<p>Miniaturization of technologies to milli-, micro- and nanoscale offers numerous advantages for diagnostic and therapeutic biomedical applications. In comparison to their macro-scale counterparts, these small-scale systems are more portable, less invasive and less costly. They can facilitate rapid, sensitive and high throughput detection of abnormalities, help track disease progression, reduce sample consumption and improve therapeutic efficacy of drug delivery while decreasing systemic toxicity. Thus, there is clearly a need for creating innovative milli-, micro- and nanoscale tools that can uncover new possibilities in detection and treatment of various types of diseases. The overall objective of this dissertation was to develop novel small-scale technologies that could help enhance diagnostic and/or therapeutic outcomes in patients with cancer, opioid addiction and inflammatory bowel disease. First, we developed an echogenically stable nanodroplet ultrasound contrast agent with potential applications in extravascular molecular imaging of tumors and targeted cancer therapies. Then, we created a polymer blend microsphere system that could be integrated in prescription opioid tablets to develop an abuse-deterrent formulation against smoking. Finally, we designed a release system for localized delivery of aminosalicylates from magnetically actuated millirobots in the colon to improve therapeutic outcomes in patients suffering from inflammatory bowel disease. Overall, the technologies we developed could serve as a basis for designing diagnostic and therapeutic tools that are superior to currently existing platforms.</p>

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Contactless ultrasonic power transfer (UPT), using piezoelectric transducers, is based on transferring energy using acoustic waves, in which the waves are generated by an acoustic source or transmitter and then transferred through an acoustic medium such as water or human tissue to a sensor or receiver. The receiver then converts the mechanical strain induced by the incident acoustic waves to electricity and delivers to an electrical load, in which the electrical power output of the system can be determined. The execution and efficiency of this technology can be significantly enhanced through patterning, focusing, and localization of the transmitted acoustic energy in space to simultaneously power pre-determined distributed sensors or devices. A passive 3D-printed acoustic hologram plate alongside a single transducer can generate arbitrary and pre-designed ultrasound fields in a particular distance from the hologram mounted on the transmitter, i.e., a target plane. This dissertation presents the use of these simple, cost-effective, and high-fidelity acoustic holograms in UPT systems to selectively enhance and pattern the electrical power output from the receivers. Different holograms are numerically designed to create single and multi-focal pressure patterns in a target plane where an array of receivers are placed. The incident sound wave from a transmitter, after passing through the hologram, is manipulated, hence, the output field is the desired pressure field, which excites the receivers located at the pre-determined focal points more significantly. Furthermore, multi-functional holograms are designed to generate multiple images at different target planes and driving frequencies, called, respectively, multi-image-plane and multi-frequency patterning holograms. The multiple desired pressure distributions are encoded on the single hologram plate and each is reconstructed by changing the axial distance and by switching the frequency. Several proof-of-concept experiments are performed to verify the functionality of the computationally designed holograms, which are fabricated using modern 3D-printers, i.e., the desired wavefronts are encoded in the hologram plates' thickness profile, being input to the 3D-printer. The experiments include measurement of output pressure fields in water using needle hydrophones and acquisition of receivers' voltage output in UPT systems. Another technique investigated in this dissertation is the implementation of acoustic impedance matching layers deposited on the front leading surface of the transmitter and receiver transducers. Current UPT systems suffer from significant acoustic losses through the transmission line from a piezoelectric transmitter to an acoustic medium and then to a piezoelectric receiver. This is due to the unfavorable acoustic impedance mismatch between the transducers and the medium, which causes a narrow transducer bandwidth and a considerable reflection of the acoustic pressure waves at the boundary layers. Using matching layers enhance the acoustic power transmission into the medium and then reinforce the input as an excitation into the receiver. Experiments are performed to identify the input acoustic pressure from a cylindrical transmitter to a receiver disk operating in the 33-mode of piezoelectricity. Significant enhancements are obtained in terms of the receiver's electrical power output when implementing a two-layer matching structure. A design platform is also developed that can facilitate the construction of high-fidelity acoustically matched transducers, that is, the material layers' selection and determination of their thicknesses. Furthermore, this dissertation presents a numerical analysis for the dynamical motions of a high-intensity focused ultrasound (HIFU)-excited microbubble or stable acoustic cavitation, which includes the effects of acoustic nonlinearity, diffraction, and absorption of the medium, and entails the problem of several biomedical ultrasound applications. Finally, the design and use of acoustic holograms in microfluidic channels are addressed which opens the door of acoustic patterning in particle and cell sorting for medical ultrasound systems. / Doctor of Philosophy / This dissertation presents several techniques to enhance the wireless transfer of ultrasonic energy in which the sound wave is generated by an acoustic source or transmitter, transferred through an acoustic medium such as water or human tissue to a sensor or receiver. The receiver transducer then converts the vibrational energy into electricity and delivers to an electrical load in which the electrical power output from the system can be determined. The first enhancement technique presented in this dissertation is using a pre-designed and simple structured plate called an acoustic hologram in conjunction with a transmitter transducer to arbitrarily pattern and shape ultrasound fields at a particular distance from the hologram mounted on the transmitter. The desired wavefront such as single or multi-focal pressure fields or an arbitrary image such as a VT image pattern can simply be encoded in the thickness profile of this hologram plate by removing some of the hologram material based on the desired shape. When the sound wave from the transmitter passes this structured plate, it is locally delayed in proportion to the hologram thickness due to the different speed of sound in the hologram material compared to water. In this dissertation, various hologram types are designed numerically to implement in the ultrasonic power transfer (UPT) systems for powering receivers located at the predetermined focal points more significantly and finally, their functionality and performances are verified in several experiments. Current UPT systems suffer from significant acoustic losses through the transmission from a transmitter to an acoustic medium and then to a receiver due to the different acoustic impedance (defined as the product of density and sound speed) between the medium and transducers material, which reflects most of the incident pressure wave at the boundary layers. The second enhancement technology addressed in this dissertation is using intermediate materials, called acoustic impedance matching layers, bonded to the front side of the transmitter and receiver face to alleviate the acoustic impedance mismatch. Experiments are performed to identify the input acoustic pressure from a transmitter to a receiver. Using a two-layer matching structure, significant enhancements are observed in terms of the receiver's electrical power output. A design platform is also developed that can facilitate the construction of high-fidelity acoustically matched transducers, that is, the material layers' selection and determination of their thicknesses. Furthermore, this dissertation presents a numerical analysis for the dynamical motions of a microbubble exposed to a high-intensity focused ultrasound (HIFU) field, which entails the problem of several biomedical ultrasound applications such as microbubble-mediated ultrasound therapy or targeted drug delivery. Finally, an enhancement technique involving the design and use of acoustic holograms in microfluidic channels is addressed which opens the door of acoustic patterning in particle and cell sorting for medical ultrasound systems.

Plusieurs types cancéreux prolifèrent par leur capacité à exprimer les marqueurs de régulation négative du système immunitaire, tels que les récepteurs PD-L1 et CD80/86 qui inhibent l’activation et la prolifération des lymphocytes T. L’inhibition de ces voies par des anticorps peut ainsi réactiver la réponse immunitaire chez certains patients. D’autres voies de signalisations sont aujourd’hui explorées, incluant la signalisation purinergique (ATP/adénosine) dans la modulation du microenvironnement tumoral. L’adénosine triphosphate extracellulaire (ATPe) est classifiée parmi les molécules de danger extracellulaire et joue un rôle crucial dans l’activation de l’inflammasome NLRP3, un médiateur important de l’activation des réactions pro-inflammatoires. Les ultrasons sont des ondes mécaniques de haute pression capable d’engendrer la cavitation inertielle des microbulles. Il a été démontré que les microbulles (MB) stimulées par ultrasons (US) libèrent de l’ATP dans le muscle squelettique et dans le muscle cardiaque. Nous posons l’hypothèse selon laquelle le traitement US+MB appliqué sur une tumeur de cancer du sein murin (4T1) in vivo peut libérer de l’ATPe localement dans le but d’activer des réactions pro-inflammatoires pour l’immunothérapie du cancer. Dans ce mémoire, nous présentons la quantification du signal d’ATPe d’une culture de cellules 4T1, puis in vivo dans le muscle et dans une tumeur solide sous-cutanée chez la souris à la suite d’une stimulation par US+MB. Nos études démontrent que la thérapie US+MB libère de l’ATP in vitro et in vivo. En comparant le signal découlant de l’injection IM d’ATP avec celui du muscle et des tumeurs post-US+MB, nous pouvons conclure que le traitement US+MB libère une quantité d’ATPe supérieure à 250 µM, ce qui est supérieur à la quantité d’ATPe dans un microenvironnement tumoral et qui persiste pour une durée d’au moins 60 min dans le muscle et 45 min dans la tumeur. La transfection stable de cellules MC38 (carcinome colorectal) à travers le gène PLenti-PmeLUC, codant la synthèse de luciférase sur la face externe de la membrane cellulaire, est explorée afin d’augmenter le rapport signal sur bruit en bioluminescence (annexe A). L’utilisation de POM-1 (inhibiteur pharmacologique de CD39) et l’utilisation de souris knockout du gène CD39 sont discutées pour la suite du projet afin d’inhiber la dégradation de l’ATP extracellulaire (Annexe B). / Several cancer types proliferate due to their ability to express the negative regulatory markers of the immune system (PD-L1 and CD80/86) which inhibit the activation and proliferation of T cells. Inhibition of these pathways by antibodies (anti-PDL-1, anti-PD-1, anti-CTLA-4) can thus reactivate the immune system in some patients. Other signaling pathways are currently being explored, including purinergic signaling (ATP/adenosine) in the modulation of the tumor microenvironment. Extracellular Adenosine triphosphate (eATP) is classified as danger signal plays a critical role in the activation of the NLRP3 inflammasome, an important mediator of the innate immune response. Ultrasound (US) and microbubbles (MB) have been shown to release ATP in skeletal and cardiac muscle. Thus, we hypothesized that US+MB treatment in 4T1 breast cancer cells could locally activate pro-inflammatory responses by releasing an eATP in tumors for cancer immunotherapy. In this thesis, I present the quantification of the eATP signal after US+MB stimulation in vitro (4T1 cell culture), then in muscle and subcutaneous solid tumors in the mouse. Our studies demonstrate that US+MB treatment releases ATP both in vitro and in vivo. In comparison with the IM injection of ATP, we can conclude that US+MB released a large amount of ATP (>250 µM), which is more than the eATP concentration in the untreated tumor microenvironment, and which persisted for at least 60 min in muscle and 45 min in tumor. The stable transfection of MC38 cells (colorectal carcinoma) through the Plenti-PmeLUC gene, encoding the synthesis of luciferase on the external surface of cell membrane is explored to increase the signal to noise ratio in bioluminescence (see appendix A). The use of POM-1 (pharmacological inhibitor of CD39) and CD39 gene knockout mice to inhibit the degradation of eATP signal are discussed for the continuation of the project.

Mit dieser Arbeit wurde erstmalig eine qualitative und quantitative Analyse zum Status quo der studentischen US-Ausbildung im deutschsprachigen Raum durchgeführt. Eingeschlossen wurden alle medizinischen Fakultäten (n=44) Deutschlands, Österreichs und der deutschsprachigen Schweiz, die im Dezember 2015 auf den Webseiten des MFT und Thieme.de verzeichnet waren [3, 70]. Ein standardisierter Fragebogen mit insgesamt 32 Fragen beleuchtete folgende Aspekte der studentischen US-Ausbildung: 1. Allgemeine Angaben 2. Organisation 3. Ressourcen 4. Überprüfung des Lernerfolgs 5. Evaluation Der Fragebogen wurde an alle LeiterInnen der jeweiligen fakultätseigenen Skillslabs verschickt mit der Bitte nach Beantwortung bzw. Weiterleitung an die US-Verantwortlichen der Fakultät. Die Befragung begann im Dezember 2015 und endete im Mai 2016. Die finale Rücklaufquote betrug 64% (28/44). Die statistische Auswertung erfolgte mit SPSS® 20, IBM Chicago. Die Mehrzahl der medizinischen Fakultäten im deutschsprachigen Raum bieten US-Kurse an. Allerdings ist die studentische US-Ausbildung vielerorts heterogen organisiert mit eher zu kurzer praktischer Übungszeit und zu hohem Studierenden-Lehrenden-Verhältnis. Damit US als bereicherndes Lehrmittel sinnvoll in das bereits überfüllte Curriculum des Humanmedizinstudiums integriert werden kann, sind minimale Standards notwendig. Basierend auf den Ergebnissen dieser Studie und einer Literaturrecherche schlagen der Autor und die Koautoren ein mögliches Rahmenwerk und Meilensteine auf dem Weg zu einem longitudinalen US-Curriculum im Humanmedizinstudium vor.:A Abkürzungsverzeichnis 3 B Einführung 4 1 Ultraschall als Grundkompetenz zukünftiger ÄrztInnen 4 2 Ultraschall als integraler Bestandteil des Humanmedizinstudiums 7 2.1 Ultraschall als Lehrmethode in der Makroanatomie und Physiologie 7 2.2 Ultraschall als Erweiterung der körperlichen Untersuchung 7 2.3 Wesentliche Inhalte publizierter Ultraschall-Curricula 8 2.4 Peer-Teaching und Studierendeninitiativen 10 2.5 Rahmencurriculum für die studentische Ultraschallausbildung 11 3 Ableitung der Rationale für die publizierte Studie 13 C Originalpublikation 14 1 Allgemeine Angaben 14 2 Skizzierung der publizierten Studie 15 3 Formatierte Originalpublikation 16 D Zusammenfassung 28 1 Hintergrund und Durchführung 28 2 Ergebnisse und Auswertung 29 E Literaturverzeichnis 33 F Anlagen 41 1 Anschreiben 41 2 Fragebogen 42 G Darstellung des eigenen Beitrags 52 H Verzeichnis über die wissenschaftlichen Veröffentlichungen und Vorträge 53 I Lebenslauf 54 J Erklärung über die eigenständige Abfassung der Arbeit 56 K Danksagung 57

This thesis examines the use of nonlinear ultrasound to evaluate sensitization, a precursor to stress corrosion cracking in austenitic stainless steel. Ultrasonic Rayleigh surface waves are generated on a specimen; as these waves pass through sensitized material, second harmonic generation (SHG) increases. In austenitic stainless steel with oven-induced sensitization, this increase is due only to the formation of chromium carbide precipitates, key products of the sensitization process. Weld-induced sensitization specimens demonstrate additional increases in SHG, likely caused by increased residual stress and dislocation density as a result of uneven heating. Experimental data are used to calculate the acoustic nonlinearity parameter, which provides a single value directly related to the quantity of micro- and nano-scale damage present within any given sample. Using this procedure, the effects of weld- and oven-induced sensitization are compared. Results demonstrate the feasibility of using nonlinear Rayleigh waves to detect and monitor stress corrosion susceptibility of welded material.

Master of Science / Department of Animal Sciences and Industry / Twig T. Marston / One hundred ninety-three crossbred steers from two herds were used to determine the association of leptin gene polymorphisms and effects of feedlot management of lean and fat steers on carcass performance. Steers were sorted into FAT and LEAN groups by ultrasound backfat at weaning and randomly assigned to a finishing phase. Steers were assigned to a backgrounding phase (BACK) and were fed a forage-based diet for 90 days or directly entered a feedlot phase (FEED). Genotypes were determined by IGENITY® (Atlanta, GA) for a panel of nine single nucleotide polymorphisms (SNP) in the leptin gene (UASMS1, UASMS2, C963T, E2FB, A1457G, and A252T), leptin receptor (T945M), growth hormone receptor (G200A), and fat metabolism enzyme (K232A). Initial backfat (BF) means for the FAT and LEAN group were 3.4 mm and 1.8 mm, respectively. Mean on-test weight was heavier for FAT (306.5 kg) than LEAN (292.9 kg). Age-adjusted hot carcass weights (HCWT) were heavier for LEAN/BACK when compared to FAT/FEED and FAT/BACK (P<0.05). Dressing percent for the FAT/FEED group tended to be higher (P<0.10) over all groups except LEAN/BACK. Steers that went directly to the feedlot had higher marbling scores than backgrounded groups. FAT/FEED had higher 12th rib BF than the other contemporaries. None of the SNPs were useful for predicting ultrasound BF at weaning. Some association was detected with UASMS2 and HCWT (P<0.10) resulting in an 11 kg difference between genotype CC and CT (P<0.05). Five of the leptin polymorphisms (UASMS1, UASMS2, A1457G, C963T, and E2FB) were associated with adjusted carcass BF (P=0.01, 0.06, 0.01, 0.01, and 0.01, respectively) and calculated yield grade (P<0.01). A252T was associated with REA, and genotype TT was larger than AA and AT (P<0.05). This study suggests that segregation by initial fatness estimates and feedlot management strategies has the opportunity to increase HCWT by 35 kg. Sorting cattle upon feedlot entry by ultrasound BF and segregation using genetic markers are useful tools that can assist in the estimation of carcass composition in the live animal. With additional research, the possibility exists to incorporate genetic markers into feedlot selection to assist in marketing decisions.

UA Open Access Publishing Fund / Study objectives: Multiple curricula have been designed to teach medical students the basics of ultrasound; however, few focus on critical problem-solving. The objective of this study is to determine whether a theme-based ultrasound teaching session, dedicated to the use of ultrasound in the management of the hypotensive patient, can impact medical students’ ultrasound education and provide critical problem-solving exercises. Methods: This was a cross-sectional study using an innovative approach to train 3rd year medical students during a 1-day ultrasound training session. The students received a 1-hour didactic session on basic ultrasound physics and knobology and were also provided with YouTube hyperlinks, and links to smart phone educational applications, which demonstrated a variety of bedside ultrasound techniques. In small group sessions, students learned how to evaluate patients for pathology associated with hypotension. A knowledge assessment questionnaire was administered at the end of the session and again 3 months later. Student knowledge was also assessed using different clinical scenarios with multiple-choice questions. Results: One hundred and three 3rd year medical students participated in this study. Appropriate type of ultrasound was selected and accurate diagnosis was made in different hypotension clinical scenarios: pulmonary embolism, 81% (95% CI, 73%–89%); abdominal aortic aneurysm, 100%; and pneumothorax, 89% (95% CI, 82%–95%). The average confidence level in performing ultrasound-guided central line placement was 7/10, focused assessment with sonography for trauma was 8/10, inferior vena cava assessment was 8/10, evaluation for abdominal aortic aneurysm was 8/10, assessment for deep vein thrombus was 8/10, and cardiac ultrasound for contractility and overall function was 7/10. Student performance in the knowledge assessment portion of the questionnaire was an average of 74% (SD =11%) at the end of workshop and 74% (SD =12%) 3 months later (P=0.00). Conclusion: At our institution, we successfully integrated ultrasound and critical problemsolving instruction, as part of a 1-day workshop for undergraduate medical education

It has been proposed that coated gas microbubbles, currently used as ultrasound contrast agents could also be used as microscale sensors due to the sensitivity of their acoustic response to changes in their environment. However, their behaviour is not fully understood and there remains considerable scope for improving their characterisation. The aim of this thesis is to improve the theoretical description of microbubble dynamics under ultrasound excitation with the ultimate aim of assessing the regimes in which they could be exploited most effectively as sensors. Previous theoretical and experimental work relating to the confinement and acoustic excitation of microbubbles is reviewed. Specifically, optical trapping as a method for the isolation and manipulation of individual bubbles is studied for use in developing a sensor. An assessment of the existing models’ validity is undertaken. This is followed by the development of models for optical trapping of single microbubbles, and the coupled radial and translational motion of a microbubble under ultrasound excitation, which includes time dependent phenomena. The latter model is used to perform a sensitivity analysis to determine the uncertainty associated with using microbubbles as sensors. The potential for uniquely characterising the shell of the microbubble from experimental data is also assessed. Subsequent chapters present the results from a combination of computer simulations and experimental data, used to develop and assess the validity of the new models for describing microbubble behaviour. Particularly, the model is used to simulate the response of a dilute suspension of microbubbles undergoing large amplitude oscillations and single microbubbles undergoing lipid shedding. The optimal regimes in which microbubbles may be utilised as sensors for liquid physical properties and local pressure variations are then assessed. Finally, a summary of the conclusions and areas for further work is presented.

Cardiovascular disease, mostly atherosclerosis, is responsible for one third of all deaths globally, rising to more than 50% in the Western World. Risk factors include smoking, diet, and familial history. Doppler ultrasound can provide estimates of blood velocity and wall shear rate. Clinically, maximum velocity is used to categorise patients for surgery, although Doppler velocity measurement is prone to errors and in need of validation. Wall shear stress—which can be derived from wall shear rate—plays a role in disease initiation and progression, although its clinical utility is unclear due to difficulties associated with its measurement. This thesis investigates the use of Doppler ultrasound as a tool to estimate blood velocity and wall shear rate. A simplified method for estimation of wall shear rate in healthy arteries is developed that uses spectral Doppler ultrasound. This method is based upon the theory of oscillatory flow in rigid pipes, requiring two measurements that are readily available with clinical ultrasound machines. This method is compared to a similar method based on colour flow imaging. The spectral Doppler method underestimated the theoretic value of wall shear rate by between 7 and 22%, with results varying between phantoms. Errors for the colour method were on average 35% greater. Test measurements from one healthy volunteer demonstrated that this method can be applied in-vivo. In more advanced stages of disease, peak velocity distal to a stenosis is of clinical interest and the simplified method for wall shear rate estimation is invalid. Steady flow in a series of simplified stenosis geometries was studied using a dual-beam Doppler system to obtain velocity vectors. These measurements were compared with data from an equivalent system that used particle image velocimetry (PIV) and was considered the gold standard. For Reynolds numbers at the stenosis throat of less than 800, flow remained laminar over the region studied, although distal flow separation did occur. For higher throat Reynolds numbers—corresponding to more severe stenoses or increased flow rates—asymmetric recirculation regions developed; the transition to turbulence occurred more proximally, with a corresponding reduction in stenotic jet and recirculation length. Qualitative agreement was observed in the velocity profile shapes measured using ultrasound and PIV at throat Reynolds numbers less than 800. Above this threshold the qualitative agreement between the velocity profiles became poorer as both downstream distance and the degree of stenosis increased. Peak axial velocity distal to the stenosis was underestimated, on average, by 15% in the ultrasound system. Estimation of shear rate remained difficult with both experimental techniques. Under a Newtonian approximation, the normalised wall shear stresses agree qualitatively. Under pulsatile flow conditions using an idealised flow waveform, superior qualitative agreement was observed in the velocity profiles at diastole than at systole. Similar to the steady flow behaviour, this agreement deteriorated with stenosis severity. The current generation of clinical ultrasound machines are capable of estimating the wall shear rate in healthy arteries. In the presence of significant arterial disease, errors in the peak velocity may result in mis-selection of patients for surgery, while estimation of the wall shear stress remains extremely problematic; particularly with identifying the wall location and measuring velocities close to the wall.