: Background: DALI (direct adsorption of lipids) is the first LDL‐apheresis technique able to adsorb low‐density lipoprotein (LDL) and lipoproteina) directly from whole blood. In the standard ...procedure, acid citrate dextrose (ACD‐A) is used as anticoagulation and the adsorber is rinsed with a specially manufactured priming solution (PS). Using neutral trisodium citrate (TSC) instead of ACD‐A might improve the acid‐base homeostasis during DALI apheresis; moreover, applying wholesale hemofiltration solutions instead of the special PS might avoid the use of two separate solutions for both priming before and reinfusion after the treatment, thus simplifiying the procedure. Aim: The present study was performed to test the effect of neutral (TSC) anticoagulation and of two different commercially available hemofiltration (HF) priming solutions on the efficacy and biocompatibility of DALI apheresis. Materials and Methods: Five hypercholesterolemic chronic DALI patients were treated prospectively, on a weekly or biweekly basis, 3 times each by standard DALI‐apheresis (A), by DALI using 4% TSC and bicarbonate‐buffered HF BIC35‐210 priming (B), as well as by DALI using 4% TSC and lactate‐buffered HF 23 priming (C). After the sessions, the extracorporeal circuit (ECC) was rinsed with saline in study arm A and with the corresponding HF solutions in study arms B and C, respectively. Results: Acute LDL‐cholesterol reductions in the study arms A/B/C averaged 64/64/63%, for Lp(a) 62/64/62%, respectively (n=15). Clinically, all sessions were essentially uneventful and no clots were observed in the ECC. No major differences were found between the 3 study arms with respect to biocompatibility (elastase, C3a, thrombin‐antithrombin, β‐thromboglobulin, bradykinin). Conclusion: DALI apheresis using TSC anticoagulation and HF solutions for both priming and reinfusion proved to be as safe and effective as the standard DALI apheresis. These modifications, however, further simplify the procedure.
Abstract
AIM
Evaluate within a pilot setup feasibility and safety of minimally invasive needle-biopsy of sentinel nodes guided by SPECT/US as compared to surgical removal while defining optimal ...needle for follow-up trial.
METHOD AND MATERIALS
As pretrial test phase of the MinimalSNB study, 38 breast cancer patients (6 centers) were taken a needle-biopsy of their sentinel lymph nodes (SLNs) under guidance of SPECT/US (SentiGuide by SurgicEye, Munich, DE). All patients were indicated for a surgical SLN biopsy which was performed immediately after the needle-biopsy. For the test phase, 4 different biopsy systems were tested: HistoCore 14G (BIP, Tuerkenfeld, DE), elite 10G and 13G (Mammotome, Cincinnati, OH, US) and CASSI II 10G (Scion Medical Technologies, Boston, MA, US). Histopathological examination (H&E, step-sectioning) of needle-biopsies and surgically removed SLNs were compared.
RESULTS
No single complication was reported. Occasionally, small hematomas could be found close to the SLN during surgery. Duration of complete procedure (imaging, needle placement, biopsy) took in average 17min. A learning curve was observed in duration (average after 5 biopsies 12min). 1-14 samples were taken of each SLN (average 5 samples). Final pathological examination of material harvested with both methods matched in 34 cases (33 negatives, 1 positive). The needle biopsy failed to detect metastases in 2 pN1 SLNs. In 1 case, the surgically resected tissue did not contain lymph nodes and the needle biopsy remained the only information on nodal status. In 1 case a metastasis found in needle-biopsy motivated a second reading of an originally negative SLN which resulted in the upstaging of the patient. In both cases a metastases was missed by needle-biopsy, the retrieved lymph tissue was minimal (1x 14G sample, 1x 10G sample tangential to node).
CONCLUSION
SPECT/US showed to be a valid method for percutaneous detection of SLNs and needle-guidance. Sampling SLNs with a needle seems safe and feasible. However it requires proper training and user experienced with axillary needle-biopsies. Retrieving more tissue (more cores and larger lumen needles) improves diagnostic power of needle-biopsy. These considerations will be taken within the upcoming MinimalSNB trial.
CLINICAL RELEVANCE
Sentinel lymph biopsy today is a surgical diagnostic procedure with an nonzero morbidity. Moving it out of the operating theatre to a needle-based intervention has a huge impact on the burden of this procedure for the patient as well as relevant improvements in logistics, workflow and radiation burden.
Citation Format: Paepke S, Pfob CH, Ohlinger R, Gruber I, Thill M, Blohmer JU, Kuehn T, Hahn M, Kiechle M, Wendler T. Can sentinel node staging be performed using a minimally invasive needle-biopsy? Results of German multicentric pilot study. abstract. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-16.
In the last few years, following on an initial concept developed by Cipriani et al., a new medical device has been certified in Europe for the therapy of basal and squamous cell carcinomas of the ...skin. Here we report our initial experience on technical and safety aspects.
The principle of operation is based on the application of a resin of 188Re over a thin plastic film attached on the lesion. After appropriate treatment time, the plastic foil is safely removed and discarded.
The device is all-in-one, as it allows the final formulation of the resin, the application of the compound and measurement of activity. Irradiation of the operators is minimal: the ampule of the resin is extracted from the shielded cabinet only for measurement in the dedicated activity meter, and for the application. The operators are protected by leaded aprons (against the 155-keV photons), and by plastic shields/glasses for the beta radiation.
Size and depth of the lesion are determined by a Dermatologist and from biopsy, and used, together with the amount of activity effectively applied, as the input data in the code Varskin (RASSC, USA; v.5.3), to assess the treatment time.
The completeness of the device makes its clinical use relatively simple, after the necessary initial training. Operation is safe and completely painless for the patient.
Proper timing in the application to patients is necessary, since multiple layers of the resin may be necessary to reach the wanted activity (the resin hardens in approximately 15 min).
At the time of submitting this abstract we have treated 7 patients (activity range 700–1000 MBq applied for 30–120 min). While lesions’ healing was observed, it’s still not possible to draw sound clinical conclusions; meantime we are currently working on a MonteCarlo model to support dosimetry calculations with Varskin.
The recently developed technique of Cyclotron Radiation Emission Spectroscopy (CRES) uses frequency information from the cyclotron motion of an electron in a magnetic bottle to infer its kinetic ...energy. Here we derive the expected radio-frequency signal from an electron in a waveguide CRES apparatus from first principles. We demonstrate that the frequency-domain signal is rich in information about the electron's kinematic parameters and extract a set of measurables that in a suitably designed system are sufficient for disentangling the electron's kinetic energy from the rest of its kinematic features. This lays the groundwork for high-resolution energy measurements in future CRES experiments, such as the Project 8 neutrino mass measurement.
In routine DALI apheresis--the first technique for direct adsorption of lipoproteins from whole blood--heparin plus citrate (ACD-A) is used as anticoagulation regimen. However, recently several ...publications have warned of heparin-induced thrombocytopenia as a rare but potentially life-threatening complication of heparin administration (HIT type 2). The aim of the present study was therefore to test the efficacy and biocompatibility of DALI using a heparin-free anticoagulation regimen consisting exclusively of citrate.
Four symptomatic hypercholesterolemic patients on regular DALI apheresis were switched to the heparin-free protocol for two sessions each. Two of the patients were on oral anticoagulation using phenprocoumon. In the weekly sessions, 1.3 patient blood volumes were processed at a blood flow rate of 60 ml/min using ACD-A at a ratio of 1:20 (v/v) during adsorber priming and the session.
Clinically, all sessions were essentially uneventful. Uncorrected lipoprotein reductions amounted to 65% for LDL-C, 62% for Lp(a), 53% for VLDL-C, 24% for HDL-C, 17% for triglycerides and 19% for fibrinogen. Cell counts remained virtually constant. No signs of hemolysis or clotting could be detected. Thromboplastin time (Quick) was slightly prolonged and partial thromboplastin time (PTT) moderately elevated in all patients. In contrast, whole blood coagulation time acc. to Lee-White and activated clotting times were increased only in orally anticoagulated patients. Biocompatibility in terms of complement, leukocyte and thrombocyte activation was excellent. Bradykinin activation was moderate peaking at 3038 pg/ml in the efferent line. Systemic thrombin-antithrombin complex (TAT) reflected perfect anticoagulation in orally anticoagulated patients and adequate anticoagulation in the patients without phenprocoumon.
In this pilot study, heparin-free DALI apheresis was safe and effective and may thus be performed in LDL-apheresis dependent patients who suffer from heparin intolerance.
: Direct adsorption of lipoproteins (DALI) is the first lipid apheresis system compatible with whole blood with the advantage of a very simple procedure. A mixture of heparin plus citrate (ACD‐A) is ...used for the anticoagulation regimen (AR). A clinical, prospective, controlled crossover study was performed to test the safety and efficacy of low‐dose citrate (LDC) anticoagulation in DALI. Five chronic DALI patients suffering from coronary heart disease and hypercholesterolemia underwent 3 DALI sessions each using the LDC anticoagulation regimen (60 IU heparin/kg body weight as initial bolus; 1:40 ACD‐A: blood as perfusion). This was compared to 3 sessions per patient with the standard AR (bolus of 20 IU heparin/kg, 1:20 ACD‐A as perfusion). Patient blood volumes (1.6; average of 7,040 ml) were treated with 750 ml adsorber gel per session at a blood flow rate of 60 ml/min. Mean LDL and Lp(a) reductions exceeded 60% with both AR. No clinical side effects were observed. Both AR controlled the coagulation well as evidenced by a sufficient prolongation of the partial prothrombin time (PTT) and activated clotting time as well as low thrombin–antithrombin (TAT) formation. Biocompatibility parameters exhibited favorable results (low activation of complement and cells, and only slight formation of C3a, C5a, β‐thromboglobulin, elastase, and TNF‐α). The asymptomatic bradykinin generation was comparable in both study arms. LDC optimized the ionized calcium levels and pH in the efferent blood postadsorber. LDC anticoagulation was safe and effective, and may further improve the tolerance of DALI apheresis in hypercholesterolemic patients.
We calculate transition probabilities between vibrational levels of a diatomic molecule induced by an incident atom. Our prototype model is constructed treating the relative translation of the ...colliding species as a classical variable. The vibrational states of the diatomic molecule are treated quantum mechanically in terms of the evolution operator without involving wave functions. The corresponding equations of motion are coupled quasi-classically. For illustration purposes we present applications to the time dependence of transition probabilities for different initial and final states as well as a canonical ensemble of initial conditions.
For electronic equipment, especially medical imaging systems, this doubling of processing power also implies greater availability of network bandwidth, larger storage capacity, smarter computer ...algorithms, and better understanding of clinical information. The chapters on personal healthcare discuss future scenarios in which individuals take increasing responsibility for managing their own healthcare, especially through their use of electronic remote monitoring devices and day-to-day interaction via a variety of platforms such as Web browsers, cell phones, and digital medium devices.
PDF
