The impact of conventional and heavy ion irradiation on tumor cell migration in vitro

PURPOSE

The influence of X-ray and (12)C heavy ion irradiation on tumor cell migration and of beta(3) and beta(1) integrin expression was investigated.

MATERIAL AND METHODS

Two different tumor cell lines (U87 glioma and HCT116 colon carcinoma cells) were irradiated with 1, 3, or 10 Gy X-rays or (12)C heavy ions. 24 h after irradiation a standardized Boyden Chamber assay for migration analysis was performed and cells were lysed for Western blotting.

RESULTS

Radiation-induced influences were cell line- and radiation type-dependent. X-rays decreased HCT116 migration at higher doses and appear to increase U87 migration after 3 Gy. Heavy ions decreased migration of both cell lines dose-dependently. A trend of increased beta(3) and beta(1) integrin expression in U87 cells after both radiation types was observed. beta(1) integrin expression in HCT116 cells was increased after X-rays but decreased after heavy ion irradiation.

CONCLUSIONS

Results suggest that irradiation of tumor cells can modulate their migratory behavior. An increased migration, as shown with U87, leaves a higher probability of metastatic induction after irradiation of solid tumors in vivo, whereas an invariably reduced tumor cell migration, as shown after heavy ion treatment, could diminish the hazard of radiation-induced metastasis. As integrin expression and migration were only partially correlated, other migration-related surface molecules may be more relevant for radiation effects on tumor cell motility.

Deep venous thrombosis after lumbar disc surgery due to compression of the vena cava caused by a retroperitoneal haematoma

The case of a 46-year-old Arabian male complaining of low back pain due to congenital lumbar spinal canal stenosis with additional disc herniation is presented. Following CT scan and MRI, bilateral enlarged partial hemilaminectomy was performed in L5/S1 with removal of herniated disc material. Intraoperatively, no complication was encountered. In the postoperative course, the patient had persistent low back pain and developed deep venous thrombosis in the left leg. Phlebography revealed thrombosis in the deep veins of the left leg extending into the pelvic region. The source of this high obstruction of the venous outflow was a retroperitoneal haematoma, visible on CT scan, compressing the vena cava at the level of L5/S1, the most probable cause of which was accidental perforation of the anterior spinal ligament. This case demonstrates that injury to the retroperitoneal vessels during lumbar disc surgery can also present as deep venous thrombosis due to obstruction of venous outflow.

[Ventral stabilization of the lumbar spine of a 2-year-old boy with an expandable cage : 7-year course]

This case report describes the first implantation of an expandable cage into the lumbar spine of a 2-year-old boy. Due to incomplete remission of a teratoma, it was necessary to replace the second lumbar vertebral body with an expandable cage implantation and subsequent dorsoventral stabilization. During the follow-up period with annual x-ray examinations, a loss of correction without increased pain or neurological deficits could be shown in the now 9-year-old boy.

EEG changes and serum anticholinergic activity measured in patients with delirium in the intensive care unit

The aim of this study was to examine whether serum anticholinergic activity (SAA) is a reliable indicator of delirium in the ICU, and whether there is a significant correlation between SAA and quantitative electroencephalographic (EEG) data in delirious patients. In a prospective cohort study, we assessed ICU patients diagnosed with delirium (n = 37). EEG measurements and blood analysis including SAA were performed 48 h following ICU admission. The presence of delirium was evaluated using the Confusion Assessment Method for critically ill patients in ICU (CAM-ICU). The SAA level was measured using a competitive radioreceptor binding assay for muscarinergic receptors and quantitative EEG was measured using the CATEEM system. We found that, under comparable conditions, patients in the delirium group showed a higher relative EEG theta power and a reduced alpha power (n = 17) than did the non-delirious patients (n = 20). No difference in measured SAA levels were seen; therefore, there was no correlation between SAA and EEG measurements in delirious patients. We conclude that, in contrast to the EEG, the SAA level cannot be proposed as a tool for diagnosing delirium in ICU patients.

Assessment of capillary suction time (CST) test methodologies

The capillary suction time (CST) test is a commonly used method to measure the filterability and the easiness of removing moisture from slurry and sludge in numerous environmental and industrial applications. This study assessed several novel alterations of both the test methodology and the current standard capillary suction time (CST) apparatus. Twelve different papers including the standard Whatman No. 17 chromatographic paper were tested. The tests were run using four different types of sludge including a synthetic sludge, which was specifically developed for benchmarking purposes. The standard apparatus was altered by the introduction of a novel rectangular funnel instead of a standard circular one. A stirrer was also introduced to solve the problem of test inconsistency (e.g. high CST variability) particularly for heavy types of sludge. Results showed that several alternative papers, which are cheaper than the standard paper, can be used to estimate CST values accurately, and that the test repeatability can be improved in many cases and for different types of sludge. The introduction of the rectangular funnel demonstrated an obvious enhancement of test repeatability. The use of a stirrer to avoid sedimentation of heavy sludge did not have statistically significant impact on the CST values or the corresponding data variability. The application of synthetic sludge can support the testing of experimental methodologies and should be used for subsequent benchmarking purposes.

Current status of intraoperative real-time vibrography in neurosurgery

PURPOSE

Intracranial lesions are often characterized by different elasticities. The aim of the present study was to test the application of vibrography during brain tumor surgery.

MATERIALS AND METHODS

The real-time vibrography system consisted of a conventional ultrasound system (Siemens Sonoline Omnia) with a custom-designed RF interface and a 6.5-MHz endocavity curved array (Siemens 6.5EC10). The RF data were digitized using a 50-MHz, 12-bit PCI analog/digital (A/D) converter for real-time or offline processing. Static compression was replaced by low-frequency axial vibration of the probe. A special applicator equipped with a stepping motor moved the ultrasonic probe and produced a low frequency mechanical vibration of 5-10 Hz with a vibration amplitude of 0.3 mm and slight preliminary compression (total<1 mm). The maximum application time was 60 sec. A pneumatic holding device (Unitrac, Aesculap, Tuttlingen, Germany) was used.

RESULTS

Brain tissue is normally color coded between red and orange. In this study 41 out of 45 tumors could be detected via vibrography. Two tumors could not be detected with this imaging technique: a glioblastoma at a depth of 2 cm and a metastasis at a depth of 3 cm. Two additional tumors were not recognized because of technical problems. In 4 cases tumors with strain values identical to those in brain tissue (coded red or orange) but easily identified by a peripheral zone of high strain (yellow) were found. Tumors with strain values higher than those measured in brain tissue coded yellow and were softer than brain during surgical intervention. Higher strain was found in 23 tumors. Tumors with strain values lower than those in cerebral tissue were found to be harder during surgery and coded brown or black. Lower strain was found in 10 cases. Four tumors were inhomogeneous and could not be assigned to one of the above groups. Mortality was 0%, morbidity 2.3%. One patient displayed transient paresis of the lower extremity due to microsurgical difficulties during the approach. In one patient minimal bleeding of the cortical surface occurred in a frontobasal tumor; however, no postoperative deficits were noted.

CONCLUSION

Vibrography is a new low-risk technique for intraoperative imaging. In low-grade astrocytomas and oligodendrogliomas, this additional technique can be used to control resection. In other cortical and subcortical tumors (e. g. metastases), it can provide an impression of the intratumoral elasticities.

Pooled historical MRI data as a basis for research in multiple sclerosis--a statistical evaluation

Pooled data from placebo groups of different trials can serve as historical control for ongoing or future therapeutic studies and as a reference for power calculations. In order to assess their usefulness for this purpose, we investigated the degree of heterogeneity of placebo arm data from 14 controlled studies included in the database of the Sylvia Lawry Centre for Multiple Sclerosis Research. Since different criteria for the inclusion/exclusion of patients were used in these studies, an attempt was made to adjust the distribution of magnetic resonance imaging (MRI) measures for the differences in the study populations. The analyses showed that, even after adjustment, significant differences remained. This heterogeneity does not reduce the usefulness of the database for statistical analysis of inter-relationships between variables, provided that it is explicitly taken into account as a stratification factor. However, care must be taken when trying to compare the results of a newly treated group with the patients of this pool. Heterogeneity in some MRI variables was greatly reduced when only studies from the same image analysis centre were compared.

Überlebensverbesserung eines unizentrischen Gesamtkollektivs aus 20 Jahren

PURPOSE

The development of overall survival of a DOSAK (German-Austrian-Swiss Cooperative Group on tumours of the maxillofacial region) clinic's overall population comprising a time period of more than 20 years (1983-2004) should be assessed. At a cutoff date (January 1st, 1997), a change from a primarily surgically based to a consequent multi-modality treatment regimen was implemented. The periods of time before and after that change should be compared.

METHODS AND PATIENTS

The data of the DOSAK registry entries on 1038 patients suffering from primary untreated oral and oropharyngeal carcinomas were updated with respect to follow-up and mortality data to achieve a 100% quality of follow-up. The end point (death) was reached in 67% of the overall population. Statistical analysis was carried out by the Trium Analysis Online corporation, Munich.

RESULTS

The portion of female and older tumor patients increased, more than half of all tumor patients were clearly in stage IV of the disease at first referral. The portion of patients operated on persisted approximately (80%), the portion of additional treatment modalities could be increased considerably. The fact of a bony infiltration by the tumor and the operability remained highly significantly relevant for survival in multivariate analysis, despite of multi-modality treatment. The survival rate of the patients remained significantly dependent on the clinical stage of the disease in multivariate analysis but could be improved by 10% in the clinical stages II and III and in the patients who could not be operated on. All in all, the cutoff date was statistically relevant for survival in multivariate analysis, i.[Symbol: see text]e. the change in the treatment regimen had a verifiable positive effect on the survival of a unicentric overall population.

CONCLUSION

Survival improvement in an overall population via change in treatment strategy is possible in relatively short time; the clinical stages II and III and the non-operable patients have the greatest benefit from a multi-modality treatment.

Investigations concerning the COX/5-LOX inhibiting and hydroxyl radical scavenging potencies of novel 4,5-diaryl isoselenazoles

The aim of this study was to investigate 4,5-diaryl isoselenazoles as multiple target non-steroidal anti-inflammatory drugs (MTNSAIDs) which can intervene into the inflammatory processes via different mechanisms of action creating a new class of compounds. Here we describe the synthesis of COX/LOX inhibitors which additionally reduce the level of reactive oxygen species, such as hydroxyl radicals which are well known for supporting inflammation processes in Parkinson's disease, Alzheimer's disease and rheumatoid arthritis.

Non-classical light emission from a single electrically driven quantum dot

Easy to handle light sources with non-classical emission features are strongly demanded in the growing field of quantum communication. We report on single-photon emission from an electrically pumped quantum dot with unmatched spectral purity, making spatial or spectral filtering dispensable.

Radiobiological characterization of human tumor cell multilayers after conventional and particle irradiation

The goal of this study was to establish planar multilayers from human tumor cells (WiDr and SiHa) as a model for irradiation of solid tumors. In addition to using conventional X rays (250 kV) as a reference standard, multilayers were tested for their suitability in cell survival studies with heavy-ion irradiation ((12)C(6+)) in the plateau and the extended Bragg peak with a scanned ion beam. Multilayers of both cell lines showed decreased survival compared to the corresponding monolayers after both X and heavy-ion irradiation. This multicellular sensitization effect is in contrast to the multicellular resistance or contact effect commonly described in the literature. Flow cytometry measurements showed an arrest of irradiated SiHa cells in G(2)/M phase. In contrast to the transient arrest of the monolayers, the multilayers stayed in a prolonged arrest. After Bragg-peak irradiation of monolayers, the arrest time was increased by 12-24 h, and more cells were arrested than with X rays. For multilayers, there were no differences between G(2) arrest after X rays and heavy ions for the entire observation period.

Effectiveness of Carbon Ion Radiotherapy in the Treatment of Skull-Base Chordomas

PURPOSE

The aim of this study was to evaluate the effectiveness and toxicity of carbon ion radiotherapy in chordomas of the skull base.

METHODS AND MATERIALS

Between November 1998 and July 2005, a total of 96 patients with chordomas of the skull base have been treated with carbon ion radiation therapy (RT) using the raster scan technique at the Gesellschaft für Schwerionenforschung (GSI) in Darmstadt, Germany. All patients had gross residual tumors. Median total dose was 60 CGE (range, 60-70 CGE) delivered in 20 fractions within 3 weeks. Local control and overall survival rates were calculated using the Kaplan-Meier method. Toxicity was assessed according to the Common Terminology Criteria (CTCAE v.3.0) and the Radiation Therapy Oncology Group (RTOG) / European Organization for Research and Treatment of Cancer (EORTC) score.

RESULTS

Mean follow-up was 31 months (range, 3-91 months). Fifteen patients developed local recurrences after carbon ion RT. The actuarial local control rates were 80.6% and 70.0% at 3 and 5 years, respectively. Target doses in excess of 60 CGE and primary tumor status were associated with higher local control rates. Overall survival was 91.8% and 88.5% at 3 and 5 years, respectively. Late toxicity consisted of optic nerve neuropathy RTOG/EORTC Grade 3 in 4.1% of the patients and necrosis of a fat plomb in 1 patient. Minor temporal lobe injury (RTOG/EORTC Grade 1-2) occurred in 7 patients (7.2%).

CONCLUSIONS

Carbon ion RT offers an effective treatment option for skull-base chordomas with acceptable toxicity. Doses in excess of 75 CGE with 2 CGE per fraction are likely to increase local control probability.

[Influence of ML-1 standardized mistletoe extract on the quality of life in head and neck cancer patients]

BACKGROUND

ML-1 standardized mistletoe extracts have been recommended for increasing the health-related quality of life in cancer patients.

PATIENTS AND METHODS

The EORTC questionnaire QLQ-C30((V2)) was given to a randomly chosen subgroup of 399 patients of a prospective, randomized, open, multi-center trial. A total of 200 patients from this trial were randomized for ML-1 treatment (1 ng/kg body weight ML-1 was injected subcutaneously twice weekly over a 60-week period. Treatment cycles of 12 weeks were followed by a break of 4 weeks (between weeks 12-16, 28-32, and 44-48)). The remaining 199 patients formed the control group.

RESULTS

Patients completed questionnaires before the start of their treatments at week 0 and continued until week 156. The compliance rate was high: 3611 questionnaires were available, which equals a median of nine longitudinal measurements per patient between weeks 0 and 156. Analysis did not indicate any improvement in the quality of life for either group. A significant decrease in quality of life, however, was seen in patients undergoing radiotherapy. In these patients, the global state of health was reduced and four symptom scales were significantly worse.

CONCLUSION

Our results demonstrated no improvement in the quality of life in head and neck cancer patients when treated with ML-1 extract.

Robust registration procedures for endoscopic imaging

This paper presents a robust algorithm for calibration and system registration of endoscopic imaging devices. The system registration allows us to map accurately each point in the world coordinate system into the endoscope image and vice versa to obtain the world line of sight for each image pixel. The key point of our system is a robust linear algorithm based on singular value decomposition (SVD) for estimating simultaneously two unknown coordinate transformations. We show that our algorithm is superior in terms of robustness and computing efficiency to iterative procedures based on Levenberg-Marquardt optimization or on quaternion approaches. The algorithm does not require the calibration pattern to be tracked. Experimental results and simulations verify the robustness and usefulness of our approach. They give an accuracy of less than 0.7 mm and a success rate >99%. We apply the calibrated endoscope to the neurosurgical relevant case of red out, where in spite of the complete loss of vision the surgeon gets visual aids in the endoscope image at the actual position, allowing him/her to manoeuvre a coagulation fibre into the right position. Finally, we outline how our registration algorithm can be used also for standard registration applications (establish the mapping between two sets of points). We propose our algorithm as a linear, non-iterative algorithm also for projective transformations and for 2D-3D-mappings. Thus, it can be seen as a generalization of the well-known Umeyama registration algorithm.

Prognosis of the individual course of disease--steps in developing a decision support tool for Multiple Sclerosis

Background

Multiple sclerosis is a chronic disease of uncertain aetiology. Variations in its disease course make it difficult to impossible to accurately determine the prognosis of individual patients. The Sylvia Lawry Centre for Multiple Sclerosis Research (SLCMSR) developed an "online analytical processing (OLAP)" tool that takes advantage of extant clinical trials data and allows one to model the near term future course of this chronic disease for an individual patient.

Results

For a given patient the most similar patients of the SLCMSR database are intelligently selected by a model-based matching algorithm integrated into an OLAP-tool to enable real time, web-based statistical analyses. The underlying database (last update April 2005) contains 1,059 patients derived from 30 placebo arms of controlled clinical trials. Demographic information on the entire database and the portion selected for comparison are displayed. The result of the statistical comparison is provided as a display of the course of Expanded Disability Status Scale (EDSS) for individuals in the database with regions of probable progression over time, along with their mean relapse rate. Kaplan-Meier curves for time to sustained progression in the EDSS and time to requirement of constant assistance to walk (EDSS 6) are also displayed. The software-application OLAP anticipates the input MS patient's course on the basis of baseline values and the known course of disease for similar patients who have been followed in clinical trials.

Conclusion

This simulation could be useful for physicians, researchers and other professionals who counsel patients on therapeutic options. The application can be modified for studying the natural history of other chronic diseases, if and when similar datasets on which the OLAP operates exist.

Steps towards a miniaturized, robust and autonomous measurement device for the long-term monitoring of patient activity: ActiBelt

We describe the first steps in the development of a wearable measurement device for measuring a subject's three-dimensional acceleration. The ultimate aim is a standard measurement instrument integrated in a belt buckle that allows objective evaluation of treatment and rehabilitation measures in patients, in particular for disabling chronic diseases such as multiple sclerosis. In a first step we combined standard hardware elements to record test data from healthy volunteers. We then developed algorithms to automatically distinguish between different stages of activity, such as jogging, walking, lying, standing and sitting, and to detect and count steps. Distinction between standing and sitting is the most difficult to accomplish. As a first validation, we calculated the distance traveled from data of 17 experiments and a total of 4.5 h, for which one proband was walking and running for a known distance, and compared the results with two commercially available pedometers. We could show that the relative error for the ActiBelt is only half of that for the two pedometers. Apart from developing much smaller, robust and integrated hardware, we describe ideas on how to develop algorithms that allow extraction of a "baseline step pattern" in analogy to baseline ECG to define and detect clinically relevant deviations.

Cluster Effects within the Local Effect Model

The local effect model predicts the relative biological effectiveness (RBE) for different ions and cell lines starting from the corresponding experimental photon data and an amorphous track structure model. Here we present an extension of the model that takes cluster effects of single-strand breaks (SSBs) at the nanometer scale into account. In line with the main idea of the local effect model, we take the yields of SSBs and double-strand breaks (DSBs) from experimental photon data and use a Monte Carlo method to distribute them onto the DNA. We score clusters of SSBs where individual SSBs are separated by less than 25 bp as additional DSBs. Assuming that the number of DSBs is a measure of cell lethality, we derive a modified cell survival curve for photons that takes these cluster effects into account. In combination with an improved radial dose distribution, we find that the extended local effect model including cluster effects reproduces most experimental data better than the original local effect model and thus enhances the accuracy of the local effect model.