Real-time intraoperative monitoring of blood coagulability via coherence-gated light scattering

Real-Time Detection of Circulating Thrombi in an Extracorporeal Circuit Using Doppler Ultrasound: In-Vitro Proof of Concept Study

BACKGROUND

Thromboembolic stroke continues to be by far the most common severe adverse event in patients supported with mechanical circulatory assist devices. Feasibility of using Doppler ultrasound to detect circulating thrombi in an extracorporeal circuit was investigated.

METHODS

A mock extracorporeal circulatory loop of uncoated cardiopulmonary bypass tubing and a roller pump was setup. A Doppler bubble counter was used to monitor the mean ultrasound backscatter signal (MUBS). The study involved two sets of experiments. In Scenario 1, the circuit was sequentially primed with human blood components, and the MUBS was measured. In Scenario 2, the circuit was primed with heparinized fresh porcine blood, and the MUBS was measured. Fresh blood clots (diameter <1,000 microns, 1,000-5,000 microns, >5,000 microns) were injected into the circuit followed by protamine administration.

RESULTS

In Scenario 1 (n = 3), human platelets produced a baseline MUBS of 1.5 to 3.5 volts/s. Addition of packed human red blood cells increased the baseline backscatter to 17 to 21 volts/s. Addition of fresh frozen plasma did not change the baseline backscatter. In Scenario 2 (n = 5), the blood-primed circuit produced a steady baseline MUBS. Injection of the clots resulted in abrupt and transient increase (range: 3-30 volts/s) of the baseline MUBS. Protamine administration resulted in a sustained increase of MUBS followed by circuit thrombosis.

CONCLUSIONS

Doppler ultrasound may be used for real-time detection of circulating solid microemboli in the extracorporeal circuit. This technology could potentially be used to design safety systems that can reduce the risk of thromboembolic stroke associated with mechanical circulatory support therapy.

Measuring nanoparticles shape by structured illumination

Exploiting the size and shape of nanoparticles is critical for engineering the optical and mechanical properties of nanoparticle systems that are ubiquitous in everyday life. However, accurate determination of nanoparticle morphology usually requires elaborated methods such as XRD or TEM, which are not suitable for non-invasive and rapid control. Dynamic light scattering on the other hand, relies on the motion of nanoparticles and mixes different rotational and translational diffusion coefficients to infer synthetic information about the shape in terms of effective hydrodynamic characteristics. Here, we introduce a new scattering approach for measuring shape. We demonstrate analytically, numerically, and experimentally that the contrast of low-intensity fluctuations arising from the scattering of classically entangled optical fields allows determining the polarimetric anisotropy of nanoparticles. By leveraging the active variation of illumination structuring, we control the non-Gaussian statistics of the measured fluctuations, which, in turn, provides means to improve the measurement sensitivity. This technique offers practical opportunities for applications ranging from molecular chemistry to drug delivery to nanostructures synthesis where the real-time, quantitative assessment of nanoparticles shapes is indispensable.

Optical characterization of native aerosols from e-cigarettes in localized volumes

Measuring the size distribution of aerosols typically requires processing a sample, specifically to adjust the particle concentration to an adequate level. Unfortunately, this manipulation can significantly alter the native composition of some aerosols, which can lead to unreliable or even unusable measurements. We demonstrate that coherence-gated dynamic light scattering is suitable to measure the size distribution of native aerosols without the need for sample processing. Another novel aspect of the present work is the first demonstration of these type of localized light-scattering-based measurements in aerial media. Measuring the size distribution reliably in optically dense aerosols is possible thanks to the interferometric amplification of single scattering in an optically isolated, picolitre-sized coherence volume. We carried out proof-of-concept experiments in aerosols from electronic cigarettes, which poses a challenge mainly due to their high concentration, volatility, and hygroscopicity. We generated aerosols using two common moisturizers, propylene glycol and glycerol, and measured their particle size distribution as a function of the burning power. The aerosols generated in the presence of glycerol are more polydisperse and have larger particles with increasing burning power. This unique characterization of native aerosols can provide valuable information for dosimetry and hosting sites in the respiratory system.

Ergodicity Breaking and Self-Destruction of Cancer Cells by Induced Genome Chaos

During the progression of some cancer cells, the degree of genome instability may increase, leading to genome chaos in populations of malignant cells. While normally chaos is associated with ergodicity, i.e., the state when the time averages of relevant parameters are equal to their phase space averages, the situation with cancer propagation is more complex. Chromothripsis, a catastrophic massive genomic rearrangement, is observed in many types of cancer, leading to increased mutation rates. We present an entropic model of genome chaos and ergodicity and experimental evidence that increasing the degree of chaos beyond the non-ergodic threshold may lead to the self-destruction of some tumor cells. We study time and population averages of chromothripsis frequency in cloned rhabdomyosarcomas from rat stem cells. Clones with frequency above 10% result in cell apoptosis, possibly due to mutations in the BCL2 gene. Potentially, this can be used for suppressing cancer cells by shifting them into a non-ergodic proliferation regime.

Valve-Adjustable Optofluidic Bio-Imaging Platform for Progressive Stenosis Investigation

The clinical evidence has proven that valvular stenosis is closely related to many vascular diseases, which attracts great academic attention to the corresponding pathological mechanisms. The investigation is expected to benefit from the further development of an in vitro model that is tunable for bio-mimicking progressive valvular stenosis and enables accurate optical recognition in complex blood flow. Here, we develop a valve-adjustable optofluidic bio-imaging recognition platform to fulfill it. Specifically, the bionic valve was designed with in situ soft membrane, and the internal air-pressure chamber could be regulated from the inside out to bio-mimic progressive valvular stenosis. The developed imaging algorithm enhances the recognition of optical details in blood flow imaging and allows for quantitative analysis. In a prospective clinical study, we examined the effect of progressive valvular stenosis on hemodynamics within the typical physiological range of veins by this way, where the inhomogeneity and local enhancement effect in the altered blood flow field were precisely described and the optical differences were quantified. The effectiveness and consistency of the results were further validated through statistical analysis. In addition, we tested it on fluorescence and noticed its good performance in fluorescent tracing of the clotting process. In virtue of theses merits, this system should be able to contribute to mechanism investigation, pharmaceutical development, and therapeutics of valvular stenosis-related diseases.

Space-time-regulated imaging analyzer for smart coagulation diagnosis

The development of intelligent blood coagulation diagnoses is awaited to meet the current need for large clinical time-sensitive caseloads due to its efficient and automated diagnoses. Herein, a method is reported and validated to realize it through artificial intelligence (AI)-assisted optical clotting biophysics (OCB) properties identification. The image differential calculation is used for precise acquisition of OCB properties with elimination of initial differences, and the strategy of space-time regulation allows on-demand space time OCB properties identification and enables diverse blood function diagnoses. The integrated applications of smartphones and cloud computing offer a user-friendly automated analysis for accurate and convenient diagnoses. The prospective assays of clinical cases (n = 41) show that the system realizes 97.6%, 95.1%, and 100% accuracy for coagulation factors, fibrinogen function, and comprehensive blood coagulation diagnoses, respectively. This method should enable more low-cost and convenient diagnoses and provide a path for potential diagnostic-markers finding.

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An ultraportable optofluidic analyzer empowers convenient coagulation diagnoses

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The system enables optical clotting biophysics (OCB) properties acquisition and process

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Coagulation function diagnoses uses intelligent OCB properties identification

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Space-time regulation of OCB properties endow it capability to diverse diagnoses

Topological bio-scaling analysis as a universal measure of protein folding

Scaling relationships for polymeric molecules establish power law dependencies between the number of molecular segments and linear dimensions, such as the radius of gyration. They also establish spatial topological properties of the chains, such as their dimensionality. In the spatial domain, power exponents α = 1 (linear stretched molecule), α = 0.5 (the ideal chain) and α = 0.333 (compact globule) are significant. During folding, the molecule undergoes the transition from the one-dimensional linear to the three-dimensional globular state within a very short time. However, intermediate states with fractional dimensions can be stabilized by modifying the solubility (e.g. by changing the solution temperature). Topological properties, such as dimension, correlate with the interaction energy, and thus by tuning the solubility one can control molecular interaction. We investigate these correlations using the example of a well-studied short model of Trp-cage protein. The radius of gyration is used to estimate the fractal dimension of the chain at different stages of folding. It is expected that the same principle is applicable to much larger molecules and that topological (dimensional) characteristics can provide insights into molecular folding and interactions.

Evaluation of Blood Coagulation by Optical Vortex Tracking

Blood coagulation is a complicated dynamic process that maintains the blood's fluid state and prevents uncontrollable bleeding. The real-time monitoring of coagulation dynamics is critical for blood transfusion guidance, emergency management of trauma-induced coagulopathy, perioperative bleeding, and targeted hemostatic therapy. Here, we utilize optical vortex dynamics to detect the blood coagulation dynamic process in a rapid and non-contact manner. To characterize the temporal changes in viscoelastic properties of blood during coagulation, we track the stochastic motion of optical vortices in the time-varying speckles reflected from 100 blood samples with varied coagulation profiles. The mean square displacement (MSD) of the vortices increases nonlinearly with time lag during blood coagulation reminiscent of the particles in viscoelastic fluids. The MSD curves with coagulation time are similar to the tracings of thromboelastography (TEG) during the blood coagulation. The retrieved coagulation parameters, such as reaction time and activated clotting time measured using the optical vortex method, exhibit a close correlation to those parameters acquired from TEG. These results demonstrate the feasibility of the optical vortex method for monitoring blood coagulation at the point of care. Our method is also applicable to measuring the viscoelasticity of complex fluids and turbid soft matters.

Passive high-frequency microrheology of blood

Indicative of various pathologies, blood properties are under intense scrutiny. The hemorheological characteristics are traditionally gauged by bulk, low-frequency indicators that average out critical information about the complex, multi-scale, and multi-component structure. In particular, one cannot discriminate between the erythrocytes contribution to global rheology and the impact of plasma. Nevertheless, in their fast stochastic movement, before they encounter each other, the erythrocytes probe the subtle viscoelasticity of their protein-rich environment. Thus, if these short time scales can be resolved experimentally, the plasma properties could be determined without having to separate the blood components; the blood is practically testing itself. This microrheological description of blood plasma provides a direct link between the composition of whole blood and its coagulability status. We present a parametric model for the viscoelasticity of plasma, which is probed by the erythrocytes over frequency ranges of kilohertz in a picoliter-sized volume. The model is validated both in vitro, using artificial hemo-systems where the composition is controlled, as well as on whole blood where continuous measurements provide real-time information. We also discuss the possibility of using this passive microrheology as an in vivo assay for clinically relevant situations where the blood clotting condition must be observed and managed continuously for diagnosis or during therapeutic procedures at different stages of hemostatic and thrombotic processes.

Thermal hysteresis in microtubule assembly/disassembly dynamics: The aging-induced degradation of tubulin dimers

The assembly/disassembly of biological macromolecules plays an important role in their biological functionalities. Although the dynamics of tubulin polymers and their super-assembly into microtubule structures is critical for many cellular processes, details of their cyclical polymerization/depolymerization are not fully understood. Here, we use a specially designed light scattering technique to continuously examine the effects of temperature cycling on the process of microtubule assembly/disassembly. We observe a thermal hysteresis loop during tubulin assembly/disassembly, consistently with earlier reports on the coexistence of tubulin and microtubules as a phase transition. In a cyclical process, the structural hysteresis has a kinetic component that depends on the rate of temperature change but also an intrinsic thermodynamic component that depends on the protein topology, possibly related to irreversible processes. Analyzing the evolution of such thermal hysteresis loops over successive cycles, we found that the assembly/disassembly ceases after some time, which is indicative of protein aging leading to its inability to self-assemble after a finite number of temperature cycles. The emergence of assembly-incompetent tubulin could have major consequences for human pathologies related to microtubules, including aging, neurodegenerative diseases and cancer.

Time-of-flight resolved light field fluctuations reveal deep human tissue physiology

Red blood cells (RBCs) transport oxygen to tissues and remove carbon dioxide. Diffuse optical flowmetry (DOF) assesses deep tissue RBC dynamics by measuring coherent fluctuations of multiply scattered near-infrared light intensity. While classical DOF measurements empirically correlate with blood flow, they remain far-removed from light scattering physics and difficult to interpret in layered media. To advance DOF measurements closer to the physics, here we introduce an interferometric technique, surmounting challenges of bulk motion to apply it in awake humans. We reveal two measurement dimensions: optical phase, and time-of-flight (TOF), the latter with 22 picosecond resolution. With this multidimensional data, we directly confirm the unordered, or Brownian, nature of optically probed RBC dynamics typically assumed in classical DOF. We illustrate how incorrect absorption assumptions, anisotropic RBC scattering, and layered tissues may confound classical DOF. By comparison, our direct method enables accurate and comprehensive assessment of blood flow dynamics in humans.

Probing complex dynamics with spatiotemporal coherence-gated DLS

We discuss the specific features of fiber-based implementations of optical sensing techniques based on spatiotemporal coherence-gated dynamic light scattering (DLS). This sensing approach has a number of unique capabilities such as an effective isolation of single scattering, a large sensitivity, and high collection efficiency, and it can also operate over a wide range of optical regimes while providing means for proper ensemble averaging. We review a number of applications in which these specific characteristics permit recovering information beyond the capabilities of traditional light-scattering-based techniques.

Highly parallel, interferometric diffusing wave spectroscopy for monitoring cerebral blood flow dynamics

Light-scattering methods are widely used in soft matter physics and biomedical optics to probe dynamics in turbid media, such as diffusion in colloids or blood flow in biological tissue. These methods typically rely on fluctuations of coherent light intensity, and therefore cannot accommodate more than a few modes per detector. This limitation has hindered efforts to measure deep tissue blood flow with high speed, since weak diffuse light fluxes, together with low single-mode fiber throughput, result in low photon count rates. To solve this, we introduce multimode fiber (MMF) interferometry to the field of diffuse optics. In doing so, we transform a standard complementary metal-oxide-semiconductor (CMOS) camera into a sensitive detector array for weak light fluxes that probe deep in biological tissue. Specifically, we build a novel CMOS-based, multimode interferometric diffusing wave spectroscopy (iDWS) system and show that it can measure ∼20 speckles simultaneously near the shot noise limit, acting essentially as ∼20 independent photon-counting channels. We develop a matrix formalism, based on MMF mode field solutions and detector geometry, to predict both coherence and speckle number in iDWS. After validation in liquid phantoms, we demonstrate iDWS pulsatile blood flow measurements at 2.5 cm source-detector separation in the adult human brain in vivo. By achieving highly sensitive and parallel measurements of coherent light fluctuations with a CMOS camera, this work promises to enhance performance and reduce cost of diffuse optical instruments.

Characterizing Viscoelastic Modulations in Biopolymer Hydrogels by Coherence-Gated Light Scattering

pH-responsive hydrogels are of great interest for the controlled release of drugs. However, the changes in the structural and mechanical properties of hydrogels during the pH-responsive swelling/contraction process remains largely unknown. In this article, we demonstrate that coherence-gated dynamic light scattering can be used to in situ characterize the structural dynamics of chitosan (CS) hydrogels at different pH values and show that the CS hydrogels undergo viscoelastic modulations during the swelling/contraction/recovery process induced by pH changes. The conditions for the CS hydrogels to undergo these modulations are found by continuously monitoring the nonequilibrium, long-term dynamical process. Our findings are in a close correspondence to the macroscopic observations made at time points where the CS hydrogels are at equilibrium.