The emerging field of bionanotechnology aims at revolutionizing biomedical research and clinical practice via introduction of nanoparticle-based tools, expanding capabilities of existing investigative, diagnostic, and therapeutic techniques as well as creating novel instruments and approaches for addressing challenges faced by medicine. Quantum dots (QDs), semiconductor nanoparticles with unique photo-physical properties, have become one of the dominant classes of imaging probes as well as universal platforms for engineering of multifunctional nanodevices. Possessing versatile surface chemistry and superior optical features, QDs have found initial use in a variety of in vitro and in vivo applications. However, careful engineering of QD probes guided by application-specific design criteria is becoming increasingly important for successful transition of this technology from proof-of-concept studies towards real-life clinical applications. This review outlines the major design principles and criteria, from general ones to application-specific, governing the engineering of novel QD probes satisfying the increasing demands and requirements of nanomedicine and discusses the future directions of QD-focused bionanotechnology research (critical review, 201 references).

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Hypothesis: Early risk factors for hepatic-related morbidity in patients undergoing initial nonoperative management of complex blunt hepatic injuries can be accurately identified.Design: Multicenter historical cohort.Setting: Seven urban level I trauma centers.Patients: Patients from January 2000 through May 2003 with complex (grades 3-5) blunt hepatic injuries not requiring laparotomy in the first 24 hours. Intervention: Nonoperative treatment of complex blunt hepatic injuries.Main Outcome Measures: Complications and treatment strategies.Results: Of 699 patients with complex blunt hepatic injuries, 453 (65%) were treated nonoperatively. Overall, 61 patients (13%) developed 87 hepatic complications including bleeding (38), biliary (bile peritonitis, 7; bile leak, 9; biloma, 11; biliary-venous fistula, 1; and bile duct injury, 1), abdominal compartment syndrome (5), and infections (abscess, 7; necrosis, 2; and suspected abdominal sepsis, 6), which required 86 multimodality treatments (angioembolization, 32; endoscopic retrograde cholangiopancreatography and stenting, 9; interventional radiology drainage, 16; paracentesis, 1; laparotomy, 24; and laparoscopy, 4). Hepatic complications developed in 5% (13 of 264) of patients with grade 3 injuries, 22% (36 of 166) of patients with grade 4 injuries, and 52% (12 of 23) of patients with grade 5 injuries. Univariate analysis revealed 24-hour crystalloid, total and first 24-hour packed red blood cells, fresh frozen plasma, platelet, and cryoprecipitate requirements and liver injury grade to be significant but only liver injury grade (grade 4 odds ratio, 4.439; grade 5 odds ratio, 12.001) and 24-hour transfusion requirement (odds ratio, 6.446) predicted complications by multivariable analysis.Conclusions: Nonoperative management of high-grade liver injuries is associated with significant morbidity and correlates with grade of liver injury. Screening patients with transfusion requirements and high-grade injuries may result in earlier diagnosis and treatment of hepatic-related complications.

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PURPOSE Multiple equations exist for predicting resting energy expenditure (REE). The accuracy of these for estimating caloric requirements of critically ill patients is not clear, especially for obese patients. We sought to compare REE, calculated with published formulas, with measured REE in a cohort of mechanically-ventilated subjects. MATERIALS AND METHODS We retrospectively identified all mechanically-ventilated patients with measured body mass index (BMI) who underwent indirect calorimetry (IC) in the ICU. Limits of agreement and Pitman’s test of difference in variance were performed to compare REE by equations with REE measured by IC. RESULTS 927 patients were identified, including 401 obese patients. There was bias and poor agreement between measured REE and REE predicted by the Harris-Benedict, Owen, ACCP, and Mifflin equations (p > 0.05). There was poor agreement between measured and predicted REE by the Ireton-Jones equation, stratifying by gender. Ireton-Jones was the only equation which was unbiased, for men and those in weight categories I and II. In all cases except Ireton-Jones, predictive equations underestimated measured REE. CONCLUSION None of these equations accurately estimated measured REE in this group of mechanically-ventilated patients, most underestimating caloric needs. Development of improved predictive equations for adequate assessment of energy needs is needed.

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Neurosurgeons prefer more liberal transfusion of TBI patients than TS and CC, suggesting that actual practice may depend largely on which specialist is primarily managing care. The observed clinical equipoise would justify a randomized trial of liberal versus restrictive transfusion strategies in patients with TBI.