[Vena cava cement embolism after percutaneous kyphoplasty. Interventional radiological recovery in metastasized urothelial cancer]

For patients suffering from vertebral metastases vertebroplasty and kyphoplasty offer two relatively new treatment options for the stabilization of vertebral compression fractures. This can help to reduce the fracture-associated symptoms and can improve the quality of life. Cement extravasation is a specific complication of this therapy. This article reports a case of multiple cement paravasations in the paravertebral veins, the vena cava inferior and peripheral segmental and subsegmental pumonary arteries after kyphoplasty of an extensive pathological vertebral body fracture in a 64-year-old man suffering from metastatic urothelial cancer.

VCSEL-based, high-speed, in situ TDLAS for in-cylinder water vapor measurements in IC engines

We report the first application of a vertical-cavity surfaceemitting laser (VCSEL) for calibration- and sampling-free, high-speed, in situ H2O concentration measurements in IC engines using direct TDLAS (tunable diode laser absorption spectroscopy). Measurements were performed in a single-cylinder research engine operated under motored conditions with a time resolution down to 100 μs (i.e., 1.2 crank angle degrees at 2000 rpm). Signal-to-noise ratios (1σ) up to 29 were achieved, corresponding to a H2O precision of 0.046 vol.% H2O or 39 ppm · m. The modulation frequency dependence of the performance was investigated at different engine operating points in order to quantify the advantages of VCSEL against DFB lasers.

Evaluation of prognostic factors in liver-limited metastatic colorectal cancer: a preplanned analysis of the FIRE-1 trial

Background:

Liver-limited disease (LLD) denotes a specific subgroup of metastatic colorectal cancer (mCRC) patients.

Patients and Methods:

A total of 479 patients with unresectable mCRC from an irinotecan-based randomised phase III trial were evaluated. Patients with LLD and non-LLD and hepatic resection were differentiated. Based on baseline patient characteristic, prognostic factors for hepatic resection were evaluated. Furthermore, prognostic factors for median overall survival (OS) were estimated via Cox regression in LLD patients.

Results:

Secondary liver resection was performed in 38 out of 479 patients (resection rate: 7.9%). Prognostic factors for hepatic resection were LLD, lactate dehydrogenase (LDH), node-negative primary, alkaline phosphatase (AP) and Karnofsky performance status (PS). Median OS was significantly increased after hepatic resection (48 months), whereas OS in LLD (17 months) and non-LLD (19 months) was comparable in non-resected patients. With the inapplicability of Koehne's risk classification in LLD patients, a new score based on only the independent prognostic factors LDH and white blood cell (WBC) provided markedly improved information on the outcome.

Conclusion:

Patients undergoing hepatic resection showed favourable long-term survival, whereas non-resected LLD patients and non-LLD patients did not differ with regard to progression-free survival and OS. The LDH levels and WBC count were confirmed as prognostic factors and provide a useful and simple score for OS-related risk stratification also in LLD.

Viability and function of primary human endothelial cells on smooth poly(ether imide) films

Poly(ether imide) (PEI) is being explored as potential biomaterial for cardiovascular applications. Different studies showed that human umbilical venous endothelial cells (HUVEC) are able to adhere and proliferate on PEI membranes (R(q) = 13.20 ± 1.58 nm). A recently published study revealed evidence for much lower platelet adhesion on very smooth PEI-films (R(q) = 2.37 ± 1.40 nm). Therefore, we explored whether primary human venous endothelial cells (HUVEC) are able to adhere and proliferate on such very smooth PEI-films compared to tissue-cultured polystyrene (TCP) as reference material. Cytotoxicity testing revealed that PEI had a slight cytotoxic effect on HUVEC accompanied by a marginal reduced integrity of the plasma membrane and a significant lower mitochondrial activity. However long-term seeding experiments up to eleven days exhibited that HUVEC were able to proliferate on the PEI-films till confluence (TCP 96,190 ± 18,289 cells/cm(2); PEI 91,590 ± 19,583 cells/cm(2)). Further studies are planned to monitor the influence of shear force on the endothelial cell monolayer in a dynamic test system to determine its stability in view of shear resistant endothelialization of PEI for cardiovascular devices.

Effect of cytochrome P450-dependent epoxyeicosanoids on Ristocetin-induced thrombocyte aggregation

Epoxyeicosatrienoic acids (EETs) produced by cytochrome P450 (CYP)-dependent epoxidation of arachidonic acid (AA) inhibit thrombocyte adhesion to the vascular wall. Upon dietary omega-3 fatty acid supplementation, EETs are partially replaced by eicosapentaenoic acid (EPA)-derived epoxyeicosatetraenoic acids (EEQs) and docosahexaenoic acid (DHA)-derived epoxydocosapentaenoic acids (EDPs). We hypothesized that the omega-3 epoxy-metabolites may exhibit superior anti-thrombogenic properties compared to their AA-derived counterparts. To test this hypothesis, we analyzed the effects of 11,12-EET, 17,18-EEQ and 19,20-EDP on Ristocetin-induced thrombocyte aggregation (RITA), a process that mimics thrombocyte adhesion to the vascular wall. The eicosanoids were added for 5, 30, or 60 minutes to thrombocyte-rich plasma freshly prepared immediately after blood collection from stringently selected apparently healthy subjects. Thrombocyte aggregation was then induced by Ristocetin (0.75 mg/mL) and assessed by turbidimetric measurements. After 60 minutes of preincubation, all three epoxy-metabolites significantly decreased the rate of RITA. 17,18-EEQ and 19,20-EDP were effective already at 1 μM, whereas 5-fold higher concentrations were required with 11,12-EET. Addition of AUDA, an inhibitor of the soluble epoxide hydrolase, potentiated the effect of 17,18-EEQ resulting in a significant further decrease of the velocity as well as amplitude of the aggregation process. In contrast to their profound effects on RITA, none of the epoxy-metabolites was effective in reducing collagen- or ADP-induced thrombocyte aggregation. These results indicate a highly specific role of CYP-eicosanoids in preventing thromboembolic events and suggest that the formation of 17,18-EEQ and 19,20-EDP may contribute to the anti-thrombotic effects of omega-3 fatty acids.

Crossroads of coagulation and innate immunity: the case of deep vein thrombosis

Deep vein thrombosis (DVT) is a common condition characterized by the formation of an occlusive blood clot in the venous vascular system, potentially complicated by detachment and embolization of thrombi into the lung. Recent evidence from mouse models has shed light on the sequence of events and on the cellular (innate immune cells, platelets) and molecular (hematopoietic tissue factor, nucleic acids) components involved. In response to decreased blood flow, circulating neutrophils and monocytes adhere to the activated endothelium within hours. They initiate and propagate DVT by interacting with platelets and by the exposure and activation of circulating tissue factor and FXII. Intravascular blood coagulation is also induced by extracellular nucleosomes released mainly from activated neutrophils. Interestingly, these mechanisms are closely linked to an evolutionary conserved immune defense mechanism activated in response to infections. In this review, we will give an overview of DVT and the role of innate immune pathways supporting this process. While the latter are aimed at preserving tissue integrity and function, uncontrolled blood coagulation and activation of immune cells may result in pathological thrombus formation and vascular occlusion. Understanding the molecular and cellular players triggering occlusion of large veins, and their distinction from physiological hemostasis, is important for the development of strategies to prevent and treat DVT.

Early tumor shrinkage in patients with metastatic colorectal cancer receiving first-line treatment with cetuximab combined with either CAPIRI or CAPOX: an analysis of the German AIO KRK 0104 trial

PURPOSE

This study investigated the impact of early tumor shrinkage (ETS) on progression-free- (PFS) and overall survival (OS) in patients with metastatic colorectal cancer (mCRC) treated within the AIO KRK 0104 trial as first-line therapy. Moreover, correlations of ETS with clinical characteristics and prognostic markers were evaluated.

PATIENTS AND METHODS

In total, 121 patients were included into this analysis. Patients were treated with cetuximab combined with either CAPIRI or CAPOX. ETS at six weeks was defined as a relative change of ≥ 20% in the sum of the longest diameters of target lesions compared to baseline. Survival times were compared between patients with ETS ≥ 20% versus no-ETS.

RESULTS

ETS ≥ 20% was observed in 59% of all patients with KRAS wild-type tumors. In these patients ETS ≥ 20% was associated with higher overall response rate (82% vs. 19%, p < 0.001). Also, PFS (8.9 vs. 4.7 months, p < 0.001) and OS (31.6 vs. 15.8 months, p = 0.005) were significantly superior in ETS ≥ 20% of patients compared to no-ETS. In patients with KRAS mutant mCRC ETS ≥ 20% neither had an effect on PFS nor OS. Cetuximab-induced skin toxicity correlated with the occurrence of ETS ≥ 20% (p = 0.002).

CONCLUSION

In patients with KRAS wild-type tumors treated with cetuximab plus capecitabine-based chemotherapy ETS ≥ 20% is an important predictor of favorable outcome.

Acute and chronic nitrite toxicity in juvenile pike-perch (Sander lucioperca) and its compensation by chloride

Pike-perch Sander lucioperca is currently considered as one of the most promising candidates for production in freshwater recirculation aquaculture systems (RAS). Here, due to the lack of studies on nitrite (NO(2)(-)) toxicity in pike-perch, a flow-through exposure at 0, 0.44, 0.88, 1.75, 3.5, 7, 14 and 28 mg/L NO(2)(-)-N was carried out to determine the acute and chronic toxicity over a period of 32 days. In juvenile pike-perch, 120 h LC(50) was 6.1mg/L NO(2)(-)-N and at ≥14 mg/L NO(2)(-)-N all fish had died within 24 h. Chronic exposure revealed a significant build up of NO(2)(-) in the plasma as well as in the muscles at ≥0.44 mg/L NO(2)(-)-N peaking in fish exposed to the highest concentration of 3.5 mg/L NO(2)(-)-N after 32 days. Still, due to high individual variation methemoglobin (MetHb) was only significantly increased (p<0.01) at 3.5 mg/L NO(2)(-)-N. No adverse effects on red blood cells (RBC) and hematocrit were observed in any of the treatments. In a second experiment, compensation of NO(2)(-) toxicity at increasing chloride concentrations (40 (freshwater), 65, 90, 140, 240, 440 mg/L Cl(-)) was observed at a constant exposure of 10 mg/L NO(2)(-)-N for 42 days. At ≥240 mg/L Cl(-), NO(2)(-) build-up in blood plasma and muscle was completely inhibited. At lower Cl(-) concentrations (≤140 mg/L), NO(2)(-) was significantly increased in plasma, but only insignificantly elevated in muscle due to high individual variation. MetHb was increased significantly difference only at 40 mg/L Cl(-) (freshwater control) compared to the control. Again, high individual variations were observed. As a conclusion, S. lucioperca is moderately sensitive towards NO(2)(-) and acceptable levels in RAS should hence not exceed 1.75 mg/L NO(2)(-)-N to avoid MetHb formation. However, based on the 120 h LC(50) and a factor of 0.01 according to Sprague (1971), a NO(2)(-) concentration of ≤0.061 mg/L NO(2)(-)-N is considered as "safe." Thereby, no NO(2)(-) should accumulate in the plasma or muscle tissue during chronic exposure. For 10 mg/L NO(2)(-)-N, ≥240 mg/L chloride compensates for NO(2)(-) uptake in plasma and muscle.

Prognostic value of CA 19-9, CEA, CRP, LDH and bilirubin levels in locally advanced and metastatic pancreatic cancer: results from a multicenter, pooled analysis of patients receiving palliative chemotherapy

PURPOSE

CA 19-9 is the only established tumor marker in pancreatic cancer (PC); the prognostic role of other serum markers like CEA, CRP, LDH or bilirubin has not yet been defined.

METHODS

We pooled pre-treatment data on CA 19-9, CEA, CRP, LDH and bilirubin levels from two German multicenter randomized phase II trials together with prospective patient data from one high-volume German Cancer Center. Marker levels were assessed locally before the start of palliative first-line therapy for advanced PC and serially during treatment (for CA 19-9 only). Clinical and biomarker data (overall 12 variables) were correlated with the efficacy endpoints time-to-progression (TTP) and overall survival (OS) by using uni- and multivariate Cox models.

RESULTS

Data from 291 patients were included in this pooled analysis; 253 patients (87 %) received treatment within prospective clinical trials. Median TTP in the study cohort was 5.1 months and median OS 9.0 months. In univariate analysis, pre-treatment CA 19-9 (HR 1.55), LDH (HR 2.04) and CEA (HR 1.89) levels were significantly associated with TTP. Regarding OS, baseline CA 19-9 (HR 1.46), LDH (HR 2.07), CRP (HR 1.69) and bilirubin (HR 1.62) were significant prognostic factors. Within multivariate analyses, pre-treatment log [CA 19-9] (as continuous variable for TTP) and log [bilirubin] as well as log [CRP] (for OS) had an independent prognostic value. A CA 19-9 decline of ≥25 % during the first two chemotherapy cycles was predictive for TTP and OS, independent of the applied CA 19-9 assay.

CONCLUSION

Baseline CA 19-9 and CA 19-9 kinetics during first-line chemotherapy are prognostic in advanced PC. Besides that finding other serum markers like CRP, LDH and bilirubin can also provide prognostic information on TTP and OS.

Experimental investigation and modeling of the kinetics of CCl4 pyrolysis behind reflected shock waves using high-repetition-rate time-of-flight mass spectrometry

The pyrolysis kinetics of CCl(4) behind reflected shock waves was studied with high-repetition-rate time-of-flight mass spectrometry. For modeling, quantum mechanical calculations were performed to evaluate the dissociation energies of CCl bonds for the different CCl(x) (x = 1 to 4) radicals. Good agreement with the JANAF thermochemical table was found. With the reaction mechanism developed for CCl(4) decomposition satisfactory agreement with experimental results was obtained. The investigations show the importance of C(2)Cl(2) formation for understanding the processes of carbon cluster growth leading to carbonaceous particle formation.

Glucose and lipid metabolism in patients with advanced pancreatic cancer receiving palliative chemotherapy

BACKGROUND

The role of diabetes mellitus (DM) in the pathogenesis of pancreatic cancer (PC) and its prognostic role on patients with advanced disease remain undefined.

PATIENTS AND METHODS

Within a prospective single-center pilot study, 30 consecutive patients with advanced PC underwent metabolic profiling for glucose (fasting glucose level, oral glucose tolerance test (oGTT), serum insulin levels) and lipid metabolism (cholesterol, triglycerides, lipoprotein a) at the initiation of and two months after chemotherapy. Subgroups (DM vs. non-DM) were analyzed with regard to metabolic and outcome parameters.

RESULTS

Sixteen patients (53%) had DM, in seven of whom DM was newly-diagnosed by an oGTT. Patients in the DM subgroup had a higher prevalence of hypertension (p=0.05) and a higher BMI (p=0.01), but with no significant differences in pre-treatment cholesterol (p=0.55) and triglyceride levels (p=0.37). Regarding baseline oncological parameters, patients with DM more often had a reduced performance status (p=0.06), and were more likely to present with metastatic disease (p=0.09). The median overall survival was 3.9 months in the DM group and 8.3 months in the non-DM group (hazard ratio=0.67, 95% confidence interval=0.31-1.45, p=0.31), respectively.

CONCLUSION

The incidence of DM is high in patients with PC and the lipid profile associated with DM may be different from that of patients with metabolic syndromes. The role of DM as a negative prognostic factor in advanced PC remains to be determined.

[Concept for a German national birth cohort for environmental health research]

The German Federal Environment Agency has commissioned the conceptual work for a birth cohort study to investigate environmental health problems in children. The recruitment is intended to start as early as possible in pregnancy and to take place in several regions of Germany. To detect health risks for exposures and outcomes with low prevalence as well as gene-environment interactions, a cohort size of 100,000-200,000 parent-child pairs is needed. The concept focuses on five health issues: neurodevelopment; reproductive development; pregnancy and birth outcomes; asthma, allergies and respiratory disease; obesity, insulin resistance and diabetes. The examination of additional health conditions will be possible. The exposure assessment will cover chemical, biological and physical exposures; psychosocial factors and genetics will be assessed as well. Biological and environmental samples will be stored in a repository for future analyses. The birth cohort study will contribute to the detection of associations between environmental exposures and health conditions over the course of life, which in turn will have an impact on environmental and health policies.