysis of the method is proposed, which relates the numerical aperture and the magnification of the microscope objective, as well as the confocal pinhole size, to the performance of the technique