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Houvast RD, Badr N, March T, de Muynck LDAN, Sier VQ, Schomann T, Bhairosingh S, Baart VM, Peeters JAHM, van Westen GJP, Plückthun A, Burggraaf J, Kuppen PJK, Vahrmeijer AL, Sier CFM. Preclinical evaluation of EpCAM-binding designed ankyrin repeat proteins (DARPins) as targeting moieties for bimodal near-infrared fluorescence and photoacoustic imaging of cancer. Eur J Nucl Med Mol Imaging 2024; 51:2179-2192. [PMID: 37642704 PMCID: PMC11178671 DOI: 10.1007/s00259-023-06407-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Fluorescence-guided surgery (FGS) can play a key role in improving radical resection rates by assisting surgeons to gain adequate visualization of malignant tissue intraoperatively. Designed ankyrin repeat proteins (DARPins) possess optimal pharmacokinetic and other properties for in vivo imaging. This study aims to evaluate the preclinical potential of epithelial cell adhesion molecule (EpCAM)-binding DARPins as targeting moieties for near-infrared fluorescence (NIRF) and photoacoustic (PA) imaging of cancer. METHODS EpCAM-binding DARPins Ac2, Ec4.1, and non-binding control DARPin Off7 were conjugated to IRDye 800CW and their binding efficacy was evaluated on EpCAM-positive HT-29 and EpCAM-negative COLO-320 human colon cancer cell lines. Thereafter, NIRF and PA imaging of all three conjugates were performed in HT-29_luc2 tumor-bearing mice. At 24 h post-injection, tumors and organs were resected and tracer biodistributions were analyzed. RESULTS Ac2-800CW and Ec4.1-800CW specifically bound to HT-29 cells, but not to COLO-320 cells. Next, 6 nmol and 24 h were established as the optimal in vivo dose and imaging time point for both DARPin tracers. At 24 h post-injection, mean tumor-to-background ratios of 2.60 ± 0.3 and 3.1 ± 0.3 were observed for Ac2-800CW and Ec4.1-800CW, respectively, allowing clear tumor delineation using the clinical Artemis NIRF imager. Biodistribution analyses in non-neoplastic tissue solely showed high fluorescence signal in the liver and kidney, which reflects the clearance of the DARPin tracers. CONCLUSION Our encouraging results show that EpCAM-binding DARPins are a promising class of targeting moieties for pan-carcinoma targeting, providing clear tumor delineation at 24 h post-injection. The work described provides the preclinical foundation for DARPin-based bimodal NIRF/PA imaging of cancer.
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Affiliation(s)
- Ruben D Houvast
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - Nada Badr
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Taryn March
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Vincent Q Sier
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Timo Schomann
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Shadhvi Bhairosingh
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Victor M Baart
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Judith A H M Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Gerard J P van Westen
- Division of Drug Discovery and Safety, Leiden Academic Centre for Drug Research, Leiden, the Netherlands
| | - Andreas Plückthun
- Department of Biochemistry, University of Zürich, Zurich, Switzerland
| | - Jacobus Burggraaf
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Centre for Human Drug Research, Leiden, the Netherlands
| | - Peter J K Kuppen
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Cornelis F M Sier
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Chen Y, Zhang S, Miao K, Li J. Evaluating the effectiveness of dual dye combination of indocyanine green and carbon nanoparticles with parathyroid hormone test in preserving parathyroid gland during papillary thyroid cancer surgery: a single-center retrospective cohort study. Updates Surg 2024; 76:1063-1071. [PMID: 38507176 PMCID: PMC11130042 DOI: 10.1007/s13304-024-01804-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/24/2024] [Indexed: 03/22/2024]
Abstract
Preserving the integrity of parathyroid glands is crucial in papillary thyroid cancer (PTC) surgery to avoid hypoparathyroidism. In recent years, two novel dyes, activated carbon nanoparticles (CNP) and indocyanine green (ICG), have been utilized to assist in parathyroid gland identification. However, the use of CNP or ICG alone can result in extravasation of dye or excessive fluorescence of non-parathyroid tissue, which can affect the accuracy of surgical outcomes by yielding false negative or false positive results. Therefore, it is important to further optimize the application of these two dyes in surgery. We analyzed case files of 124 PTC patients who underwent routine total or near-total thyroidectomy with bilateral lymph node dissection in the central region at the Affiliated People's Hospital of Ningbo University from January to November 2022. The patients were randomly divided into three groups based on the type of intraoperative dye used. The CNP group (n = 38) received an intra-thyroidal injection of CNP dye. The ICG group (n = 42) used the ICG near-infrared fluorescence endoscopy system to show parathyroid fluorescence. The group that received a combined approach of ICG and CNP (n = 44) leveraged the advantages of both methods that allow for positive development of ICG and negative development of CNP to identify and preserve the parathyroid gland during operation. The parathyroid hormone detection reagent (PTH test method) was employed to verify the highly suspected parathyroid tissue in all three groups. We analyzed intraoperative data pertaining to intraoperative parathyroid identification, misexcision, number of autotransplantation, and postoperative hypoparathyroidism among the three groups. Compared with the ICG group and the CNP group, the combined group demonstrated more prominent advantages in identifying average the number of lower parathyroid glands (1.93 ± 0.26, p = 0.015), reducing the average numberrate of misexcision (0.45 ± 0.5, p = 0.004), and reducing the incidence of postoperative temporary hypothyroidism (3/44, p = 0.015). The combined use of ICG and CNP dual-dye with PTH test method appears to be more effective in both identifying and protecting parathyroid glands during PTC surgery.
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Affiliation(s)
- Yuliang Chen
- Department of Thyroid and Breast Surgery, The Affiliated People's Hospital of Ningbo University, No. 251, Baizhang East Road, Yinzhou District, Ningbo, 315040, Zhejiang, China
| | - Songze Zhang
- Department of Thyroid and Breast Surgery, The Affiliated People's Hospital of Ningbo University, No. 251, Baizhang East Road, Yinzhou District, Ningbo, 315040, Zhejiang, China
| | - Keyu Miao
- Department of Thyroid and Breast Surgery, The Affiliated People's Hospital of Ningbo University, No. 251, Baizhang East Road, Yinzhou District, Ningbo, 315040, Zhejiang, China
| | - Jiagen Li
- Department of Thyroid and Breast Surgery, The Affiliated People's Hospital of Ningbo University, No. 251, Baizhang East Road, Yinzhou District, Ningbo, 315040, Zhejiang, China.
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Mullen KM, Regier PJ, Perez-Rodriguez V, Fox-Alvarez WA, Bertran J, Colee J. Use of real-time near-infrared fluorescence to assess gastric viability in dogs with gastric dilatation volvulus: A case-control study. Vet Surg 2024; 53:684-694. [PMID: 38135927 DOI: 10.1111/vsu.14067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/20/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To describe near-infrared fluorescence (NIRF) for assessment of gastric viability and describe NIRF's influence on the surgeon's operative strategy in dogs with gastric dilatation and volvulus (GDV). STUDY DESIGN Prospective clinical trial. ANIMALS Twenty dogs with GDV and 20 systemically healthy dogs. METHODS Following gastric derotation, the surgeon's subjective assessment of gastric viability was recorded prior to near-infrared imaging. Changes in the surgeon's initial assessment of viability based on the visual pattern of gastric fluorescence was recorded. If nonviable (lack of defined vessels), a partial gastrectomy was performed and submitted for histopathology. The stapled gastrectomy line was imaged. Viable (defined vessels) and nonviable fluorescence intensities were compared with healthy dogs undergoing surgery for nongastrointestinal disease. RESULTS Subjective assessment diagnosed 17 viable and three nonviable GDVs (2 fundi; 1 cardia). Near-infrared imaging demonstrated nonviable gastric fluorescence in 4 dogs (3 fundi/cardia; 1 fundus). The surgeon's margins for resection were altered in 3/20 dogs. Fluorescence intensity (cardia, fundus, body, pylorus) was lower in GDV viable (30.59%, p = .04; 38.17%, p < .01; 51.18%, p < .01; 44.12%, p= .01) and nonviable (11.00%, p < .01; 4.33%, p < .01; 57.67%, p = .22; 54.33%, p = .72) dogs compared to healthy controls (44.7%, 70.05%, 84.00%, 63.95%). Fundic fluorescence was less in nonviable gastric tissue in comparison with viable gastric tissue (p = .03). Fluorescence of the gastrectomy staple line approximated that of viable tissue. CONCLUSION Near-infrared fluorescence can identify histologically confirmed nonviable gastric tissue. CLINICAL SIGNIFICANCE These results provide enough evidence to support the implementation of NIRF as an adjunct to gross examination of the gastric wall in dogs with GDV.
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Affiliation(s)
- Kaitlyn M Mullen
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Penny J Regier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Veronica Perez-Rodriguez
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Judith Bertran
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - James Colee
- IFAS Statistical Consulting, University of Florida, Gainesville, Florida, USA
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Tappero S, Fallara G, Chierigo F, Micalef A, Ambrosini F, Diaz R, Dorotei A, Pompeo E, Limena A, Bravi CA, Longoni M, Piccinelli ML, Barletta F, Albano L, Mazzone E, Dell'Oglio P. Intraoperative image-guidance during robotic surgery: is there clinical evidence of enhanced patient outcomes? Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06706-w. [PMID: 38607386 DOI: 10.1007/s00259-024-06706-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND To date, the benefit of image guidance during robot-assisted surgery (IGS) is an object of debate. The current study aims to address the quality of the contemporary body of literature concerning IGS in robotic surgery throughout different surgical specialties. METHODS A systematic review of all English-language articles on IGS, from January 2013 to March 2023, was conducted using PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases. Comparative studies that tested performance of IGS vs control were included for the quantitative synthesis, which addressed outcomes analyzed in at least three studies: operative time, length of stay, blood loss, surgical margins, complications, number of nodal retrievals, metastatic nodes, ischemia time, and renal function loss. Bias-corrected ratio of means (ROM) and bias-corrected odds ratio (OR) compared continuous and dichotomous variables, respectively. Subgroup analyses according to guidance type (i.e., 3D virtual reality vs ultrasound vs near-infrared fluoresce) were performed. RESULTS Twenty-nine studies, based on 11 surgical procedures of three specialties (general surgery, gynecology, urology), were included in the quantitative synthesis. IGS was associated with 12% reduction in length of stay (ROM 0.88; p = 0.03) and 13% reduction in blood loss (ROM 0.87; p = 0.03) but did not affect operative time (ROM 1.00; p = 0.9), or complications (OR 0.93; p = 0.4). IGS was associated with an estimated 44% increase in mean number of removed nodes (ROM 1.44; p < 0.001), and a significantly higher rate of metastatic nodal disease (OR 1.82; p < 0.001), as well as a significantly lower rate of positive surgical margins (OR 0.62; p < 0.001). In nephron sparing surgery, IGS significantly decreased renal function loss (ROM 0.37; p = 0.002). CONCLUSIONS Robot-assisted surgery benefits from image guidance, especially in terms of pathologic outcomes, namely higher detection of metastatic nodes and lower surgical margins. Moreover, IGS enhances renal function preservation and lowers surgical blood loss.
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Affiliation(s)
- Stefano Tappero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppe Fallara
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Francesco Chierigo
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genoa, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
| | - Andrea Micalef
- Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
| | - Francesca Ambrosini
- Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genoa, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
| | - Raquel Diaz
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
| | - Andrea Dorotei
- Department of Orthopaedics, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Edoardo Pompeo
- Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessia Limena
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Carlo Andrea Bravi
- Department of Urology, Northampton General Hospital, Northampton, UK
- Department of Urology, Royal Marsden Foundation Trust, London, UK
| | - Mattia Longoni
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Luca Piccinelli
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Francesco Barletta
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Albano
- Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Elio Mazzone
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
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Sharma A, Verwilst P, Li M, Ma D, Singh N, Yoo J, Kim Y, Yang Y, Zhu JH, Huang H, Hu XL, He XP, Zeng L, James TD, Peng X, Sessler JL, Kim JS. Theranostic Fluorescent Probes. Chem Rev 2024; 124:2699-2804. [PMID: 38422393 PMCID: PMC11132561 DOI: 10.1021/acs.chemrev.3c00778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/31/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
The ability to gain spatiotemporal information, and in some cases achieve spatiotemporal control, in the context of drug delivery makes theranostic fluorescent probes an attractive and intensely investigated research topic. This interest is reflected in the steep rise in publications on the topic that have appeared over the past decade. Theranostic fluorescent probes, in their various incarnations, generally comprise a fluorophore linked to a masked drug, in which the drug is released as the result of certain stimuli, with both intrinsic and extrinsic stimuli being reported. This release is then signaled by the emergence of a fluorescent signal. Importantly, the use of appropriate fluorophores has enabled not only this emerging fluorescence as a spatiotemporal marker for drug delivery but also has provided modalities useful in photodynamic, photothermal, and sonodynamic therapeutic applications. In this review we highlight recent work on theranostic fluorescent probes with a particular focus on probes that are activated in tumor microenvironments. We also summarize efforts to develop probes for other applications, such as neurodegenerative diseases and antibacterials. This review celebrates the diversity of designs reported to date, from discrete small-molecule systems to nanomaterials. Our aim is to provide insights into the potential clinical impact of this still-emerging research direction.
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Affiliation(s)
- Amit Sharma
- Amity
School of Chemical Sciences, Amity University
Punjab, Sector 82A, Mohali 140 306, India
| | - Peter Verwilst
- Rega
Institute for Medical Research, Medicinal Chemistry, KU Leuven, Herestraat 49, Box 1041, 3000 Leuven, Belgium
| | - Mingle Li
- College
of Materials Science and Engineering, Shenzhen
University, Shenzhen 518060, China
| | - Dandan Ma
- College
of Materials Science and Engineering, Shenzhen
University, Shenzhen 518060, China
- College
of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China
| | - Nem Singh
- Department
of Chemistry, Korea University, Seoul 02841, Korea
| | - Jiyoung Yoo
- Department
of Chemistry, Korea University, Seoul 02841, Korea
| | - Yujin Kim
- Department
of Chemistry, Korea University, Seoul 02841, Korea
| | - Ying Yang
- School of
Light Industry and Food Engineering, Guangxi
University, Nanning, Guangxi 530004, China
| | - Jing-Hui Zhu
- College
of Materials Science and Engineering, Shenzhen
University, Shenzhen 518060, China
- College
of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China
| | - Haiqiao Huang
- College
of Materials Science and Engineering, Shenzhen
University, Shenzhen 518060, China
- College
of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China
| | - Xi-Le Hu
- Key
Laboratory for Advanced Materials and Joint International Research
Laboratory of Precision Chemistry and Molecular Engineering, Feringa
Nobel Prize Scientist Joint Research Center, School of Chemistry and
Molecular Engineering, East China University
of Science and Technology, 130 Meilong Road, Shanghai 200237, China
| | - Xiao-Peng He
- Key
Laboratory for Advanced Materials and Joint International Research
Laboratory of Precision Chemistry and Molecular Engineering, Feringa
Nobel Prize Scientist Joint Research Center, School of Chemistry and
Molecular Engineering, East China University
of Science and Technology, 130 Meilong Road, Shanghai 200237, China
- National
Center for Liver Cancer, the International Cooperation Laboratory
on Signal Transduction, Eastern Hepatobiliary
Surgery Hospital, Shanghai 200438, China
| | - Lintao Zeng
- School of
Light Industry and Food Engineering, Guangxi
University, Nanning, Guangxi 530004, China
| | - Tony D. James
- Department
of Chemistry, University of Bath, Bath BA2 7AY, United Kingdom
- School
of Chemistry and Chemical Engineering, Henan
Normal University, Xinxiang 453007, China
| | - Xiaojun Peng
- College
of Materials Science and Engineering, Shenzhen
University, Shenzhen 518060, China
- State
Key Laboratory of Fine Chemicals, Dalian
University of Technology, Dalian 116024, China
| | - Jonathan L. Sessler
- Department
of Chemistry, The University of Texas at
Austin, Texas 78712-1224, United
States
| | - Jong Seung Kim
- Department
of Chemistry, Korea University, Seoul 02841, Korea
- TheranoChem Incorporation, Seongbuk-gu, Seoul 02841, Korea
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Li L, Xue Y, Li X, Li J, Fu Y, Ding Y, Liu T, Jia N, Wu Y, Bu H, Ouyang X. Copper Nanosheet-Based Wash-Free Fluorescence Imaging of Cancer Cells. Anal Chem 2024; 96:2052-2058. [PMID: 38263605 DOI: 10.1021/acs.analchem.3c04644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Near-infrared fluorescence (NIRF) probes greatly facilitate in vivo imaging of various biologically important species. However, there are several significant limitations such as consuming washing steps, photobleaching, and low signal intensity. Herein, we synthesized fluorescent copper nanosheets templated with DNA scaffolds (DNS/CuNSs). We employ them and Cy5.5 of the fluorescence resonance energy transfer (FRET) system, which have a larger Stokes shift (∼12-fold) than the traditional NIRF dye Cy5.5. Based on their excellent fluorescence properties, we employ DNS/CuNSs-Cy5.5 for fluorescence probes in cancer cell imaging. Compared with the free Cy5.5 fluorescence probe, the novel fluorescence imaging probe implements wash-free imaging and exhibits enhanced anti-photobleaching ability (∼5.5-fold). Moreover, the FRET system constructed by DNS/CuNSs has a higher signal amplification ability (∼4.17-fold), which is more similar to that of Cu nanoclusters prepared with DNA nanomonomers as a template. This work provides a new idea for cancer cell MCF-7 imaging and is expected to promote the development of cancer cell fluorescence imaging.
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Affiliation(s)
- Le Li
- Xi'an Key Laboratory of Functional Supramolecular Structure and Materials, Key Laboratory of Synthetic and Natural Functional Molecule of Ministry of Education, College of Chemistry & Materials Science, Northwest University, Xi'an, Shaanxi 710127, P. R. China
| | - Yumiao Xue
- Xi'an Key Laboratory of Functional Supramolecular Structure and Materials, Key Laboratory of Synthetic and Natural Functional Molecule of Ministry of Education, College of Chemistry & Materials Science, Northwest University, Xi'an, Shaanxi 710127, P. R. China
| | - Xinyi Li
- Xi'an Key Laboratory of Functional Supramolecular Structure and Materials, Key Laboratory of Synthetic and Natural Functional Molecule of Ministry of Education, College of Chemistry & Materials Science, Northwest University, Xi'an, Shaanxi 710127, P. R. China
| | - Jiaqi Li
- Key Laboratory of Resource Biology and Biotechnology in Western China (Ministry of Education), College of Life Sciences, Northwest University, Xi'an, Shaanxi 710069, P. R. China
| | - Yue Fu
- Xi'an Key Laboratory of Functional Supramolecular Structure and Materials, Key Laboratory of Synthetic and Natural Functional Molecule of Ministry of Education, College of Chemistry & Materials Science, Northwest University, Xi'an, Shaanxi 710127, P. R. China
| | - Yawen Ding
- Xi'an Key Laboratory of Functional Supramolecular Structure and Materials, Key Laboratory of Synthetic and Natural Functional Molecule of Ministry of Education, College of Chemistry & Materials Science, Northwest University, Xi'an, Shaanxi 710127, P. R. China
| | - Ting Liu
- Xi'an Key Laboratory of Functional Supramolecular Structure and Materials, Key Laboratory of Synthetic and Natural Functional Molecule of Ministry of Education, College of Chemistry & Materials Science, Northwest University, Xi'an, Shaanxi 710127, P. R. China
| | - Nan Jia
- Xi'an Key Laboratory of Functional Supramolecular Structure and Materials, Key Laboratory of Synthetic and Natural Functional Molecule of Ministry of Education, College of Chemistry & Materials Science, Northwest University, Xi'an, Shaanxi 710127, P. R. China
| | - Yongli Wu
- Xi'an Key Laboratory of Functional Supramolecular Structure and Materials, Key Laboratory of Synthetic and Natural Functional Molecule of Ministry of Education, College of Chemistry & Materials Science, Northwest University, Xi'an, Shaanxi 710127, P. R. China
| | - Huaiyu Bu
- Key Laboratory of Resource Biology and Biotechnology in Western China (Ministry of Education), College of Life Sciences, Northwest University, Xi'an, Shaanxi 710069, P. R. China
| | - Xiangyuan Ouyang
- Xi'an Key Laboratory of Functional Supramolecular Structure and Materials, Key Laboratory of Synthetic and Natural Functional Molecule of Ministry of Education, College of Chemistry & Materials Science, Northwest University, Xi'an, Shaanxi 710127, P. R. China
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7
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Du J, Zeng T, Zhang S, Chen M, Huang G, Xu C, Xu G, Ni C, Hong R, Zheng W, Chen C, Zheng B. Comparison of indocyanine green-near-infrared fluorescence guided and traditional mediastinal lymphadenectomy during radical esophagectomy: A randomized controlled trial. Surgery 2024; 175:347-352. [PMID: 38012899 DOI: 10.1016/j.surg.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/02/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The extent of lymph node dissection during radical esophagectomy remains a controversial topic. Thus, this study mainly aimed to explore the location of sentinel lymph nodes in esophageal squamous cell carcinoma and the application value of the indocyanine green-near-infrared fluorescence system in lymphadenectomy. METHODS This randomized controlled clinical trial (ClinicalTrials.gov, NCT04615806) included 42 participants without neoadjuvant therapy who were lymph node negative based on positron emission tomography/computed tomography findings. Traditional esophagectomy with indocyanine green-near-infrared fluorescence imaging was performed after injecting 0.5 mL indocyanine green (1.25 mg/mL) into the esophageal submucosa in the 4 peritumoral quadrants. The primary endpoint was to determine the location of the sentinel lymph node in esophageal squamous cell carcinoma based on postoperative pathologic reports. RESULTS A total of 40 patients, with 20 in each group, were included in the final analysis. In the indocyanine green group, indocyanine green-near-infrared fluorescence imaging was successful in all subjects. Seven cases (cases 2, 3, 9, 11, 17, 18, and 20) in the indocyanine green group exhibited lymph node metastases, all of which were near-infrared positive. The detection rate, positive predictive value, negative predictive value, sensitivity, and specificity were 100% (20 of 20 cases), 8.7% (13/150), 100% (265/265), 100% (13/13), and 65.9% (265/402), respectively. All near-infrared-negative lymph nodes were nonmetastatic lymph nodes. In addition, the number of mediastinal lymph nodes resected in the indocyanine green group was significantly higher than in the non-indocyanine green group. CONCLUSION Indocyanine green-near-infrared might be an important and promising technique in predicting sentinel lymph nodes of esophageal squamous cell carcinoma and could significantly improve the detection rate of lymph nodes of esophageal squamous cell carcinoma.
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Affiliation(s)
- Jianting Du
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province, Fuzhou, China
| | - Taidui Zeng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province, Fuzhou, China
| | - Shuliang Zhang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province, Fuzhou, China
| | - Maohui Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province, Fuzhou, China
| | - Guanglei Huang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province, Fuzhou, China
| | - Chi Xu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province, Fuzhou, China
| | - Guobing Xu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province, Fuzhou, China
| | - Chenhui Ni
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province, Fuzhou, China
| | - Ruopeng Hong
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province, Fuzhou, China
| | - Wei Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province, Fuzhou, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province, Fuzhou, China.
| | - Bin Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province, Fuzhou, China.
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8
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Shevchenko I, Serban D, Dascalu AM, Tribus L, Alius C, Cristea BM, Suceveanu AI, Voiculescu D, Dumitrescu D, Bobirca F, Suceveanu AP, Georgescu DE, Serboiu CS. Factors Affecting the Efficiency of Near-Infrared Indocyanine Green (NIR/ICG) in Lymphatic Mapping for Colorectal Cancer: A Systematic Review. Cureus 2024; 16:e55290. [PMID: 38558607 PMCID: PMC10981778 DOI: 10.7759/cureus.55290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
As laparoscopy gained global popularity in oncologic surgery, the challenge of detecting lymph nodes spurred researchers to explore innovative techniques and approach the situation from a fresh perspective. While many proposed methods have faded into obscurity, the utilization of indocyanine green (ICG) in the surgical treatment of oncologic patients has continued to advance. The immense potential of this dye is widely acknowledged, yet its full extent and limitations in lymphatic mapping for colorectal cancer remain to be precisely determined. This article aims to assess the magnitude of its potential and explore the constraints based on insights from clinical studies published by pioneering researchers. A systematic review of the existing literature, comprising articles in English, was conducted using the Scopus, PubMed, and Springer Link databases. The search employed keywords such as "colorectal cancer" AND/OR "indocyanine green," "fluorescence" AND/OR "lymphatic mapping" AND/OR "lymph nodes." Initially identifying 129 articles, the application of selection criteria narrowed down the pool to 10 articles, which served as the primary sources of data for our review. Despite the absence of a standardized protocol for the application of ICG in colorectal cancer, particularly in the context of lymphatic mapping, the detection rates have exhibited considerable variation across studies. Nevertheless, all authors unanimously regarded this technique as beneficial and promising. Additionally, it is advocated as an adjunctive tool to enhance the accuracy of cancer staging. Near-infrared (NIR)-enhanced surgery holds the promise of transforming the landscape of oncologic surgery, emerging as a valuable tool for surgeons. However, the absence of a standardized technique and the subjective nature of result assessment impose limitations on the potential of this method. Consequently, it can be inferred that the establishment of a universally accepted protocol, encompassing parameters such as dose, concentration, technique, and site of administration of ICG, along with the optimal time needed for fluorescence visualization, would enhance the outcomes. Emphasizing the accurate selection of patients is crucial to prevent the occurrence of false-negative results.
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Affiliation(s)
- Irina Shevchenko
- Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- General Surgery, Emergency University Hospital Bucharest, Bucharest, ROU
| | - Dragos Serban
- Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- General Surgery, Emergency University Hospital Bucharest, Bucharest, ROU
| | - Ana Maria Dascalu
- Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Laura Tribus
- Gastroenterology, Faculty of Oral Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Catalin Alius
- Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- General Surgery, Emergency University Hospital Bucharest, Bucharest, ROU
| | - Bogdan Mihai Cristea
- Anatomy, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Andra Iulia Suceveanu
- Gastroenterology, Faculty of Medicine, Ovidius University of Constanta, Constanta, ROU
- Gastroenterology, Clinical Emergency Hospital St Apostle Andrew, Constanta, ROU
| | - Daniel Voiculescu
- Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- General Surgery, Emergency University Hospital Bucharest, Bucharest, ROU
| | - Dan Dumitrescu
- Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- General Surgery, Emergency University Hospital Bucharest, Bucharest, ROU
| | - Florin Bobirca
- Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- General Surgery, Clinic Hospital "Dr. Ioan Cantacuzino" Bucharest, Bucharest, ROU
| | - Adrian Paul Suceveanu
- Medicine, Faculty of Medicine, Ovidius University of Constanta, Constanta, ROU
- Gastroenterology, Clinical Emergency Hospital St Apostle Andrew, Constanta, ROU
| | - Dragos Eugen Georgescu
- Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Crenguta Sorina Serboiu
- Radiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
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9
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Huang ZN, He QC, Qiu WW, Wu J, Zheng CY, Lin GS, Li P, Wang JB, Lin JX, Lu J, Cao LL, Lin M, Tu RH, Zheng CH, Chen QY, Huang CM, Xie JW. OSATS scoring confirms ICG enhancement of performance in laparoscopic radical gastrectomy: a post-hoc analysis of a randomized controlled trial. Int J Surg 2024; 110:342-352. [PMID: 37939147 PMCID: PMC10793768 DOI: 10.1097/js9.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/28/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Indocyanine green (ICG) fluorescence imaging is effective in increasing the number of lymph node dissections during laparoscopic radical gastrectomy; however, no studies have attempted to explain this phenomenon. METHODS This study utilized the data from a previous randomized controlled trial (FUGES-012 study) investigating ICG-guided laparoscopic radical gastrectomy performed between November 2018 and July 2019. The Objective Structured Assessments of Technical Skills (OSATS) scoring system was used to grade videos from the ICG and non-ICG groups. Patients with an OSATS score greater than 29 were classified as the high-OSATS population, while those with an OSATS score less than or equal to 29 were classified as the low-OSATS population. RESULTS A total of 258 patients were included in the modified intention-to-treat analysis: 129 in the ICG group and 129 in the non-ICG group. The OSATS score of the ICG group was higher than that of the non-ICG group (29.6±2.6 vs. 26.6±3.6; P <0.001). The ICG group underwent a significantly higher mean total number of lymph node dissections than the non-ICG group (50.5±15.9 vs. 42.0±10.3; adjusted P <0.001). The group assigned to ICG use, better OSATS (high-OSATS) scores were observed, which correlated with greater D2 lymph node retrieval (54.1±15.0 vs. 47.2±8.7; adjusted P =0.039). Finally, the ICG group had a lower rate of lymph node noncompliance than that of the non-ICG group (31.8 vs. 57.4%; P <0.001). CONCLUSIONS By applying the ICG fluorescence navigation technique, better OSATS scores were observed, which correlated with greater lymph node retrieval and a lower lymph node noncompliance rate, as recommended for individualized laparoscopic radical gastrectomy.
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Affiliation(s)
- Ze-Ning Huang
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Qi-Chen He
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Wen-Wu Qiu
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Ju Wu
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian
| | - Chang-Yue Zheng
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
- Department of Gastrointestinal Surgery, the Affiliated Hospital of Putian University, Putian, People’s Republic of China
| | - Guo-Sheng Lin
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Ping Li
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Jia-Bin Wang
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Jian-Xian Lin
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Jun Lu
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Long-Long Cao
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Mi Lin
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Ru-Hong Tu
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Chao-Hui Zheng
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Qi-Yue Chen
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Chang-Ming Huang
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Jian-Wei Xie
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
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10
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Vogel R, Heinzelmann F, Büchler P, Mück B. [Roboticassisted incisional hernia surgery-Retromuscular techniques]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:27-33. [PMID: 38051317 DOI: 10.1007/s00104-023-01998-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/07/2023]
Abstract
The trend to minimally invasive surgery has also made its way into the surgical treatment of incisional hernias. Unlike other areas of visceral surgery, recent years have seen a resurgence of open sublay repair in incisional hernia procedures, primarily due to the recognition of the retromuscular layer as the optimal mesh placement site. Additionally, with the growing availability of robotic systems in visceral surgery, these procedures are increasingly being offered in the form of minimally invasive procedures. These methods can be categorized based on the access routes: robotic-assisted transperitoneal procedures (e.g., r‑Rives, r‑TARUP, r‑TAR) and total extraperitoneal hernia repair (e.g., r‑eTEP, r‑eTAR). Notably, the introduction of transversus abdominis muscle release enables the robotic-assisted treatment of larger and more complex hernia cases with complete fascial closure. With respect to the comparison with open surgery required in retromuscular hernia treatment, the currently available literature on incisional hernia repair seems to show initial advantages of robotic-assisted surgery in the perioperative course. New technologies create new possibilities. In the context of surgical training the use of surgical robot systems with double consoles opens up completely new perspectives. Furthermore, the robot enables the implementation of models of artificial intelligence and augmented reality and could therefore open up novel dimensions in surgery.
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Affiliation(s)
- R Vogel
- Klinik für Allgemein‑, Viszeral‑ und Kinderchirurgie, Hernienzentrum Kempten - Allgäu, Klinikverbund Allgäu gGmbH, Klinikum Kempten, Robert-Weixler-Straße 50, 87439, Kempten (Allgäu), Deutschland
| | - F Heinzelmann
- Klinik für Allgemein‑, Viszeral‑ und Kinderchirurgie, Hernienzentrum Kempten - Allgäu, Klinikverbund Allgäu gGmbH, Klinikum Kempten, Robert-Weixler-Straße 50, 87439, Kempten (Allgäu), Deutschland
| | - P Büchler
- Klinik für Allgemein‑, Viszeral‑ und Kinderchirurgie, Hernienzentrum Kempten - Allgäu, Klinikverbund Allgäu gGmbH, Klinikum Kempten, Robert-Weixler-Straße 50, 87439, Kempten (Allgäu), Deutschland
| | - Björn Mück
- Klinik für Allgemein‑, Viszeral‑ und Kinderchirurgie, Hernienzentrum Kempten - Allgäu, Klinikverbund Allgäu gGmbH, Klinikum Kempten, Robert-Weixler-Straße 50, 87439, Kempten (Allgäu), Deutschland.
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11
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Górecka Ż, Idaszek J, Heljak M, Martinez DC, Choińska E, Kulas Z, Święszkowski W. Indocyanine green and iohexol loaded hydroxyapatite in poly(L-lactide-co-caprolactone)-based composite for bimodal near-infrared fluorescence- and X-ray-based imaging. J Biomed Mater Res B Appl Biomater 2024; 112:e35313. [PMID: 37596854 DOI: 10.1002/jbm.b.35313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/19/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Abstract
This study aimed to develop material for multimodal imaging by means of X-ray and near-infrared containing FDA- and EMA-approved iohexol and indocyanine green (ICG). The mentioned contrast agents (CAs) are hydrophilic and amphiphilic, respectively, which creates difficulties in fabrication of functional polymeric composites for fiducial markers (FMs) with usage thereof. Therefore, this study exploited for the first time the possibility of enhancing the radiopacity and introduction of the NIR fluorescence of FMs by adsorption of the CAs on hydroxyapatite (HAp) nanoparticles. The particles were embedded in the poly(L-lactide-co-caprolactone) (P[LAcoCL]) matrix resulting in the composite material for bimodal near-infrared fluorescence- and X-ray-based imaging. The applied method of material preparation provided homogenous distribution of both CAs with high iohexol loading efficiency and improved fluorescence signal due to hindered ICG aggregation. The material possessed profound contrasting properties for both imaging modalities. Its stability was evaluated during in vitro experiments in phosphate-buffered saline (PBS) and foetal bovine serum (FBS) solutions. The addition of HAp nanoparticles had significant effect on the fluorescence signal. The X-ray radiopacity was stable within minimum 11 weeks, even though the addition of ICG contributed to a faster release of iohexol. The stiffness of the material was not affected by iohexol or ICG, but incorporation of HAp nanoparticles elevated the values of bending modulus by approximately 70%. Moreover, the performed cell study revealed that all tested materials were not cytotoxic. Thus, the developed material can be successfully used for fabrication of FMs.
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Affiliation(s)
- Żaneta Górecka
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
- Centre for Advanced Materials and Technologies CEZAMAT, Warsaw University of Technology, Warsaw, Poland
| | - Joanna Idaszek
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Marcin Heljak
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Diana C Martinez
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Emilia Choińska
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Zbigniew Kulas
- Faculty of Mechanical Engineering, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Wojciech Święszkowski
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
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12
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Yun WS, Cho H, Jeon SI, Lim DK, Kim K. Fluorescence-Based Mono- and Multimodal Imaging for In Vivo Tracking of Mesenchymal Stem Cells. Biomolecules 2023; 13:1787. [PMID: 38136656 PMCID: PMC10742164 DOI: 10.3390/biom13121787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
The advancement of stem cell therapy has offered transformative therapeutic outcomes for a wide array of diseases over the past decades. Consequently, stem cell tracking has become significant in revealing the mechanisms of action and ensuring safe and effective treatments. Fluorescence stands out as a promising choice for stem cell tracking due to its myriad advantages, including high resolution, real-time monitoring, and multi-fluorescence detection. Furthermore, combining fluorescence with other tracking modalities-such as bioluminescence imaging (BLI), positron emission tomography (PET), photoacoustic (PA), computed tomography (CT), and magnetic resonance (MR)-can address the limitations of single fluorescence detection. This review initially introduces stem cell tracking using fluorescence imaging, detailing various labeling strategies such as green fluorescence protein (GFP) tagging, fluorescence dye labeling, and nanoparticle uptake. Subsequently, we present several combinations of strategies for efficient and precise detection.
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Affiliation(s)
- Wan Su Yun
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul 02841, Republic of Korea; (W.S.Y.); (D.-K.L.)
| | - Hanhee Cho
- Graduate School of Pharmaceutical Sciences, College of Pharmacy, Ewha Woman’s University, Seoul 03760, Republic of Korea; (H.C.); (S.I.J.)
| | - Seong Ik Jeon
- Graduate School of Pharmaceutical Sciences, College of Pharmacy, Ewha Woman’s University, Seoul 03760, Republic of Korea; (H.C.); (S.I.J.)
| | - Dong-Kwon Lim
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul 02841, Republic of Korea; (W.S.Y.); (D.-K.L.)
| | - Kwangmeyung Kim
- Graduate School of Pharmaceutical Sciences, College of Pharmacy, Ewha Woman’s University, Seoul 03760, Republic of Korea; (H.C.); (S.I.J.)
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13
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Studier-Fischer A, Schwab FM, Rees M, Seidlitz S, Sellner J, Özdemir B, Ayala L, Odenthal J, Knoedler S, Kowalewski KF, Haney CM, Dietrich M, Salg GA, Kenngott HG, Müller-Stich BP, Maier-Hein L, Nickel F. ICG-augmented hyperspectral imaging for visualization of intestinal perfusion compared to conventional ICG fluorescence imaging: an experimental study. Int J Surg 2023; 109:3883-3895. [PMID: 38258996 PMCID: PMC10720797 DOI: 10.1097/js9.0000000000000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/13/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Small bowel malperfusion (SBM) can cause high morbidity and severe surgical consequences. However, there is no standardized objective measuring tool for the quantification of SBM. Indocyanine green (ICG) imaging can be used for visualization, but lacks standardization and objectivity. Hyperspectral imaging (HSI) as a newly emerging technology in medicine might present advantages over conventional ICG fluorescence or in combination with it. METHODS HSI baseline data from physiological small bowel, avascular small bowel and small bowel after intravenous application of ICG was recorded in a total number of 54 in-vivo pig models. Visualizations of avascular small bowel after mesotomy were compared between HSI only (1), ICG-augmented HSI (IA-HSI) (2), clinical evaluation through the eyes of the surgeon (3) and conventional ICG imaging (4). The primary research focus was the localization of resection borders as suggested by each of the four methods. Distances between these borders were measured and histological samples were obtained from the regions in between in order to quantify necrotic changes 6 h after mesotomy for every region. RESULTS StO2 images (1) were capable of visualizing areas of physiological perfusion and areas of clearly impaired perfusion. However, exact borders where physiological perfusion started to decrease could not be clearly identified. Instead, IA-HSI (2) suggested a sharp-resection line where StO2 values started to decrease. Clinical evaluation (3) suggested a resection line 23 mm (±7 mm) and conventional ICG imaging (4) even suggested a resection line 53 mm (±13 mm) closer towards the malperfused region. Histopathological evaluation of the region that was sufficiently perfused only according to conventional ICG (R3) already revealed a significant increase in pre-necrotic changes in 27% (±9%) of surface area. Therefore, conventional ICG seems less sensitive than IA-HSI with regards to detection of insufficient tissue perfusion. CONCLUSIONS In this experimental animal study, IA-HSI (2) was superior for the visualization of segmental SBM compared to conventional HSI imaging (1), clinical evaluation (3) or conventional ICG imaging (4) regarding histopathological safety. ICG application caused visual artifacts in the StO2 values of the HSI camera as values significantly increase. This is caused by optical properties of systemic ICG and does not resemble a true increase in oxygenation levels. However, this empirical finding can be used to visualize segmental SBM utilizing ICG as contrast agent in an approach for IA-HSI. Clinical applicability and relevance will have to be explored in clinical trials. LEVEL OF EVIDENCE Not applicable. Translational animal science. Original article.
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Affiliation(s)
| | | | - Maike Rees
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ)
- Faculty of Mathematics and Computer Science
| | - Silvia Seidlitz
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ)
- Faculty of Mathematics and Computer Science
- HIDSS4Health—Helmholtz Information and Data Science School for Health, Karlsruhe
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg
| | - Jan Sellner
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ)
- Faculty of Mathematics and Computer Science
- HIDSS4Health—Helmholtz Information and Data Science School for Health, Karlsruhe
| | - Berkin Özdemir
- Departments ofGeneral, Visceral, and Transplantation Surgery
| | - Leonardo Ayala
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ)
- Medical Faculty, Heidelberg University
| | - Jan Odenthal
- Departments ofGeneral, Visceral, and Transplantation Surgery
| | - Samuel Knoedler
- Departments ofGeneral, Visceral, and Transplantation Surgery
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | - Lena Maier-Hein
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ)
- Faculty of Mathematics and Computer Science
- HIDSS4Health—Helmholtz Information and Data Science School for Health, Karlsruhe
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg
| | - Felix Nickel
- Departments ofGeneral, Visceral, and Transplantation Surgery
- HIDSS4Health—Helmholtz Information and Data Science School for Health, Karlsruhe
- Department of General, Visceral, and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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14
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Hsieh YC, Guo KW, Wang MW, Su SP, Syu YH, Huang CS, Chan YH. A Novel Injection Protocol Using Voluven®-Assisted Indocyanine Green with Improved Near-Infrared Fluorescence Guidance in Breast Cancer Sentinel Lymph Node Mapping-A Translational Study. Ann Surg Oncol 2023; 30:8419-8427. [PMID: 37605084 PMCID: PMC10625936 DOI: 10.1245/s10434-023-14129-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/24/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Near-infrared (NIR) fluorescence-guided surgery with indocyanine green (ICG) has been demonstrated to provide high sensitivity in sentinel lymph node biopsy (SLNB) for breast cancer but has several limitations, such as unstable pharmacokinetics, limited fluorescence brightness, and undesired diffusion to neighboring tissues. This paper investigates the use of Voluven® as the solvent for ICG fluorescence-guided SLNB (ICG-SLNB). METHODS The photophysical properties of ICG in water and Voluven® were evaluated in laboratory experiments and in a mouse model. Nine patients with early breast cancer underwent subareolar injection of diluted ICG (0.25 mg/ml) for ICG-SLNB. Six of the nine patients received ICG dissolved in Voluven® (ICG:Voluven®), while three were administered ICG dissolved in water (ICG:water); a repetitive injection-observation protocol was followed for all patients. The mapping image quality was evaluated. RESULTS Laboratory experiments and in vivo mouse study showed improved fluorescence and better targeting using Voluven® as the solvent. ICG-SLNB with a repetitive injection-observation protocol was successfully performed in all nine patients. ICG:Voluven® administration had an overall better signal-to-background ratio (SBR) in sequential sentinel lymph nodes. The rates of transportation within the lymphatics were also improved using ICG:Voluven® compared with ICG:water. CONCLUSIONS From basic research to animal models to in-human trial, our study proposes a repetitive injection-observation technique with ICG:Voluven®, which is characterized by better transportation and more stable mapping quality for ICG-SLNB in breast cancer patients.
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Affiliation(s)
- Yung-Chun Hsieh
- Department of Surgery, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan, ROC
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, ROC
- National Taiwan University College of Medicine, Taipei, Taiwan, ROC
| | - Kai-Wei Guo
- Department of Applied Chemistry, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
| | - Man-Wen Wang
- Department of Applied Chemistry, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
| | - Shih-Po Su
- Institute of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Han Syu
- Department of Applied Chemistry, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, ROC
- National Taiwan University College of Medicine, Taipei, Taiwan, ROC
| | - Yang-Hsiang Chan
- Department of Applied Chemistry, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC.
- Center for Emergent Functional Matter Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC.
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
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15
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Pugachev AD, Kozlenko AS, Makarova NI, Rostovtseva IA, Ozhogin IV, Dmitriev VS, Borodkin GS, Tkachev VV, Utenyshev AN, Sazykina MA, Sazykin IS, Azhogina TN, Karchava SK, Klimova MV, Metelitsa AV, Lukyanov BS. Molecular design and synthesis of methoxy-substitued spiropyrans with photomodulated NIR-fluorescence. Photochem Photobiol Sci 2023; 22:2651-2673. [PMID: 37733213 DOI: 10.1007/s43630-023-00479-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023]
Abstract
This study focuses on the molecular design and synthesis of salt spiropyrans with near-IR fluorescence. The structure of the obtained compounds was confirmed by NMR, IR and mass spectroscopy. In the course of studying the spectral and photoluminescent characteristics, it was possible to reveal the effect of some substituents in various positions on the properties of spiropyran dyes. Due to the structural similarity of one of the isomers to cyanine dyes, the obtained compounds are of interest as potential fluorescent probes for bioimagimg, in particular, for DNA studies. To reveal their ability of binding to DNA molecules molecular docking was carried out. Toxic effects of compounds demonstrating NIR fluorescence were studied on biofilms, as well as using bacterial lux-biosensors.
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Affiliation(s)
- Artem D Pugachev
- Institute of Physical and Organic Chemistry, Southern Federal University, 344090 Stachki prosp., 194/2, Rostov-On-Don, Russian Federation.
| | - Anastasia S Kozlenko
- Institute of Physical and Organic Chemistry, Southern Federal University, 344090 Stachki prosp., 194/2, Rostov-On-Don, Russian Federation
| | - Nadezhda I Makarova
- Institute of Physical and Organic Chemistry, Southern Federal University, 344090 Stachki prosp., 194/2, Rostov-On-Don, Russian Federation
| | - Irina A Rostovtseva
- Institute of Physical and Organic Chemistry, Southern Federal University, 344090 Stachki prosp., 194/2, Rostov-On-Don, Russian Federation
| | - Ilya V Ozhogin
- Institute of Physical and Organic Chemistry, Southern Federal University, 344090 Stachki prosp., 194/2, Rostov-On-Don, Russian Federation
| | - Vitaly S Dmitriev
- Institute of Physical and Organic Chemistry, Southern Federal University, 344090 Stachki prosp., 194/2, Rostov-On-Don, Russian Federation
| | - Gennady S Borodkin
- Institute of Physical and Organic Chemistry, Southern Federal University, 344090 Stachki prosp., 194/2, Rostov-On-Don, Russian Federation
| | - Valery V Tkachev
- Federal Research Center of Problems of Chemical Physics and Medicinal Chemistry RAS, 142432 Ac. Semenov Avenue, 1, Moscow Region, Chernogolovka, Russian Federation
| | - Andrey N Utenyshev
- Federal Research Center of Problems of Chemical Physics and Medicinal Chemistry RAS, 142432 Ac. Semenov Avenue, 1, Moscow Region, Chernogolovka, Russian Federation
| | - Marina A Sazykina
- Academy of Biology and Biotechnologies, Southern Federal University, 344090 Stachki prosp., 194/1, Rostov-On-Don, Russian Federation
| | - Ivan S Sazykin
- Academy of Biology and Biotechnologies, Southern Federal University, 344090 Stachki prosp., 194/1, Rostov-On-Don, Russian Federation
| | - Tatiana N Azhogina
- Academy of Biology and Biotechnologies, Southern Federal University, 344090 Stachki prosp., 194/1, Rostov-On-Don, Russian Federation
| | - Shorena K Karchava
- Academy of Biology and Biotechnologies, Southern Federal University, 344090 Stachki prosp., 194/1, Rostov-On-Don, Russian Federation
| | - Maria V Klimova
- Academy of Biology and Biotechnologies, Southern Federal University, 344090 Stachki prosp., 194/1, Rostov-On-Don, Russian Federation
| | - Anatoly V Metelitsa
- Institute of Physical and Organic Chemistry, Southern Federal University, 344090 Stachki prosp., 194/2, Rostov-On-Don, Russian Federation
| | - Boris S Lukyanov
- Institute of Physical and Organic Chemistry, Southern Federal University, 344090 Stachki prosp., 194/2, Rostov-On-Don, Russian Federation
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16
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Kvorjak M, Ruffo E, Tivon Y, So V, Parikh A, Deiters A, Lohmueller J. Conditional Control of Universal CAR T Cells by Cleavable OFF-Switch Adaptors. ACS Synth Biol 2023; 12:2996-3007. [PMID: 37791909 PMCID: PMC10594876 DOI: 10.1021/acssynbio.3c00320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Indexed: 10/05/2023]
Abstract
As living drugs, engineered T cell therapies are revolutionizing disease treatment with their unique functional capabilities. However, they suffer from limitations of potentially unpredictable behavior, toxicities, and nontraditional pharmacokinetics. Engineering conditional control mechanisms responsive to tractable stimuli such as small molecules or light is thus highly desirable. We and others previously developed "universal" chimeric antigen receptors (CARs) that interact with coadministered antibody adaptors to direct target cell killing and T cell activation. Universal CARs are of high therapeutic interest due to their ability to simultaneously target multiple antigens on the same disease or different diseases by combining with adaptors to different antigens. Here, we further enhance the programmability and potential safety of universal CAR T cells by engineering OFF-switch adaptors that can conditionally control CAR activity, including T cell activation, target cell lysis, and transgene expression, in response to a small molecule or light stimulus. Moreover, in adaptor combination assays, OFF-switch adaptors were capable of orthogonal conditional targeting of multiple antigens simultaneously, following Boolean logic. OFF-switch adaptors represent a robust new approach for the precision targeting of universal CAR T cells with potential for enhanced safety.
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Affiliation(s)
- Michael Kvorjak
- UPMC
Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania 15232, United States
- Division
of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15232, United States
- Department
of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, United States
- Center
for Systems Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, United States
| | - Elisa Ruffo
- UPMC
Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania 15232, United States
- Division
of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15232, United States
- Department
of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, United States
- Center
for Systems Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, United States
| | - Yaniv Tivon
- Department
of Chemistry, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - Victor So
- UPMC
Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania 15232, United States
- Division
of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15232, United States
- Department
of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, United States
- Center
for Systems Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, United States
| | - Avani Parikh
- UPMC
Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania 15232, United States
- Division
of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15232, United States
- Department
of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, United States
- Center
for Systems Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, United States
| | - Alexander Deiters
- Center
for Systems Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, United States
- Department
of Chemistry, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - Jason Lohmueller
- UPMC
Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania 15232, United States
- Division
of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15232, United States
- Department
of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, United States
- Center
for Systems Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, United States
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17
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Wang T, Li H, Pu T, Yang L. Microsurgery Robots: Applications, Design, and Development. SENSORS (BASEL, SWITZERLAND) 2023; 23:8503. [PMID: 37896597 PMCID: PMC10611418 DOI: 10.3390/s23208503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
Microsurgical techniques have been widely utilized in various surgical specialties, such as ophthalmology, neurosurgery, and otolaryngology, which require intricate and precise surgical tool manipulation on a small scale. In microsurgery, operations on delicate vessels or tissues require high standards in surgeons' skills. This exceptionally high requirement in skills leads to a steep learning curve and lengthy training before the surgeons can perform microsurgical procedures with quality outcomes. The microsurgery robot (MSR), which can improve surgeons' operation skills through various functions, has received extensive research attention in the past three decades. There have been many review papers summarizing the research on MSR for specific surgical specialties. However, an in-depth review of the relevant technologies used in MSR systems is limited in the literature. This review details the technical challenges in microsurgery, and systematically summarizes the key technologies in MSR with a developmental perspective from the basic structural mechanism design, to the perception and human-machine interaction methods, and further to the ability in achieving a certain level of autonomy. By presenting and comparing the methods and technologies in this cutting-edge research, this paper aims to provide readers with a comprehensive understanding of the current state of MSR research and identify potential directions for future development in MSR.
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Affiliation(s)
- Tiexin Wang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
| | - Haoyu Li
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Tanhong Pu
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Liangjing Yang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
- Department of Mechanical Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
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18
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Jiang R, Zeng J, Liu Q, Li S, He L, Cheng D. Engineering a near-infrared LAP fluorescent probe with high sensitivity and selectivity for surgical resection of liver cancer. J Mater Chem B 2023; 11:9459-9466. [PMID: 37728020 DOI: 10.1039/d3tb01627g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Hepatocellular carcinoma (HCC) is a type of cancer associated with a high rate of mortality and morbidity. In order to achieve precise HCC theranostics, it is important to develop excellent fluorescent probes. However, the existing probes are not sensitive or specific enough to accurately identify HCC margins and contours. For diagnosing HCC and identifying tumors during surgery, it is urgent to engineer highly sensitive and selective fluorescent probes. Liver tumor progression is closely associated with leucine aminopeptidase (LAP) overexpression, a biomarker of liver cancer. Herein, we have rationally designed a NIR fluorescent probe, NLAP, which is specially activated by LAP. The probe exhibited high sensitivity (detection limit = 6.8 mU L-1) and superior affinity (Km = 2.98 μM) for LAP. With this probe, we distinguished cancer cells overexpressing LAP from normal cells and applied it intraoperatively to guide liver tumor excisions. Furthermore, NLAP was employed to successfully detect the LAP of intestinal and splenic metastatic tumors in orthotopic liver tumor mice by "in situ spraying" and good performances were demonstrated.
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Affiliation(s)
- Renfeng Jiang
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, School of Pharmaceutical Science, Hengyang Medical School, University of South China, Hengyang 421002, Hunan, China.
| | - Jiayu Zeng
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, School of Pharmaceutical Science, Hengyang Medical School, University of South China, Hengyang 421002, Hunan, China.
| | - Qian Liu
- Clinical Research Institute, the Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang 421002, Hunan, China.
| | - Songjiao Li
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, School of Pharmaceutical Science, Hengyang Medical School, University of South China, Hengyang 421002, Hunan, China.
| | - Longwei He
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, School of Pharmaceutical Science, Hengyang Medical School, University of South China, Hengyang 421002, Hunan, China.
| | - Dan Cheng
- Clinical Research Institute, the Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang 421002, Hunan, China.
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19
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Fujimoto D, Taniguchi K, Takashima J, Kobayashi H. Indocyanine Green Tracer-Guided Radical Robotic Distal Gastrectomy Using the Firefly™ System Improves the Quality of Lymph Node Dissection in Patients with Gastric Cancer. J Gastrointest Surg 2023; 27:1804-1811. [PMID: 37308737 DOI: 10.1007/s11605-023-05740-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/03/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study investigated indocyanine green (ICG) as an intraoperative tool for improving lymph node dissection quality in radical robotic distal gastrectomy (RDG) for gastric cancer by comparing the rate of lymph node (LN) noncompliance with or without use of the Firefly™ system. METHODS Patients with potentially resectable gastric cancer including cT1-T4a, N0/ + , M0 were registered in a prospective nonrandomized cohort study at our institution between March 2019 and December 2022. Patients were assigned to the da Vinci surgical system with Firefly system (F group) or that without Firefly system (non-F group). F group patients received endoscopic peritumoral injection of ICG to the submucosa one day before surgery. Rate of LN noncompliance, number of harvested LNs, and short-term outcomes were compared. RESULTS Of the 94 patients in this study, 55 underwent Firefly system-guided RDG and 39 underwent conventional RDG. The mean [SD] total number of harvested lymph nodes in F group, 31.2 [10.2], was significantly higher than that harvested in non-F group (25.6 [12.6]; p = 0.026). The LN noncompliance rate in F group was lower than that in non-F group (32.7% vs. 61.5%, p = 0.006). The mean number of LNs harvested in F group was significantly higher than that harvested in non-F group (31.2 [10.2] vs. 25.7 [12.6], p = 0.02). Significant differences were found between the F vs. non-F groups in blood loss and postoperative hospital stay (83.9 [75.1] vs. 301.9 [766.7] mL; p = 0.003 and 13.4 vs. 17.4 days, p = 0.049). CONCLUSION The Firefly system-assisted ICG tracer improved LN dissection quality without compromising safety.
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Affiliation(s)
- Daisuke Fujimoto
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, 5-1-1 Futako, Takatsu-Ku, Kawasaki-City, Kanagawa, 213-8507, Japan.
| | - Keizo Taniguchi
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, 5-1-1 Futako, Takatsu-Ku, Kawasaki-City, Kanagawa, 213-8507, Japan
| | - Junpei Takashima
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, 5-1-1 Futako, Takatsu-Ku, Kawasaki-City, Kanagawa, 213-8507, Japan
| | - Hirotoshi Kobayashi
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, 5-1-1 Futako, Takatsu-Ku, Kawasaki-City, Kanagawa, 213-8507, Japan
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20
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Chon B, Ghann W, Uddin J, Anvari B, Kundra V. Indocyanine Green (ICG) Fluorescence Is Dependent on Monomer with Planar and Twisted Structures and Inhibited by H-Aggregation. Int J Mol Sci 2023; 24:13030. [PMID: 37685837 PMCID: PMC10488082 DOI: 10.3390/ijms241713030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/14/2023] [Accepted: 07/28/2023] [Indexed: 09/10/2023] Open
Abstract
The optical properties of indocyanine green (ICG) as a near-infrared (NIR) fluorescence dye depend on the nature of the solvent medium and the dye concentration. In the ICG absorption spectra of water, at high concentrations, there were absorption maxima at 700 nm, implying H-aggregates. With ICG dilution, the main absorption peak was at 780 nm, implying monomers. However, in ethanol, the absorption maximum was 780 nm, and the shapes of the absorption spectra were identical regardless of the ICG concentration, indicating that ICG in ethanol exists only as a monomer without H-aggregates. We found that emission was due to the monomer form and decreased with H-aggregate formation. In the fluorescence spectra, the 820 nm emission band was dominant at low concentrations, whereas at high concentrations, we found that the emission peaks were converted to 880 nm, suggesting a new form via the twisted intramolecular charge transfer (TICT) process of ICG. The NIR fluorescence intensity of ICG in ethanol was approximately 12- and 9-times brighter than in water in the NIR-I and -II regions, respectively. We propose an energy diagram of ICG to describe absorptive and emissive transitions through the ICG structures such as the monomer, H-aggregated, and TICT monomer forms.
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Affiliation(s)
- Bonghwan Chon
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD 21201, USA;
| | - William Ghann
- Center for Nanotechnology, Department of Natural Sciences, Coppin State University, 2500 W North Ave, Baltimore, MD 21216, USA
| | - Jamal Uddin
- Center for Nanotechnology, Department of Natural Sciences, Coppin State University, 2500 W North Ave, Baltimore, MD 21216, USA
| | - Bahman Anvari
- Department of Biochemistry, University of California, Riverside, 900 University Ave, Riverside, CA 92521, USA
- Department of Bioengineering, University of California, Riverside, 900 University Ave, Riverside, CA 92521, USA
| | - Vikas Kundra
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD 21201, USA;
- Marlene and Stewart Greenebaum NCI Comprehensive Cancer Center Program in Oncology, Experimental Therapeutics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
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21
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Park SY, Choi YS, Hwang YM, Yi JW. Robot-Assisted Parathyroidectomy Using Indocyanine Green (ICG) Fluorescence in Primary Hyperparathyroidism. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1456. [PMID: 37629746 PMCID: PMC10456807 DOI: 10.3390/medicina59081456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Surgical treatment for primary hyperparathyroidism (PHPT) has evolved from bilateral exploration through a long transcervical incision to focused parathyroidectomy with a minimal incision above the pathologic gland. Recently, endoscopic or robot-assisted parathyroid surgery without direct neck incision has been introduced. The aim of this study was to investigate the effectiveness of indocyanine green (ICG) fluorescence as a new method for the visual identification of abnormal hyperfunctioning parathyroid glands in robot-assisted parathyroidectomy using FireflyTM technology. We also aimed to conduct a comparative analysis between robot-assisted parathyroidectomy and conventional focused parathyroidectomy in order to identify clinical differences between the two surgical approaches. Materials and Methods: A total of 37 patients with PHPT underwent parathyroidectomy at a single university hospital between September 2018 and December 2022. Thirty-one patients underwent open focused parathyroidectomy (open group), and six patients underwent robot-assisted parathyroidectomy (robot group). Pre-operative localization via parathyroid SPECT-CT and an intraoperative parathyroid hormone (IOPTH) assay were used to successfully remove the pathologic parathyroid in both groups. ICG was administered only in the robot group. Results: Pathologic parathyroid showed a persistent fluorescence pattern under near-infrared vision. After the removal of the fluorescent parathyroid gland, IOPTH was normalized in all six patients in the robot group. However, the open group showed shorter hospital stays (1.8 ± 1.2 vs. 3.0 ± 0.0 days, p < 0.001) and shorter operation times (91.1 ± 69.1 vs. 152.5 ± 23.6 min, p = 0.001) than the robot group. After 6 months of surgery, PTH, calcium, and ionized calcium levels were all normalized without significant differences between the groups. Conclusions: Robot-assisted parathyroidectomy using ICG is helpful for the visual identification of the pathologic parathyroid gland. The advantage of robot parathyroidectomy is a better cosmetic outcome. However, it still does not show better clinical outcomes than conventional open focused parathyroidectomy.
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Affiliation(s)
| | | | | | - Jin Wook Yi
- Department of Surgery, Inha University Hospital & College of Medicine, Incheon 22332, Republic of Korea
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22
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Shamim M, Dinh J, Yang C, Nomura S, Kashiwagi S, Kang H, Choi HS, Henary M. Synthesis, Optical Properties, and In Vivo Biodistribution Performance of Polymethine Cyanine Fluorophores. ACS Pharmacol Transl Sci 2023; 6:1192-1206. [PMID: 37588753 PMCID: PMC10425993 DOI: 10.1021/acsptsci.3c00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Indexed: 08/18/2023]
Abstract
Near-infrared (NIR) cyanine dyes showed enhanced properties for biomedical imaging. A systematic modification within the cyanine skeleton has been made through a facile design and synthetic route for optimal bioimaging. Herein, we report the synthesis of 11 NIR cyanine fluorophores and an investigation of their physicochemical properties, optical characteristics, photostability, and in vivo performance. All synthesized fluorophores absorb and emit within 610-817 nm in various solvents. These dyes also showed high molar extinction coefficients ranging from 27,000 to 270,000 cm-1 M-1, quantum yields 0.01 to 0.33, and molecular brightness 208-79,664 cm-1 M-1 in the tested solvents. Photostability data demonstrate that all tested fluorophores 28, 18, 20, 19, 25, and 24 are more photostable than the FDA-approved indocyanine green. In the biodistribution study, most compounds showed tissue-specific targeting to selectively accumulate in the adrenal glands, lymph nodes, or gallbladder while excreted to the hepatobiliary clearance route. Among the tested, compound 23 showed the best targetability to the bone marrow and lymph nodes. Since the safety of cyanine fluorophores is well established, rationally designed cyanine fluorophores established in the current study will expand an inventory of contrast agents for NIR imaging of not only normal tissues but also cancerous regions originating from these organs/tissues.
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Affiliation(s)
- Md Shamim
- Department
of Chemistry, Center of Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
| | - Jason Dinh
- Gordon
Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Chengeng Yang
- Gordon
Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Shinsuke Nomura
- Gordon
Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Satoshi Kashiwagi
- Gordon
Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Homan Kang
- Gordon
Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Hak Soo Choi
- Gordon
Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Maged Henary
- Department
of Chemistry, Center of Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
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23
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Shi Y, Liu J, Liu Y, Quan H, Li B, Lu H, Ding H, Yu Z, Han J. Detection of breast cancer cells by a near-infrared fluorescent probe targeting mitochondrial viscosity. Heliyon 2023; 9:e18704. [PMID: 37560648 PMCID: PMC10407741 DOI: 10.1016/j.heliyon.2023.e18704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023] Open
Abstract
Monitoring abnormal viscosity in biological systems is important for basic research and clinical applications. Fluorescence imaging technology is adaptable for the visualization of tumor tissues due to its comprehensive features. However, fluorescence detection of intracellular viscosity in clinical samples remains challenging. We developed a promising near-infrared fluorescent probe, M556, for viscosity measurement. M556, which targets mitochondria, was successfully applied to monitor the mitochondrial viscosity in living cells. Furthermore, M556 was demonstrated to effectively discriminate tumors from normal tissues in a mouse tumor model and in clinical specimens from breast cancer patients, thus indicating the potential perioperative use of this probe by clinicians to assist with biopsy procedures.
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Affiliation(s)
- Yu Shi
- Department of Breast Cancer, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Junjun Liu
- Department of Breast Cancer, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Yingying Liu
- Department of Physiology and Pathophysiology, Health Science Center, Peking University, Beijing 100191, China
| | - Hong Quan
- Department of Breast Cancer, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Bo Li
- Department of Breast Cancer, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Haili Lu
- Department of Breast Cancer, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Hanzhi Ding
- Department of Breast Cancer, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Zuoren Yu
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Jing Han
- Department of Breast Cancer, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
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24
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Wong LY, Lui NS. Intraoperative Molecular Imaging of Lung Cancer. Thorac Surg Clin 2023; 33:227-232. [PMID: 37414478 DOI: 10.1016/j.thorsurg.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Intraoperative molecular imaging innovations have been propelled by the development of fluorescent contrast agents that specifically target tumor tissues and advanced camera systems that can detect the specified fluorescence. The most promising agent to date is OTL38, a targeted and near-infrared agent that was recently approved by the Food and Drug Administration for intraoperative imaging for lung cancer.
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Affiliation(s)
- Lye-Yeng Wong
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Falk Building, Stanford, CA 94305, USA. https://twitter.com/LyeYengWongMD
| | - Natalie S Lui
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Falk Building, Stanford, CA 94305, USA.
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25
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Yuan Y, Li X, Bao X, Huangfu M, Zhang H. The magic mirror: a novel intraoperative monitoring method for parathyroid glands. Front Endocrinol (Lausanne) 2023; 14:1160902. [PMID: 37284221 PMCID: PMC10239973 DOI: 10.3389/fendo.2023.1160902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
The accurate detection of parathyroid glands (PGs) during surgery is of great significance in thyroidectomy and parathyroidectomy, which protects the function of normal PGs to prevent postoperative hypoparathyroidism and the thorough removal of parathyroid lesions. Existing conventional imaging techniques have certain limitations in the real-time exploration of PGs. In recent years, a new, real-time, and non-invasive imaging system known as the near-infrared autofluorescence (NIRAF) imaging system has been developed to detect PGs. Several studies have confirmed that this system has a high parathyroid recognition rate and can reduce the occurrence of transient hypoparathyroidism after surgery. The NIRAF imaging system, like a magic mirror, can monitor the PGs during surgery in real time, thus providing great support for surgeries. In addition, the NIRAF imaging system can evaluate the blood supply of PGs by utilizing indocyanine green (ICG) to guide surgical strategies. The NIRAF imaging system and ICG complement each other to protect normal parathyroid function and reduce postoperative complications. This article reviews the effectiveness of the NIRAF imaging system in thyroidectomies and parathyroidectomies and briefly discusses some existing problems and prospects for the future.
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Kwon KH, Kim MY. Robust H-K Curvature Map Matching for Patient-to-CT Registration in Neurosurgical Navigation Systems. SENSORS (BASEL, SWITZERLAND) 2023; 23:4903. [PMID: 37430817 DOI: 10.3390/s23104903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 07/12/2023]
Abstract
Image-to-patient registration is a coordinate system matching process between real patients and medical images to actively utilize medical images such as computed tomography (CT) during surgery. This paper mainly deals with a markerless method utilizing scan data of patients and 3D data from CT images. The 3D surface data of the patient are registered to CT data using computer-based optimization methods such as iterative closest point (ICP) algorithms. However, if a proper initial location is not set up, the conventional ICP algorithm has the disadvantages that it takes a long converging time and also suffers from the local minimum problem during the process. We propose an automatic and robust 3D data registration method that can accurately find a proper initial location for the ICP algorithm using curvature matching. The proposed method finds and extracts the matching area for 3D registration by converting 3D CT data and 3D scan data to 2D curvature images and by performing curvature matching between them. Curvature features have characteristics that are robust to translation, rotation, and even some deformation. The proposed image-to-patient registration is implemented with the precise 3D registration of the extracted partial 3D CT data and the patient's scan data using the ICP algorithm.
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Affiliation(s)
- Ki Hoon Kwon
- School of Electronic and Electrical Engineering, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Min Young Kim
- School of Electronic and Electrical Engineering, Kyungpook National University, Daegu 41566, Republic of Korea
- Research Center for Neurosurgical Robotic System, Kyungpook National University, Daegu 41566, Republic of Korea
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Luo L, Zhou H, Wang S, Pang M, Zhang J, Hu Y, You J. The Application of Nanoparticle-Based Imaging and Phototherapy for Female Reproductive Organs Diseases. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023:e2207694. [PMID: 37154216 DOI: 10.1002/smll.202207694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/06/2023] [Indexed: 05/10/2023]
Abstract
Various female reproductive disorders affect millions of women worldwide and bring many troubles to women's daily life. Let alone, gynecological cancer (such as ovarian cancer and cervical cancer) is a severe threat to most women's lives. Endometriosis, pelvic inflammatory disease, and other chronic diseases-induced pain have significantly harmed women's physical and mental health. Despite recent advances in the female reproductive field, the existing challenges are still enormous such as personalization of disease, difficulty in diagnosing early cancers, antibiotic resistance in infectious diseases, etc. To confront such challenges, nanoparticle-based imaging tools and phototherapies that offer minimally invasive detection and treatment of reproductive tract-associated pathologies are indispensable and innovative. Of late, several clinical trials have also been conducted using nanoparticles for the early detection of female reproductive tract infections and cancers, targeted drug delivery, and cellular therapeutics. However, these nanoparticle trials are still nascent due to the body's delicate and complex female reproductive system. The present review comprehensively focuses on emerging nanoparticle-based imaging and phototherapies applications, which hold enormous promise for improved early diagnosis and effective treatments of various female reproductive organ diseases.
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Affiliation(s)
- Lihua Luo
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Huanli Zhou
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Sijie Wang
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Mei Pang
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Junlei Zhang
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Yilong Hu
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Jian You
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
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Sutton PA, van Dam MA, Cahill RA, Mieog S, Polom K, Vahrmeijer AL, van der Vorst J. Fluorescence-guided surgery: comprehensive review. BJS Open 2023; 7:7162090. [PMID: 37183598 PMCID: PMC10183714 DOI: 10.1093/bjsopen/zrad049] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Despite significant improvements in preoperative workup and surgical planning, surgeons often rely on their eyes and hands during surgery. Although this can be sufficient in some patients, intraoperative guidance is highly desirable. Near-infrared fluorescence has been advocated as a potential technique to guide surgeons during surgery. METHODS A literature search was conducted to identify relevant articles for fluorescence-guided surgery. The literature search was performed using Medical Subject Headings on PubMed for articles in English until November 2022 and a narrative review undertaken. RESULTS The use of invisible light, enabling real-time imaging, superior penetration depth, and the possibility to use targeted imaging agents, makes this optical imaging technique increasingly popular. Four main indications are described in this review: tissue perfusion, lymph node assessment, anatomy of vital structures, and tumour tissue imaging. Furthermore, this review provides an overview of future opportunities in the field of fluorescence-guided surgery. CONCLUSION Fluorescence-guided surgery has proven to be a widely innovative technique applicable in many fields of surgery. The potential indications for its use are diverse and can be combined. The big challenge for the future will be in bringing experimental fluorophores and conjugates through trials and into clinical practice, as well as validation of computer visualization with large data sets. This will require collaborative surgical groups focusing on utility, efficacy, and outcomes for these techniques.
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Affiliation(s)
- Paul A Sutton
- The Colorectal and Peritoneal Oncology Centre, Christie Hospital, Manchester, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Martijn A van Dam
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ronan A Cahill
- RAC, UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
- RAC, Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sven Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Karol Polom
- Clinic of Oncological, Transplantation and General Surgery, Gdansk Medical University, Gdansk, Poland
| | | | - Joost van der Vorst
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Bao K, Tully M, Cardenas K, Wang H, Srinivas S, Rho J, Jeon OH, Dinh J, Yokomizo S, McDonnell R, Yamashita A, Kashiwagi S, Kang H, Kim HK, Choi HS. Ultralow Background Near-Infrared Fluorophores with Dual-Channel Intraoperative Imaging Capability. Adv Healthc Mater 2023; 12:e2203134. [PMID: 36640372 PMCID: PMC10175134 DOI: 10.1002/adhm.202203134] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Indexed: 01/15/2023]
Abstract
Two of the most pressing challenges facing bioimaging are nonspecific uptake of intravenously administered contrast agents and incomplete elimination of unbound targeted agents from the body. Designing a targeted contrast agent that shows fast clearance from background tissues and eventually the body after complete targeting is key to the success of image-guided interventions. Here, this work describes the development of renally clearable near-infrared contrast agents and their potential use for dual-channel image-guided tumor targeting. cRGD-ZW800-PEG (800 nm channel) and ZW700-PEG (700 nm channel) are able to visualize tumor margins and tumor vasculature simultaneously and respectively. These targeted agents show rapid elimination from the bloodstream, followed by renal clearance, which together significantly lower off-target background signals and potential toxicity. To demonstrate its applicability, this multispectral imaging is performed in various tumor-bearing animal models including lung cancer, pancreatic neuroendocrine tumors, breast, and ovarian cancer.
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Affiliation(s)
- Kai Bao
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Molly Tully
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Kevin Cardenas
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Haoran Wang
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Surbhi Srinivas
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Jiyun Rho
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States; Department of Biomedical Sciences, College of Medicine, Korea University, Seoul 08308, South Korea
| | - Ok Hwa Jeon
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul 08308, South Korea
| | - Jason Dinh
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Shinya Yokomizo
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Rose McDonnell
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Atsushi Yamashita
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Satoshi Kashiwagi
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Homan Kang
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Hyun Koo Kim
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul 08308, South Korea
| | - Hak Soo Choi
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
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30
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Li Z, Liang PZ, Xu L, Zhang XX, Li K, Wu Q, Lou XF, Ren TB, Yuan L, Zhang XB. In situ orderly self-assembly strategy affording NIR-II-J-aggregates for in vivo imaging and surgical navigation. Nat Commun 2023; 14:1843. [PMID: 37012267 PMCID: PMC10070396 DOI: 10.1038/s41467-023-37586-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 03/23/2023] [Indexed: 04/05/2023] Open
Abstract
J-aggregation, an effective strategy to extend wavelength, has been considered as a promising method for constructing NIR-II fluorophores. However, due to weak intermolecular interactions, conventional J-aggregates are easily decomposed into monomers in the biological environment. Although adding external carriers could help conventional J-aggregates stabilize, such methods still suffer from high-concentration dependence and are unsuitable for activatable probes design. Besides, these carriers-assisted nanoparticles are risky of disassembly in lipophilic environment. Herein, by fusing the precipitated dye (HPQ) which has orderly self-assembly structure, onto simple hemi-cyanine conjugated system, we construct a series of activatable, high-stability NIR-II-J-aggregates which overcome conventional J-aggregates carrier's dependence and could in situ self-assembly in vivo. Further, we employ the NIR-II-J-aggregates probe HPQ-Zzh-B to achieve the long-term in situ imaging of tumor and precise tumor resection by NIR-II imaging navigation for reducing lung metastasis. We believe this strategy will advance the development of controllable NIR-II-J-aggregates and precise bioimaging in vivo.
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Affiliation(s)
- Zhe Li
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, China
| | - Ping-Zhao Liang
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, China
| | - Li Xu
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, China
| | - Xing-Xing Zhang
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, China
| | - Ke Li
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, China
| | - Qian Wu
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, China
| | - Xiao-Feng Lou
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, China
| | - Tian-Bing Ren
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, China
| | - Lin Yuan
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, China
| | - Xiao-Bing Zhang
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, China.
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31
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Lifante J, de la Fuente-Fernández M, Román-Carmena M, Fernandez N, Jaque García D, Granado M, Ximendes E. In vivo grading of lipids in fatty liver by near-infrared autofluorescence and reflectance. JOURNAL OF BIOPHOTONICS 2023; 16:e202200208. [PMID: 36377726 DOI: 10.1002/jbio.202200208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/16/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
The prevalence of nonalcoholic fatty liver (NAFLD) is rapidly increasing worldwide. When untreated, it may lead to complications such as liver cirrhosis or hepatocarcinoma. The diagnosis of NAFLD is usually obtained by ultrasonography, a technique that can underestimate its prevalence. For this reason, physicians aspire for an accurate, cost-effective, and noninvasive method to determine both the presence and the specific stage of the NAFLD. In this paper, we report an integrated approach for the quantitative estimation of the density of triglycerides in the liver based on the use of autofluorescence and reflectance signals generated by the abdomen of obese C57BL6/J mice. Singular value decomposition is applied to the generated spectra and its corresponding regression model provided a determination coefficient of 0.99 and a root mean square error of 240 mg/dl. This, in turn, enabled the quantitative imaging of triglycerides density in the livers of mice under in vivo conditions.
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Affiliation(s)
- José Lifante
- Nanomaterials for Bioimaging Group (nanoBIG), Universidad Autónoma de Madrid, Madrid, Spain
- IRYCIS, Madrid, Spain
| | | | | | - Nuria Fernandez
- Nanomaterials for Bioimaging Group (nanoBIG), Universidad Autónoma de Madrid, Madrid, Spain
| | - Daniel Jaque García
- Nanomaterials for Bioimaging Group (nanoBIG), Universidad Autónoma de Madrid, Madrid, Spain
- IRYCIS, Madrid, Spain
| | - Miriam Granado
- Nanomaterials for Bioimaging Group (nanoBIG), Universidad Autónoma de Madrid, Madrid, Spain
| | - Erving Ximendes
- Nanomaterials for Bioimaging Group (nanoBIG), Universidad Autónoma de Madrid, Madrid, Spain
- IRYCIS, Madrid, Spain
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32
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Mohamed M, Klenke AK, Anokhin MV, Amadou H, Bothwell PJ, Conroy B, Nesterov EE, Nesterova IV. Zero-Background Small-Molecule Sensors for Near-IR Fluorescent Imaging of Biomacromolecular Targets in Cells. ACS Sens 2023; 8:1109-1118. [PMID: 36866808 PMCID: PMC10515643 DOI: 10.1021/acssensors.2c02342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
In this study, we report a general approach to the design of a new generation of small-molecule sensors that produce a zero background but are brightly fluorescent in the near-IR spectral range upon selective interaction with a biomolecular target. We developed a fluorescence turn-on/-off mechanism based on the aggregation/deaggregation of phthalocyanine chromophores. As a proof of concept, we designed, prepared, and characterized sensors for in-cell visualization of epidermal growth factor receptor (EGFR) tyrosine kinase. We established a structure/bioavailability correlation, determined conditions for the optimal sensor uptake and imaging, and demonstrated binding specificity and applications over a wide range of treatment options involving live and fixed cells. The new approach enables high-contrast imaging and requires no in-cell chemical assembly or postexposure manipulations (i.e., washes). The general design principles demonstrated in this work can be extended toward sensors and imaging agents for other biomolecular targets.
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Affiliation(s)
- Myar Mohamed
- Department of Chemistry and Biochemistry, Northern Illinois University, DeKalb, IL 60115, USA
| | - Anastasia K. Klenke
- Department of Chemistry and Biochemistry, Northern Illinois University, DeKalb, IL 60115, USA
| | - Maksim V. Anokhin
- Department of Chemistry and Biochemistry, Northern Illinois University, DeKalb, IL 60115, USA
| | - Harouna Amadou
- Department of Chemistry and Biochemistry, Northern Illinois University, DeKalb, IL 60115, USA
| | - Paige J. Bothwell
- Department of Chemistry and Biochemistry, Northern Illinois University, DeKalb, IL 60115, USA
| | - Brigid Conroy
- Department of Chemistry and Biochemistry, Northern Illinois University, DeKalb, IL 60115, USA
| | - Evgueni E. Nesterov
- Department of Chemistry and Biochemistry, Northern Illinois University, DeKalb, IL 60115, USA
| | - Irina V. Nesterova
- Department of Chemistry and Biochemistry, Northern Illinois University, DeKalb, IL 60115, USA
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33
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Duan QJ, Zhao ZY, Zhang YJ, Fu L, Yuan YY, Du JZ, Wang J. Activatable fluorescent probes for real-time imaging-guided tumor therapy. Adv Drug Deliv Rev 2023; 196:114793. [PMID: 36963569 DOI: 10.1016/j.addr.2023.114793] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/17/2023] [Accepted: 03/20/2023] [Indexed: 03/26/2023]
Abstract
Surgery and drug therapy are the two principal options for cancer treatment. However, their clinical benefits are hindered by the difficulty of accurate location of the tumors and timely monitoring of the treatment efficacy of drugs, respectively. Rapid development of imaging techniques provides promising tools to address these challenges. Compared with conventional imaging techniques such as magnetic resonance imaging and computed tomography etc., fluorescence imaging exhibits high spatial resolution, real-time imaging capability, and relatively low costs devices. The advancements in fluorescent probes further accelerate the implementation of fluorescence imaging in tumor diagnosis and treatment monitoring. In particular, the emergence of site-specifically activatable fluorescent probes fits the demands of tumor delineation and real-time feedback of the treatment efficacy. A variety of small molecule probes or nanoparticle-based probes have been developed and explored for the above-mentioned applications. This review will discuss recent advances in fluorescent probes with a special focus on activatable nanoprobes and highlight the potential implementation of activatable nanoprobes in fluorescence imaging-guided surgery as well as imaging-guided drug therapy.
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Affiliation(s)
- Qi-Jia Duan
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Zhong-Yi Zhao
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Yao-Jun Zhang
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, China
| | - Liangbing Fu
- School of Biomedical Sciences and Engineering, Guangzhou International Campus, South China University of Technology, Guangzhou 511442, China
| | - You-Yong Yuan
- School of Biomedical Sciences and Engineering, Guangzhou International Campus, South China University of Technology, Guangzhou 511442, China; Guangdong Provincial Key Laboratory of Biomedical Engineering, and Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, China
| | - Jin-Zhi Du
- School of Medicine, South China University of Technology, Guangzhou 510006, China; Guangdong Provincial Key Laboratory of Biomedical Engineering, and Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, China.
| | - Jun Wang
- School of Biomedical Sciences and Engineering, Guangzhou International Campus, South China University of Technology, Guangzhou 511442, China; National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China.
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34
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Cassinotti E, Al-Taher M, Antoniou SA, Arezzo A, Baldari L, Boni L, Bonino MA, Bouvy ND, Brodie R, Carus T, Chand M, Diana M, Eussen MMM, Francis N, Guida A, Gontero P, Haney CM, Jansen M, Mintz Y, Morales-Conde S, Muller-Stich BP, Nakajima K, Nickel F, Oderda M, Parise P, Rosati R, Schijven MP, Silecchia G, Soares AS, Urakawa S, Vettoretto N. European Association for Endoscopic Surgery (EAES) consensus on Indocyanine Green (ICG) fluorescence-guided surgery. Surg Endosc 2023; 37:1629-1648. [PMID: 36781468 PMCID: PMC10017637 DOI: 10.1007/s00464-023-09928-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/28/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND In recent years, the use of Indocyanine Green (ICG) fluorescence-guided surgery during open and laparoscopic procedures has exponentially expanded across various clinical settings. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference on this topic with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS An expert panel of surgeons has been selected and invited to participate to this project. Systematic reviews of the PubMed, Embase and Cochrane libraries were performed to identify evidence on potential benefits of ICG fluorescence-guided surgery on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by the panel; they were then submitted to all EAES members through a two-rounds online survey and results presented at the EAES annual congress, Barcelona, November 2021. RESULTS A total of 18,273 abstracts were screened with 117 articles included. 22 statements and 16 recommendations were generated and approved. In some areas, such as the use of ICG fluorescence-guided surgery during laparoscopic cholecystectomy, the perfusion assessment in colorectal surgery and the search for the sentinel lymph nodes in gynaecological malignancies, the large number of evidences in literature has allowed us to strongly recommend the use of ICG for a better anatomical definition and a reduction in post-operative complications. CONCLUSIONS Overall, from the systematic literature review performed by the experts panel and the survey extended to all EAES members, ICG fluorescence-guided surgery could be considered a safe and effective technology. Future robust clinical research is required to specifically validate multiple organ-specific applications and the potential benefits of this technique on clinical outcomes.
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Affiliation(s)
- E Cassinotti
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy.
| | - M Al-Taher
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - S A Antoniou
- Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - A Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - L Baldari
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - L Boni
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - M A Bonino
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - N D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R Brodie
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - T Carus
- Niels-Stensen-Kliniken, Elisabeth-Hospital, Thuine, Germany
| | - M Chand
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - M Diana
- IHU Strasbourg, Institute of Image-Guided Surgery and IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - M M M Eussen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - N Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - A Guida
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - P Gontero
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - C M Haney
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Jansen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Y Mintz
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain
| | - B P Muller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - K Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - F Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Oderda
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - P Parise
- U.O.C. Chirurgia Generale, Policlinico di Abano Terme, Abano Terme, PD, Italy
| | - R Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - M P Schijven
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, North Holland, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
| | - G Silecchia
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - A S Soares
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - S Urakawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - N Vettoretto
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Montichiari, Italy
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Baart VM, van Manen L, Bhairosingh SS, Vuijk FA, Iamele L, de Jonge H, Scotti C, Resnati M, Cordfunke RA, Kuppen PJK, Mazar AP, Burggraaf J, Vahrmeijer AL, Sier CFM. Side-by-Side Comparison of uPAR-Targeting Optical Imaging Antibodies and Antibody Fragments for Fluorescence-Guided Surgery of Solid Tumors. Mol Imaging Biol 2023; 25:122-132. [PMID: 34642899 PMCID: PMC9970952 DOI: 10.1007/s11307-021-01657-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/27/2021] [Accepted: 09/21/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Radical resection is paramount for curative oncological surgery. Fluorescence-guided surgery (FGS) aids in intraoperative identification of tumor-positive resection margins. This study aims to assess the feasibility of urokinase plasminogen activator receptor (uPAR) targeting antibody fragments for FGS in a direct comparison with their parent IgG in various relevant in vivo models. PROCEDURES Humanized anti-uPAR monoclonal antibody MNPR-101 (uIgG) was proteolytically digested into F(ab')2 and Fab fragments named uFab2 and uFab. Surface plasmon resonance (SPR) and cell assays were used to determine in vitro binding before and after fluorescent labeling with IRDye800CW. Mice bearing subcutaneous HT-29 human colonic cancer cells were imaged serially for up to 120 h after fluorescent tracer administration. Imaging characteristics and ex vivo organ biodistribution were further compared in orthotopic pancreatic ductal adenocarcinoma (BxPc-3-luc2), head-and-neck squamous cell carcinoma (OSC-19-luc2-GFP), and peritoneal carcinomatosis (HT29-luc2) models using the clinical Artemis fluorescence imaging system. RESULTS Unconjugated and conjugated uIgG, uFab2, and uFab specifically recognized uPAR in the nanomolar range as determined by SPR and cell assays. Subcutaneous tumors were clearly identifiable with tumor-to-background ratios (TBRs) > 2 after 72 h for uIgG-800F and 24 h for uFab2-800F and uFab-800F. For the latter two, mean fluorescence intensities (MFIs) dipped below predetermined threshold after 72 h and 36 h, respectively. Tumors were easily identified in the orthotopic models with uIgG-800F consistently having the highest MFIs and uFab2-800F and uFab-800F having similar values. In biodistribution studies, kidney and liver fluorescence approached tumor fluorescence after uIgG-800F administration and surpassed tumor fluorescence after uFab2-800F or uFab-800F administration, resulting in interference in the abdominal orthotopic mouse models. CONCLUSIONS In a side-by-side comparison, FGS with uPAR-targeting antibody fragments compared with the parent IgG resulted in earlier tumor visualization at the expense of peak fluorescence intensity.
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Affiliation(s)
- Victor M Baart
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Labrinus van Manen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Floris A Vuijk
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Luisa Iamele
- Unit of Immunology and General Pathology, Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Ardis Srl, Pavia, Italy
| | - Hugo de Jonge
- Unit of Immunology and General Pathology, Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Ardis Srl, Pavia, Italy
| | - Claudia Scotti
- Unit of Immunology and General Pathology, Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Ardis Srl, Pavia, Italy
| | - Massimo Resnati
- Age Related Diseases Unit, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milano, Italy
| | - Robert A Cordfunke
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter J K Kuppen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jacobus Burggraaf
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Centre for Human Drug Research, Leiden, The Netherlands
| | | | - Cornelis F M Sier
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Percuros BV, Leiden, The Netherlands
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36
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van Oosterom MN, van Leeuwen SI, Mazzone E, Dell’Oglio P, Buckle T, van Beurden F, Boonekamp M, van de Stadt H, Bauwens K, Simon H, van Leeuwen PJ, van der Poel HG, van Leeuwen FWB. Click-on fluorescence detectors: using robotic surgical instruments to characterize molecular tissue aspects. J Robot Surg 2023; 17:131-140. [PMID: 35397108 PMCID: PMC9939496 DOI: 10.1007/s11701-022-01382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/29/2022] [Indexed: 11/24/2022]
Abstract
Fluorescence imaging is increasingly being implemented in surgery. One of the drawbacks of its application is the need to switch back-and-forth between fluorescence- and white-light-imaging settings and not being able to dissect safely under fluorescence guidance. The aim of this study was to engineer 'click-on' fluorescence detectors that transform standard robotic instruments into molecular sensing devices that enable the surgeon to detect near-infrared (NIR) fluorescence in a white-light setting. This NIR-fluorescence detector setup was engineered to be press-fitted onto standard forceps instruments of the da Vinci robot. Following system characterization in a phantom setting (i.e., spectral properties, sensitivity and tissue signal attenuation), the performance with regard to different clinical indocyanine green (ICG) indications (e.g., angiography and lymphatic mapping) was determined via robotic surgery in pigs. To evaluate in-human applicability, the setup was also used for ICG-containing lymph node specimens from robotic prostate cancer surgery. The resulting Click-On device allowed for NIR ICG signal identification down to a concentration of 4.77 × 10-6 mg/ml. The fully assembled system could be introduced through the trocar and grasping, and movement abilities of the instrument were preserved. During surgery, the system allowed for the identification of blood vessels and assessment of vascularization (i.e., bowel, bladder and kidney), as well as localization of pelvic lymph nodes. During human specimen evaluation, it was able to distinguish sentinel from non-sentinel lymph nodes. With this introduction of a NIR-fluorescence Click-On sensing detector, a next step is made towards using surgical instruments in the characterization of molecular tissue aspects.
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Affiliation(s)
- Matthias N. van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands ,Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Sven I. van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elio Mazzone
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy ,ORSI Academy, Melle, Belgium
| | - Paolo Dell’Oglio
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands ,Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands ,ORSI Academy, Melle, Belgium ,Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands ,Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Florian van Beurden
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands ,Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Michael Boonekamp
- Design & Prototyping, Department of Medical Technology, Leiden University Medical Center, Leiden, The Netherlands
| | - Huybert van de Stadt
- Design & Prototyping, Department of Medical Technology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Pim J. van Leeuwen
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henk G. van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Fijs W. B. van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands ,Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands ,ORSI Academy, Melle, Belgium
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Sun JX, Xu JZ, An Y, Ma SY, Liu CQ, Zhang SH, Luan Y, Wang SG, Xia QD. Future in precise surgery: Fluorescence-guided surgery using EVs derived fluorescence contrast agent. J Control Release 2023; 353:832-841. [PMID: 36496053 DOI: 10.1016/j.jconrel.2022.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Surgery is the only cure for many solid tumors, but positive resection margins, damage to vital nerves, vessels and organs during surgery, and the range and extent of lymph node dissection are significant concerns which hinder the development of surgery. The emergence of fluorescence-guided surgery (FGS) means a farewell to the era when surgeons relied only on visual and tactile feedback, and it gives surgeons another eye to distinguish tumors from normal tissues for precise resection and helps to find a balance between complete tumor lesions removal and maximal organ function conservation. However, the existing synthetic fluorescence contrast agent has flaws in safety, specificity and biocompatibility to various extents. Extracellular vesicles (EVs) are a group of heterogeneous types of cell-derived membranous structures present in all biological fluids. EVs, especially engineered targeting EVs, play an increasingly important role in drug delivery because of their good biocompatibility, validated safety and targeting ability. Nevertheless, few studies have employed EVs loaded with fluorophores to construct fluorescence contrast agents and used them in FGS. Here, we systematically reviewed the current state of knowledge regarding FGS, fundamental characteristics of EVs, and the development of engineered targeting EVs, and put forward a novel strategy and procedures to produce EVs-based fluorescence contrast agent used in fluorescence-guided surgery.
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Affiliation(s)
- Jian-Xuan Sun
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, 430030 Wuhan, China
| | - Jin-Zhou Xu
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, 430030 Wuhan, China
| | - Ye An
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, 430030 Wuhan, China
| | - Si-Yang Ma
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, 430030 Wuhan, China
| | - Chen-Qian Liu
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, 430030 Wuhan, China
| | - Si-Han Zhang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, 430030 Wuhan, China
| | - Yang Luan
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, 430030 Wuhan, China.
| | - Shao-Gang Wang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, 430030 Wuhan, China.
| | - Qi-Dong Xia
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, 430030 Wuhan, China.
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Rodríguez-Zentner H, Cukier M, Montagne V, Arrue E. Ureteral identification with indocyanine green in laparoscopic colorectal surgery. Asian J Endosc Surg 2022; 16:312-316. [PMID: 36562203 DOI: 10.1111/ases.13149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Fluorescence-guided surgery has emerged as a complement of traditional laparoscopic surgery with the advantage that is adaptable to existent platforms. The purpose of this article is to describe our technique for ureteral identification with indocyanine green (ICG) during laparoscopic colorectal surgery. MATERIALS AND SURGICAL TECHNIQUE We report a case series of all patients who underwent laparoscopic colorectal surgery and ureteral injection of ICG in a private third level hospital. RESULTS We performed 30 laparoscopic colorectal surgeries in which we used this technique to identify the ureters. Mean age was 52.6 ± 15.28 years; 16 (53.3%) were men. The indication for surgery was diverticulitis in 18 patients. Mean urological operative time was 22.4 minutes. There were no immediate or delayed adverse effects attributable to intra-ureteral ICG administration. DISCUSSION Although ureteric iatrogenic injury is uncommon, when it does happen, it significantly increases the patient's morbidity. We consider this technique has the potential to make laparoscopic surgeries safer mostly in patients with cancer, diverticular disease or endometriosis who have extensive fibrosis, adhesions, and inflammation.
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Affiliation(s)
- Homero Rodríguez-Zentner
- Division of General Surgery, Department of Surgery, Pacifica Salud Hospital, Panama City, Panama
| | - Moises Cukier
- Division of General Surgery, Department of Surgery, Pacifica Salud Hospital, Panama City, Panama
| | - Vianette Montagne
- Division of Urology, Department of Surgery, Pacifica Salud Hospital, Panama City, Panama
| | - Emmy Arrue
- Division of General Surgery, Department of Surgery, Pacifica Salud Hospital, Panama City, Panama
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Wan J, Wang S, Yan B, Tang Y, Zheng J, Ji H, Hu Y, Zhuang B, Deng H, Yan J. Indocyanine green for radical lymph node dissection in patients with sigmoid and rectal cancer: randomized clinical trial. BJS Open 2022; 6:6901348. [PMID: 36515673 PMCID: PMC9897192 DOI: 10.1093/bjsopen/zrac151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/05/2022] [Accepted: 10/19/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND D3 lymph node dissection is recommended for patients with advanced sigmoid and rectal cancer in Japan. This trial aimed to investigate the feasibility of indocyanine green (ICG) as a tracer to increase the nodal harvest during D3 lymph node dissection in patients with sigmoid and rectal cancer. METHODS This prospective randomized clinical trial was performed between May 2021 and April 2022. The inclusion criteria were patients with stage I-III sigmoid or rectal cancer eligible for laparoscopic resection. Patients were 1: 1 randomized to either the ICG group (endoscopic ICG injection at the tumour site and intraoperative imaging to guide dissection) or the control group (routine laparoscopic white-light imaging). All patients were treated with D3 dissection, and the primary outcome was the number of harvested lymph nodes at the D3 level. RESULTS Out of 210 patients screened, a total of 66 patients were enrolled and randomized. Patients in the two groups presented similar ages and clinical stages (ICG group versus control group, median age of 58.0 versus 58.5 years; stage III 36.4 per cent versus 36.4 per cent, whereas the rate of rectal cancer was 27.3 per cent versus 48.5 per cent respectively). ICG imaging was helpful for completely dissecting D3 lymph nodes and could identify a median of more than 2 (range 1-6) D3 lymph nodes neglected by routine laparoscopic white-light imaging during surgery. The median number of D3 lymph nodes harvested in the ICG group was significantly higher than that in the control group (7.0 versus 5.0, P = 0.003); however, there was no significant difference in the median numbers of positive D1, D2, and D3 lymph nodes between the two groups. CONCLUSION ICG is safe and feasible to guide D3 lymph node dissection and can increase the number of harvested D3 lymph nodes in patients with sigmoid and rectal cancer. Registration number: NCT04848311 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Jinliang Wan
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou City, PR China,Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou City, PR China,Department of General Surgery, Affiliated Hospital of Jiujiang University, Jiujiang City, PR China
| | - Shijie Wang
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou City, PR China,Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou City, PR China
| | - Botao Yan
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou City, PR China,Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou City, PR China
| | - Yuting Tang
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou City, PR China,Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou City, PR China
| | - Jixiang Zheng
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou City, PR China,Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou City, PR China
| | - Hongli Ji
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou City, PR China,Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou City, PR China
| | - Yaowen Hu
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou City, PR China,Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou City, PR China
| | - Baoxiong Zhuang
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou City, PR China,Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou City, PR China
| | - Haijun Deng
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou City, PR China,Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou City, PR China
| | - Jun Yan
- Correspondence to: Jun Yan, Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, PR China (e-mail: )
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40
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Demarchi MS, Karenovics W, Bédat B, Triponez F. Near-infrared fluorescent imaging techniques for the detection and preservation of parathyroid glands during endocrine surgery. Innov Surg Sci 2022; 7:87-98. [PMID: 36561508 PMCID: PMC9742281 DOI: 10.1515/iss-2021-0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/14/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives In over 30% of all thyroid surgeries, complications arise from transient and definitive hypoparathyroidism, underscoring the need for real-time identification and preservation of parathyroid glands (PGs). Here, we evaluate the promising intraoperative optical technologies available for the identification, preservation, and functional assessment of PGs to enhance endocrine surgery. Methods We performed a review of the literature to identify published studies on fluorescence imaging in thyroid and parathyroid surgery. Results Fluorescence imaging is a well-demonstrated approach for both in vivo and in vitro localization of specific cells or tissues, and is gaining popularity as a technique to detect PGs during endocrine surgery. Autofluorescence (AF) imaging and indocyanine green (ICG) angiography are two emerging optical techniques to improve outcomes in thyroid and parathyroid surgeries. Near-infrared-guided technology has significantly contributed to the localization of PGs, through the detection of glandular AF. Perfusion through the PGs can be visualized with ICG, which can also reveal the blood supply after dissection. Conclusions Near infrared AF and ICG angiography, providing a valuable spatial and anatomical information, can decrease the incidence of complications in thyroid surgery.
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Affiliation(s)
- Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Wolfram Karenovics
- Department of Thoracic and Endocrine Surgery, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Benoît Bédat
- Department of Thoracic and Endocrine Surgery, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Intraoperative Tumor Detection Using Pafolacianine. Int J Mol Sci 2022; 23:ijms232112842. [PMID: 36361630 PMCID: PMC9658182 DOI: 10.3390/ijms232112842] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/16/2022] [Accepted: 10/21/2022] [Indexed: 12/24/2022] Open
Abstract
Cancer is a leading cause of death worldwide, with increasing numbers of new cases each year. For the vast majority of cancer patients, surgery is the most effective procedure for the complete removal of the malignant tissue. However, relapse due to the incomplete resection of the tumor occurs very often, as the surgeon must rely primarily on visual and tactile feedback. Intraoperative near-infrared imaging with pafolacianine is a newly developed technology designed for cancer detection during surgery, which has been proven to show excellent results in terms of safety and efficacy. Therefore, pafolacianine was approved by the U.S. Food and Drug Administration (FDA) on 29 November 2021, as an additional approach that can be used to identify malignant lesions and to ensure the total resection of the tumors in ovarian cancer patients. Currently, various studies have demonstrated the positive effects of pafolacianine’s use in a wide variety of other malignancies, with promising results expected in further research. This review focuses on the applications of the FDA-approved pafolacianine for the accurate intraoperative detection of malignant tissues. The cancer-targeting fluorescent ligands can shift the paradigm of surgical oncology by enabling the visualization of cancer lesions that are difficult to detect by inspection or palpation. The enhanced detection and removal of hard-to-detect cancer tissues during surgery will lead to remarkable outcomes for cancer patients and society, specifically by decreasing the cancer relapse rate, increasing the life expectancy and quality of life, and decreasing future rates of hospitalization, interventions, and costs.
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Sposito C, Maspero M, Belotti P, Simonotti N, Altomare M, Ciana P, Mazzaferro V. Indocyanine Green Fluorescence-Guided Surgery for Gastrointestinal Tumors: A Systematic Review. ANNALS OF SURGERY OPEN 2022; 3:e190. [PMID: 37601143 PMCID: PMC10431291 DOI: 10.1097/as9.0000000000000190] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To conduct a systematic review of the currently available literature on the use of ICG to guide surgical dissection in gastrointestinal (GI) cancer surgery. Background Real-time indocyanine green (ICG) fluorescence-guided surgery has the potential to enhance surgical outcomes by increasing patient-tailored oncological precision. Methods MEDLINE, PubMed, EMBASE, and Google Scholar were searched for publications on the use of ICG as a contrast agent in GI cancer surgery until December 2020. Perfusion studies were excluded. Quality of the studies was assessed with the Methodological Index for nonrandomized Studies or Jadad scale for randomized controlled trials. A narrative synthesis of the results was provided, with descriptive statistics when appropriate. Results Seventy-eight studies were included. ICG was used for primary tumor and metastases localization, for sentinel lymph node detection, and for lymph flow mapping. The detection rate for primary colorectal and gastric tumors was 100% after preoperative ICG endoscopic injection. For liver lesions, the detection rate after intravenous ICG infusion was 80% and up to 100% for lesions less than 8 mm from the liver surface. The detection rate for sentinel lymph nodes was 89.8% for esophageal, 98.6% for gastric, 87.4% for colorectal, and 83.3% for anal tumors, respectively. In comparative studies, ICG significantly increases the quality of D2 lymphadenectomy in oncological gastrectomy. Conclusion The use of ICG as a guiding tool for dissection in GI surgery is promising. Further evidence from high-quality studies on larger sample sizes is needed to assess whether ICG-guided surgery may become standard of care.
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Affiliation(s)
- Carlo Sposito
- From the General Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Marianna Maspero
- From the General Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- University of Milan, Milan, Italy
| | | | | | | | - Paolo Ciana
- Department of Health Sciences, Institute of Pharmacology, University of Milan, Milan, Italy
| | - Vincenzo Mazzaferro
- From the General Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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43
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Martin E, Hom M, Mani L, Rosenthal EL. Current and Future Applications of Fluorescence-Guided Surgery in Head and Neck Cancer. Surg Oncol Clin N Am 2022; 31:695-706. [DOI: 10.1016/j.soc.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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44
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He W, Zhang Z, Luo Y, Kwok RTK, Zhao Z, Tang BZ. Recent advances of aggregation-induced emission materials for fluorescence image-guided surgery. Biomaterials 2022; 288:121709. [PMID: 35995625 DOI: 10.1016/j.biomaterials.2022.121709] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/23/2022] [Accepted: 07/31/2022] [Indexed: 01/10/2023]
Abstract
Real-time intraoperative guidance is essential during various surgical treatment of many diseases. Aggregation-induced emission (AIE) materials have shown great potential for guiding surgeons during complex interventions, with the merits of deep tissue penetration, high quantum yield, high molar absorptivity, low background, good targeting ability and excellent photostability. Herein, we provided insights to design efficient AIE materials regarding three key parameters, i.e., deep-tissue penetration ability, high brightness of AIE luminogens (AIEgens), and precise tumor/other pathology nidus targeting strategies, for realizing better application of fluorescence image-guided surgery. Representative interdisciplinary achievements were outlined for the demonstration of this emerging field. Challenges and future opportunities of AIE materials were briefly discussed. The aim of this review is to provide a comprehensive view of AIE materials for intraoperative guidance for researchers and surgeons, and to inspire more further correlational studies in the new frontiers of image-guided surgery.
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Affiliation(s)
- Wei He
- School of Science and Engineering, Clinical Translational Research Center of Aggregation-Induced Emission, School of Medicine, The Second Affiliated Hospital, The Chinese University of Hong Kong, Shenzhen, Guangdong, 518172, China; Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China; HKUST Shenzhen Research Institute, No. 9 Yuexing 1st RD, South Area Hi-tech Park, Nanshan, Shenzhen, 518057, China; Center for Aggregation-Induced Emission and State Key Laboratory of Luminescent Materials and Devices, South China University of Technology, Guangzhou, 510640, China.
| | - Zicong Zhang
- School of Science and Engineering, Clinical Translational Research Center of Aggregation-Induced Emission, School of Medicine, The Second Affiliated Hospital, The Chinese University of Hong Kong, Shenzhen, Guangdong, 518172, China.
| | - Yumei Luo
- School of Science and Engineering, Clinical Translational Research Center of Aggregation-Induced Emission, School of Medicine, The Second Affiliated Hospital, The Chinese University of Hong Kong, Shenzhen, Guangdong, 518172, China.
| | - Ryan Tsz Kin Kwok
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China; HKUST Shenzhen Research Institute, No. 9 Yuexing 1st RD, South Area Hi-tech Park, Nanshan, Shenzhen, 518057, China.
| | - Zheng Zhao
- School of Science and Engineering, Clinical Translational Research Center of Aggregation-Induced Emission, School of Medicine, The Second Affiliated Hospital, The Chinese University of Hong Kong, Shenzhen, Guangdong, 518172, China; HKUST Shenzhen Research Institute, No. 9 Yuexing 1st RD, South Area Hi-tech Park, Nanshan, Shenzhen, 518057, China.
| | - Ben Zhong Tang
- School of Science and Engineering, Clinical Translational Research Center of Aggregation-Induced Emission, School of Medicine, The Second Affiliated Hospital, The Chinese University of Hong Kong, Shenzhen, Guangdong, 518172, China; Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China; HKUST Shenzhen Research Institute, No. 9 Yuexing 1st RD, South Area Hi-tech Park, Nanshan, Shenzhen, 518057, China; Center for Aggregation-Induced Emission and State Key Laboratory of Luminescent Materials and Devices, South China University of Technology, Guangzhou, 510640, China.
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45
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Shinoda K, Suganami A, Moriya Y, Yamashita M, Tanaka T, Suzuki AS, Suito H, Akutsu Y, Saito K, Shinozaki Y, Isojima K, Nakamura N, Miyauchi Y, Shirasawa H, Matsubara H, Okamoto Y, Nakayama T, Tamura Y. Indocyanine green conjugated phototheranostic nanoparticle for photodiagnosis and photodynamic reaciton. Photodiagnosis Photodyn Ther 2022; 39:103041. [PMID: 35914696 DOI: 10.1016/j.pdpdt.2022.103041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/20/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Phototheranostics represents a highly promising paradigm for cancer therapy, although selecting an appropriate optical imager and sensitizer for clinical use remains challenging. METHODS Liposomally formulated phospholipid-conjugated indocyanine green, denoted as LP-iDOPE, was developed as phototheranostic nanoparticle and its cancer imaging-mediated photodynamic reaction, defined as the immune response induced by photodynamic and photothermal effects, was evaluated with a near-infrared (NIR)-light emitting diode (LED) light irradiator. RESULTS Using in vivo NIR fluorescence imaging, we demonstrated that LP-iDOPE was selectively delivered to tumor sites with high accumulation and a long half-life. Following low-intensity NIR-LED light irradiation on the tumor region of LP-iDOPE accumulated, effector CD8+ T cells were activated at the secondary lymphoid organs, migrated, and subsequently released cytokines including interferon-γ and tumor necrosis factor-α, resulting in effective tumor regression. CONCLUSIONS Our anti-cancer strategy based on tumor-specific LP-iDOPE accumulation and low-intensity NIR-LED light irradiation to the tumor regions, i.e., photodynamic reaction, represents a promising approach to noninvasive cancer therapy.
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Affiliation(s)
- Kenta Shinoda
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Akiko Suganami
- Department of Bioinformatics, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; Molecular Chirality Research Center, Chiba University, Chiba 263-8522, Japan
| | - Yasumitsu Moriya
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Masamichi Yamashita
- Department of Veterinary Clinical Medicine, School of Veterinary Medicine, Tottori University, Tottori 680-8553, Japan
| | - Tsutomu Tanaka
- Department of Veterinary Clinical Medicine, School of Veterinary Medicine, Tottori University, Tottori 680-8553, Japan
| | - Akane S Suzuki
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Hiroshi Suito
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Yasunori Akutsu
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Kengo Saito
- Department of Molecular Virology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | | | | | | | | | - Hiroshi Shirasawa
- Department of Molecular Virology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Yoshiharu Okamoto
- Department of Veterinary Clinical Medicine, School of Veterinary Medicine, Tottori University, Tottori 680-8553, Japan
| | - Toshinori Nakayama
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Yutaka Tamura
- Department of Bioinformatics, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; Molecular Chirality Research Center, Chiba University, Chiba 263-8522, Japan.
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46
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Géczi T, Simonka Z, Lantos J, Wetzel M, Szabó Z, Lázár G, Furák J. Near-infrared fluorescence guided surgery: State of the evidence from a health technology assessment perspective. Front Surg 2022; 9:919739. [PMID: 35959120 PMCID: PMC9360526 DOI: 10.3389/fsurg.2022.919739] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Different applications of near-infrared fluorescence-guided surgery are very promising, and techniques that help surgeons in intraoperative guidance have been developed, thereby bridging the gap between preoperative imaging and intraoperative visualization and palpation. Thus, these techniques are advantageous in terms of being faster, safer, less invasive, and cheaper. There are a few fluorescent dyes available, but the most commonly used dye is indocyanine green. It can be used in its natural form, but different nanocapsulated and targeted modifications are possible, making this dye more stable and specific. A new active tumor-targeting strategy is the conjugation of indocyanine green nanoparticles with antibodies, making this dye targeted and highly selective to various tumor proteins. In this mini-review, we discuss the application of near-infrared fluorescence-guided techniques in thoracic surgery. During lung surgery, it can help find small, non-palpable, or additional tumor nodules, it is also useful for finding the sentinel lymph node and identifying the proper intersegmental plane for segmentectomies. Furthermore, it can help visualize the thoracic duct, smaller bullae of the lung, phrenic nerve, or pleural nodules. We summarize current applications and provide a framework for future applications and development.
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Affiliation(s)
- Tibor Géczi
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
- Correspondence: Tibor Géczi
| | - Zsolt Simonka
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Judit Lantos
- Department of Neurology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Melinda Wetzel
- Department of Anesthesiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zsolt Szabó
- Institute of Surgical Research, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - György Lázár
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - József Furák
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
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47
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Yokomizo S, Henary M, Buabeng ER, Fukuda T, Monaco H, Baek Y, Manganiello S, Wang H, Kubota J, Ulumben AD, Lv X, Wang C, Inoue K, Fukushi M, Kang H, Bao K, Kashiwagi S, Choi HS. Topical pH Sensing NIR Fluorophores for Intraoperative Imaging and Surgery of Disseminated Ovarian Cancer. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2201416. [PMID: 35567348 PMCID: PMC9286000 DOI: 10.1002/advs.202201416] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Indexed: 05/05/2023]
Abstract
Fluorescence-guided surgery (FGS) aids surgeons with real-time visualization of small cancer foci and borders, which improves surgical and prognostic efficacy of cancer. Despite the steady advances in imaging devices, there is a scarcity of fluorophores available to achieve optimal FGS. Here, 1) a pH-sensitive near-infrared fluorophore that exhibits rapid signal changes in acidic tumor microenvironments (TME) caused by the attenuation of intramolecular quenching, 2) the inherent targeting for cancer based on chemical structure (structure inherent targeting, SIT), and 3) mitochondrial and lysosomal retention are reported. After topical application of PH08 on peritoneal tumor regions in ovarian cancer-bearing mice, a rapid fluorescence increase (< 10 min), and extended preservation of signals (> 4 h post-topical application) are observed, which together allow for the visualization of submillimeter tumors with a high tumor-to-background ratio (TBR > 5.0). In addition, PH08 is preferentially transported to cancer cells via organic anion transporter peptides (OATPs) and colocalizes in the mitochondria and lysosomes due to the positive charges, enabling a long retention time during FGS. PH08 not only has a significant impact on surgical and diagnostic applications but also provides an effective and scalable strategy to design therapeutic agents for a wide array of cancers.
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Affiliation(s)
- Shinya Yokomizo
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
- Department of Radiological SciencesTokyo Metropolitan University7‐2‐10 Higashi‐OguArakawaTokyo116–8551Japan
| | - Maged Henary
- Department of Chemistry and Center for Diagnostics and TherapeuticsGeorgia State University100 Piedmont Avenue SEAtlantaGA30303USA
| | - Emmanuel R. Buabeng
- Department of Chemistry and Center for Diagnostics and TherapeuticsGeorgia State University100 Piedmont Avenue SEAtlantaGA30303USA
| | - Takeshi Fukuda
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
- Department of Obstetrics and GynecologyOsaka City University Graduate School of Medicine1‐4‐3, AsahimachiAbeno‐kuOsaka545–8585Japan
| | - Hailey Monaco
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
| | - Yoonji Baek
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
| | - Sophia Manganiello
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
| | - Haoran Wang
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
| | - Jo Kubota
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
| | - Amy Daniel Ulumben
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
| | - Xiangmin Lv
- Vincent Center for Reproductive BiologyVincent Department of Obstetrics and GynecologyMassachusetts General HospitalBostonMA02114USA
| | - Cheng Wang
- Vincent Center for Reproductive BiologyVincent Department of Obstetrics and GynecologyMassachusetts General HospitalBostonMA02114USA
| | - Kazumasa Inoue
- Department of Radiological SciencesTokyo Metropolitan University7‐2‐10 Higashi‐OguArakawaTokyo116–8551Japan
| | - Masahiro Fukushi
- Department of Radiological SciencesTokyo Metropolitan University7‐2‐10 Higashi‐OguArakawaTokyo116–8551Japan
| | - Homan Kang
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
| | - Kai Bao
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
| | - Satoshi Kashiwagi
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
| | - Hak Soo Choi
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
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48
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Wilson BC, Eu D. Optical Spectroscopy and Imaging in Surgical Management of Cancer Patients. TRANSLATIONAL BIOPHOTONICS 2022. [DOI: 10.1002/tbio.202100009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Brian C. Wilson
- Princess Margaret Cancer Centre/University Health Network 101 College Street Toronto Ontario Canada
- Department of Medical Biophysics, Faculty of Medicine University of Toronto Canada
| | - Donovan Eu
- Department of Otolaryngology‐Head and Neck Surgery‐Surgical Oncology, Princess Margaret Cancer Centre/University Health Network University of Toronto Canada
- Department of Otolaryngology‐Head and Neck Surgery National University Hospital System Singapore
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49
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Leiloglou M, Kedrzycki MS, Chalau V, Chiarini N, Thiruchelvam PTR, Hadjiminas DJ, Hogben KR, Rashid F, Ramakrishnan R, Darzi AW, Leff DR, Elson DS. Indocyanine green fluorescence image processing techniques for breast cancer macroscopic demarcation. Sci Rep 2022; 12:8607. [PMID: 35597783 PMCID: PMC9124184 DOI: 10.1038/s41598-022-12504-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/05/2022] [Indexed: 12/13/2022] Open
Abstract
Re-operation due to disease being inadvertently close to the resection margin is a major challenge in breast conserving surgery (BCS). Indocyanine green (ICG) fluorescence imaging could be used to visualize the tumor boundaries and help surgeons resect disease more efficiently. In this work, ICG fluorescence and color images were acquired with a custom-built camera system from 40 patients treated with BCS. Images were acquired from the tumor in-situ, surgical cavity post-excision, freshly excised tumor and histopathology tumour grossing. Fluorescence image intensity and texture were used as individual or combined predictors in both logistic regression (LR) and support vector machine models to predict the tumor extent. ICG fluorescence spectra in formalin-fixed histopathology grossing tumor were acquired and analyzed. Our results showed that ICG remains in the tissue after formalin fixation. Therefore, tissue imaging could be validated in freshly excised and in formalin-fixed grossing tumor. The trained LR model with combined fluorescence intensity (pixel values) and texture (slope of power spectral density curve) identified the tumor's extent in the grossing images with pixel-level resolution and sensitivity, specificity of 0.75 ± 0.3, 0.89 ± 0.2.This model was applied on tumor in-situ and surgical cavity (post-excision) images to predict tumor presence.
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Affiliation(s)
- Maria Leiloglou
- Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK. .,Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Martha S Kedrzycki
- Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Breast Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Vadzim Chalau
- Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nicolas Chiarini
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul T R Thiruchelvam
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Breast Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Dimitri J Hadjiminas
- Department of Breast Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Katy R Hogben
- Department of Breast Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Faiza Rashid
- Department of Histopathology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Rathi Ramakrishnan
- Department of Histopathology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Ara W Darzi
- Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Daniel R Leff
- Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Breast Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Daniel S Elson
- Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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50
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Precisely translating computed tomography diagnosis accuracy into therapeutic intervention by a carbon-iodine conjugated polymer. Nat Commun 2022; 13:2625. [PMID: 35551194 PMCID: PMC9098856 DOI: 10.1038/s41467-022-30263-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/23/2022] [Indexed: 12/24/2022] Open
Abstract
X-ray computed tomography (CT) has an important role in precision medicine. However, CT contrast agents with high efficiency and the ability to translate diagnostic accuracy into therapeutic intervention are scarce. Here, poly(diiododiacetylene) (PIDA), a conjugated polymer composed of only carbon and iodine atoms, is reported as an efficient CT contrast agent to bridge CT diagnostic imaging with therapeutic intervention. PIDA has a high iodine payload (>84 wt%), and the aggregation of nanofibrous PIDA can further amplify CT intensity and has improved geometrical and positional stability in vivo. Moreover, with a conjugated backbone, PIDA is in deep blue color, making it dually visible by both CT imaging and the naked eyes. The performance of PIDA in CT-guided preoperative planning and visualization-guided surgery is validated using orthotopic xenograft rat models. In addition, PIDA excels clinical fiducial markers of imaging-guided radiotherapy in efficiency and biocompatibility, and exhibits successful guidance of robotic radiotherapy on Beagles, demonstrating clinical potential to translate CT diagnosis accuracy into therapeutic intervention for precision medicine.
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