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Duncan Graham opened a general discussion of the paper by Pavel Matousek: Regarding the temperature measurements, how did you do them? Stokes/anti-Stokes measurement? The values are not what I'd expect and seem lower. What was the wavelength and power of the laser and did you calculate what you thought the temperature measurement should be based on that? How far does the temperature gradient reach? The scattering absorption ration changes with nanoparticle size and composition. Have you thought about using more highly absorbing nanoparticles such as hollow gold nanoshells?

This translational research evaluates a novel, custom-built Raman probe for potential application as an in vivo diagnostic tool in the oesophagus. Raman spectroscopy (RS) is a well established analytical technique which is capable of probing the biochemical changes associated with neoplastic progression in oesophageal tissue. RS relies on measurement of subtle inelastic scattering signals following monochromatic laser excitation. Clinical utilisation of RS within hollow organs requires accurate collection and transmission of signal through fibre-optic cables. This research aims to evaluate the ability of a custom built fibre-optic Raman probe, in conjunction with multivariate classification models, to differentiate between benign and neoplastic oesophageal pathologies ex vivo. The need for spectral stability and reproducibility are addressed, as are difficulties associated with multisystem reliability. In addition, the biochemical basis of spectral classification is evaluated and discussed. Cont/d.

This study has involved the analysis of volatile fingerprints using a hybrid electronic nose (e-nose) to discriminate between and diagnose the microorganisms which cause ventilator–associated pneumonia (VAP), one of the most important infections in the hospital environment. This infection occurs in hospitalised patients with 48-72 hrs of mechanical ventilation. VAP diagnostics still remains a problem due to the lack of a precise diagnostic tool. The current tests are mostly based on quantitative cultures of samples from the lower lung airways with clinical findings, which do not often result in accurate diagnoses of the disease. Cont/d.

Ventilator associated pneumonia (VAP) is a significant challenge for the Intensive Care doctors worldwide. It is both difficult to diagnose accurately and quickly and to treat effectively once the diagnosis has been established. Current diagnostic microbiological methods of diagnosis can take up to 48 hours to yield results. Early diagnosis and treatment remain the best way of improving outcome for patients with VAP. In this study we look at novel diagnostic techniques for VAP. Electronic nose (Enose) technology was used to identify to identify the presence of microorganisms in bronchoalveolar lavage (BAL) fluid samples taken from the respiratory tracts of ventilated patients. The results were compared with standard microbiological culture and sensitivities. The Enose was able to discriminate 83% of samples into growth or no growth groups on samples grown in the lab. When the technique was employed to samples taken directly from patients the accuracy fell to 68.2%. This suggests that patient related factors may be reducing the accuracy of the Enose classification. The use of antimicrobial drugs prior to patient sampling is likely to have played a major role. The second part of this study used Gas Chromatography-Mass Spectrometry (GC-MS) analysis of patient’s breath in an attempt to identify patients with VAP. Breath samples were taken at the same time as the bronchoalveolar lavage samples described above. The use of this technique did show differences between the breath samples of patients who did not have any microbiological growth from their BAL samples and those that did. Leave one out cross validation of a PC fed LDA model showed 84% correct classification between healthy volunteers, no growth and growth groups. Finally, we evaluated the Breathotron, which is a breath analysis device designed and built at Cranfield Health. It allows for analysis of breath samples using a single sensor system as opposed to a sensor array employed in traditional Enose devices. This allows it to be more portable and cheaper to build. The Breathotron also allows collection of breath onto sorbent cartridges for GC-MS analysis. Its single sensor did not allow for accurate discrimination between samples.

Raman spectroscopy is a technique that utilises inelastic scattering processes to provide a biochemical fingerprint that has been shown to successfully discriminate oesophageal pathologies. The aim of this study was to develop Raman spectroscopy as a clinical tool; both in vivo for ‘targeted biopsy’, and in ex vivo for ‘automated histopathology’. Two different Raman probes were evaluated and compared and tissue classification models generated ex vivo. A preliminary classification model of a novel single collection fibre probe demonstrated potential for the probe design. Both probes were shown to discriminate three different oesophageal pathology groups. A cross-validated tissue classification model (88 samples) discriminated normal, Barrett’s and neoplasia with an overall accuracy of 86.5% with a sensitivity of 83.3-89.5% and specificity of 89.2-97.1%. A novel rapid Raman mapping technique was evaluated. It was shown that sufficient biochemical information for pathology diagnosis could be extracted from low signal to noise ratio data using multivariate analysis providing the dataset was sufficiently large, thus demonstrating the feasibility of automated histopathology in a clinically realistic time frame. Furthermore, it was demonstrated that high spatial resolution imaging was not necessarily required for automated histopathology using novel interpretation of multivariate techniques. A tissue classification model generated from two rapid Raman maps containing separated substrate, normal, HGD, luminescence and fibrous connective tissue with an overall training performance of 97.5% Problems limiting clinical implementation of Raman techniques were investigated and methods of overcoming devised.