Browsing by Subject "Diagnosis"
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Item Open Access Acoustofluidic Manipulation for Diagnosis and Drug Loading(2021) Wang, ZeyuShowing increased application in biological and medical fields, acoustofluidics is a combined technology between acoustics and microfluidics. The core function of acoustofluidics is a label-free and contact-free manipulation of particles in the fluid, which can be applied as active separation, active mixing, and active concentration. Since in therapeutic and diagnostic applications, contamination in the samples can significantly interference analysis results and treatment outcome, proper per-screening of the sample can significantly decrease the target detection threshold and avoiding interferences come from noise and misreading. The acoustofluidic technology derive a particle manipulation based on physical properties of the particles and fluids, specifically, the size of the particle, densities for the particles and fluid, and the viscosity of the fluid, which generate a screening system that can separate particles with different sizes and densities. By utilizing this property, acoustofluidics has been applied on separating multiple biological particles and objects including circulating cancer cells, red blood cells, and multiple populations of vesicles. These reagent-free and contact-free separations have been demonstrated biocompatible for cells and vesicles and can conserve the cell viabilities and vesicle cargoes including DNA, miRNA, and proteins. However, current achievements on acoustofluidic manipulation focus on general analysis of the separated components, which are not disease specific biomarkers, and the body fluid using for separation are limited to blood and artificial isotonic solutions including phosphate-buffered saline. Although these works demonstrated acoustofluidic technology is eligible for separating bio-particles that have diagnosis and therapeutic functions, lack of real cases related applications and diseases specific investigations still make the technology’s application abilities being restricted to possibilities but not promised functions. To deeply investigate and demonstrate the acoustofluidic technology’s potential on diagnostic application, the technology was evaluated by using samples related with multiple specific diseases. Since the acoustofluidic technology has been demonstrated eligible for isolating exosomes, which are 50-200 nm vesicles secreted from cells, pathology related exosomes were selected for diagnostic application investigation. Exosomes’ vesicle structures make them ideal candidate for diagnosis, since vesicles formed by lipid bilayer membrane contain both proteins or nucleic acids as cargoes inside and transmembrane or membrane proteins and polysaccharides on the surface. Furthermore, the forming and secreting pathologies of exosomes are highly dependent on endocytosis and exocytosis pathologies, which are influenced by cellular metabolism. Exosomes’ cargoes have been found specifically correlated with secreting cells populations, indicates depending on types of cells, like tumor cells or stem cells, the secreted exosomes will contain different molecules that can be used as biomarkers for reversed identifying secreting cells. Except high values on biological and medical research and applications, exosomes’ small size makes the vesicles difficult for isolation and increase the cost on both equipment and time aspects. Since acoustofluidics provides an active approach for separating nanometer sized particles and the isolation is a continuous procedure, the simple and rapid exosome isolation the acoustofluidics can provide makes the technology high valuable. Considering these improvements, the acoustofluidics can provide on exosome related fields, demonstrating acoustofluidic devices separated exosomes containing disease biomarkers and could be used for diagnostic applications become a necessary step for validating the technology’s ability. In this dissertation, the first attempt for validating acoustofluidic exosome separation’s diagnostic potential was made for isolating salivary exosomes aimed at human papillomavirus (HPV) induced oropharyngeal cancer diagnosis. Different with previous research that worked on blood exosome separation, a unique property of this study is achieving exosome separation from saliva, which is a more unstable system on components and physical properties than blood. By isolating salivary exosome using the acoustofluidic technology and processing down-stream digital droplet polymerase chain reaction (PCR) analysis, HPV-16 virus, which has been found can induce oropharyngeal cancer, was found majorly distributed in isolated exosome fractions. Since saliva has complex components that cause inaccuracy analysis result, the application of acoustofluidic technology can increase the diagnostic sensitive and enable saliva based liquid biopsy for early screening of oropharyngeal cancer. In the next work, we further demonstrate the acoustofluidic technology’s advantage on rapid isolation of exosomes benefits the time sensitive diagnosis. The acoustofluidic devices were applied for isolating exosomes from mice models that were induced to traumatic brain injury (TBI), which can develop to chronic diseases or deteriorate in short term. Since these outcomes induced by improper or untimely treatments, fast screening of TBI becomes critical for achieving ideal therapeutic outcomes. By collecting plasma from mice and deriving exosome isolation through the acoustofluidics devices, isolated exosome samples with less contamination were found compared with original plasma. Protein analysis further indicates isolated exosomes keeps several exosome specific and neuron damage specific proteins, indicates the acoustofluidic technology is biocompatible and low harmful for exosome structures and components. High isolation purity achieved by the acoustofluidic technology also benefits downstream analysis by decreasing detection noise. In flow cytometer analysis, the acoustofluidic devices isolated exosomes demonstrated TBI disease biomarker increasing in 24 h after the mice were induced to TBI, while the plasma sample cannot demonstrate this tendency. The success of revealing early stage TBI biomarker changes indicates the acoustofluidic technology not only can benefit diagnosis, but also eligible for achieving diagnosis in a very early stage of the pathology. Since the acoustofluidic technology had demonstrated a promising performance on biocompatibility and rapid separation, other time-sensitive samples, including live virus was applied for evaluating the device’s performance. To achieve better control and eliminate irrelevant variable, we use cultured reverse transcription virus that is used for mammal cells transfection as target for isolation. The acoustofluidic technology showed reliable isolation of the murine leukemia virus and majority of the virus particles were separated out from the original sample. Virus viability was further validated robust based on the transfection experiments that using acoustofluidic separated virus and original virus samples demonstrated similar level transfection rates. This work indicates except vesicles like exosomes, the acoustofluidic technology is also eligible for isolating virus and keeping its viability, which significantly expands the application of the technology. Next, to expend the acoustofluidic technology’s functions, we utilized the concentration and manipulation ability of the device for deriving high efficiency membrane degradation. By generating strong microstreaming and microstreaming derived shear stress, the acoustofluidic devices can generate strong vertex flow fields in channel that can capture and lyse mammal cells. Since the acoustofluidic cell lysis is totally a physical process without participation of any chemical reagent and demonstrates a high lysis efficiency, this acoustofluidics application has potential for achieving high efficiency cell analysis. Since the acoustofluidic technology has demonstrated potential for concentration and lysis effect by generating high flow rate microstreaming vertex, we further investigated whether similar effect can derive exosome concentration and lysis. By generating acoustofluidic vertex in droplet containing exosome, nanoparticles, and small molecule drugs, exosome concentration and lysis effects were utilized for high efficiency drug loading and carrier encapsulation. Derived by the acoustofluidic concentration effect, the porous nanoparticles and drug molecules are concentrated in small area of the fluid system and this active concentration increasing induces a high drug loading rate. Simultaneously, the acoustofluidic vertex disrupts exosome membrane and concentrates exosomes with the nanoparticles, which induces exosome encapsulation. These exosome encapsulated drug-loaded nanoparticles demonstrate high intake rate of cells and derive more efficient drug delivery rate. Since the drug loading and exosome encapsulation are physical processes, the acoustofluidic technology derived particle manipulation has potential for deriving loading and encapsulation for large varieties of drugs, particles, and vesicles, which significantly expand the technology’s application.
Item Open Access Chronic hypersensitivity pneumonitis in the southeastern United States: an assessment of how clinicians reached the diagnosis.(BMC pulmonary medicine, 2020-02-05) Gu, Jessie P; Tsai, Chen-Liang; Wysham, Nicholas G; Huang, Yuh-Chin TBACKGROUND:Chronic hypersensitivity pneumonitis (cHP) is a disease caused by exposure to inhaled environmental antigens. Diagnosis of cHP is influenced by the awareness of the disease prevalence, which varies significantly in different regions, and how clinicians utilize relevant clinical information. We conducted a retrospective study to evaluate how clinicians in the Southeast United States, where the climate is humid favoring mold growth, diagnosed cHP using items identified in the international modified Delphi survey of experts, i.e., environmental exposure, CT imaging and lung pathology, METHODS: We searched Duke University Medical Center database for patients over the age of 18 with a diagnosis of cHP (ICD-9 code: 495) between Jan. 1, 2008 to Dec. 31, 2013 using a query tool, Duke Enterprise Data Unified Content Explorer (DEDUCE). RESULTS:Five hundred patients were identified and 261 patients had cHP confirmed in clinic notes by a pulmonologist or an allergist. About half of the patients lived in the Research Triangle area where our medical center is located, giving an estimated prevalence rate of 6.5 per 100,000 persons. An exposure source was mentioned in 69.3% of the patient. The most common exposure sources were environmental molds (43.1%) and birds (26.0%). We used Venn diagram to evaluate how the patients met the three most common cHP diagnostic criteria: evidence of environmental exposures (history or precipitin) (E), chest CT imaging (C) and pathology from lung biopsies (P). Eighteen patients (6.9%) met none of three criteria. Of the remaining 243 patients, 135 patients (55.6%) had one (E 35.0%, C 3.3%, P 17.3%), 81 patients (33.3%) had two (E + C 12.3%, E + P 17.3%, C + P 4.9%), and 27 patients (11.1%) had all three criteria (E + C + P). Overall, 49.4% of patients had pathology from lung biopsy compared to 31.6% with CT scan. CONCLUSIONS:Environmental mold was the most common exposure for cHP in the Southeast United States. Lung pathology was available in more than half of cHP cases in our tertiary care center, perhaps reflecting the complexity of referrals. Differences in exposure sources and referral patterns should be considered in devising future diagnostic pathways or guidelines for cHP.Item Open Access How to diagnose cervicogenic dizziness.(Archives of physiotherapy, 2017-01) Reiley, Alexander S; Vickory, Frank M; Funderburg, Sarah E; Cesario, Rachel A; Clendaniel, Richard ACervicogenic dizziness (CGD) is a clinical syndrome characterized by the presence of dizziness and associated neck pain. There are no definitive clinical or laboratory tests for CGD and therefore CGD is a diagnosis of exclusion. It can be difficult for healthcare professionals to differentiate CGD from other vestibular, medical and vascular disorders that cause dizziness, requiring a high level of skill and a thorough understanding of the proper tests and measures to accurately rule in or rule out competing diagnoses. Consequently, the purpose of this paper is to provide a systematic diagnostic approach to enable healthcare providers to accurately diagnose CGD. This narrative will outline a stepwise process for evaluating patients who may have CGD and provide steps to exclude diagnoses that can present with symptoms similar to those seen in CGD, including central and peripheral vestibular disorders, vestibular migraine, labyrinthine concussion, cervical arterial dysfunction, and whiplash associated disorder.Item Open Access Knowledge-Driven Board-Level Functional Fault Diagnosis(2014) Ye, FangmingThe semiconductor industry continues to relentlessly advance silicon technology scaling into the deep-submicron (DSM) era. High integration levels and structured design methods enable complex systems that can be manufactured in high volume. However, due to increasing integration densities and high operating speeds, subtle manifestation of defects leads to functional failures at the board level. Functional fault diagnosis is, therefore, necessary for board-level product qualification. However, ambiguous diagnosis results can lead to long debug times and wrong repair actions, which significantly increase repair cost and adversely impact yield.
A state-of-the-art diagnosis system involves several key components: (1) design of functional test programs, (2) collection of functional-failure syndromes, (3) building of the diagnosis engine, (4) isolation of root causes, and (5) evaluation of the diagnosis engine. Advances in each of these components can pave the way for a more effective diagnosis system, thus improving diagnosis accuracy and reducing diagnosis time. Machine-learning techniques offer an unprecedented opportunity to develop an automated and adaptive diagnosis system to increase diagnosis accuracy and speed. This dissertation targets all the above components of an advanced diagnosis system by leveraging various machine-learning techniques.
This thesis first describes a diagnosis system based on support-vector machines (SVMs), multi-kernel SVMs (MK-SVMs) and incremental learning. The MK-SVM method leverages a linear combination of single kernels to achieve accurate root-cause isolation. The MK-SVMs thus generated also can be updated based on incremental learning. Furthermore, a data-fusion technique, namely majority-weighted voting, is used to leverage multiple learning techniques for diagnosis.
The diagnosis time is considerable for complex boards due to the large number of syndromes that must be used to ensure diagnostic accuracy. Syndrome collection and analysis are major bottlenecks in state-of-the-art diagnosis procedures. Therefore, this thesis describes an adaptive diagnosis method based on decision trees (DT). The number of syndromes required for diagnosis can be significantly reduced compared to the number of syndromes used for system training. Furthermore, an incremental version of DTs is used to facilitate online learning, so as to bridge the knowledge obtained at test-design stage with the knowledge gained during volume production.
This dissertation also includes an evaluation and enhancement framework based on information theory for guiding diagnosis systems using syndrome and root-cause analysis. Syndrome analysis based on subset selection provides a representative set of syndromes. Root-cause analysis measures the discriminative ability of differentiating a given root cause from others. The metrics obtained from the proposed framework can provide guidelines for test redesign to enhance diagnosis. In addition, traditional diagnosis systems fail to provide appropriate repair suggestions when the diagnostic logs are fragmented and some syndromes are not available. The feature of handling missing syndromes based on imputation methods has therefore been added to the diagnosis system.
Finally, to tackle the bottleneck of data acquisition during the initial product ramp-up phase, a knowledge-discovery method and a knowledge-transfer method are proposed for enriching the training data set, thus facilitating board-level functional fault diagnosis. In summary, this dissertation targets the realization of an automated diagnosis system with the features of high accuracy, low diagnosis time, self-evaluation, self-learning, and ability of selective learning from other diagnosis systems. Machine learning and information-theoretic techniques have been adopted to enable the above-listed features. The proposed diagnosis system is expected to contribute to quality assurance, accelerated product release, and manufacturing-cost reduction in the semiconductor industry.
Item Open Access The Project Baseline Health Study: a step towards a broader mission to map human health.(NPJ digital medicine, 2020-01) Arges, Kristine; Assimes, Themistocles; Bajaj, Vikram; Balu, Suresh; Bashir, Mustafa R; Beskow, Laura; Blanco, Rosalia; Califf, Robert; Campbell, Paul; Carin, Larry; Christian, Victoria; Cousins, Scott; Das, Millie; Dockery, Marie; Douglas, Pamela S; Dunham, Ashley; Eckstrand, Julie; Fleischmann, Dominik; Ford, Emily; Fraulo, Elizabeth; French, John; Gambhir, Sanjiv S; Ginsburg, Geoffrey S; Green, Robert C; Haddad, Francois; Hernandez, Adrian; Hernandez, John; Huang, Erich S; Jaffe, Glenn; King, Daniel; Koweek, Lynne H; Langlotz, Curtis; Liao, Yaping J; Mahaffey, Kenneth W; Marcom, Kelly; Marks, William J; Maron, David; McCabe, Reid; McCall, Shannon; McCue, Rebecca; Mega, Jessica; Miller, David; Muhlbaier, Lawrence H; Munshi, Rajan; Newby, L Kristin; Pak-Harvey, Ezra; Patrick-Lake, Bray; Pencina, Michael; Peterson, Eric D; Rodriguez, Fatima; Shore, Scarlet; Shah, Svati; Shipes, Steven; Sledge, George; Spielman, Susie; Spitler, Ryan; Schaack, Terry; Swamy, Geeta; Willemink, Martin J; Wong, Charlene AThe Project Baseline Health Study (PBHS) was launched to map human health through a comprehensive understanding of both the health of an individual and how it relates to the broader population. The study will contribute to the creation of a biomedical information system that accounts for the highly complex interplay of biological, behavioral, environmental, and social systems. The PBHS is a prospective, multicenter, longitudinal cohort study that aims to enroll thousands of participants with diverse backgrounds who are representative of the entire health spectrum. Enrolled participants will be evaluated serially using clinical, molecular, imaging, sensor, self-reported, behavioral, psychological, environmental, and other health-related measurements. An initial deeply phenotyped cohort will inform the development of a large, expanded virtual cohort. The PBHS will contribute to precision health and medicine by integrating state of the art testing, longitudinal monitoring and participant engagement, and by contributing to the development of an improved platform for data sharing and analysis.Item Open Access Validation of a host response test to distinguish bacterial and viral respiratory infection.(EBioMedicine, 2019-10-17) Lydon, Emily C; Henao, Ricardo; Burke, Thomas W; Aydin, Mert; Nicholson, Bradly P; Glickman, Seth W; Fowler, Vance G; Quackenbush, Eugenia B; Cairns, Charles B; Kingsmore, Stephen F; Jaehne, Anja K; Rivers, Emanuel P; Langley, Raymond J; Petzold, Elizabeth; Ko, Emily R; McClain, Micah T; Ginsburg, Geoffrey S; Woods, Christopher W; Tsalik, Ephraim LBACKGROUND:Distinguishing bacterial and viral respiratory infections is challenging. Novel diagnostics based on differential host gene expression patterns are promising but have not been translated to a clinical platform nor extensively tested. Here, we validate a microarray-derived host response signature and explore performance in microbiology-negative and coinfection cases. METHODS:Subjects with acute respiratory illness were enrolled in participating emergency departments. Reference standard was an adjudicated diagnosis of bacterial infection, viral infection, both, or neither. An 87-transcript signature for distinguishing bacterial, viral, and noninfectious illness was measured from peripheral blood using RT-PCR. Performance characteristics were evaluated in subjects with confirmed bacterial, viral, or noninfectious illness. Subjects with bacterial-viral coinfection and microbiologically-negative suspected bacterial infection were also evaluated. Performance was compared to procalcitonin. FINDINGS:151 subjects with microbiologically confirmed, single-etiology illness were tested, yielding AUROCs 0•85-0•89 for bacterial, viral, and noninfectious illness. Accuracy was similar to procalcitonin (88% vs 83%, p = 0•23) for bacterial vs. non-bacterial infection. Whereas procalcitonin cannot distinguish viral from non-infectious illness, the RT-PCR test had 81% accuracy in making this determination. Bacterial-viral coinfection was subdivided. Among 19 subjects with bacterial superinfection, the RT-PCR test identified 95% as bacterial, compared to 68% with procalcitonin (p = 0•13). Among 12 subjects with bacterial infection superimposed on chronic viral infection, the RT-PCR test identified 83% as bacterial, identical to procalcitonin. 39 subjects had suspected bacterial infection; the RT-PCR test identified bacterial infection more frequently than procalcitonin (82% vs 64%, p = 0•02). INTERPRETATION:The RT-PCR test offered similar diagnostic performance to procalcitonin in some subgroups but offered better discrimination in others such as viral vs. non-infectious illness and bacterial/viral coinfection. Gene expression-based tests could impact decision-making for acute respiratory illness as well as a growing number of other infectious and non-infectious diseases.