Mass Spectrometry-Based Assessment of M-protein in Peripheral Blood During Maintenance Therapy in Multiple Myeloma

Mass spectrometry (MS) can detect multiple myeloma-derived monoclonal proteins in peripheral blood (PB) with high sensitivity, potentially serving as a PB assay for measurable residual disease (MRD). This study evaluated the significance of PB MS MRD negativity during post-transplant therapy in patients with newly diagnosed multiple myeloma. Serum samples from 138 patients treated in the phase 3 ATLAS trial of post-transplant maintenance with either carfilzomib, lenalidomide, dexamethasone or lenalidomide alone were analyzed using EXENT MS methodology. We established feasibility of measuring MRD by MS in PB in the post-transplant setting, despite unavailability of pre-treatment calibration samples. There was high agreement between MRD by MS in PB and paired BM MRD results at the 10-5 threshold, assessed by either next generation sequencing (NGS) or multiparameter flow cytometry (MFC) (70% and 67%, respectively). Agreement between PB MS and both BM MRD methods was lowest early after transplant and increased with time. MS negativity was associated with improved progression-free survival (PFS), which in landmark analysis reached statistical significance after 18 cycles post-transplant. Combined PB/BM MRD negativity by MFC or NGS was associated with superior PFS compared to MRD negativity by only one modality. Sustained MS negativity carried similar prognostic performance to sustained BM MRD negativity at the 10-5 threshold. Overall, post-transplant MS assessment was feasible and provided additional prognostic information to BM MRD negativity. Further studies are needed to confirm the role and optimal timing of MS in disease evaluation algorithms. The ATLAS trial is registered at www.clinicaltrials.gov as #NCT02659293.

Mechanical and Material Analysis of 3D-Printed Temporary Materials for Implant Reconstructions-A Pilot Study

In this study, the authors analyzed modern resin materials typically used for temporary reconstructions on implants and manufactured via 3D printing. Three broadly used resins: NextDent Denture 3D, NextDent C&B MFH Bleach, and Graphy TC-80DP were selected for analysis and compared to currently used acrylic materials and ABS-like resin. In order to achieve this, mechanical tests were conducted, starting with the static tensile test PN-EN. After the mechanical tests, analysis of the chemical composition was performed and images of the SEM microstructure were taken. Moreover, numerical simulations were conducted to create numerical models of materials and compare the accuracy with the tensile test. The parameters obtained in the computational environment enabled more than 98% correspondence between numerical and experimental charts, which constitutes an important step towards the further development of numeric methods in dentistry and prosthodontics.

Proton Shell Gaps in N=28 Nuclei from the First Complete Spectroscopy Study with FRIB Decay Station Initiator

The first complete measurement of the β-decay strength distribution of _{17}^{45}Cl_{28} was performed at the Facility for Rare Isotope Beams (FRIB) with the FRIB Decay Station Initiator during the second FRIB experiment. The measurement involved the detection of neutrons and γ rays in two focal planes of the FRIB Decay Station Initiator in a single experiment for the first time. This enabled an analytical consistency in extracting the β-decay strength distribution over the large range of excitation energies, including neutron unbound states. We observe a rapid increase in the β-decay strength distribution above the neutron separation energy in _{18}^{45}Ar_{27}. This was interpreted to be caused by the transitioning of neutrons into protons excited across the Z=20 shell gap. The SDPF-MU interaction with reduced shell gap best reproduced the data. The measurement demonstrates a new approach that is sensitive to the proton shell gap in neutron rich nuclei according to SDPF-MU calculations.

Microsecond Isomer at the N=20 Island of Shape Inversion Observed at FRIB

Excited-state spectroscopy from the first experiment at the Facility for Rare Isotope Beams (FRIB) is reported. A 24(2)-μs isomer was observed with the FRIB Decay Station initiator (FDSi) through a cascade of 224- and 401-keV γ rays in coincidence with ^{32}Na nuclei. This is the only known microsecond isomer (1  μs≤T_{1/2}<1  ms) in the region. This nucleus is at the heart of the N=20 island of shape inversion and is at the crossroads of the spherical shell-model, deformed shell-model, and ab initio theories. It can be represented as the coupling of a proton hole and neutron particle to ^{32}Mg, ^{32}Mg+π^{-1}+ν^{+1}. This odd-odd coupling and isomer formation provides a sensitive measure of the underlying shape degrees of freedom of ^{32}Mg, where the onset of spherical-to-deformed shape inversion begins with a low-lying deformed 2^{+} state at 885 keV and a low-lying shape-coexisting 0_{2}^{+} state at 1058 keV. We suggest two possible explanations for the 625-keV isomer in ^{32}Na: a 6^{-} spherical shape isomer that decays by E2 or a 0^{+} deformed spin isomer that decays by M2. The present results and calculations are most consistent with the latter, indicating that the low-lying states are dominated by deformation.

Effect of repeated low doses of GnRH analogue (buserelin) on fertility performance of dairy cows with anovulation type I

The aim of this study was to evaluate the fertility response of dairy cows with anovulation type I on repeated low doses of GnRH agonist buserelin. The study was conducted on 83 anovulatory and 60 cyclic Polish Holstein Friesian cows. Anovulation type I was defined as small ovaries with follicles of ≤ 5 mm in diameter and without corpus luteum on two examinations in a 7-10 day interval between 50-60 days after parturition. Cows from the experimental group (n=58) received 0.4 μg of buserelin i.m. once a day for 5 consecutive days. Cows from the negative control group (n = 25) received saline. Sixty cyclic cows receiving no treatment served as positive controls. Intervals from calving to estrus and from calving to conception, pregnancy rate 30-35 days and 260 days after AI, and pregnancy loss were calculated. The anovulatory cows had a substantially prolonged calving to conception interval, decreased pregnancy rate and increased pregnancy loss and culling rate compared to cyclic herd mates. The average calving to conception interval was significantly (p⟨0.05) shorter in treated cows compared to non-treated anovulatory cows (153.7 days vs 209.3 days). In conclusion, repeated low doses of GnRH analogue buserelin led to a significant shortening of calving to conception interval. More clinical trials are needed to determine the practical usefulness of this method for the treatment of anovulation type I in dairy cows.

Carfilzomib, lenalidomide, and dexamethasone or lenalidomide alone as maintenance therapy after autologous stem-cell transplantation in patients with multiple myeloma (ATLAS): interim analysis of a randomised, open-label, phase 3 trial

BACKGROUND

Lenalidomide is a cornerstone of maintenance therapy in patients with newly diagnosed multiple myeloma after autologous stem-cell transplantation. We aimed to compare the efficacy and safety of maintenance therapy with carfilzomib, lenalidomide, and dexamethasone versus lenalidomide alone in this patient population.

METHODS

This study is an interim analysis of ATLAS, which is an investigator-initiated, multicentre, open-label, randomised, phase 3 trial in 12 academic and clinical centres in the USA and Poland. Participants were aged 18 years or older with newly diagnosed multiple myeloma, completed any type of induction and had stable disease or better, autologous stem-cell transplantation within 100 days, initiated induction 12 months before enrolment, and an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients were randomly assigned (1:1) using permuted blocks of sizes 4 and 6 and a web-based system to receive up to 36 cycles of carfilzomib, lenalidomide, and dexamethasone (28-day cycles of carfilzomib 20 mg/m2 administered intravenously in cycle one on days 1 and 2 then 36 mg/m2 on days 1, 2, 8, 9, 15, and 16 in cycles one to four and 36 mg/m2 on days 1, 2, 15, and 16 from cycle five up to 36 [per protocol]; lenalidomide 25 mg administered orally on days 1-21; and dexamethasone 20 mg administered orally on days 1, 8, 15, and 22) or lenalidomide alone (10 mg administered orally for the first three cycles and then at the best tolerated dose [≤15 mg for 28 days in 28-day cycles]) until disease progression or unacceptable toxicity as maintenance therapy. After 36 cycles, patients in both treatment groups received lenalidomide maintenance. Randomisation was stratified by response to previous treatment, cytogenetic risk factors, and country. Investigators and patients were not masked to treatment allocation. Patients in the carfilzomib, lenalidomide, and dexamethasone group with no detectable minimal residual disease after cycle six (as per International Myeloma Working Group criteria) and standard-risk cytogenetics were switched to lenalidomide maintenance as of cycle nine. The primary endpoint was progression-free survival in the intention-to-treat population (defined as all randomly assigned patients). Safety was analysed in all randomly assigned patients who received at least one dose of study treatment. This unplanned interim analysis was triggered by the occurrence of 59 (61%) of the expected 96 events for the primary analysis and the results are considered preliminary. This trial is registered with ClinicalTrials.gov, NCT02659293 (active, not recruiting) and EudraCT, 2015-002380-42.

FINDINGS

Between June 10, 2016, and Oct 21, 2020, 180 patients were randomly assigned to receive either carfilzomib, lenalidomide, and dexamethasone (n=93) or lenalidomide alone (n=87; intention-to-treat population). The median age of patients was 59·0 years (IQR 49·0-63·0); 84 (47%) patients were female and 96 (53%) were male. With a median follow-up of 33·8 months (IQR 20·9-42·9), median progression-free survival was 59·1 months (95% CI 54·8-not estimable) in the carfilzomib, lenalidomide, and dexamethasone group versus 41·4 months (33·2-65·4) in the lenalidomide group (hazard ratio 0·51 [95% CI 0·31-0·86]; p=0·012). The most common grade 3 and 4 adverse events were neutropenia (44 [48%] in the carfilzomib, lenalidomide, and dexamethasone group vs 52 [60%] in the lenalidomide group), thrombocytopenia (12 [13%] vs six [7%]), and lower respiratory tract infections (seven [8%] vs one [1%]). Serious adverse events were reported in 28 (30%) patients in the carfilzomib, lenalidomide, and dexamethasone group and 19 (22%) in the lenalidomide group. One treatment-related adverse event led to death (respiratory failure due to severe pneumonia) in the carfilzomib, lenalidomide, and dexamethasone group.

INTERPRETATION

This interim analysis provides support for considering carfilzomib, lenalidomide, and dexamethasone therapy in patients with newly diagnosed multiple myeloma who completed any induction regimen followed by autologous stem-cell transplantation, which requires confirmation after longer follow-up of this ongoing phase 3 trial.

FUNDING

Amgen and Celgene (Bristol Myers Squibb).

Flow imaging using differential Golay encoded ultrasound

In our research we present a new method of differential compression of the Golay encoded ultrasound (DCGEU) in the standard beamforming mode to visualize the slow (<1cm/s) blood mimicking fluid flow in small diameter tubes. The proposed DCGEU method is based on synthesis of several subsequent B-mode frames acquired with certain time intervals (30 ms in this study) followed by the visualization of differential beamformed radio frequency (RF) echoes, which yielded the images of the scatterers moving slowly in the vessel and suppressing the static echoes outside the vessel. In order to extract small backscattered echoes from the vessel area we took an advantage of improved sensitivity of the complementary Golay coded sequences (CGCS). The validation of the proposed DCGEU method was carried out in two stages. In the first one, we compared the flow images in small tubes with a diameter of 1 mm and 2.5 mm, reconstructed from numerically simulated acoustic data for the standard transmission of short pulses and 16-bits long CGCS signals. In the second stage of the research, the experimental data were acquired in a flow phantom with silicone tubes with an internal diameter of 1.5 mm and 4.5 mm and a fluid flow velocity of 0.9 cm/s. The experiments were carried out using preprogrammed Verasonics Vantage™ research ultrasound system equipped with ALT L12-5/50 mm MHz linear array transducer with 7.8 MHz center frequency. It was evidenced both in simulations and experiments that the DCGEU provided a good flow image along the entire length of tubing with virtually angle independent detection in comparison with the conventional short pulse interrogation.

Crossing N=28 Toward the Neutron Drip Line: First Measurement of Half-Lives at FRIB

New half-lives for exotic isotopes approaching the neutron drip-line in the vicinity of N∼28 for Z=12-15 were measured at the Facility for Rare Isotope Beams (FRIB) with the FRIB decay station initiator. The first experimental results are compared to the latest quasiparticle random phase approximation and shell-model calculations. Overall, the measured half-lives are consistent with the available theoretical descriptions and suggest a well-developed region of deformation below ^{48}Ca in the N=28 isotones. The erosion of the Z=14 subshell closure in Si is experimentally confirmed at N=28, and a reduction in the ^{38}Mg half-life is observed as compared with its isotopic neighbors, which does not seem to be predicted well based on the decay energy and deformation trends. This highlights the need for both additional data in this very exotic region, and for more advanced theoretical efforts.

Evaluation of biofilm formation on acrylic resins used to fabricate dental temporary restorations with the use of 3D printing technology

Background

Temporary implant-retained restorations are required to support function and esthetics of the masticatory system until the final restoration is completed and delivered. Acrylic resins are commonly used in prosthetic dentistry and lately they have been used in three-dimensional (3D) printing technology. Since this technology it is fairly new, the number of studies on their susceptibility to microbial adhesion is low. Restorations placed even for a short period of time may become the reservoir for microorganisms that may affect the peri-implant tissues and trigger inflammation endangering further procedures. The aim of the study was to test the biofilm formation on acrylamide resins used to fabricate temporary restorations in 3D printing technology and to assess if the post-processing impacts microbial adhesion.

Methods

Disk-shaped samples were manufactured using the 3D printing technique from three commercially available UV-curable resins consisting of acrylate and methacrylate oligomers with various time and inhibitors of polymerization (NextDent MFH bleach, NextDent 3D Plus, MazicD Temp). The tested samples were raw, polished and glazed. The ability to create biofilm by oral streptococci (S. mutans, S. sanguinis, S. oralis, S. mitis) was tested, as well as species with higher pathogenic potential: Staphylococcus aureus, Staphylococcus epidermidis and Candida albicans. The roughness of the materials was measured by an atomic force microscope. Biofilm formation was assessed after 72 h of incubation by crystal violet staining with absorbance measurement, quantification of viable microorganisms, and imaging with a scanning electron microscope (SEM).

Results

Each tested species formed the biofilm on the samples of all three resins. Post-production processing resulted in reduced roughness parameters and biofilm abundance. Polishing and glazing reduced roughness parameters significantly in the NextDent resin group, while glazing alone caused significant surface smoothing in Mazic Temp. A thin layer of microbial biofilm covered glazed resin surfaces with a small number of microorganisms for all tested strains except S. oralis and S. epidermidis, while raw and polished surfaces were covered with a dense biofilm, rich in microorganisms.

Conclusions

UV-curing acrylic resins used for fabricating temporary restorations in the 3D technology are the interim solution, but are susceptible to adhesion and biofilm formation by oral streptococci, staphylococci and Candida. Post-processing and particularly glazing process significantly reduce bacterial biofilm formation and the risk of failure of final restoration.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02488-5.

Effect of repeated low doses of GnRH on follicular development and ovulation in anovulatory dairy cows with follicle growth to emergence size

The aim of the study was to evaluate the effect of repeated low doses of GnRH agonist buserelin once a day for 5 days on follicle development and ovulation in anovulatory dairy cows with follicles growth only to emergence. The study was conducted on 71 anovulatory Polish Holstein Friesian cows. Anovulation with growth of follicles to emergence was defined as small ovaries with follicles of ≤ 5 mm in diameter and without corpus luteum on two examinations in a 7-10 day interval between 50-60 days after parturition. Cows were allocated to one of two group. Cows from group 1 (n = 58) received 0.4 μg of buserelin (Receptal, MSD, Poland) i.m. once a day for 5 days. Control cows from group 2 (n = 13) received saline. Ovarian structures were monitored weekly after the end of treatment by ultrasound for 4 weeks. The diameter of ovarian follicles on the ovaries was measured and recorded. Occurrence of ovulation was determined by the presence of corpus luteum. Overall, ovulation occurred in 46.6% (27/58) of cows treated with repeated doses of GnRH, while no corpus luteum was observed in the control group during the study period. There were significantly (p⟨0.05) more follicles 6-9 mm in diameter and 10-20 mm in diameter in cows treated with GnRH than in control cows. In conclusion, repeated low doses of GnRH analogue buserelin once a day for 5 days stimulate the development of ovarian follicles in anovulatory dairy cows with small ovarian follicles and led to ovulation in 46.6% of cows during 4 weeks after the end of the treatment.

ATLAS: A phase 3 randomized trial of carfilzomib, lenalidomide, and dexamethasone versus lenalidomide alone after stem-cell transplant for multiple myeloma

8001

Background: Treatment following autologous stem cell transplantation (ASCT) for multiple myeloma (MM) remains an area of active investigation. We have shown that extended post-ASCT treatment with carfilzomib, lenalidomide, and dexamethasone (KRd) after KRd induction improved the depth and duration of response (Jasielec et al, Blood 2020), suggesting a benefit of post-ASCT KRd therapy. Here we directly compare that strategy to standard lenalidomide (R) maintenance. Methods: This international open-label phase 3 randomized trial recruited newly-diagnosed MM patients (pts) who received any induction therapy for up to 12 months (mo) followed by single ASCT and achievement of at least stable disease within 100 days afterward. Pts were randomized to receive either KRd or R, stratified by post-transplant response (≥VGPR vs < VGPR) and cytogenetic risk [standard risk (SR) vs high [HR: presence of t(4;14), t(14;16), or del(17p)]. Pts randomized to KRd received carfilzomib 36 mg/m2 on days (D) 1,2,8,9,15,16 for 4 cycles (C) then D1,2,15,16 starting C5; R 25 mg D1-21, and dexamethasone 20 mg D1,8,15,22 in 28-day cycles. KRd pts with SR who reached IMWG-defined MRD-negativity after C6 de-escalated therapy to R alone after C8 (KRd- > R); the rest continued KRd through C36 followed by R alone until progression. Pts randomized to R received lenalidomide 10 mg C1-3 and then 15 mg daily. The primary objective was to compare progression free survival (PFS) rate between the two arms. Based on historical PFS rates, a sample size of 180 Pts was calculated to provide 85% power with 2-sided alpha 0.05. Results: 180 pts were enrolled (R n = 87; KRd n = 93) through 10/21/20; data cutoff was 12/31/21. Pt characteristics in the KRd and R arms were balanced for median age (58 vs 59 yrs), >VGPR (88% vs 92%), and HR (23% vs 21%). After 6 cycles, 47% pts in the KRd arm and 29% in the R arm achieved MRD-negativity (p = 0.017). 34 KRd pts eligible for de-escalation converted to R alone after C8 and were analyzed on the KRd arm per intention-to-treat. At median follow-up of 33.8 mo, 23 pts (25%) on the KRd arm and 38 pts (44%) on the R arm progressed; estimated median PFS was 59.0 mo for KRd vs 41.4 mo for R (Hazard Ratio 0.56, logrank p = 0.026). At cutoff, 90% of KRd and 87% of R pts were alive; no deaths were treatment-related. All-grade toxicities were generally comparable between arms. The most common grade 3+ AEs and those of special interest were neutropenia (KRd 47%; R 59%), thrombocytopenia (KRd 13%; R 7%), infections (KRd 15%; R 6%), cardiovascular toxicities (KRd 4%, R 5%), and secondary malignancies (KRd 2, R 2). Conclusions: This is the first randomized phase 3 trial demonstrating superior PFS with extended post-transplant KRd therapy compared to R maintenance. Therefore, MRD/risk-adapted post-ASCT extended KRd treatment may represent a new standard of care. Clinical trial information: NCT02659293.

Comparison of efficacy of Ovsynch protocol to single PGF2α administration in treatment of individual dairy cows with post-service subestrus

The aim of this study was to evaluate the efficacy of the Ovsynch protocol in the treatment of post-service subestrus in individual dairy cows compared to a single administration of PGF2α. The study was performed on 517 Polish Friesian Holstein cows with post-service anestrus over four years in 3 dairy herds under a herd health program. Cows (n=240) diagnosed ultrasonographically as non-pregnant and with a mature corpus were treated with a single PGF2α administration and inseminated at detected estrus. Cows without corpus (n=277) were treated with the Ovsynch protocol. The estrus detection rate after PGF2α administration, percentages of cows pregnant after the treatment and at day 260, intervals from parturition to treatment and from treatment to conception and pregnancy loss rates were calculated. The overall percentage of cows pregnant after treatment did not differ between animals treated with the Ovsynch protocol and with PGF2α (38.9% vs. 42.5%; p>0.05). In herd A the percentage of cows pregnant after treatment was significantly lower (p⟨0.05) for the Ovsynch group than for the PGF2α group (30.2% vs. 61.2%). In contrast, in herd C the percentage of cows pregnant after treatment was significantly higher (p⟨0.05) in the Ovsych group than in the PGF2α group (39.6% vs. 28.8%). The overall estrus detection rate after administration of PGF2α was 59.6%. However, it was significantly lower (p⟨0.05) in herd C (44.7%) than in herds A (79.6%) and B (76.3%). The overall pregnancy loss rate ranged from 5.1% to 13.3% and did not differ significantly between herds and treatment groups (p>0.05). In conclusion, Ovsynch protocol can be a useful alternative for treatment of post-service suboestrus in individual cows in dairy herds with insufficient oestrus detection.

Effect of an integrated veterinary herd health program on fertility performance and incidence of reproductive disorders in five dairy herds

The study was carried out in 5 dairy herds of Polish Holstein-Friesian cows. The average milk yield was about 9000 kg per year. For each herd, the following fertility parameters were calculated at the start of the program and 4 years later: first- service conception rate, services per conception, length of inter-calving period and culling rate due to infertility. The incidence of silent heat, ovarian cysts, ovarian afunction, retained placenta and clinical endometritis was also recorded. Four years after implementation of the program, the average first-service conception rate increased from 43.2% to 51.2%. In three herds the differences were statistically significant (p⟨0.05). There was also a decrease in the number of services per pregnancy and in the culling rate due to infertility. Fertility performance was maintained in two herds. The average incidence of silent heat decreased from 38.1% to 29.7% and the difference was statistically significant (p⟨0.05) in three herds. There was no significant reduction in incidence of other reproductive disorders during the 4 years except for clinical endometritis in one herd. The average milk yield increased from 9300 kg to 9530 kg milk per cow per year. In conclusion, the results indicate that the implementation of the integrated veterinary herd health program improved or maintained fertility performance despite an increase in milk yield.

Mutually orthogonal Golay complementary sequences in the simultaneous synthetic aperture method for medical ultrasound diagnostics. An experimental study

Complementary Golay coded sequences (CGCS) have several advantages over conventional short pulse transmitted signals. Specifically, CGCS allow the signal-to-noise ratio (SNR) to be increased. Moreover, due to matched filtering and compression, echoes resembling the short pulse waveform with substantially higher amplitude can be obtained. However, CGCS require two subsequent transmissions to obtain a single compressed signal. This decreases the data acquisition rate and the frame rate of ultrasound imaging by two-fold. To alleviate this problem, mutually orthogonal Golay complementary sequences (MOGCS) can be used. MOGCS allow the simultaneous transmission of two CGCS pairs to be implemented, yielding the acoustic data for two image frames in one data acquisition cycle. The main objective of this work was an experimental study of the most crucial parameters of the received acoustic signals, e.g. the signal-to-noise ratio (SNR), the side-lobes level (SLL) of the signal and the axial resolution, obtained from simultaneous transmission of two pairs of CGCS comprising a MOGCS set to demonstrate their feasibility of being used in ultrasonography. For this purpose, a simultaneous synthetic transmit aperture method (SSTA) was proposed. The SSTA is based on MOGCS transmission and simultaneous reconstruction of two image frames from a single data acquisition cycle. This doubles the image reconstruction rate in comparison with conventional CGCS signals. In this paper, the ultrasound data from a perfect reflector, commercial phantoms and in vivo measurements were analysed. Two 16-bit long CGCS pairs comprising the MOGCS set were programmed and transmitted using the Verasonics Vantage™ research ultrasound system equipped with a Philips ATL L7-4 linear array ultrasound probe. It was shown that the signal parameters and overall quality of reconstructed B-mode images did not deteriorate when using the MOGCS in comparison to the conventional CGCS and short pulse signals explored so far.

P1833 Ultrasonic imaging of radial artery reactive response in patients with hypertension with and without left ventricular hypertrophy

Background

Endothelium plays an important role in anti-inflammatory process and regulating vascular tone.

It has been shown in numerous studies that increase of vessel dilation after several minutes hyperemia, was induced by mechanical transient flow stimulation of the endothelium. Most of the reported research experiments were conducted on the brachial artery. We proposed to measure the flow-mediated dilation in the radial artery (FMDr) in patients with hypertension (HT). In order to improve the axial resolution affecting the precision of FMDr determination, radial artery imaging was performed using a high frequency 20 MHz ultrasound.

Aim

The aim of the study was assessment of FMDr in patients with HT using 20 MHz probe.

Methods: Our studies involved two groups

group I consisted of 76 pts. 35 men and 41 women (71 ± 5.6 yr. old); with documented HT and group II consisted of 16 healthy volunteers, 12 men and 4 women (51.4 ± 9.4 yr. old). We divided patients with HT in to three subgroups: IA - 25 pts. with HT and left ventricular hypertrophy (VH), IB - 26 pts. with HT without VH, and IC patients with HT without VH but with coexisting coronary artery disease (CAD).

Results

Statistically significant differences in FMDr between the two groups were confirmed by a Wilcoxon-Mann-Whitney test. In group II FMDr was 11.9 ± 4.8%, and in group I FMDr was significantly less at 5.1% ± 4%. We have not observed any statistical differences in FMDr between groups: IA and IB ( 5.05%, 5.55%) respectively. We calculated FMDr for IC 4.21% (p = 0.018). Fig. 1.

Conclusion

The results confirm the usefulness of the proposed measurements of radial artery FMDr to differentiation of normal subjects from those with documented HT. There are no significant differences between males and females in all considered groups of subjects. We did not find the differences in FMDr between patients with and without VH. Patients with HT, without VH and with coexisting CAD had the lowest reactive response of FMDr.

Abstract P1833 Figure. Fig. 1

Second prostaglandin F2α treatment during Ovsynch protocol does not improve fertility outcomes in dairy cows

The objective of this study was to evaluate the effect of a second prostaglandin F2α (PGF2α) treatment during Ovsynch on luteal regression and fertility in dairy cows, compared with standard Ovsynch. The study was conducted on 111 Holstein Friesian multiparous cows on commercial dairy farm. The cows in the experimental group (n=48) received two treatments of PGF2α 24 hours apart during Ovsynch. The cows in the control group (n=63) were synchronized with standard Ovsynch. To assess the progesterone (P4) concentration blood samples were collected at the day of PGF2α treatment and at the 2nd GnRH treatment. Pregnancy was evaluated by ultrasound examination 37-40 days after timed artificial insemination (TAI) by ultrasound. Cows diagnosed pregnant were re-examined between days 70-80 after TAI. The percentage of cows with complete corpus luteum (CL) regression (P4⟨0.5 ng/ml at the time of the 2nd GnRH treatment) was 89.6 % after two PGF2α treatments and 88.9 % after one PGF2α treatment. There were no statistically significant differences (p>0.05) in the pregnancies per artificial insemination (P/AI) between the experimental and control group (P/AI). However, the pregnancy loss rate was lower in cows receiving two PGF2α treatments than in the control animals (0.0 % vs. 6.4 %; p⟨0.05). In conclusion, the second PGF2α treatment during Ovsynch protocol had no significant effect on CL regression and P/AI in dairy cows. The pregnancy losses until days 75-80 after TAI were significantly lower after two PGF2α treatments than after one PGF2α treatment.

Effect of single treatment with cloprostenol or dinoprost on estrus and reproductive performance in anestrous dairy cows after service

Previous studies have compared the effectiveness of dinoprost and cloprostenol in cows yielding conflicting results. The aim of our study was to evaluate the efficacy of single treatment with cloprostenol or dinoprost on estrus and reproductive performance in cows with unobserved estrus after service. The study was conducted over four years in two dairy herds of Polish Holstein Frisian cows under a herd health program with an average milk yield per cow over 9000 L. Cows (n=523) diagnosed ultrasonographically as non-pregnant and with a corpus luteum were randomly assigned to be treated with either cloprostenol (n=261) or dinoprost (n=262). The estrus detection rates after administration of cloprostenol or dinoprost were 59.4%, and 57.6%, respectively. The difference between both groups was not statistically significant (p>0.05). Distribution of observed estrus did not differ between cloprostenol and dinoprost. There were no differences (p>0.05) between cloprostenol and dinoprost in conception rate (65.2% vs. 66.2%, respectively) and pregnancy rate (57.5% vs. 54.9%, respectively). Mean days open were similar in cows of both treatments (177.5 ± 74.6 days vs. 175.8 ± 62.6 days, respectively; p>0.05). In conclusion, data from this study showed no significant differences in estrus detection rates and fertility between cows with unobserved estrus after service treated with cloprostenol or dinoprost. Both products are equally useful for the treatment of non-pregnant dairy cows with anestrus after service within a reproductive herd health program.

Incidence of clinical form of anestrus after unsuccessful service in cows in eight dairy herds in north-east of Poland

There is no information available about the incidence of anestrus and its clinical forms after service in dairy cows in Poland. Thus, the aim of this study was to investigate the incidence of clinical forms of anoestrus after unsuccessful artificial insemination in dairy cows based on ultrasound examination. The study was carried out on 1543 Polish Holstein-Friesian cows in 8 dairy herds in north-east Poland over a three-year period. Cows were examined for pregnancy on day 35 after AI using a Honda 1500 portable ultrasound scanner equipped with a 5 MHz linear-array transducer. Cows diagnosed as pregnant were re-examined on day 45. Of the 1543 inseminated cows, 408 (26.4%) showed no estrus signs and were diagnosed not-pregnant by ultrasonography, 328 (21.3%) returned to estrus within 35 days, and 807 (52.3%) were pregnant via artificial insemination. The incidence of anestrus after service in non-pregnant cows varied among herds from 10.3% to 32.9% of cows (p0.05). Based on ultrasound examination silent heat was diagnosed in 324 (79.4%), corpus luteum pseudograviditatis in 36 (8.8%), ovarian cysts in 26 (6.4%), and ovarian afunction in 22 (5.4%) of 408 anestrous, non-pregnant cows. The results of this study showed that the incidence of anestrus after service in dairy herds in North-East Poland was high. The most prevalent clinical form of post-service anestrus was silent heat.

Genes involved in regulation of cellular metabolic processes, signaling and adhesion are the markers of porcine buccal pouch mucosal cells long-term primary cultured in vitro

Extraordinary abilities for continuous proliferation and differentiation, associated with constant renewal triggered by stimulation from the mastication process, together with the relative lack of aesthetic complications associated with post-surgery healing, have highlighted buccal pouch mucosa as a potential source of explants that could be used in transplantation and tissue engineering. Additionally, this tissue plays a major role in the oral drug delivery process, which brings special interest to its molecular properties in the context of new drug development. There is therefore a need to analyse the exact mechanisms of oral mucosa functioning, especially when it comes to the processes that are associated with the potential clinical applications. In this study we analysed a complete transcriptome of long-term in vitro cultures of porcine buccal pouch oral mucosa cells. Using a microarray approach, we focused on genes associated with cellular metabolic processes, signalling and adhesion, from 4 gene ontology groups: "Positive regulation of cellular component movement", "Positive regulation of cellular process", "Positive regulation of intracellular signal transduction" and "Single organism cell adhesion". Nineteen genes (CCL8, CXCL2, PLK2, DUSP5, PTGS2, LIF, CCL2, ATP1B1, REL, ITGB3, SCARB1, UGCG, PDPN, LYN, ETS1, FCER1G, TGFB1, RFC4, LMO2) with fold changes higher than |2| and p value Extraordinary abilities for continuous proliferation and differentiation, associated with constant renewal triggered by stimulation from the mastication process, together with the relative lack of aesthetic complications associated with post-surgery healing, have highlighted buccal pouch mucosa as a potential source of explants that could be used in transplantation and tissue engineering. Additionally, this tissue plays a major role in the oral drug delivery process, which brings special interest to its molecular properties in the context of new drug development. There is therefore a need to analyse the exact mechanisms of oral mucosa functioning, especially when it comes to the processes that are associated with the potential clinical applications. In this study we analysed a complete transcriptome of long-term in vitro cultures of porcine buccal pouch oral mucosa cells. Using a microarray approach, we focused on genes associated with cellular metabolic processes, signalling and adhesion, from 4 gene ontology groups: "Positive regulation of cellular component movement", "Positive regulation of cellular process", "Positive regulation of intracellular signal transduction" and "Single organism cell adhesion". Nineteen genes (CCL8, CXCL2, PLK2, DUSP5, PTGS2, LIF, CCL2, ATP1B1, REL, ITGB3, SCARB1, UGCG, PDPN, LYN, ETS1, FCER1G, TGFB1, RFC4, LMO2) with fold changes higher than |2| and p value less than 0.05 were identified, described in context and analysed. While the study needs much further validation to become applicable in a clinical environment, it yields valuable information about the transcriptomic basis of oral mucosal cell functioning in vitro, that might serve as a reference for further research, aiming to apply this knowledge in clinical situations.0.05 were identified, described in context and analysed. While the study needs much further validation to become applicable in a clinical environment, it yields valuable information about the transcriptomic basis of oral mucosal cell functioning in vitro, that might serve as a reference for further research, aiming to apply this knowledge in clinical situations.

Role of macrophages in the pathogenesis of atherosclerosis and aortocoronary graft disease

Atherosclerosis and disease of graft implanted to bypass occluded coronary or peripheral arteries are similar processes. Patency of implanted grafts is of paramount importance in respect to long-term outcomes. Although few cell types participate in atherosclerotic plaque formation, macrophages play a crucial role. In this article we review the fate of monocytes that infiltrate vessel wall following endothelium damage, and then undergo transformation to macrophages (identified as CD68 positive cells) and eventually lead to severe stenosis of vessel. Opposing biological activity of two subpopulations of macrophages and their impact on plaque instability and its calcification is also presented. At the end of this paper, a possible clinical significance of pre-existing, CD68 positive cell infiltration of vessel wall, applied as aortocoronary grafts, is discussed.

Comparative proteomic profiling of refractory/relapsed multiple myeloma reveals biomarkers involved in resistance to bortezomib-based therapy

Identifying biomarkers of the resistance in multiple myeloma (MM) is a key research challenge. We aimed to identify proteins that differentiate plasma cells in patients with refractory/relapsed MM (RRMM) who achieved at least very good partial response (VGPR) and in those with reduced response to PAD chemotherapy (bortezomib, doxorubicin and dexamethasone). Comparative proteomic analysis was conducted on pretreatment plasma cells from 77 proteasome inhibitor naïve patients treated subsequently with PAD due to RRMM. To increase data confidence we used two independent proteomic platforms: isobaric Tags for Relative and Absolute Quantitation (iTRAQ) and label free (LF). Proteins were considered as differentially expressed when their accumulation between groups differed by at least 50% in iTRAQ and LF. The proteomic signature revealed 118 proteins (35 up-regulated and 83 down-regulated in ≥ VGPR group). Proteins were classified into four classes: (1) involved in proteasome function; (2) involved in the response to oxidative stress; (3) related to defense response; and (4) regulating the apoptotic process. We confirmed the differential expression of proteasome activator complex subunit 1 (PSME1) by enzyme-linked immunosorbent assay. Increased expression of proteasomes and proteins involved in protection from oxidative stress (eg., TXN, TXNDC5) plays a major role in bortezomib resistance.

Comparative proteomic profiling of sera from patients with refractory multiple myeloma reveals potential biomarkers predicting response to bortezomib-based therapy

INTRODUCTION

In the era of implementing novel agents in multiple myeloma (MM) regimens, drug resistance has become a key factor undermining the results of treatment. Identifying biomarkers allows the prediction of therapy outcomes with specific agents and may lead to the avoidance of resistance.

OBJECTIVES

This study aimed to identify biomarkers in the pretreatment sera of patients with refractory/ relapsed MM that differ from those in the sera of patients who achieved a better depth of response with bortezomib-containing therapy.

PATIENTS AND METHODS

Pretreatment serum samples were obtained from 61 proteasome inhibitor-naive, transplant-eligible patients who were eligible for salvage PAD (bortezomib, doxorubicin, and dexamethasone) or VTD (bortezomib, thalidomide, and dexamethasone) chemotherapy. Based on their response to therapy, patients were classified into 3 groups: complete or very good partial response, partial response, and progressive or stable disease. A comparative proteomic analysis of the groups was performed.

RESULTS

The analyzed groups significantly differed in terms of both overall survival and progression‑free survival. In total, 632 proteins were identified. The proteomic signature revealed 54 proteins that differentiated each analyzed experimental group. Functional analysis revealed that the main identified pathways (17 proteins) involved the regulation of hydrolase activity and cellular response to stimuli. The identified proteins included apolipoprotein C1, complement components, and sulfhydryl oxidase 1.

CONCLUSIONS

Our results demonstrated that the label-free proteomic analysis is a useful method for describing proteins differentially expressed in the sera of patients with MM. Further studies are needed to analyze the use of identified proteins as biomarkers.

Efficacy and safety of lenalidomide treatment in multiple myeloma (MM) patients--Report of the Polish Myeloma Group

The aim of the multi-centre retrospective study was to evaluate the efficacy and safety of lenalidomide (LEN) therapy in patients with resistant or relapsed multiple myeloma (MM) as well as in patients with stable disease (LEN used due to neurological complications). The primary endpoint of this study was an overall response rate (ORR). The secondary endpoints were as follows: time to progression (TTP), overall survival (OS) and the safety of drug use. Data were collected in 19 centres of the Polish Multiple Myeloma Study Group. The study group consisted of 306 subjects: 153 females and 153 males. In 115 patients (38.8%, group A), a resistant myeloma was diagnosed; in 135 (44.1%, group B) a relapse, and in 56 (18.3%, group C) a stable disease were stated. In 92.8% of patients, LEN+DEX combination was used; in remaining group, LEN monotherapy or a combination therapy LEN+bortezomib or LEN+bendamustine and other were used. In the entire study group, ORR was 75.5% (including 12.4% patients achieving complete remission [CR] or stringent CR [sCR]). Median time to progression (TTP) was 20 months. Median overall survival (OS) was 33.3 months. The regression model for "treatment response" was on the borderline of statistical significance (p=0.07), however the number of LEN treatment cycles ≥ 6 (R(2)=17.2%), baseline LDH level (R(2)=1.1%) and no ASCT use (R(2)=1.7%) where the factors most affecting treatment response achievement. The regression model for dependant variable--"overall survival"--was statistically significant (p=0.0000004). Factors with the most impact on OS were as follows: number of LEN cycles treatment ≥ 6 (R(2)=16.7%), treatment response achievement (R(2)=6.9%), β-2-microglobulin (β-2-M) level (R(2)=4.8%), renal function (R(2)=3.0%) and lack of 3/4 grade adverse events (R(2)=1.4%).

SUMMARY

LEN is an effective and safe therapeutic option, even in intensively treated resistant and relapsed MM patients, as well as in patients with stable disease and previous treatment-induced neurological complications. In particular, the number of LEN treatment cycles ≥ 6 was the factor which affected treatment response achievement the most, together with an important impact on OS.

High frequency ultrasonography: a complementary diagnostic method in evaluation of primary cutaneous melanoma

AIM

The aim of our study was to assess the usefulness of high frequency ultrasonography in the diagnosis of melanoma.

METHODS

We examined 84 patients with suspicious melanocytic skin lesions, including 19 cases of melanoma. In vivo high-resolution ultrasonography (30 MHz) was performed prior to excision.

RESULTS

In ultrasound scans early melanomas presented as flat oval or fusiform shaped structures and were clearly demarcated, while advanced melanomas were characterized by a roundish shape with less distinct borders. The ultrasonographic thickness of in situ melanomas ranged from 0.02 to 0.85 mm. In the case of invasive tumors, the mean thickness evaluated by high frequency ultrasonography was 10.7% higher compared to the Breslow Score (1.44±0.8 mm and 1.3±0.88 mm, respectively). In all melanomas of Breslow Score of 1 mm or more ultrasound also indicated a Breslow Score of 1 mm or more.

CONCLUSION

High frequency ultrasound examination has limited value in differential diagnosis of melanoma, but it gives a clear picture of the size and depth of the tumor. The method should be used as a complementary method (after dermoscopy and, where applicable, reflectance confocal microscopy) in preoperative evaluation of the tumor. In some cases of locally advanced melanoma, ultrasound examination may allow to reduce the number of surgical procedures and favor the decision of a one-time surgical treatment (removal of primary tumor and sentinel lymph node biopsy at the same time).

Impact of thermal effects induced by ultrasound on viability of rat C6 glioma cells

In order to have consistent and repeatable effects of sonodynamic therapy (SDT) on various cancer cells or tissue lesions we should be able to control a delivered ultrasound energy and thermal effects induced. The objective of this study was to investigate viability of rat C6 glioma cells in vitro depending on the intensity of ultrasound in the region of cells and to determine the exposure time inducing temperature rise above 43 °C, which is known to be toxic for cells. For measurements a planar piezoelectric transducer with a diameter of 20 mm and a resonance frequency of 1.06 MHz was used. The transducer generated tone bursts with 94 μs duration, 0.4 duty-cycle and initial intensity ISATA (spatial averaged, temporal averaged) varied from 0.33 W/cm(2) to 8 W/cm(2) (average acoustic power varied from 1 W to 24 W). The rat C6 glioma cells were cultured on a bottom of wells in 12-well plates, incubated for 24h and then exposed to ultrasound with measured acoustic properties, inducing or causing no thermal effects leading to cell death. Cell viability rate was determined by MTT assay (a standard colorimetric assay for assessing cell viability) as the ratio of the optical densities of the group treated by ultrasound to the control group. Structural cellular changes and apoptosis estimation were observed under a microscope. Quantitative analysis of the obtained results allowed to determine the maximal exposure time that does not lead to the thermal effects above 43 °C in the region of cells for each initial intensity of the tone bursts used as well as the threshold intensity causing cell death after 3 min exposure to ultrasound due to thermal effects. The averaged threshold intensity was found to be about 5.7 W/cm(2).

Case-adjusted bortezomib-based strategy in routine therapy of relapsed/refractory multiple myeloma shown to be highly effective--a report by Polish Myeloma Study Group

The observational study was aimed at evaluating response, survival and toxicity of bortezomib-based, case-adjusted regimens in real-life therapy of 708 relapsed/refractory MM patients. Bortezomib was combined with anthracyclines, steroids, thalidomide, alkylators or given in monotherapy. The ORR was 67.9% for refractory and 69.9% for relapsed MM. The median PFS was 14 months and OS 57 months. Patients responding to the therapy had the probability of a 4-year OS at 67.0%. No toxicity was noted in 33.1% of patients. Severe events (grade 3/4) were reported in 35.9% of patients: neurotoxicity (16.7%), neutropenia (9.2%), thrombocytopenia (8.5%), and infections (6.5%). Bortezomib-based, case-adjusted regimens are in real-life practice effective in salvage therapy offering reliable survival with acceptable toxicity for relapsed/refractory MM patients.

Modified multi-element synthetic transmit aperture method for ultrasound imaging: A tissue phantom study

The paper presents the modified multi-element synthetic transmit aperture (MSTA) method for ultrasound imaging. It is based on coherent summation of RF echo signals with apodization weights taking into account the finite size of the transmit subaperture and of the receive element. The work presents extension of the previous study where the modified synthetic transmit aperture (STA) method was considered and verified [1]. In the case of MSTA algorithm the apodization weights were calculated for each imaging point and all combinations of the transmit subaperture and receive element using their angular directivity functions (ADFs). The ADFs were obtained from the exact solution of the corresponding mixed boundary-value problem for periodic baffle system modeling the transducer array. Performance of the developed method was tested using Field II simulated synthetic aperture data of point reflectors for 4MHz 128-element transducer array with 0.3mm pitch and 0.02mm kerf to estimate the visualization depth and lateral resolution. Also experimentally determined data of the tissue-mimicking phantom (Dansk Fantom Service, model 571) obtained using 128 elements, 4MHz, linear transducer array (model L14-5/38) and Ultrasonix SonixTOUCH Research platform were used for qualitative assessment of imaging contrast improvement. Comparison of the results obtained by the modified and conventional MSTA algorithms indicated 15dB improvement of the noise reduction in the vicinity of transducer's surface (1mm depth), and concurrent increase in the visualization depth (86% augment of the scattered amplitude at the depth of 90mm). However, this increase was achieved at the expense of minor degradation of the lateral resolution of approximately 8% at the depth of 50mm and 5% at the depth of 90mm.

Treatment strategy based on gemcitabine-containing salvage chemotherapy used with intent to proceed to second stem cell transplant for patients with Hodgkin lymphoma relapsing after a prior autologous transplant

This report is an analysis of patients with Hodgkin lymphoma who relapsed after autologous stem cell transplant (autoHCT) and who were treated with gemcitabine-based therapy as a bridge to either allogeneic or second autologous transplant. Sixteen patients were treated with gemcitabine, cisplatin and steroid and 21 with gemcitabine plus vinorelbine. The overall response rate was 68%. The grade 3-4 toxicity was myelosupression and infections. Fifteen patients proceeded to allogeneic and five to autologous transplant. Two-year overall survival (OS) and progression-free survival (PFS) for all patients were 36% and 25%, respectively. In multivariate analysis, relapse > 6 months after autoHCT and response to gemcitabine-based chemotherapy were associated with superior OS and response to gemcitabine-based chemotherapy with improved PFS. A treatment strategy based on gemcitabine-containing chemotherapy and second transplant appears to be an effective treatment option for patients relapsing > 6 months after autoHCT, providing a median survival time of 34 months.

Ultrasonically assisted evaluation of the impact of atherosclerotic plaque on the pulse pressure wave propagation: a clinical feasibility study

The purpose of this work was to evaluate ultrasound modality as a non-invasive tool for determination of impact of the degree of the atherosclerotic plaque located in human internal carotid arteries on the values of the parameters of the pulse wave. Specifically, the applicability of the method to such arteries as brachial, common, and internal carotid was examined. The method developed is based on analysis of two characteristic parameters: the value of the mean reflection coefficient modulus |Γ|(a) of the blood pressure wave and time delay Δt between the forward (travelling) and backward (reflected) blood pressure waves. The blood pressure wave was determined from ultrasound measurements of the artery's inner (internal) diameter, using the custom made wall tracking system (WTS) operating at 6.75 MHz. Clinical data were obtained from the carotid arteries measurements of 70 human subjects. These included the control group of 30 healthy individuals along with the patients diagnosed with the stenosis of the internal carotid artery (ICA) ranging from 20% to 99% or with the ICA occlusion. The results indicate that with increasing level of stenosis of the ICA the value of the mean reflection coefficient measured in the common carotid artery, significantly increases from |Γ|(a)=0.45 for healthy individuals to |Γ|(a)=0.61 for patients with stenosis level of 90-99%, or ICA occlusion. Similarly, the time delay Δt decreases from 52 ms to 25 ms for the respective groups. The method described holds promise that it might be clinically useful as a non-invasive tool for localization of distal severe artery narrowing, which can assist in identifying early stages of atherosclerosis especially in regions, which are inaccessible for the ultrasound probe (e.g. carotid sinus or middle cerebral artery).

Modified synthetic transmit aperture algorithm for ultrasound imaging

The modified synthetic transmit aperture (STA) algorithm is described. The primary goal of this work was to assess the possibility to improve the image quality achievable using synthetic aperture (SA) approach and to evaluate the performance and the clinical applicability of the modified algorithm using phantoms. The modified algorithm is based on the coherent summation of back-scattered RF echo signals with weights calculated for each point in the image and for all possible combinations of the transmit-receive pairs. The weights are calculated using the angular directivity functions of the transmit-receive elements, which are approximated by a far-field radiation pattern of a narrow strip transducer element vibrating with uniform pressure amplitude over its width. In this way, the algorithm takes into account the finite aperture of each individual element in the imaging transducer array. The performance of the approach developed was tested using FIELD II simulated synthetic aperture data of the point reflectors, which allowed the visualization (penetration) depth and lateral resolution to be estimated. Also, both simulated and measured data of cyst phantom were used for qualitative assessment of the imaging contrast improvement. The experimental data were obtained using 128 elements, 4MHz, linear transducer array of the Ultrasonix research platform. The comparison of the results obtained using the modified and conventional (unweighted) STA algorithms revealed that the modified STA exhibited an increase in the penetration depth accompanied by a minor, yet discernible upon the closer examination, degradation in lateral resolution, mainly in the proximity of the transducer aperture. Overall, however, a considerable (12dB) improvement in the image quality, particularly in the immediate vicinity of the transducer's surface was demonstrated. The modified STA method holds promise to be of clinical importance, especially in the applications where the quality of the "near-field" image, that is the image in the immediate vicinity of the scanhead is of critical importance such as for instance in skin- and breast-examinations.

Modeling and analysis of multiple scattering of acoustic waves in complex media: application to the trabecular bone

The integral equations that describe scattering in the media with step-rise changing parameters have been numerically solved for the trabecular bone model. The model consists of several hundred discrete randomly distributed elements. The spectral distribution of scattering coefficients in subsequent orders of scattering has been presented. Calculations were carried on for the ultrasonic frequency ranging from 0.5 to 3 MHz. Evaluation of the contribution of the first, second, and higher scattering orders to total scattering of the ultrasounds in trabecular bone was done. Contrary to the approaches that use the μCT images of trabecular structure to modeling of the ultrasonic wave propagation condition, the 3D numerical model consisting of cylindrical elements mimicking the spatial matrix of trabeculae, was applied. The scattering, due to interconnections between thick trabeculae, usually neglected in trabecular bone models, has been included in calculations when the structure backscatter was evaluated. Influence of the absorption in subsequent orders of scattering is also addressed. Results show that up to 1.5 MHz, the influence of higher scattering orders on the total scattered field characteristic can be neglected while for the higher frequencies, the relatively high amplitude interference peaks in higher scattering orders clearly occur.

The effectiveness of anticellulite treatment using tripolar radiofrequency monitored by classic and high-frequency ultrasound

BACKGROUND

  Cellulite affects nearly 85% of the female population. Given the size of the phenomenon, we are continuously looking for effective ways to reduce cellulite. Reliable monitoring of anticellulite treatment remains a problem.

OBJECTIVE

  The main aim of the study was to evaluate the effectiveness of anticellulite treatment carried out using radiofrequency (RF), which was monitored by classical and high-frequency ultrasound.

METHODS

  Twenty-eight women underwent anticellulite treatment using RF, 17 women were in the placebo group. The therapy was monitored by classical and high-frequency ultrasound. The examinations evaluated the thickness of the epidermal echo, dermis thickness, dermis echogenicity, the length of the subcutaneous tissue bands growing into the dermis, the presence or absence of oedema, the thickness of subcutaneous tissue as well as thigh circumference and the stage of cellulite (according to the Nürnberger-Müller scale).

RESULTS

  Cellulite was reduced in 89.286% of the women who underwent RF treatment. After the therapy, the following observations were made: a decrease in the thickness of the dermis and subcutaneous tissue, an increase in echogenicity reflecting on the increase in the number of collagen fibres, decreased subcutaneous tissue growing into bands in the dermis, and the reduction of oedema. In the placebo group, no statistically significant changes of the above parameters were observed.

CONCLUSION

  Radiofrequency enables cellulite reduction. A crucial aspect is proper monitoring of the progress of such therapy, which ultrasound allows.

The role of AlkB protein in repair of 1,N⁶-ethenoadenine in Escherichia coli cells

Etheno (ε) DNA adducts, including 1,N(6)-ethenoadenine (εA), are formed by various bifunctional agents of exogenous and endogenous origin. The AT→TA transversion, the most frequent mutation provoked by the presence of εA in DNA, is very common in critical codons of the TP53 and RAS genes in tumours induced by exposure to carcinogenic vinyl compounds. Here, using a method that allows examination of the mutagenic potency of a metabolite of vinyl chloride, chloroacetaldehyde (CAA), but eliminates its cytotoxicity, we studied the participation of alkA, alkB and mug gene products in the repair of εA in Escherichia coli cells. The test system used comprised the pIF105 plasmid bearing the lactose operon of CC105 origin, which allowed monitoring of Lac(+) revertants that arose by AT→TA substitutions due to the modification of adenine by CAA. The plasmid was CAA-modified in vitro and replicated in E.coli of various genetic backgrounds (wt, alkA, alkB, mug, alkAalkB, alkAmug and alkBmug). To modify the levels of the AlkA and AlkB proteins, mutagenesis was studied in E.coli cells induced or not in adaptive response to alkylating agents. Considering the levels of CAA-induced Lac(+) revertants in strains harbouring the CAA-modified pIF105 plasmid and induced or not in adaptive response, we conclude that the AlkB dioxygenase plays a major role in decreasing the level of AT→TA mutations, thus in the repair of εA in E.coli cells. The observed differences of mutation frequencies in the various mutant strains assayed indicate that Mug glycosylase is also engaged in the repair of εA, whereas the role the AlkA glycosylase in this repair is negligible.

Fast prediction of pulsed nonlinear acoustic fields from clinically relevant sources using time-averaged wave envelope approach: comparison of numerical simulations and experimental results

The primary goal of this work was to verify experimentally the applicability of the recently introduced time-averaged wave envelope (TAWE) method [J. Wójcik, A. Nowicki, P.A. Lewin, P.E. Bloomfield, T. Kujawska, L. Filipczyński, Wave envelopes method for description of nonlinear acoustic wave propagation, Ultrasonics 44 (2006) 310-329.] as a tool for fast prediction of four dimensional (4D) pulsed nonlinear pressure fields from arbitrarily shaped acoustic sources in attenuating media. The experiments were performed in water at the fundamental frequency of 2.8 MHz for spherically focused (focal length F=80 mm) square (20 x 20 mm) and rectangular (10 x 25mm) sources similar to those used in the design of 1D linear arrays operating with ultrasonic imaging systems. The experimental results obtained with 10-cycle tone bursts at three different excitation levels corresponding to linear, moderately nonlinear and highly nonlinear propagation conditions (0.045, 0.225 and 0.45 MPa on-source pressure amplitude, respectively) were compared with those yielded using the TAWE approach [J. Wójcik, A. Nowicki, P.A. Lewin, P.E. Bloomfield, T. Kujawska, L. Filipczyński, Wave envelopes method for description of nonlinear acoustic wave propagation, Ultrasonics 44 (2006) 310-329.]. The comparison of the experimental results and numerical simulations has shown that the TAWE approach is well suited to predict (to within+/-1 dB) both the spatial-temporal and spatial-spectral pressure variations in the pulsed nonlinear acoustic beams. The obtained results indicated that implementation of the TAWE approach enabled shortening of computation time in comparison with the time needed for prediction of the full 4D pulsed nonlinear acoustic fields using a conventional (Fourier-series) approach [P.T. Christopher, K.J. Parker, New approaches to nonlinear diffractive field propagation, J. Acoust. Soc. Am. 90 (1) (1991) 488-499.]. The reduction in computation time depends on several parameters, including the source geometry, dimensions, fundamental resonance frequency, excitation level as well as the strength of the medium nonlinearity. For the non-axisymmetric focused transducers mentioned above and excited by a tone burst corresponding to moderately nonlinear and highly nonlinear conditions the execution time of computations was 3 and 12h, respectively, when using a 1.5 GHz clock frequency, 32-bit processor PC laptop with 2 GB RAM memory, only. Such prediction of the full 4D pulsed field is not possible when using conventional, Fourier-series scheme as it would require increasing the RAM memory by at least 2 orders of magnitude.

Influence of the ultrasound transducer bandwidth on selection of the complementary Golay bit code length

In contrast to previously published papers [A. Nowicki, Z. Klimonda, M. Lewandowski, J. Litniewski, P.A. Lewin, I. Trots, Comparison of sound fields generated by different coded excitations - Experimental results, Ultrasonics 44 (1) (2006) 121-129; J. Litniewski, A. Nowicki, Z. Klimonda, M. Lewandowski, Sound fields for coded excitations in water and tissue: experimental approach, Ultrasound Med. Biol. 33 (4) (2007) 601-607], which examined the factors influencing the spatial resolution of coded complementary Golay sequences (CGS), this paper investigates the effect of ultrasound imaging transducer's fractional bandwidth on the gain of the compressed echo signal for different spectral widths of the CGS. Two different bit lengths were considered, specifically one and two cycles. Three transducers having fractional bandwidth of 25%, 58% and 80% and operating at frequencies 6, 4.4 and 6 MHz, respectively were examined (one of the 6 MHz sources was focused and made of composite material). The experimental results have shown that by increasing the code length, i.e. decreasing the bandwidth, the compressed echo amplitude could be enhanced. The smaller the bandwidth was the larger was the gain; the pulse-echo sensitivity of the echo amplitude increased by 1.88, 1.62 and 1.47, for 25%, 58% and 80% bandwidths, respectively. These results indicate that two cycles bit length excitation is more suitable for use with bandwidth limited commercially available imaging transducers. Further, the time resolution is retained for transducers with two cycles excitation providing the fractional bandwidth is lower than approximately 90%. The results of this work also show that adjusting the code length allows signal-to-noise-ratio (SNR) to be enhanced while using limited (less that 80%) bandwidth imaging transducers. Also, for such bandwidth limited transducers two cycles excitation would not decrease the time resolution, obtained with "conventional" spike excitation. Hence, CGS excitation could be successfully implemented with the existing, relatively narrow band imaging transducers without the need to use usually more expensive wideband, composite ones.

Activity of bortezomib in adult de novo and relapsed acute myeloid leukemia

BACKGROUND

Bortezomib is an inhibitor of proteasome and NF-kappaB, with activity in various solid tumors and hematological malignancies.

AIM

The aim of the study was the analysis of in vitro drug resistance to bortezomib and other anticancer drugs in de novo and relapsed adult acute myeloid leukemia (AML).

PATIENTS AND METHODS

The leukemic cells of 46 adult patients with AML were tested for the in vitro drug resistance profile. The group included 20 de novo and 26 relapsed AML patients, among whom, 12 relapsed after allogeneic hematopoietic stem cell transplantation (HSCT) and 4 after autologous HSCT. The MTT assay was performed for 21 drugs. Expression of P-glycoprotein (PGP), multidrug resistance-associated protein-1 (MRP1) and lung resistance protein (LRP) proteins was measured by flow cytometry.

RESULTS

No significant differences in drug resistance were found for all tested drugs between de novo and relapsed AML samples, while expression of PGP, MRP1 and LRP was higher in relapsed patients. Patients with refractory or relapsed disease, had higher resistance of myeloblasts to cyclophosphamide (RR = 2.4, p = 0.050), and better sensitivity to busulfan (RR = 0.4, p = 0.054) and topotecan (RR = 0.4, p = 0.031). Those who have died due to refractory/relapsed disease (n = 16) had better sensitivity to bortezomib (RR = 0.6, p = 0.046) and treosulfan (RR = 0.1, p = 0.018).

CONCLUSION

In vitro drug resistance in relapsed adult AML is comparable to that in de novo disease. Activity in vitro of bortezomib might be a rationale for its use in refractory/relapsed AML adult patients.

Wave envelopes method for description of nonlinear acoustic wave propagation

A novel, free from paraxial approximation and computationally efficient numerical algorithm capable of predicting 4D acoustic fields in lossy and nonlinear media from arbitrary shaped sources (relevant to probes used in medical ultrasonic imaging and therapeutic systems) is described. The new WE (wave envelopes) approach to nonlinear propagation modeling is based on the solution of the second order nonlinear differential wave equation reported in [J. Wójcik, J. Acoust. Soc. Am. 104 (1998) 2654-2663; V.P. Kuznetsov, Akust. Zh. 16 (1970) 548-553]. An incremental stepping scheme allows for forward wave propagation. The operator-splitting method accounts independently for the effects of full diffraction, absorption and nonlinear interactions of harmonics. The WE method represents the propagating pulsed acoustic wave as a superposition of wavelet-like sinusoidal pulses with carrier frequencies being the harmonics of the boundary tone burst disturbance. The model is valid for lossy media, arbitrarily shaped plane and focused sources, accounts for the effects of diffraction and can be applied to continuous as well as to pulsed waves. Depending on the source geometry, level of nonlinearity and frequency bandwidth, in comparison with the conventional approach the Time-Averaged Wave Envelopes (TAWE) method shortens computational time of the full 4D nonlinear field calculation by at least an order of magnitude; thus, predictions of nonlinear beam propagation from complex sources (such as phased arrays) can be available within 30-60 min using only a standard PC. The approximate ratio between the computational time costs obtained by using the TAWE method and the conventional approach in calculations of the nonlinear interactions is proportional to 1/N2, and in memory consumption to 1/N where N is the average bandwidth of the individual wavelets. Numerical computations comparing the spatial field distributions obtained by using both the TAWE method and the conventional approach (based on a Fourier series representation of the propagating wave) are given for circular source geometry, which represents the most challenging case from the computational time point of view. For two cases, short (2 cycle) and long (8 cycle) 2 MHz bursts, the computational times were 10 min and 15 min versus 2 h and 8 h for the TAWE method versus the conventional method, respectively.

Comparison of sound fields generated by different coded excitations--experimental results

This work reports the results of measurements of spatial distributions of ultrasound fields obtained from five energizing schemes. Three different codes, namely, chirp signal and two sinusoidal sequences were investigated. The sequences were phase modulated with 13 bits Barker code and 16 bits Golay complementary codes. Moreover, two reference signals generated as two and sixteen cycle sine tone bursts were examined. Planar, 50% (fractional) bandwidth, 15 mm diameter source transducer operating at 2 MHz center frequency was used in all measurements. The experimental data were collected using computerized scanning system and recorded using wideband, PVDF membrane hydrophone (Sonora 804). The measured echoes were compressed, so the complete pressure field in the investigated location before and after compression could be compared. In addition to a priori anticipated increase in the signal to noise ratio (SNR) for the decoded pressure fields, the results indicated differences in the pressure amplitude levels, directivity patterns, and the axial distance at which the maximum pressure amplitude was recorded. It was found that the directivity patterns of non-compressed fields exhibited shapes similar to the patterns characteristic for sinusoidal excitation having relatively long time duration. In contrast, the patterns corresponding to compressed fields resembled those produced by brief, wideband pulses. This was particularly visible in the case of binary sequences. The location of the maximum pressure amplitude measured in the 2 MHz field shifted towards the source by 15 mm and 25 mm for Barker code and Golay code, respectively. The results of this work may be applicable in the development of new coded excitation schemes. They could also be helpful in optimizing the design of imaging transducers employed in ultrasound systems designed for coded excitation. Finally, they could shed additional light on the relationship between the spatial field distribution and achievable image quality and in this way facilitate optimization of the images obtained using coded systems.

[Recurrent hemoptysis following thienopyridines and amiodarone administration. therapeutic dilemma]

The authors describe a case of a 74-year-old man with advanced coronary heart disease in whom pulmonary hemorrhagic complications during therapy with ticlopidine and subsequently with clopidogrel and amiodarone were observed. Fever and massive hemoptysis following five days of ticlopidine treatment, before elective coronary angiography, were noticed. Transient interstitial X-ray changes of the right lung were visible. Three months later a new episode on the third day of clopidogrel administration was manifested. He was after PCI, performed because of ACS complicated with ventricular fibrillation. Two days following clopidogrel discontinuation hemoptysis remitted but after ten days occurred again (this time with bilateral X-ray changes). Amiodarone, given after VF, was stopped. Spectacular improvement with steroid treatment was observed. Indobufen (reversible COX- 1 inhibitor) as an antiplatelet therapy was availed. The authors discuss therapeutic dilemma concerning the patient with coexisting different diseases.

The influence of finite aperture and frequency response of ultrasonic hydrophone probes on the determination of acoustic output

The influence of finite aperture and frequency response of piezoelectric ultrasonic hydrophone probes on the Thermal and Mechanical Indices was investigated using a comprehensive acoustic wave propagation model. The experimental verification of the model was obtained using a commercially available, 8 MHz, dynamically focused linear array and a single element, 5 MHz, focused rectangular source. The pressure-time waveforms were recorded using piezoelectric polymer hydrophone probes of different active element diameters and bandwidths. The nominal diameters of the probes ranged from 50 to 500 microm and their usable bandwidths varied between 55 and 100 MHz. The Pulse Intensity Integral (PII), used to calculate the Thermal Index (TI), was found to increase with increasing bandwidth and decreasing effective aperture of the probes. The Mechanical Index (MI), another safety indicator, was also affected, but to a lesser extent. The corrections needed were predicted using the model and successfully reduced the discrepancy as large as 30% in the determination of PII. The results of this work indicate that by accounting for hydrophones' finite aperture and correcting the value of PII, all intensities derived from the PII can be corrected for spatial averaging error. The results also point out that a caution should be exercised when comparing acoustic output data. In particular, hydrophone's frequency characteristics of the effective diameter and sensitivity are needed to correctly determine the MI, TI, and the total acoustic output power produced by an imaging transducer.

Hydrophones' effective diameter measurements as a quasi-continuous function of frequency

The spatial averaging effect is strongly dependent on the active aperture of the hydrophone probes used to measure ultrasound fields. An experimental method was developed to determine the effective diameter of the probes as a quasi-continuous function of frequency. The implementation of the method utilizes the time delay spectrometry (TDS) technique and a set of focused acoustic sources. The use of focused sources ensured plane wave conditions for the whole frequency range and TDS eliminated all the reflections from the water tank boundaries. This approach allows effective diameter of circular aperture hydrophones to be determined as a quasi-continuous function of frequency up to 40 MHz. The measurements were performed for both needles and membrane designs having nominal diameters ranging from 50 to 500 microm. The results were successfully employed in the development of spatial averaging correction algorithms. Current efforts are being focused on extension of the frequency range up to 60 MHz by using a novel measurement technique termed time gating frequency analysis.

Estimation of ultrasonic attenuation in a bone using coded excitation

This paper describes a novel approach to estimate broadband ultrasound attenuation (BUA) in a bone structure in human in vivo using coded excitation. BUA is an accepted indicator for assessment of osteoporosis. In the tested approach a coded acoustic signal is emitted and then the received echoes are compressed into brief, high amplitude pulses making use of matched filters and correlation receivers. In this way the acoustic peak pressure amplitude probing the tissue can be markedly decreased whereas the average transmitted intensity increases proportionally to the length of the code. This paper examines the properties of three different transmission schemes, based on Barker code, chirp and Golay code. The system designed is capable of generating 16 bits complementary Golay code (CGC), linear frequency modulated (LFM) chirp and 13-bit Barker code (BC) at 0.5 and 1 MHz center frequencies. Both in vivo data acquired from healthy heel bones and in vitro data obtained from human calcaneus were examined and the comparison between the results using coded excitation and two cycles sine burst is presented. It is shown that CGC system allows the effective range of frequencies employed in the measurement of broadband acoustic energy attenuation in the trabecular bone to be doubled in comparison to the standard 0.5 MHz pulse transmission. The algorithm used to calculate the pairs of Golay sequences of the different length, which provide the temporal side-lobe cancellation is also presented. Current efforts are focused on adapting the system developed for operation in pulse-echo mode; this would allow examination and diagnosis of bones with limited access such as hip bone.

Calibration of ultrasonic hydrophone probes up to 100 MHz using time gating frequency analysis and finite amplitude waves

A number of ultrasound imaging systems employs harmonic imaging to optimize the trade off between resolution and penetration depth and center frequencies as high as 15 MHz are now used in clinical practice. However, currently available measurement tools are not fully adequate to characterize the acoustic output of such nonlinear systems primarily due to the limited knowledge of the frequency responses beyond 20 MHz of the available piezoelectric hydrophone probes. In addition, ultrasound hydrophone probes need to be calibrated to eight times the center frequency of the imaging transducer. Time delay spectrometry (TDS) is capable of providing transduction factor of the probes beyond 20 MHz, however its use is in practice limited to 40 MHz. This paper describes a novel approach termed time gating frequency analysis (TGFA) that provides the transduction factor of the hydrophone probes in the frequency domain and significantly extends the quasi-continuous calibration of the probes up to 60 MHz. The verification of the TGFA data was performed using TDS calibration technique (up to 40 MHz) and a nonlinear calibration method (up to 100 MHz). The nonlinear technique was based on a novel wave propagation model capable of predicting the true pressure-time waveforms at virtually any point in the field. The spatial averaging effects introduced by the finite aperture hydrophones were also accounted for. TGFA calibration results were obtained for different PVDF probes, including needle and membrane designs with nominal diameters from 50 to 500 micro m. The results were compared with discrete calibration data obtained from an independent national laboratory and the overall uncertainty was determined to be +/-1.5 dB in the frequency range 40-60 MHz and less than +/-1 dB below 40 MHz.

Nonlinear propagation model for ultrasound hydrophones calibration in the frequency range up to 100 MHz

To facilitate the implementation and verification of the new ultrasound hydrophone calibration techniques described in the companion paper (somewhere in this issue) a nonlinear propagation model was developed. A brief outline of the theoretical considerations is presented and the model's advantages and disadvantages are discussed. The results of simulations yielding spatial and temporal acoustic pressure amplitude are also presented and compared with those obtained using KZK and Field II models. Excellent agreement between all models is evidenced. The applicability of the model in discrete wideband calibration of hydrophones is documented in the companion paper somewhere in this volume.