Anterior Spinal Artery Syndrome Due to Fibrocartilaginous Embolism-Case Report and Treatment Options

Acute occlusion of the anterior spinal artery and subsequent spinal ischemic infarction leads to anterior spinal artery syndrome characterized by back pain and bilateral flaccid paresis with loss of protopathic sensibility. As a rare cause fibrocartilaginous embolism has been described and is associated with sports or unusual strain.Following gymnastic exercise the day before symptom-onset, a 11 years old girl presented with neck pain, paresis of arms and legs, and impaired deep tendon reflexes. She was unable to lift her arms, grasp, stand, walk and had urinary incontinence. Magnetic resonance imaging revealed a longitudinal T2 hyperintense signal in the anterior spinal cord from C3 to C6 with accompanying bilateral diffusion restriction involving gray matter bilaterally at the level of C4 and C5 and unilaterally at the level of C3/4. The adjacent annulus fibrosus of the intervertebral disc showed a fissure without disc protrusion. Treatment with prednisolone and enoxaparin was started within 12 hours of symptom-onset and continued over 6 days and 8 weeks, respectively. After 2 months, her motor function gradually improved, spinal imaging showed persistent T2 signal hyperintense defects at the level of C4/5. After 5 months, there was only slight impairment affecting elevation and abduction of the right arm.Following physical exercise, the patient suffered from acute anterior spinal cord ischemia with imaging findings in line with a presumed fibrocartilaginous embolism. Unlike most cases, our patient showed almost complete recovery following treatment with prednisolone and enoxaparin. We speculate that the positive outcome is related to rapid treatment initiation.

Investigation of Photodynamic Therapy Promoted by Cherenkov Light Activated Photosensitizers-New Aspects and Revelations

This work investigates the proposed enhanced efficacy of photodynamic therapy (PDT) by activating photosensitizers (PSs) with Cherenkov light (CL). The approaches of Yoon et al. to test the effect of CL with external radiation were taken up and refined. The results were used to transfer the applied scheme from external radiation therapy to radionuclide therapy in nuclear medicine. Here, the CL for the activation of the PSs (psoralen and trioxsalen) is generated by the ionizing radiation from rhenium-188 (a high-energy beta-emitter, Re-188). In vitro cell survival studies were performed on FaDu, B16 and 4T1 cells. A characterization of the PSs (absorbance measurement and gel electrophoresis) and the CL produced by Re-188 (luminescence measurement) was performed as well as a comparison of clonogenic assays with and without PSs. The methods of Yoon et al. were reproduced with a beam line at our facility to validate their results. In our studies with different concentrations of PS and considering the negative controls without PS, the statements of Yoon et al. regarding the positive effect of CL could not be confirmed. There are slight differences in survival fractions, but they are not significant when considering the differences in the controls. Gel electrophoresis showed a dominance of trioxsalen over psoralen in conclusion of single and double strand breaks in plasmid DNA, suggesting a superiority of trioxsalen as a PS (when irradiated with UVA). In addition, absorption measurements showed that these PSs do not need to be shielded from ambient light during the experiment. An observational test setup for a PDT nuclear medicine approach was found. The CL spectrum of Re-188 was measured. Fluctuating inconclusive results from clonogenic assays were found.

Determination of Radiation Exposure of Individuals in the Population by Patients after Radioiodine Therapy - Comparison of two Measurement Systems

According to the requirements of radiation protection legislation, patients may only be discharged from the nuclear medicine therapy ward if it is ensured that the cumulative radiation exposure of the population is below 1 mSv per year. In the present study, dose measurements of patients after radioiodine therapy (RIT) and their relatives are to be used to prove that the radiation exposure resulting from the medical application is low and that the legal framework conditions are complied with. Furthermore, the results allow conclusions to be drawn about the measurement accuracy of the dosimeters used.

METHODS

In 147 patients after RIT and their relatives, the dosage was measured over 14 days with different measuring systems. Finger ring dosimeters (FRD) were worn during the whole day, furthermore the dose was determined by non-official OSL and TLD dosimeters during the sleep phase.

RESULTS

88 data sets were used for the final analysis. With the FRD, dose values between 0.1-50 mSv were determined for the patients. As expected, the finger ring dose of the relatives was significantly lower, averaging 0.75 mSv compared to 10 mSv for the patient. For the TLD and OSL used in the sleep phase, the measured values were in the same range. The reproducibility of the measurement results was significantly better for the OSL than for the TLD.

CONCLUSION

Despite method-related measurement uncertainties, it can be concluded that the exposure dose of patients' relatives after radioiodine therapy is low and that the legal requirements are met. Moreover, the now official OSL dosimeters represent a more accurate and for the chosen measurement task better suited measurement system than the TLD.

KEY POINTS

· The exposure dose of patients' relatives after radioiodine therapy is low.. · The requirements of radiation protection legislation after discharge from the nuclear medicine therapy ward are complied with. · OSL dosimeters are a accurate and for the measurement task suited system.

CITATION FORMAT

· Hartmann H, Andreeff M, Claußnitzer J et al. Determination of Radiation Exposure of Individuals in the Population by Patients after Radioiodine Therapy - Comparison of two Measurement Systems. Fortschr Röntgenstr 2023; 195: 605 - 612.

Identification of the polyketide synthase gene responsible for the synthesis of tanzawaic acids in Penicillium steckii IBWF104-06

Microorganisms have been used as biological control agents (BCAs) in agriculture for a long time, but their importance has increased dramatically over the last few years. The Penicillium steckii IBWF104-06 strain has presented strong BCA activity in greenhouse experiments performed against phytopathogenic fungi and oomycetes. P. steckii strains generally produce different antifungal tanzawaic acids; interesting compounds known to be catalyzed by polyketide synthetases in other fungi. Since the decalin structure is characteristic for tanzawaic acids, two polyketide synthase genes (PsPKS1 and PsPKS2) were selected for further analysis, which have similarity in sequence and gene cluster structure with genes that are known to be responsible for the biosynthesis of decalin-containing compounds. Subsequently, gene-inactivation mutants of both PsPKS1 and PsPKS2 have been generated. It was found, that the ΔPspks1 mutant cannot produce tanzawaic acids any more, whereas reintegration of the original PsPKS1 gene into the genome of ΔPspks1 reestablished tanzawaic acid production. The mutant ΔPspks2 is not altered in tanzawaic acids production. Interestingly, both mutants ΔPsPKS1 and ΔPsPKS2 still display strong BCA activity, indicating that the mechanism of action is not related to the production of tanzawaic acids.

Assessing the meaningful change threshold of Quality of Life in Depression Scale using data from two phase 3 studies of esketamine nasal spray

Background

Major depressive disorder (MDD) directly impacts patients’ lives including symptoms, functioning and health-related quality-of-life (HRQoL). Patient-reported outcomes can capture these impacts, however interpretation of clinical meaningfulness of these measurements are often not readily available. Meaningful change thresholds (MCTs) can be derived for clinical outcome assessments to quantify the change in symptoms that is meaningful to the patient following pharmacologic treatment or other interventions. The objective of this analysis was to determine the within-patient MCT of the self-reported Quality-of-Life in Depression Scale (QLDS) among patients with MDD and active suicidal ideation with intent (MDSI) using an anchor-based approach.

Methods

Data from 2 randomized phase-3 trials of esketamine nasal spray (ASPIRE I and ASPIRE II) were analyzed. The Montgomery–Åsberg Depression Rating Scale (MADRS) was the primary anchor with three different severity criteria. Other anchor variables utilized were Clinical Global Impression of Severity of Suicidality-revised version, Clinical Global Impression of Imminent Suicide Risk, and EuroQol Visual Analog Scale [EQ-VAS]. Spearman correlation coefficients between the change in QLDS and anchor variables were calculated. The mean change in QLDS score at Day 25 from baseline was calculated based on the categorical change in the anchor. Coefficient yield from linear regression of the mean changes in EQ-VAS and QLDS, and distribution-based approach with ½ SD of change in QLDS were considered.

Results

In ASPIRE I, mean (SD) improvement in QLDS score among patients with one category improvement in MADRS from baseline to Day 25 was − 8.22 (8.87), − 8.30 (9.01), and − 8.20 (8.92) using severity criteria #1, #2, and #3, respectively. Patients who achieved a 7-point improvement (MCT) in EQ-VAS yielded a mean − 9.69-point improvement in QLDS at Day 25. The ½ SD of change in QLDS was 5.63. Similar results were obtained for ASPIRE II. The MCTs identified using multiple anchors across both trials ranged from − 11.4 to − 6.7 and had an overall mean of − 7.90 (ASPIRE I) and − 7.92 (ASPIRE II). Thus, an 8-point change was recommended as the MCT for QLDS.

Conclusion

The recommended MCT will help quantify within-person changes in HRQoL using patient-reported QLDS and determine meaningful treatment benefit in an MDD patient population with acute suicidal ideation or behavior.

Trial registration: Name of the registry: ClinicalTrials.gov. Trial registration number: ASPIRE I (NCT03039192), ASPIRE II (NCT03097133). Date of registration: February 01, 2017; March 31, 2017. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT03039192; https://clinicaltrials.gov/ct2/show/NCT03097133.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-022-00453-y.

[Treatment Planning and Dose Verification for Combined Internal and External Radiotherapy (CIERT)]

AIM

The combined internal and external radiotherapy (CIERT) take advantage of the benefits from radionuclide therapy and external beam irradiation. These include steep dose gradients and a low toxicity to normal tissue due to the use of unsealed radioisotopes as well as homogeneous dose distribution within the tumor due to external beam irradiation. For a combined irradiation planning, an infrastructure has to be developed that takes into account the dose contributions from both modalities. A physical verification of the absorbed dose distribution should follow by measurements using OSL detectors.

METHOD

Internal irradiation was performed using Re-188 in a cylindrical phantom with three inserts. SPECT images were acquired to calculate the internal dose using the software STRATOS. The dose distribution was exported as DICOM-RT data and imported in the software Pinnacle. Based on the internal dose distribution the external irradiation using 6 MV photons was planned. The dose contributions of both modalities separately as well as for combined irradiation was measured using OSL detectors made out of Beryllium oxide.

RESULTS

The planed doses of combined irradiation (1 Gy, 2 Gy, 4 Gy) could be verified within the uncertainty of the detectors. The mean energy response to Re-188 was (88.6 ± 2.4) % with respect to the calibration with 200 kV X-ray irradiation. The energy response to 6 MV photons was (146.0 ± 4.9) %.

CONCLUSION

A workflow for the treatment planning of combined internal and external radiotherapy has been developed and tested. Measurements verified the calculated doses. Therefore, the physical and technical basis for the dosimetry of combined irradiation were worked out.

Effect of exercise training on vascular function and endothelial repair in heart failure with preserved ejection fraction: results from the OptimEx trial

Background

Exercise training improves peak oxygen uptake (VO2) in heart failure with preserved ejection fraction (HFpEF), but the underlying mechanisms are unknown. In other cardiovascular diseases, exercise training improves vascular function and increases levels of circulating endothelium-repairing cells. We aimed to investigate the effects of moderate continuous training (MCT) and high intensity interval training (HIIT) on vascular function and cellular endothelial repair in HFpEF.

Methods

This was a prespecified subanalysis of the Optimizing Exercise Training in Prevention and Treatment of Diastolic Heart Failure randomized trial. HFpEF patients (n=180) were randomized to HIIT, MCT or attention control. At baseline and after 12 weeks, we measured peak VO2, fingertip arterial tonometry (n=109), brachial artery flow-mediated dilation (n=59), aortic pulse wave velocity (n=94), and flow cytometry (n=136) for endothelial progenitor cells (CD45dimCD34+VEGFR2+) and angiogenic T cells (CD3+CD31+CD184+). Changes in these parameters were compared between groups using linear mixed models. Parameters were correlated using Spearman's rho.

Results

At 3 months, we did not observe significant differences between HIIT, MCT and control group regarding changes in vascular function throughout the vascular tree (fingertip arterial tonometry, brachial artery flow-mediated dilation and central arterial stiffness, Table 1) or levels of circulating endothelium-repairing cells (endothelial progenitor cells and angiogenic T cells, Table 1). Results were similar at 12 months and when restricting analysis to patients with at least 70% adherence to training sessions. Patients with higher peak VO2 at baseline had lower numbers of circulating endothelial progenitor cells (rho=−0.22, p=0.011).

Conclusions

In patients with HFpEF, exercise training did not change vascular function or levels of endothelium-repairing cells. Thus, improved vascular function likely does not contribute to the change in peak VO2 after training. These findings are in contrast with the benefits of exercise on vascular function in heart failure with reduced ejection fraction and coronary artery disease.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EU Framework Programme 7 Table 1

Ac-EAZY! Towards GMP-Compliant Module Syntheses of 225Ac-Labeled Peptides for Clinical Application

The application of 225Ac (half-life T1/2 = 9.92 d) dramatically reduces the activity used for peptide receptor radionuclide therapy by a factor of 1000 in comparison to 90Y, 177Lu or 188Re while maintaining the therapeutic outcome. Additionally, the range of alpha particles of 225Ac and its daughter nuclides in tissue is much lower (47-85 μm for alpha energies Eα = 5.8-8.4 MeV), which results in a very precise dose deposition within the tumor. DOTA-conjugated commercially available peptides used for endoradiotherapy, which can readily be labeled with 177Lu or 90Y, can also accommodate 225Ac. The benefits are lower doses in normal tissue for the patient, dose reduction of the employees and environment and less shielding material. The low availability of 225Ac activity is preventing its application in clinical practice. Overcoming this barrier would open a broad field of 225Ac therapy. Independent which production pathway of 225Ac proves the most feasible, the use of automated synthesis and feasible and reproducible patient doses are needed. The Modular-Lab EAZY is one example of a GMP-compliant system, and the cassettes used for synthesis are small. Therefore, also the waste after the synthesis can be minimized. In this work, two different automated setups with different purification systems are presented. In its final configuration, three masterbatches were performed on the ML EAZY for DOTA-TATE and PSMA-I&T, respectively, fulfilling all quality criteria with final radiochemical yields of 80-90% for the 225Ac-labeled peptides.

Strahlenexposition bei der Herstellung von Radiopharmaka im nuklearmedizinischen Routinelabor, gemessen mit optisch stimulierten Lumineszenzdetektoren (OSL)

Ziel Vor dem Hintergrund der neuen Strahlenschutzverordnung (StrlSchV) ist es sinnvoll, sich erneut einen Überblick über die Strahlenexposition des Personals bei Radiopharmakaherstellungen im radiopharmazeutischen Labor zu verschaffen. Dabei soll die Strahlenexposition im Bereich der Herstellung und Anwendung von Radiopharmaka erfasst werden, um Tätigkeiten mit hoher Exposition zu identifizieren und Arbeitsabläufe zu optimieren. In der Klinik und Poliklinik für Nuklearmedizin am Universitätsklinikum an der TU Dresden wurden dazu Messungen mit optisch stimulierten Lumineszenzdosimetern (OSL) durchgeführt.

Material und Methode Es wurden lichtgeschützte OSL-Dosimeter auf die Fingerkuppen von Daumen, Zeigefinger und Mittelfinger beider Hände und auf der Stirn platziert. Jedes OSL-Dosimeter war zuvor kalibriert worden. Untersucht wurde die Teilkörperexposition der Hände im Präparationslabor bei: 99mTc-Präparationen im Routinebetrieb, Aufziehen von Spritzen zur Radiosynoviorthese und von 90Y-Sirtex-Partikeln sowie Herstellung von 177Lu- und 68Ga-Präparaten.

Ergebnisse Es zeigte sich, dass die 99mTc-Präparationen zu einer relativ hohen Exposition führen aufgrund der Zahl der Präparationen und der Zahl an aufgezogenen Spritzen. Das Aufziehen der RSO-Spritzen führt in Abhängigkeit von der Zahl der zu füllenden Spritzen ebenfalls zu nennenswerter Handbelastung. Im Gegensatz dazu ist das Aufziehen der Sirtex-Partikel wenig belastend. Die Strahlenexposition bei 177Lu- und 68Ga-Präparationen hängt insbesondere vom Handling bei der Herstellung, der Verwendung von Modulen und der Art der Qualitätskontrolle ab. Bei der Ermittlung der Augenlinsenexposition wurden mit einer Ausnahme unkritische 0,02 mGy oder weniger gemessen.

Active matrix metalloproteinase-8 and periodontal bacteria-interlink between periodontitis and inflammatory bowel disease?

BACKGROUND

The aim of this study was the investigation of concentration and prevalence of selected periodontal pathogenic bacteria and concentration of active matrix metalloproteinase-8 (aMMP-8) within a group of patients with inflammatory bowel diseases (IBD) and to compare the results with a group of healthy control subjects (HC).

METHODS

Fifty-nine IBD patients with Crohn`s disease (CD, n = 30) or ulcerative colitis (UC, n = 29) and 59 HC were included in this cross-sectional study. Based on periodontal probing depth (PD) and clinical attachment level (CAL), periodontitis was classified as healthy/mild, moderate, or severe. aMMP-8 was analyzed from gingival crevicular fluid using enzyme linked immunosorbent assay. Eleven selected periodontal pathogenic bacteria were analyzed in subgingival plaque samples using polymerase chain reaction.

RESULTS

IBD patients showed higher CAL (P < 0.01), more severe periodontitis (P = 0.04), gingival bleeding (P < 0.01) and aMMP-8 concentration (P < 0.01) than HC. Only in CD, increasing severity of periodontitis was associated with an increase in aMMP-8 concentration (P = 0.02). The prevalences of Eubacterium nodatum and Eikenella corrodens were significantly lower in IBD compared to HC (P = 0.01). Additionally, the prevalence of Eikenella corrodens was significantly higher in CD compared to the UC group (P = 0.04). Further statistically significant differences in selected bacteria between IBD and HC or CD and UC groups could not be found (P > 0.05).

CONCLUSIONS

The results reveal changes in host immune response of IBD patients in terms of aMMP-8. Only in CD increasing aMMP-8 was associated with severity of periodontal disease. The role of periodontal pathogenic bacteria in the interrelationship between IBD and periodontitis remains unclear.

Rapid Target Analysis for Pesticides in Water by Online Coated Capillary Microextraction Combined with Liquid Chromatography and Tandem Mass Spectrometry

The applicability of online trace enrichment with custom-made coated capillaries combined with tandem mass spectrometry was demonstrated for the target analysis of selected pesticides (mainly herbicides, e.g., triazines, phenylureas, and acetanilides) in water. The developed method allows rapid determination of several widely used plant protectants within a total analysis time of 11 min. Good linearity (r ≥ 0.995) was obtained for the selected pesticides in the range of 0.050–50 μg/L. The relative standard deviations (RSDs) of the peak areas were ≤3.8% for spiked Milli-Q water (5 μg/L). The RSDs obtained in analyses of spiked (1 μg/L) water samples (brook water, river water, sewage plant effluent) ranged from 2.9 to 6.8%, indicating low influence of the matrix on enrichment and detection. The detection limits, which ranged from 10 to 90 ng/L, fulfilled the requirements of the European regulations for drinking water. The polyacrylate coating of the extraction capillary showed good stability in the presence of water and acetonitrile and allowed ≥100 extractions with 1 capillary.

Radiation exposure of patients during 68Ga-DOTATOC PET/CT examinations

Aim: Investigation of the biodistribution and calculation of dosimetry of Ga-68-DOTATOCfor patients imaged in the routine clinical setting for diagnosis or exclusion of neuroendocrine tumours. Patients, methods: Dynamic PET/CT-imaging (Biograph 16) was performed over 20 min in 14 patients (8 men, 6 women) after injection of (112 ± 22) MBq 68Ga-DOTATOC followed by whole body 3D-acquisition (8 bed positions, 3 or 4 min each) 30 min p.i. and 120 min p.i. Urinary tracer elimination was measured and blood activity was derived non-invasively from the blood pool of the heart. The relevant organs for dosimetry were spleen, kidneys, liver, adrenals, urinary bladder and pituitary gland. Dosimetry was performed using OLINDA/ EXM 1.0 software and specific organ uptake was expressed as standardized uptake values (SUVs). Results: Rapid physiological uptake of the radiotracer could be demonstrated in liver, spleen and kidneys, adrenals and pituitary gland (mean SUVs were 6, 20, 16, 10, and 4, respectively). Radiotracer elimination was exclusively via urine (16% of injected dose within 2h); no redistribution could be observed. The spleen and the kidneys received the highest radiation exposure (0.24 mSv/MBq, 0.22 mSv/MBq resp.), mean effective dose yielded 0.023 mSv/MBq. Conclusion: 68Ga-DOTATOC is used extensively for diagnosis of somatostatin receptor positive tumours because it has several advantages over the 111In-labelled ligand. The derived dosimetric values are lower than first approximations from the biological data of OctreoScan. The use of CT for transmission correction of the PET data delivers radiation exposure up to 1 mSv (low dose).

Wirkung von Milch und Diättränken mit und ohne HCO3 –-Ionen auf den intraluminalen pH-Wert im Labmagen und den systemischen Säuren-Basen-Status beim Kalb

Problemstellung: Bei Kälbern wird nach Zufuhrvon Diättränken mit Bikarbonat-Ionen eine besonders ausgeprägte Alkalisierung der Labmageningesta erwartet. Nachfolgend könnten die an saure pH-Werte gebundene abomasale Verdauung sowie unspezifische Infektabwehr beeinträchtigt sein. Material und Methode: Bei acht klinisch gesunden Kälbern wurde operativ eine Plastkanüle in den Labmagen eingesetzt. Danach erhielten die Tiere über sieben bisneun Tage als Nahrung alternierend 1) Kuhmilch, 2) bikarbonatfreie oder 3) bikarbonathaltige Diättränke. Außerdem wurde 4) das Gemisch aus gleichen Teilen bikarbo- nathaltige Diättränke und Milch verabreicht. In den über die Kanüle entnommenen Labmageningesta bestimmten wir dieWertefür pH, Fläche unter der pH-Wert-Kurve (AUC) und [SID3]. Weiterhin wurde vergleichend im arteriellen und venösen Blut der systemische Säuren-Basen-Status anhand traditioneller Hen- derson-Hasselbalch-Parameter sowie der Stewart-Variablen ermittelt. Ergebnisse: Die Fütterung von Milch bewirkte beiden Kälbern einen Anstieg des Labmagen-pH von Nüchternbefunden mit 2,00 ± 0,44 auf Werte bis 4,70 ± 0,41 über zwei Stunden. Die AUC-Werte bis vier Stunden postprandial betrugen 898 ± 87 (= 100%). Die in Milch zubereitete bikarbonatfreie Diättränke führte zur signifikant basischeren Auslenkung desabomasalen pH mit Werten bis 5,35 ± 0,31 sowieAUC = 1084 ± 89 (= 121%). Die mit Wasser hergestellte bikarbonathaltige Diättränke allein und ebenso ihr Gemisch mit Milch verursachten dentransient stärksten Anstieg des Labmagen-pH für 1,5 bzw. 0,5 Stunden auf Werte bis 6,59 ± 0,28 bzw. 6,22 ± 0,12. Die AUC- Werte unterschieden sich mit 1119 ± 45 (= 125%) und 1126 ± 44 (= 125%) signifikant von den Befunden nach Milchtränke, jedoch nichtvon den Resultaten nach Gabe der bikarbonatfreien Diättränke. Systemisch bewirkten die Fütterungen zum Zeitpunkt zwei Stunden postprandial eine im arteriellen und venösen Blut gleichermaßen nachweisbare geringe, teilweise signifikante basische Reaktion, wie ↑ pH, ↑ [HCO3 –, ↑ [BE], ↑ [SID3] und ↓ [Atot] bei unveränderten Werten für PCO2. Die postprandial im Blut der Kälber festgestellte “basische Flut” war nach Gabe der bikarbonathaltigen Diättränken relativ am deutlichsten ausgeprägt. Schlussfolgerung: Im Vergleich zur üblichen Milchfütterung verursachte die in Milch zubereitete bikarbonatfreie Diättränke postprandial signifikant stärkere basische Auslenkungen des Labmagen-pH. Mit Wasser hergestellte bikarbonathaltige Elektrolyttränken führten kurzfristig (≤ 2 h) zu noch stärkerem Anstieg des Labmagen-pH. Die AUC der pH-Wert-Kurve bisvierStunden postprandial (= zeitabhängige “Wirksamkeit”) differierte jedoch nicht signifikant von der nach Gabe der bikarbonatfreien Diättränken.

Stewart-Variablen des Säuren-Basen-Status bei Kälbern

Gegenstand und Ziel: Bisher wird das Stewart-Modell des Säuren-Basen- Status in der klinischen Veterinärmedizin kaum genutzt. Eine Ursache dafür ist der Mangel an Kenntnissen über anerkannte Referenzbereiche der Stewart-Variablen [strong ion difference = SID] und [Acid total = Atot] bei den verschiedenen Tierarten. Außerdem ist bisher wenig über den Einfluss wichtiger Erkrankungen auf die Stewart-Parameter bekannt. Material und Methode: Bei 17 Kälbern (Alter: 1–28 d) wurden statistisch begründete Referenzdaten für Serum-[SID3, 4] und -[Atot- Pro/-Alb] ermittelt. Außerdem wurde retrospektiv der Einfluss von Kälberdiarrhö auf die Stewart-Variablen im Experiment (39 Kälber; Alter: 5,3 ± 2,5 d) und in der klinischen Praxis (36 Kälber; Alter: 8,7 ± 5,0 d) untersucht. Ergebnisse: Gesunde Kälber besitzen in der ersten Lebenswoche mit der Serum-[SID3/4] von etwa 51/48 mmol/l um 2–3 mmol/l signifikant höhere Werte als ältere Tiere. Infolge des postnatalen Anstiegs der Serumalbuminkonzentration erhöhen sich die Serum-[Atot-Alb] von etwa 15 mmol/l (1. Tag) auf Werte von 22 mmol/l (28. Tag). Aus den Stewart-Variablen PvCO2, Serum-[SID4] und -[Atot-Pro] ließ sich der BlutpH mit der Differenz von 0,063 ± 0,0336 gegenüber den gemessenen Werten vorhersagen. Spontan auftretender Durchfall senkt bei Kälbern die Serum-[SID3, 4] auf etwa 40 mmol/l (überlebende Tiere) oder ante mortem auf noch niedrigere Werte. Schlussfolgerung: Die metabolische Azidose durchfallkranker Kälber ist nach dem Stewart-Modell auf die Imbalancen der starken Elektrolyte Na+ und Cl– (SID3↓), die Anhäufung von Blut-Laktat– (SID4↓) sowie die Dehydratation (Atot↑) zurückzuführen. Eine erfolgreiche Therapie der Azidose muss die erniedrigten Serum-[SID] anheben und durch Flüssigkeitszufuhr die Euhydratation mit physiologischer Serum-[Atot] herbeiführen. Klinische Relevanz: In oralen und parenteralen Rehydratationslösungen lassen sich die Werte für [SID] und [Atot] leicht ermitteln und zur prospektiven Wirksamkeitsbeurteilung der Lösungen gegen die Azidose bei durchfallkranken Kälbern nutzen.

Twins in spirit part IV - [177Lu] high affinity DOTATATE. A promising new tracer for peptide receptor radiotherapy?

AIM

Besides the use of somatostatin analogues, small molecules like sunitinib and everolimus as well as conventional chemotherapy, peptide receptor radiotherapy (PRRT) using radiolabelled somatostatin analogues has gained an important role in the treatment of inoperable, metastasized neuroendocrine tumours (NET). There are various radiotracers in use. Based on our experience with the PET tracer [⁶⁸Ga]DOTA-3-iodo-Tyr³-octreotate ([⁶⁸Ga]HA-DOTATATE), a DOTATATE derivative with an increased binding affinity to hsst5, the current retrospective analysis is exploring the therapeutic potential of [¹⁷⁷Lu]HA-DOTATATE.

METHODS

Eighteen patients with metastatic NET (G1/G2) were treated using [¹⁷⁷Lu]DOTATATE and/or [¹⁷⁷Lu]HA-DOTATATE, and dosimetric results of both tracers were compared.

RESULTS

Using [¹⁷⁷Lu]HA-DOTATATE, a mean tumour dose of 5.34 Gy/GBq (median 2.53 Gy/GBq; range 0.89-33.3 Gy/GBq) was achieved, while [¹⁷⁷Lu]DOTATATE delivered a tumour dose of 5.53 Gy/GBq (median 2.70 Gy/GBq; range 0.44-15.3 Gy/GBq). Organ doses for [¹⁷⁷Lu]HA-DOTATATE vs. [¹⁷⁷Lu]DOTATATE were as follows: kidney 2.31 ± 0.85 vs. 2.03 ± 0.96 Gy/GBq, liver 1.06 ± 0.79 vs. 1.67 ± 1.73 Gy/GBq, spleen 3.89 ± 4.04 vs. 4.50 ± 3.69 Gy/GBq and whole body 0.16 ± 0.10 Gy/GBq vs. 0.15 ± 0.08 Gy/GBq. Tumour-to-kidney dose ratio was slightly higher for [¹⁷⁷Lu]DOTATATE (2.4 ± 5.6) compared to [¹⁷⁷Lu]HA-DOTATATE (1.5 ± 3.6).

CONCLUSION

Both tracers showed marked inter-patient variation in their dosimetry, and no significant differences in dosimetry of [¹⁷⁷Lu]HA-DOTATATE and [¹⁷⁷Lu]DOTATATE were observed when taking all patients into account. Thus, [¹⁷⁷Lu]HA-DOTATATE appears viable for PRRT, although it was marginally inferior regarding kidney dose and tumour-to-kidney dose ratio compared to the established [¹⁷⁷Lu]DOTATATE.

Multivalency of PEG-thiol ligands affects the stability of NIR-absorbing hollow gold nanospheres and gold nanorods

In this work the effect of multivalency on the stability of NIR-absorbing HAuNSs and AuNRs functionalized by mono-, bi- and tridentate polyethyleneglycol (PEG) thiol ligands is reported.

Influence of central nervous system-acting drugs on results of cognitive testing in geriatric inpatients

INTRODUCTION

Growing evidence shows a high correlation between extensive use of central nervous system-acting drugs (CNSADs) in elderly patients and adverse drug reactions (ADRs) such as falls, fractures, and mortality.

RESEARCH QUESTION

Are results of cognitive testing with the Mini Mental Status Examination (MMSE) influenced by use of CNSADs?

SETTING

Geriatric inpatient service for acute, subacute, and rehabilitation care.

METHODS

Secondary combined analysis of two prospective, single-center study cohorts (PROPSYC, 2011 and AGE OUT, 2012) with identical procedure for the MMSE at a tertiary hospital.

RESULTS

Overall, 395 patients were included, 144 male (M) and 251 female (F). Mean age was 80.0 ± 8.4 years (M 76.7 ± 9.1, F 81.9 ± 7.3, p = 0.0000). Mean MMSE points were 22.9 ± 4.8 (M 23.2 ± 4.6, F 22.6 ± 5.0, p = 0.211). In total, 258 patients (65.3 %) used drugs with potential adverse cognitive properties. Analgesics with central activity were given to 117 of 395 patients (29.6 %). Low-potency opioids (tramadol hydrochloride, tilidine) were identified in 60 patients and high-potency opioids in 57 patients. Antidepressants were used in 66 patients, benzodiazepines in 26, and hypnotics in 11, while 38 patients received other CNSADs. We only found significant correlations with the results of cognitive testing for sedatives (diazepam and oxazepam, Pearson's r - 0.79, p = 0.05), but not for lorazepam.

CONCLUSION

Our analysis shows an influence of sedatives (diazepam and oxazepam, but not lorazepam) on cognitive testing with the MMSE in users of CNSADs.

Measurement of pion, kaon and proton production in proton-proton collisions at [Formula: see text] TeV

The measurement of primary [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text] production at mid-rapidity ([Formula: see text] 0.5) in proton-proton collisions at [Formula: see text][Formula: see text] 7 TeV performed with a large ion collider experiment at the large hadron collider (LHC) is reported. Particle identification is performed using the specific ionisation energy-loss and time-of-flight information, the ring-imaging Cherenkov technique and the kink-topology identification of weak decays of charged kaons. Transverse momentum spectra are measured from 0.1 up to 3 GeV/[Formula: see text] for pions, from 0.2 up to 6 GeV/[Formula: see text] for kaons and from 0.3 up to 6 GeV/[Formula: see text] for protons. The measured spectra and particle ratios are compared with quantum chromodynamics-inspired models, tuned to reproduce also the earlier measurements performed at the LHC. Furthermore, the integrated particle yields and ratios as well as the average transverse momenta are compared with results at lower collision energies.