Concurrent Monitoring Research Articles

A discrete wavelet based feature extraction and hybrid classification technique for microarray data analysis.

Cancer classification by doctors and radiologists was based on morphological and clinical features and had limited diagnostic ability in olden days. The recent arrival of DNA microarray technology has led to the concurrent monitoring of thousands of gene expressions in a single chip which stimulates the progress in cancer classification. In this paper, we have proposed a hybrid approach for microarray data classification based on nearest neighbor (KNN), naive Bayes, and support vector machine (SVM). Feature selection prior to classification plays a vital role and a feature selection technique which combines discrete wavelet transform (DWT) and moving window technique (MWT) is used. The performance of the proposed method is compared with the conventional classifiers like support vector machine, nearest neighbor, and naive Bayes. Experiments have been conducted on both real and benchmark datasets and the results indicate that the ensemble approach produces higher classification accuracy than conventional classifiers. This paper serves as an automated system for the classification of cancer and can be applied by doctors in real cases which serve as a boon to the medical community. This work further reduces the misclassification of cancers which is highly not allowed in cancer detection.

Set Up of an Automatic Water Quality Sampling System in Irrigation Agriculture

We have developed a high-resolution automatic sampling system for continuous in situ measurements of stable water isotopic composition and nitrogen solutes along with hydrological information. The system facilitates concurrent monitoring of a large number of water and nutrient fluxes (ground, surface, irrigation and rain water) in irrigated agriculture. For this purpose we couple an automatic sampling system with a Wavelength-Scanned Cavity Ring Down Spectrometry System (WS-CRDS) for stable water isotope analysis (δ2H and δ18O), a reagentless hyperspectral UV photometer (ProPS) for monitoring nitrate content and various water level sensors for hydrometric information. The automatic sampling system consists of different sampling stations equipped with pumps, a switch cabinet for valve and pump control and a computer operating the system. The complete system is operated via internet-based control software, allowing supervision from nearly anywhere. The system is currently set up at the International Rice Research Institute (Los Baños, The Philippines) in a diversified rice growing system to continuously monitor water and nutrient fluxes. Here we present the system's technical set-up and provide initial proof-of-concept with results for the isotopic composition of different water sources and nitrate values from the 2012 dry season.

Potential, principle and pragmatism in concurrent multinational monitoring: disability rights in the European Union

This article responds to some of the limitations of traditional human rights monitoring systems by identifying the potential for more dynamic methods of recording and reporting rights-based evidence. The article distinguishes between ‘consecutive’ and ‘concurrent’ models of monitoring and between hierarchical and non-hierarchical monitoring systems. Using the example of the United Nations Convention on the Rights of Persons with Disabilities, a principled framework for systems development in this field is outlined. The practical contingencies of designing and implementing new monitoring tools across 34 European countries are then reviewed. The article concludes that more flexible and dynamic reporting tools can help to make states more accountable for the implementation of their human rights obligations and facilitate policy exchange and the sharing of good practice. Recent developments within the European Union disability field offer potential for adaptation to other human rights fields and to other regions of the world.

Concurrent Continuous Glucose Monitoring in Critically Ill Patients: Interim Results and Observations

Hyperglycemia in intensive care is a prevalent, much debated problem. Glycemic control (GC) can reduce mortality,1 but in some cases, GC has also increased hypoglycemia.2 Continuous glucose monitoring (CGM), with 1–5 min measurements, has the potential to aid GC and provide early warning of potential hypoglycemia.3 Continuous glucose monitoring could also ease nursing burden by reducing blood glucose (BG) measurements to 3–4 per day for CGM device calibration.4 Off-the-shelf CGM devices are currently being trialed in the Christchurch Hospital intensive care unit. Each patient has a Medtronic Guardian Real-Time and a Medtronic iPro2 (retrospective) CGM placed on their abdomen and a second Medtronic iPro2 on their thigh. This configuration allows assessment of interdevice and intersite variability in sensor glucose (SG), and 12–14 independent BG measurements per day provide a comparator. This preliminary analysis uses data from 10 recruited patients. The median (interquartile range) BG levels were 124 (112–137) mg/dl, indicating patients were well controlled. The mean absolute relative difference for the abdomen Guardian SG data was 24.0%, compared with 11.8% and 12.4% for the abdomen and thigh iPro2 SG data, respectively. However, some of the error can be attributed to the reference BG measurements from point-of-care glucometers. Comparing intersite discrepancies in SG to interdevice discrepancies in SG, our data suggest that the CGM device type and thus calibration has a larger impact on observed performance than sensor site. Overall, the reliability/accuracy of CGM devices can vary between patients, and performance could be influenced by illnesses or drugs/therapies among other factors. A particularly interesting observation from this study was a patient with severe edema who had approximately 18 liters of additional fluid located primarily in the abdominal region. Sensor insertion was difficult due to fluid seeping from the insertion site, and two abdominal sensors failed to adhere to the skin (one of which was replaced). The top plot in Figure 1 shows the SG and BG data collected from this patient. However, the main focus of this discussion is the lower plot, which shows the raw current (ISIG) from each sensor. During the first few days, abdominal ISIG is much lower than the thigh, where there was much less excess fluid. As patient condition improved and excess fluid decreased, abdominal sensor ISIG rose to match the thigh sensor, and they tracked each other well for the remainder of monitoring. However, these observations could be due to other factors, such as the sensor itself or drugs/therapies. Further investigation with a larger cohort containing patients with severe edema is required to determine whether or not it has a major effect on CGM performance. Figure 1. The SG and ISIG data from two CGM devices monitoring a patient with severe edema. This limited data set and preliminary analysis indicates that CGM devices have the potential to improve GC in critically ill patients. Such improvements include using SG measurements to drive insulin therapy and/or using SG data for hypoglycemia detection and alarming. However, further understanding of the clinical factors that affect CGM performance is needed before improvements to GC can be realized.

Effects of concurrent tasks on diagnostic decision making: An experimental investigation

Physicians’ decision-making performance is one of the most important factors in healthcare system engineering. Multitasking and interruptions while making diagnostic decisions have been frequently observed in the healthcare work environment. However, little evidence from controlled experiments is available to determine whether physician multitasking affects the quality and timely performance of diagnostic decisions. In the current study, we designed a diagnostic task to examine the effects of concurrent tasks on diagnostic decision making using a controlled laboratory experiment, in which potential confounding factors were controlled to allow the quantification of diagnostic performance and strategies. The results showed that diagnostic performance was negatively affected by a complex concurrent memorization task that required participants to listen to verbal updates and remember information about other patients while performing the diagnostic task. In contrast, a simple concurrent sound monitoring task did not affect diagnostic performance. Both types of concurrent tasks significantly increased mental workload. Diagnostic decision strategies were not significantly different between the single- and dual-task conditions. These findings provide new insights into the cognitive mechanisms underlying diagnostic decision and physician multitasking. Implications for the control and improvement of healthcare quality are discussed.

Long-Term Neurophysiologic Impact of Childhood Sleep Disordered Breathing on Neurocognitive Performance.

To determine the impact of sleep disordered breathing (SDB) in children on neurocognitive function 5 years later. A subgroup of 43 children from the Tucson Children's Assessment of Sleep Apnea Study (TuCASA) who had SDB (RDI ≥ 6 events/hour) at their initial exam (ages 6-11 years) were matched on the basis of age (within 1 year), gender and ethnicity (Anglo/Hispanic) to 43 children without SDB (Control, RDI ≤ 4 events/hour). The Sustained Working Memory Task (SWMT) which combines tests of working memory (1-Back Task), reaction time (Simple Reaction Time) and attention (Multiplexing Task) with concurrent electroencephalographic monitoring was administered approximately 5 years later. There were no differences in performance on the working memory, reaction time and attention tests between the SDB and Control groups. However, the SDB group exhibited lower P300 evoked potential amplitudes during the Simple Reaction Time and Multiplexing Tasks. Additionally, peak alpha power during the Multiplexing Task was lower in the SDB Group with a similar trend in the Simple Reaction Time Task (p=0.08). SDB in children may cause subtle long-term changes in executive function that are not detectable with conventional neurocognitive testing and are only evident during neuroelectrophysiologic monitoring.

Medical Decision Making Performance in Dual-task Scenarios

Physicians often perform multiple tasks concurrently, such as diagnosing a disease while talking with another physician about other patients. However, little experimental evidence is available to determine whether a concurrent task affects the quality and timely performance of diagnostic decisions. In this study, we employed a representative medical diagnostic task to examine the effects of concurrent tasks on diagnostic decision making, in which potential confounding factors are controlled to allow the quantification of diagnostic performance and strategies. The results showed that diagnostic performance was negatively affected by a complex concurrent memorization task that required participants to listen to verbal updates and remember information about other patients while performing the diagnostic task. In contrast, a simple concurrent sound monitoring task did not affect diagnostic performance. Participants used the same diagnostic strategies in the single- and dual-task conditions. These findings provide new insights into the cognitive mechanisms underlying medical diagnostic decision and physician multitasking. Implications for the improvement of healthcare quality are discussed.

Maize transpiration in response to meteorological conditions

Abstract Differences in transpiration of maize (Zea mays L.) plants in four soil moisture regimes were quantified in a pot experiment. The transpiration was measured by the “Stem Heat Balance” method. The dependence of transpiration on air temperature, air humidity, global solar radiation, soil moisture, wind speed and leaf surface temperature were quantified. Significant relationships among transpiration, global radiation and air temperature (in the first vegetation period in the drought non-stressed variant, r = 0.881**, r = 0.934**) were found. Conclusive dependence of transpiration on leaf temperature (r = 0.820**) and wind speed (r = 0.710**) was found. Transpiration was significantly influenced by soil moisture (r = 0.395**, r = 0.528**) under moderate and severe drought stress. The dependence of transpiration on meteorological factors decreased with increasing deficiency of water. Correlation between transpiration and plant dry matter weight (r = 0.997**), plant height (r = 0.973**) and weight of corn cob (r = 0.987**) was found. The results of instrumental measuring of field crops transpiration under diverse moisture conditions at a concurrent monitoring of the meteorological elements spectra are rather unique. These results will be utilized in the effort to make calculations of the evapotranspiration in computing models more accurate.

Sleep apnea and snoring

A 42-year-old man was evaluated for snoring and sleep apnea. Overnight polysomnography revealed 28 events per hour on the apnea–hypopnea index. To determine the site of obstruction and determine treatment, dynamic MRI with concurrent EEG monitoring in natural sleep was performed. We recorded 2 mechanisms of total occlusion: at the oropharyngeal level and due to movement of the uvula during snoring (videos 1 and 2).1 Two different mechanisms suggested against surgical therapy; he was treated with a continuous positive airway pressure mask at 7 cm H2O, with a good outcome.

In vivo dialysis setup with a loop injection valve facilitates retrodialysis studies

IntroductionRetrodialysis, as used in neuropharmacological research, is a technique for in vivo delivery of neuroactive agents with concurrent monitoring of their effects on cellular activity with a separation between certain degree of spatial and temporal resolution. Typically, this is accomplished either by the use of a liquid-switch requiring multiple pumps, or by exchange of flow tubing requiring stopping and restarting dialysis. In the present study, we describe the use of a medium pressure injection valve for retrodialysis that overcomes these problems. MethodsThe valve was configured with a loop to deliver 20μL of solution, and artificial CSF flow from the pump to the probe was established via this device. The application of this setup was evaluated in urethane anesthetized adult male C57BL/6J mice prepared with a CMA 11 probe implanted in the ventral hippocampus. By switching between the load and inject positions, the loop was filled with escitalopram solution (0.3μM) and delivered at a rate of 1μL/min at the probe for retrodialysis. Escitalopram (2mg/kg BW) was administered subcutaneously for microdialysis studies. During these treatments, dialysate fractions were collected for the determination of serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA). ResultsIrrespective of route of escitalopram administration, the pattern of dialysate 5-HT, and 5-HIAA response was comparable to that reported by other investigators. Accordingly, the in-line valve assembly did not compromise retrodialysis or microdialysis sampling. The manipulations to carry out retrodialysis using the valve setup are easy and simple. DiscussionAn in-line injection valve is a promising adaptation for retrodialysis studies and can be incorporated as a standard part of in vivo dialysis instrumentation.

Intrinsic connectivity network mapping in young children during natural sleep

Structural and functional neuroimaging have substantively informed the pathophysiology of numerous adult neurological and psychiatric disorders. While structural neuroimaging is readily acquired in sedated young children, pediatric application of functional neuroimaging has been limited by the behavioral demands of in-scanner task performance. Here, we investigated whether functional magnetic resonance imaging (fMRI) acquired during natural sleep and without experimental stimulation offers a viable strategy for studying young children. We targeted the lengthy epoch of non-rapid eye movement, stage 3 (NREM3) sleep typically observed at sleep onset in sleep-deprived children. Seven healthy, preschool-aged children (24–58months) were studied, acquiring fMRI measurements of cerebral blood flow (CBF) and of intrinsic connectivity networks (ICNs), with concurrent sleep-stage monitoring. ICN data (T2* fMRI) were reliably obtained during NREM3 sleep; CBF data (arterial spin labeled fMRI) were not reliably obtained, as scanner noises disrupted sleep. Applying independent component analysis (ICA) to T2* data, distinct ICNs were observed which corresponded closely with those reported in the adult literature. Notably, a network associated with orthography in adults was not observed, suggesting that ICNs exhibit a developmental trajectory. We conclude that resting-state fMRI obtained in sleep is a promising paradigm for neurophysiological investigations of young children.

Optical strategies for sensing neuronal voltage using quantum dots and other semiconductor nanocrystals.

Biophysicists have long sought optical methods capable of reporting the electrophysiological dynamics of large-scale neural networks with millisecond-scale temporal resolution. Existing fluorescent sensors of cell membrane voltage can report action potentials in individual cultured neurons, but limitations in brightness and dynamic range of both synthetic organic and genetically encoded voltage sensors have prevented concurrent monitoring of spiking activity across large populations of individual neurons. Here we propose a novel, inorganic class of fluorescent voltage sensors: semiconductor nanoparticles, such as ultrabright quantum dots (qdots). Our calculations revealed that transmembrane electric fields characteristic of neuronal spiking (~10 mV/nm) modulate a qdot's electronic structure and can induce ~5% changes in its fluorescence intensity and ~1 nm shifts in its emission wavelength, depending on the qdot's size, composition, and dielectric environment. Moreover, tailored qdot sensors composed of two different materials can exhibit substantial (~30%) changes in fluorescence intensity during neuronal spiking. Using signal detection theory, we show that conventional qdots should be capable of reporting voltage dynamics with millisecond precision across several tens or more individual neurons over a range of optical and neurophysiological conditions. These results unveil promising avenues for imaging spiking dynamics in neural networks and merit in-depth experimental investigation.

Early Stage High-Content HIV Diagnosis Based on Concurrent Monitoring of Actin Cytoskeleton, CD3, CD4, and CD8

Antiretroviral treatment can reduce the death rate of human immunodeficiency virus (HIV) infection, and its effectiveness is maximized at the early stage of HIV infection. The present study demonstrates an early stage high-content HIV diagnosis based on multicolor concurrent monitoring of CD4, CD8, and CD3 coreceptors and F-actin cytoskeleton using quantum dot (Qdot)-antibody conjugates at the single cell level. Artificial HIV infection of peripheral blood mononuclear cells (PBMCs) was achieved by the treatment of PBMCs with gp120 glycoproteins. Using the present system, it was determined that the CD4/CD8 ratios of normal PBMCs obtained from the blood samples of 11 adults were in the range of 1.04 to 1.52 as a result of the quantitative counting of single PBMCs while the CD4/CD8 ratios of artificial HIV-infected PBMCs were from 0.045 to 0.63. In addition, the structural changes of actin filament alignments in PBMCs bound to gp120 proteins were clearly observed by the multicolor single cell imaging system. This approach suggests a new model of accurate early stage HIV diagnosis simultaneously providing information on actin cytoskeleton and subtypes of PBMCs as well as their CD4/CD8 ratios.

4 Living roofs in 3 locations: Does configuration affect runoff mitigation?

Summary Four extensive living roofs and three conventional (control) roofs in Auckland, New Zealand have been evaluated over periods of 8 months to over 2 yrs for stormwater runoff mitigation. Up to 56% cumulative retention was measured from living roofs with 50–150 mm depth substrates installed over synthetic drainage layers, and with >80% plant coverage. Variation in cumulative %-retention amongst sites is attributed to different durations of monitoring, rather than actual performance. At all sites, runoff rarely occurred at all from storms with less than 25 mm of precipitation, from the combined effects of substrates designed to maximize moisture storage and because >90% of individual events were less than 25 mm. Living roof runoff depth per event is predicted well by a 2nd order polynomial model ( R 2 = 0.81), again demonstrating that small storms are well managed. Peak flow per event from the living roofs was 62–90% less than a corresponding conventional roof’s runoff. Seasonal retention performance decreased slightly in winter, but was nonetheless substantial, maintaining 66% retention at one site compared to 45–93% in spring-autumn at two sites. Peak flow mitigation did not vary seasonally. During a 4-month period of concurrent monitoring at all sites, varied substrate depth did not influence runoff depth (volume), %-retention, or %-peak flow mitigation compared to a control roof at the same site. The magnitude of peak flow was greater from garden shed-scale living roofs compared to the full-scale living roofs. Two design aspects that could be manipulated to increase peak flow mitigation include lengthening the flow path through the drainage layer to vertical gutters and use of flow-retarding drainage layer materials.

Abstract TP359: One Patient, One Standard, One Medical Record: Improving Documentation of t-PA Therapy across the Care Continuum

Background and Issues: Department specific documentation systems resulted in a non-standardized approach to assessment documentation for patients receiving intravenous t-PA for treatment of acute stroke. Subsequently, compliance with documentation requirements during transition of care from the emergency department (ED) to intensive care unit (ICU) did not meet targeted benchmarks. Purpose: Design a hospital-wide standard and system for vital signs and neuro assessment documentation for patients receiving IV t-PA for the treatment of acute stroke. Methods: A multidisciplinary team analyzed current practice and collaborated to create one standardized documentation record that would satisfy requirements for the ED and the ICU. A t-PA worksheet had proven success with physicians for documenting eligibility and ordering t-PA. The team agreed to keep this worksheet as page one of the documentation record. Page two was designed for ED documentation of medications, assessments and patient response. Page three captures the documentation of mandatory vital signs and neuro assessments. The Stroke Leadership committee approved recommendations from this team for nurses to assess patients using the abbreviated NIH Stroke Scale. Prior to implementation, Physicians and Nurses received education regarding the abbreviated stroke scale and expected documentation. Results: Concurrent monitoring for compliance in documentation of post t-PA vital signs and neuro assessments began with the implementation of this revised documentation record. First month post implementation reported 95% compliance rate and 100% by the fourth month. Conclusions: Process standardization with one consistent documentation tool has sustained 99-100% compliance in documentation of assessments pre and post t-PA administration.

Strategy for dual-analyte luciferin imaging: in vivo bioluminescence detection of hydrogen peroxide and caspase activity in a murine model of acute inflammation.

In vivo molecular imaging holds promise for understanding the underlying mechanisms of health, injury, aging, and disease, as it can detect distinct biochemical processes such as enzymatic activity, reactive small-molecule fluxes, or post-translational modifications. Current imaging techniques often detect only a single biochemical process, but, within whole organisms, multiple types of biochemical events contribute to physiological and pathological phenotypes. In this report, we present a general strategy for dual-analyte detection in living animals that employs in situ formation of firefly luciferin from two complementary caged precursors that can be unmasked by different biochemical processes. To establish this approach, we have developed Peroxy Caged Luciferin-2 (PCL-2), a H(2)O(2)-responsive boronic acid probe that releases 6-hydroxy-2-cyanobenzothiazole (HCBT) upon reacting with this reactive oxygen species, as well as a peptide-based probe, z-Ile-Glu-ThrAsp-D-Cys (IETDC), which releases D-cysteine in the presence of active caspase 8. Once released, HCBT and D-cysteine form firefly luciferin in situ, giving rise to a bioluminescent signal if and only if both chemical triggers proceed. This system thus constitutes an AND-type molecular logic gate that reports on the simultaneous presence of H(2)O(2) and caspase 8 activity. Using these probes, chemoselective imaging of either H(2)O(2) or caspase 8 activity was performed in vitro and in vivo. Moreover, concomitant use of PCL-2 and IETDC in vivo establishes a concurrent increase in both H(2)O(2) and caspase 8 activity during acute inflammation in living mice. Taken together, this method offers a potentially powerful new chemical tool for studying simultaneous oxidative stress and inflammation processes in living animals during injury, aging, and disease, as well as a versatile approach for concurrent monitoring of multiple analytes using luciferin-based bioluminescence imaging technologies.

Clinical review: Brain-body temperature differences in adults with severe traumatic brain injury

Surrogate or 'proxy' measures of brain temperature are used in the routine management of patients with brain damage. The prevailing view is that the brain is 'hotter' than the body. The polarity and magnitude of temperature differences between brain and body, however, remains unclear after severe traumatic brain injury (TBI). The focus of this systematic review is on the adult patient admitted to intensive/neurocritical care with a diagnosis of severe TBI (Glasgow Coma Scale score of less than 8). The review considered studies that measured brain temperature and core body temperature. Articles published in English from the years 1980 to 2012 were searched in databases, CINAHL, PubMed, Scopus, Web of Science, Science Direct, Ovid SP, Mednar and ProQuest Dissertations & Theses Database. For the review, publications of randomised controlled trials, non-randomised controlled trials, before and after studies, cohort studies, case-control studies and descriptive studies were considered for inclusion. Of 2,391 records identified via the search strategies, 37 were retrieved for detailed examination (including two via hand searching). Fifteen were reviewed and assessed for methodological quality. Eleven studies were included in the systematic review providing 15 brain-core body temperature comparisons. The direction of mean brain-body temperature differences was positive (brain higher than body temperature) and negative (brain lower than body temperature). Hypothermia is associated with large brain-body temperature differences. Brain temperature cannot be predicted reliably from core body temperature. Concurrent monitoring of brain and body temperature is recommended in patients where risk of temperature-related neuronal damage is a cause for clinical concern and when deliberate induction of below-normal body temperature is instituted.

The Role of Tissue Doppler Imaging in Predicting Left Ventricular Filling Pressures in Patients Undergoing Cardiac Surgery: An Intraoperative Study

The perioperative management of patients undergoing cardiac surgery usually requires the accurate assessment of left ventricular filling pressures (LVFP). The gold standard for determining LVFP involves the use of pulmonary artery catheters (PAC). Using tissue Doppler indices (TDI) obtained by transthoracic echocardiography, the ratio of early transmitral filling velocity to the corresponding early mitral annular velocity (E/E') has a strong correlation with pulmonary capillary wedge pressure (PCWP). Little is known, however, on whether this relationship between E/E' and PCWP is valid intraoperatively using transesophageal echocardiography (TEE) during cardiac surgery. The objective of our study was to determine whether TDI obtained by intraoperative TEE during cardiac surgery can accurately estimate PCWP using PAC as the gold standard. A total of 34 patients (26 males, mean age 64 ± 9 years) undergoing cardiac surgery were prospectively enrolled between 2010 and 2011 at a single tertiary care center. Conventional diastolic and tissue Doppler parameters were evaluated using intraoperative TEE with concurrent PAC monitoring before and after cardiopulmonary bypass (CPB) surgery. At both pre- and post-CPB, there was no significant correlation between lateral, septal, and mean E/E' obtained by TEE and PCWP. Intraoperative TEE was unable to accurately predict LVFP in patients undergoing cardiac surgery. PAC may continue to be the gold standard in the assessment of LVFP for this patient population.

IL-1 Generated Subsequent to Radiation-induced Tissue Injury Contributes to the Pathogenesis of Radiodermatitis

IL-1 Generated Subsequent to Radiation-induced Tissue Injury Contributes to the Pathogenesis of Radiodermatitis

Real-time concurrent monitoring of apoptosis, cytosolic calcium, and mitochondria permeability transition for hypermulticolor high-content screening of drug-induced mitochondrial dysfunction-mediated hepatotoxicity

A quantitative high-content screening (HCS) was suggested for the real-time monitoring of drug-induced mitochondrial dysfunction-mediated hepatotoxicity. This HCS is very advantageous in that it allows simultaneous observation of drug-induced activations of hepatotoxic pathways using hypermulticolor cellular imaging. The mitochondrial permeability transition (MPT), cytosolic calcium, and caspase-3 were selected as functional markers to verify drug-induced hepatotoxicity and were concurrently monitored in HepG2 cells in a real-time manner. Nefazodone, tolcapone, and troglitazone caused mitochondrial dysfunction and subsequent apoptotic HepG2 cell death in addition to marked cytosolic calcium increase. On the other hand, extrinsic pathway-mediated apoptotic cell death was monitored when HepG2 cells were treated with piroxicam. It was found that piroxicam-treated HepG2 cells showed apoptotic cell death without the MPT formation, while a cytosolic calcium increase was clearly observed. This finding was confirmed by the caspase-8 inhibition assay. These results demonstrated the unique potential of real-time hypermulticolor HCS to screen hepatotoxic drugs at the in vitro stage rather than the later in vivo stage based on an animal model and to ultimately reduce the probability of drug failure.