The role of trauma team activation by emergency physicians on outcomes in severe trauma patients

AbstractBackgroundIn our region, trauma team activation (TTA) is initiated by emergency physicians once an injured patient meets any of the criteria of TTA after the injured patient arrives at the emergency department (ED).PurposeTo evaluate the role of TTA on outcomes in patients with severe trauma.MethodsAll trauma patients who had injury severity score (ISS) >15 and were admitted from ED between January 2010 to December 2010 were included in the study. Mann–Whitney U test (non-normal distribution) or Student's t test (normal distribution) for continuous variables and Fisher exact test or Chi-square test for categorical variables were used to compare the statistically significant differences between TTA and non-TTA groups. Logistic regression was applied to determine any significant differences found in the statistical analysis for 30-day mortality.ResultsA total of 231 patients were signed up in the study. The TTA group had shorter time from ED to operation room (170 minutes vs. 534 minutes, p = 0.02) and tended to have more emergent operations (42.7% vs. 23.2%, p = 0.002). Emergent operation [odds ratio (OR), 0.34; 95% confidence interval (CI), 0.12–0.92, p = 0.035) was associated with lower mortality while ISS > 25 (OR, 7.48; 95% CI, 2.48–22.57, p < 0.0001), Glasgow coma scale score <13 (OR, 32.1; 95% CI, 4.30–94.6, p < 0.0001), hypotension (OR, 3.0; 95% CI, 1.1–7.9, p = 0.03), and coagulopathy (OR, 9.3; 95% CI, 1.2–71.4, p = 0.033) were associated with higher mortality.ConclusionThis study shows that TTA may shorten the time from ED to operation room in trauma patients with an ISS > 15

Real-time photoacoustic flow cytography and photothermolysis of single circulating melanoma cells in vivo

Metastasis is responsible for as many as 90% of cancer-related deaths, and the deadliest skin cancer, melanoma, has a high propensity for metastasis. Since hematogenous spread of circulating tumor cells (CTCs) is cancer’s main route of metastasis, detecting and destroying CTCs can impede metastasis and improve patients’ prognoses. Extensive studies employing exogenous agents to detect tumor-specific biomarkers and guide therapeutics to CTCs have achieved promising results, but biosafety remains a critical concern. Taking another approach, physical detection and destruction of CTCs is a safer way to evaluate and reduce metastasis risks. Melanoma cells strongly express melanosomes, providing a striking absorption contrast with the blood background in the red to near-infrared spectrum. Exploiting this intrinsic optical absorption contrast of circulating melanoma cells, we coupled dual-wavelength photoacoustic flow cytography with a nanosecond-pulsed laser killing mechanism that specifically targets melanoma CTCs. We have successfully achieved in vivo label-free imaging of rare single CTCs and CTC clusters in mice. Further, the photoacoustic signal from a CTC immediately hardware-triggers a lethal pinpoint laser irradiation that lyses it on the spot in a thermally confined manner. Our technology can facilitate early inhibition of metastasis by clearing circulating tumor cells from vasculature

A water-immersible 2-axis scanning mirror microsystem for ultrasound and photoacoustic microscopic imaging applications

For both ultrasound and photoacoustic microscopic imaging, a fast scanning ability is required, whereas the liquid environment for acoustic propagation limits the usage of traditional MEMS scanning mirrors. In this paper, a new waterimmersible scanning mirror microsystem has been designed, fabricated and tested. To achieve reliable underwater scanning, flexible polymer torsion hinges fabricated by laser micromachining were used to support the reflective silicon mirror plate. Two efficient electromagnetic microactuators consisting of compact RF choke inductors and high-strength neodymium magnet disc were constructed to drive the silicon mirror plate around a fast axis and a slow axis, respectively. The performance of the water-immersible scanning mirror microsystem in both air and water were tested using the laser tracing method. For the fast axis, the resonance frequency reached 224 Hz in air and 164 Hz in water, respectively. The scanning angles in air and water under ±10 V AC driving (at the resonance frequencies) were ±13.6° and ±10°. The scanning angles in both air and water under ±16 V DC driving were ±12°. For the slow axis, the resonance frequency reached 55 Hz in air and 38 Hz in water, respectively. The scanning angles in air and water under ±10 V AC driving (at the resonance frequencies) were ±8.5° and ±6°. The scanning angles in both air and water under ±10 V DC driving were ± 6.5°. The feasibility of using such a water-immersible scanning mirror microsystem for scanning ultrasound microscopic (SAM) imaging has been demonstrated with a 25-MHz ultrasound pulse/echo system and a target consisting of three optical fibers

The significance of seizures and other predictive factors during the acute illness for the long-term outcome after bacterial meningitis

SummaryBackgroundSeizures are important neurological complications of bacterial meningitis, but no information about its epidemiology and the outcomes of seizures after community-acquired bacterial meningitis (CABM) in an adult population have been reported.AimsTo determine the frequency, clinical relevance, subtypes of seizures during the acute phase of bacterial meningitis, and the long-term outcomes of seizure complicating adult CABM.MethodsIn this 12-year retrospective study, 117 adult patients were identified with culture-proven CABM. A comparison was made between the clinical data of the patients with and without seizures during hospitalization.ResultsThirty-one patients had seizures during CABM, accounting for 27% (31/117) of the episodes. The time interval between the onset of bacterial meningitis and the seizures was 1–21 days (mean, 4 days). Furthermore, 80% (25/31) of the episodes occurred within 24h of presentation. Ten patients who had seizures progressed to status epilepticus. At follow-up after completing treatment, 10 patients completely recovered and were seizure-free, 19 died of meningitis during the acute stage and the other two progressed to chronic epilepsy.ConclusionA log-rank test demonstrated that the long-term outcome of adult CABM with acute seizures produced worse outcomes than for those who had no seizures, though no difference was noted between focal and generalized seizures. None of our patients without seizures in the acute phase of bacterial meningitis developed late seizures during the follow-up periods. Poor outcome in this study may attribute to neurological complications such as seizure, hydrocephalus, infection itself, or a combination of complications

In vivo label-free photoacoustic flow cytography and on-the-spot laser killing of single circulating melanoma cells

Metastasis causes as many as 90% of cancer-related deaths, especially for the deadliest skin cancer, melanoma. Since hematogenous dissemination of circulating tumor cells is the major route of metastasis, detection and destruction of circulating tumor cells are vital for impeding metastasis and improving patient prognosis. Exploiting the exquisite intrinsic optical absorption contrast of circulating melanoma cells, we developed dual-wavelength photoacoustic flow cytography coupled with a nanosecond-pulsed melanoma-specific laser therapy mechanism. We have successfully achieved in vivo label-free imaging of rare single circulating melanoma cells in both arteries and veins of mice. Further, the photoacoustic signal from a circulating melanoma cell immediately hardware-triggers a lethal pinpoint laser irradiation to kill it on the spot in a thermally confined manner without causing collateral damage. A pseudo-therapy study including both in vivo and in vitro experiments demonstrated the performance and the potential clinical value of our method, which can facilitate early treatment of metastasis by clearing circulating tumor cells from vasculature