1
|
Meyer T, Kreft B, Bergs J, Antes E, Anders MS, Wellge B, Braun J, Doyley M, Tzschätzsch H, Sack I. Stiffness pulsation of the human brain detected by non-invasive time-harmonic elastography. Front Bioeng Biotechnol 2023; 11:1140734. [PMID: 37650041 PMCID: PMC10463728 DOI: 10.3389/fbioe.2023.1140734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/19/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction: Cerebral pulsation is a vital aspect of cerebral hemodynamics. Changes in arterial pressure in response to cardiac pulsation cause cerebral pulsation, which is related to cerebrovascular compliance and cerebral blood perfusion. Cerebrovascular compliance and blood perfusion influence the mechanical properties of the brain, causing pulsation-induced changes in cerebral stiffness. However, there is currently no imaging technique available that can directly quantify the pulsation of brain stiffness in real time. Methods: Therefore, we developed non-invasive ultrasound time-harmonic elastography (THE) technique for the real-time detection of brain stiffness pulsation. We used state-of-the-art plane-wave imaging for interleaved acquisitions of shear waves at a frequency of 60 Hz to measure stiffness and color flow imaging to measure cerebral blood flow within the middle cerebral artery. In the second experiment, we used cost-effective lineby-line B-mode imaging to measure the same mechanical parameters without flow imaging to facilitate future translation to the clinic. Results: In 10 healthy volunteers, stiffness increased during the passage of the arterial pulse wave from 4.8% ± 1.8% in the temporal parenchyma to 11% ± 5% in the basal cisterns and 13% ± 9% in the brain stem. Brain stiffness peaked in synchrony with cerebral blood flow at approximately 180 ± 30 ms after the cardiac R-wave. Line-by-line THE provided the same stiffness values with similar time resolution as high-end plane-wave THE, demonstrating the robustness of brain stiffness pulsation as an imaging marker. Discussion: Overall, this study sets the background and provides reference values for time-resolved THE in the human brain as a cost-efficient and easy-touse mechanical biomarker associated with cerebrovascular compliance.
Collapse
Affiliation(s)
- Tom Meyer
- Department of Radiology, Charité—University Medicine Berlin, Berlin, Germany
| | - Bernhard Kreft
- Department of Radiology, Charité—University Medicine Berlin, Berlin, Germany
| | - Judith Bergs
- Department of Radiology, Charité—University Medicine Berlin, Berlin, Germany
| | - Erik Antes
- Department of Radiology, Charité—University Medicine Berlin, Berlin, Germany
| | - Matthias S. Anders
- Department of Radiology, Charité—University Medicine Berlin, Berlin, Germany
| | - Brunhilde Wellge
- Department of Radiology, Charité—University Medicine Berlin, Berlin, Germany
| | - Jürgen Braun
- Institute of Medical Informatics, Charité—University Medicine Berlin, Berlin, Germany
| | - Marvin Doyley
- Hajim School of Engineering and Applied Sciences, University of Rochester, Rochester, NY, United States
| | - Heiko Tzschätzsch
- Department of Radiology, Charité—University Medicine Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité—University Medicine Berlin, Berlin, Germany
| |
Collapse
|
2
|
Martínez-Rovira I, Seksek O, Bergs J, Hirayama R, Matsufuji N, Inaniwa T, Koike S, Shimokawa T, Prezado Y, Yousef I. OC-0095 Neon minibeam radiotherapy (Ne MBRT): investigating biological mechanisms with synchrotron light. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02471-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
3
|
Prezado Y, Hirayama R, Matsufuji N, Inaniwa T, Martínez-Rovira I, Seksek O, Bertho A, Koike S, Labiod D, Pouzoulet F, Polledo L, Warfving N, Liens A, Bergs J, Shimokawa T. A Potential Renewed Use of Very Heavy Ions for Therapy: Neon Minibeam Radiation Therapy. Cancers (Basel) 2021; 13:cancers13061356. [PMID: 33802835 PMCID: PMC8002595 DOI: 10.3390/cancers13061356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 01/13/2023] Open
Abstract
Simple Summary The treatment of hypoxic tumours continues to be one of the main challenges for radiation therapy. Minibeam radiation therapy (MBRT) shows a highly promising reduction of to-xicity in normal tissue, so that very heavy ions, such as Neon (Ne) or Argon (Ar), with extremely high LET, might become applicable to clinical situations. The high LET in the target would be unrivalled to overcome hypoxia, while MBRT might limit the side effects normally preventing the use of those heavy ions in a conventional radiotherapeutic setting. The work reported in this manuscript is the first experimental proof of the remarkable reduction of normal tissue (skin) toxicities after Ne MBRT irradiations as compared to conventional Ne irradiations. This result might allow for a renewed use of very heavy ions for cancer therapy. Abstract (1) Background: among all types of radiation, very heavy ions, such as Neon (Ne) or Argon (Ar), are the optimum candidates for hypoxic tumor treatments due to their reduced oxygen enhancement effect. However, their pioneering clinical use in the 1970s was halted due to severe side effects. The aim of this work was to provide a first proof that the combination of very heavy ions with minibeam radiation therapy leads to a minimization of toxicities and, thus, opening the door for a renewed use of heavy ions for therapy; (2) Methods: mouse legs were irradiated with either Ne MBRT or Ne broad beams at the same average dose. Skin toxicity was scored for a period of four weeks. Histopathology evaluations were carried out at the end of the study; (3) Results: a significant difference in toxicity was observed between the two irradiated groups. While severe da-mage, including necrosis, was observed in the broad beam group, only light to mild erythema was present in the MBRT group; (4) Conclusion: Ne MBRT is significantly better tolerated than conventional broad beam irradiations.
Collapse
Affiliation(s)
- Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France;
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
- Correspondence:
| | - Ryochi Hirayama
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (R.H.); (N.M.); (T.I.); (S.K.); (T.S.)
| | - Naruhiro Matsufuji
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (R.H.); (N.M.); (T.I.); (S.K.); (T.S.)
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Taku Inaniwa
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (R.H.); (N.M.); (T.I.); (S.K.); (T.S.)
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Immaculada Martínez-Rovira
- Ionizing Radiation Research Group, Physics Department, Universitat Autònoma de Barcelona (UAB), E-08193 Cerdanyola del Vallès, Spain;
| | - Olivier Seksek
- Université Paris-Saclay, CNRS/IN2P3, Université de Paris, IJCLab, Pole Santé, 91405 Orsay, France;
| | - Annaïg Bertho
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France;
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Sachiko Koike
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (R.H.); (N.M.); (T.I.); (S.K.); (T.S.)
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Dalila Labiod
- Experimental Radiotherapy Platform, Translational Research Department, Institut Curie, Université Paris Saclay, 91400 Orsay, France; (D.L.); (F.P.)
| | - Frederic Pouzoulet
- Experimental Radiotherapy Platform, Translational Research Department, Institut Curie, Université Paris Saclay, 91400 Orsay, France; (D.L.); (F.P.)
| | - Laura Polledo
- AnaPath Services GmbH, Hammerstrasse 49, 4410 Liestal, Switzerland; (L.P.); (N.W.); (A.L.)
| | - Nils Warfving
- AnaPath Services GmbH, Hammerstrasse 49, 4410 Liestal, Switzerland; (L.P.); (N.W.); (A.L.)
| | - Aléthéa Liens
- AnaPath Services GmbH, Hammerstrasse 49, 4410 Liestal, Switzerland; (L.P.); (N.W.); (A.L.)
| | - Judith Bergs
- Department of Radiology Charité—Universitätsmedizin Berlin, CCM Charitéplatz 1, 10117 Berlin, Germany;
| | - Takashi Shimokawa
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (R.H.); (N.M.); (T.I.); (S.K.); (T.S.)
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| |
Collapse
|
4
|
Kreft B, Bergs J, Shahryari M, Danyel LA, Hetzer S, Braun J, Sack I, Tzschätzsch H. Cerebral Ultrasound Time-Harmonic Elastography Reveals Softening of the Human Brain Due to Dehydration. Front Physiol 2021; 11:616984. [PMID: 33505319 PMCID: PMC7830390 DOI: 10.3389/fphys.2020.616984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/09/2020] [Indexed: 01/12/2023] Open
Abstract
Hydration influences blood volume, blood viscosity, and water content in soft tissues - variables that determine the biophysical properties of biological tissues including their stiffness. In the brain, the relationship between hydration and stiffness is largely unknown despite the increasing importance of stiffness as a quantitative imaging marker. In this study, we investigated cerebral stiffness (CS) in 12 healthy volunteers using ultrasound time-harmonic elastography (THE) in different hydration states: (i) during normal hydration, (ii) after overnight fasting, and (iii) within 1 h of drinking 12 ml of water per kg body weight. In addition, we correlated shear wave speed (SWS) with urine osmolality and hematocrit. SWS at normal hydration was 1.64 ± 0.02 m/s and decreased to 1.57 ± 0.04 m/s (p < 0.001) after overnight fasting. SWS increased again to 1.63 ± 0.01 m/s within 30 min of water drinking, returning to values measured during normal hydration (p = 0.85). Urine osmolality at normal hydration (324 ± 148 mOsm/kg) increased to 784 ± 107 mOsm/kg (p < 0.001) after fasting and returned to normal (288 ± 128 mOsm/kg, p = 0.83) after water drinking. SWS and urine osmolality correlated linearly (r = -0.68, p < 0.001), while SWS and hematocrit did not correlate (p = 0.31). Our results suggest that mild dehydration in the range of diurnal fluctuations is associated with significant softening of brain tissue, possibly due to reduced cerebral perfusion. To ensure consistency of results, it is important that cerebral elastography with a standardized protocol is performed during normal hydration.
Collapse
Affiliation(s)
- Bernhard Kreft
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bergs
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mehrgan Shahryari
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Stefan Hetzer
- Bernstein Center of Advanced Neuroimaging, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Braun
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heiko Tzschätzsch
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
5
|
Kreft B, Tzschätzsch H, Schrank F, Bergs J, Streitberger KJ, Wäldchen S, Hetzer S, Braun J, Sack I. Corrigendum to 'TIME-RESOLVED RESPONSE OF CEREBRAL STIFFNESS TO HYPERCAPNIA IN HUMANS' [Ultrasound Med Biol 46 (2020) 936-43]. Ultrasound Med Biol 2020; 46:1551. [PMID: 32143860 DOI: 10.1016/j.ultrasmedbio.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Bernhard Kreft
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heiko Tzschätzsch
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Schrank
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bergs
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Stephan Wäldchen
- Department of Mathematics, Technical University Berlin, Berlin, Germany
| | - Stefan Hetzer
- Berlin Center for Advanced Neuroimaging (BCAN), Berlin, Germany
| | - Jürgen Braun
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
6
|
Kreft B, Tzschätzsch H, Schrank F, Bergs J, Streitberger KJ, Wäldchen S, Hetzer S, Braun J, Sack I. Time-Resolved Response of Cerebral Stiffness to Hypercapnia in Humans. Ultrasound Med Biol 2020; 46:936-943. [PMID: 32001088 DOI: 10.1016/j.ultrasmedbio.2019.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
Cerebral blood flow, cerebral stiffness (CS) and intracranial pressure are tightly linked variables of cerebrovascular reactivity and cerebral autoregulation. Transtemporal ultrasound time-harmonic elastography was used for rapid measurement of CS changes in 10 volunteers before, during and after administration of a gas mixture of 95% O2 and 5% CO2 (carbogen). Within the first 2.2 ± 2.0 min of carbogen breathing, shear wave speed determined as a surrogate parameter of CS increased from 1.57 ± 0.04 to 1.66 ± 0.05 m/s (p < 0.01) in synchrony with end-tidal CO2 while post-hypercapnic CS recovery was delayed by 2.7 ± 1.4 min in relation to end-tidal CO2. Our results indicate that CS is highly sensitive to changes in CO2 levels of inhaled air. Possible mechanisms underlying the observed CS changes might be associated with cerebrovascular reactivity, cerebral blood flow adaptation and intracranial regulation, all of which are potentially relevant for future diagnostic applications of transtemporal time-harmonic elastography in a wide spectrum of neurologic diseases.
Collapse
Affiliation(s)
- Bernhard Kreft
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heiko Tzschätzsch
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Schrank
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bergs
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Stephan Wäldchen
- Department of Mathematics, Technical University Berlin, Berlin, Germany
| | - Stefan Hetzer
- Berlin Center for Advanced Neuroimaging (BCAN), Berlin, Germany
| | - Jürgen Braun
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
7
|
Chae WH, Niesel K, Schulz M, Klemm F, Joyce JA, Prümmer M, Brill B, Bergs J, Rödel F, Pilatus U, Sevenich L. Evaluating Magnetic Resonance Spectroscopy as a Tool for Monitoring Therapeutic Response of Whole Brain Radiotherapy in a Mouse Model for Breast-to-Brain Metastasis. Front Oncol 2019; 9:1324. [PMID: 31828043 PMCID: PMC6890861 DOI: 10.3389/fonc.2019.01324] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 11/13/2019] [Indexed: 01/06/2023] Open
Abstract
Brain metastases are the most common intracranial tumor in adults and are associated with poor patient prognosis and median survival of only a few months. Treatment options for brain metastasis patients remain limited and largely depend on surgical resection, radio- and/or chemotherapy. The development and pre-clinical testing of novel therapeutic strategies require reliable experimental models and diagnostic tools that closely mimic technologies that are used in the clinic and reflect histopathological and biochemical changes that distinguish tumor progression from therapeutic response. In this study, we sought to test the applicability of magnetic resonance (MR) spectroscopy in combination with MR imaging to closely monitor therapeutic efficacy in a breast-to-brain metastasis model. Given the importance of radiotherapy as the standard of care for the majority of brain metastases patients, we chose to monitor the post-irradiation response by magnetic resonance spectroscopy (MRS) in combination with MR imaging (MRI) using a 7 Tesla small animal scanner. Radiation was applied as whole brain radiotherapy (WBRT) using the image-guided Small Animal Radiation Research Platform (SARRP). Here we describe alterations in different metabolites, including creatine and N-acetylaspartate, that are characteristic for brain metastases progression and lactate, which indicates hypoxia, while choline levels remained stable. Radiotherapy resulted in normalization of metabolite levels indicating tumor stasis or regression in response to treatment. Our data indicate that the use of MR spectroscopy in addition to MRI represents a valuable tool to closely monitor not only volumetrical but also metabolic changes during tumor progression and to evaluate therapeutic efficacy of intervention strategies. Adapting the analytical technology in brain metastasis models to those used in clinical settings will increase the translational significance of experimental evaluation and thus contribute to the advancement of pre-clinical assessment of novel therapeutic strategies to improve treatment options for brain metastases patients.
Collapse
Affiliation(s)
- Woon Hyung Chae
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt, Germany
| | - Katja Niesel
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt, Germany
| | - Michael Schulz
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt, Germany.,Faculty of Biological Sciences, Goethe-University, Frankfurt, Germany
| | - Florian Klemm
- Department of Oncology and Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Johanna A Joyce
- Department of Oncology and Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | | | - Boris Brill
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt, Germany
| | - Judith Bergs
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Franz Rödel
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute, Goethe University, Frankfurt am Main, Germany
| | - Ulrich Pilatus
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Lisa Sevenich
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute, Goethe University, Frankfurt am Main, Germany
| |
Collapse
|
8
|
Prezado Y, Jouvion G, Guardiola C, Gonzalez W, Juchaux M, Bergs J, Nauraye C, Labiod D, De Marzi L, Pouzoulet F, Patriarca A, Dendale R. Tumor Control in RG2 Glioma-Bearing Rats: A Comparison Between Proton Minibeam Therapy and Standard Proton Therapy. Int J Radiat Oncol Biol Phys 2019; 104:266-271. [PMID: 30703513 DOI: 10.1016/j.ijrobp.2019.01.080] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Proton minibeam radiation therapy (pMBRT) is a novel radiation therapy approach that exploits the synergies of proton therapy with the gain in normal tissue preservation observed upon irradiation with narrow, spatially fractionated, beams. The net gain in normal tissue sparing that has been shown by pMBRT may lead to the efficient treatment of very radioresistant tumors, which are currently mostly treated palliatively. The aim of this study was to perform an evaluation of the tumor effectiveness of proton minibeam radiation therapy for the treatment of RG2 glioma-bearing rats. METHODS AND MATERIALS Two groups (n = 9) of RG2 glioma-bearing rats were irradiated with either standard proton therapy or with pMBRT, with a dose prescription of 25 Gy in 1 fraction. The animals were followed up for a maximum of 6 months. At the end of the study, histopathological studies were performed to assess both the tumor presence and the possible side effects. RESULTS Tumor control was achieved in the 2 irradiated series, with superior survival in the pMBRT group compared with the standard proton therapy group. Long-term (>170 days) survival rates of 22% and 67% were obtained in the standard proton therapy and pMBRT groups, respectively. No tumor was observed in the histopathological analysis. Although animals with long-term survival in the standard radiation therapy exhibit substantial brain damage, including marked radionecrosis, less severe toxicity was observed in the pMBRT group. CONCLUSIONS pMBRT offers a significant increase in the therapeutic index of brain tumors: The majority of the glioma-bearing rats (67%) survived 6 months with less severe side effects.
Collapse
Affiliation(s)
- Yolanda Prezado
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, Orsay, France.
| | - Gregory Jouvion
- Institut Pasteur, Neuropathologie Experimentale, Paris, France
| | - Consuelo Guardiola
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, Orsay, France
| | - Wilfredo Gonzalez
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, Orsay, France
| | - Marjorie Juchaux
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, Orsay, France
| | - Judith Bergs
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS), Universités Paris 11 and Paris 7, Campus d'Orsay, Orsay, France
| | - Catherine Nauraye
- Institut Curie, PSL Research University, Radiation Oncology Department, Centre de Protonthérapie d'Orsay, Orsay, France
| | - Dalila Labiod
- Institut Curie, PSL Research University, Translational Research Department, Experimental Radiotherapy Platform, Orsay, France
| | - Ludovic De Marzi
- Institut Curie, PSL Research University, Radiation Oncology Department, Centre de Protonthérapie d'Orsay, Orsay, France
| | - Frederic Pouzoulet
- Institut Curie, PSL Research University, Translational Research Department, Experimental Radiotherapy Platform, Orsay, France
| | - Annalisa Patriarca
- Institut Curie, PSL Research University, Radiation Oncology Department, Centre de Protonthérapie d'Orsay, Orsay, France
| | - Remi Dendale
- Institut Curie, PSL Research University, Radiation Oncology Department, Centre de Protonthérapie d'Orsay, Orsay, France
| |
Collapse
|
9
|
Tzschätzsch H, Kreft B, Schrank F, Bergs J, Braun J, Sack I. In vivo time-harmonic ultrasound elastography of the human brain detects acute cerebral stiffness changes induced by intracranial pressure variations. Sci Rep 2018; 8:17888. [PMID: 30559367 PMCID: PMC6297160 DOI: 10.1038/s41598-018-36191-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/15/2018] [Indexed: 12/19/2022] Open
Abstract
Cerebral stiffness (CS) reflects the biophysical environment in which neurons grow and function. While long-term CS changes can occur in the course of chronic neurological disorders and aging, little is known about acute variations of CS induced by intracranial pressure variations. Current gold standard methods for CS and intracranial pressure such as magnetic resonance elastography and direct pressure recordings are either expensive and slow or invasive. The study objective was to develop a real-time method for in vivo CS measurement and to demonstrate its sensitivity to physiological aging and intracranial pressure variations induced by the Valsalva maneuver in healthy volunteers. We used trans-temporal ultrasound time-harmonic elastography (THE) with external shear-wave stimulation by continuous and superimposed vibrations in the frequency range from 27 to 56 Hz. Multifrequency wave inversion generated maps of shear wave speed (SWS) as a surrogate maker of CS. On average, cerebral SWS was 1.56 ± 0.08 m/s with a tendency to reduce with age (R = -0.76, p < 0.0001) while Valsalva maneuver induced an immediate stiffening of the brain as reflected by a 10.8 ± 2.5% increase (p < 0.0001) in SWS. Our results suggest that CS is tightly linked to intracranial pressure and might be used in the future as non-invasive surrogate marker for intracranial pressure, which otherwise requires invasive measurements.
Collapse
Affiliation(s)
- Heiko Tzschätzsch
- Department of Radiology, , Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bernhard Kreft
- Department of Radiology, , Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Schrank
- Department of Radiology, , Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bergs
- Department of Radiology, , Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Braun
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, , Charité - Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
10
|
Prezado Y, Jouvion G, Hardy D, Patriarca A, Nauraye C, Bergs J, González W, Guardiola C, Juchaux M, Labiod D, Dendale R, Jourdain L, Sebrie C, Pouzoulet F. Proton minibeam radiation therapy spares normal rat brain: Long-Term Clinical, Radiological and Histopathological Analysis. Sci Rep 2017; 7:14403. [PMID: 29089533 PMCID: PMC5663851 DOI: 10.1038/s41598-017-14786-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/16/2017] [Indexed: 11/16/2022] Open
Abstract
Proton minibeam radiation therapy (pMBRT) is a novel strategy for minimizing normal tissue damage resulting from radiotherapy treatments. This strategy partners the inherent advantages of protons for radiotherapy with the gain in normal tissue preservation observed upon irradiation with narrow, spatially fractionated beams. In this study, whole brains (excluding the olfactory bulb) of Fischer 344 rats (n = 16) were irradiated at the Orsay Proton Therapy Center. Half of the animals received standard proton irradiation, while the other half were irradiated with pMBRT at the same average dose (25 Gy in one fraction). The animals were followed-up for 6 months. A magnetic resonance imaging (MRI) study using a 7-T small-animal MRI scanner was performed along with a histological analysis. Rats treated with conventional proton irradiation exhibited severe moist desquamation, permanent epilation and substantial brain damage. In contrast, rats in the pMBRT group exhibited no skin damage, reversible epilation and significantly reduced brain damage; some brain damage was observed in only one out of the eight irradiated rats. These results demonstrate that pMBRT leads to an increase in normal tissue resistance. This net gain in normal tissue sparing can lead to the efficient treatment of very radio-resistant tumours, which are currently mostly treated palliatively.
Collapse
Affiliation(s)
- Yolanda Prezado
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS); Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France.
| | - Gregory Jouvion
- Institut Pasteur, Histopathologie Humaine et Modèles Animaux, Institut Pasteur, 28 Rue du Docteur Roux, 75015, Paris, France
| | - David Hardy
- Institut Pasteur, Histopathologie Humaine et Modèles Animaux, Institut Pasteur, 28 Rue du Docteur Roux, 75015, Paris, France
| | - Annalisa Patriarca
- Institut Curie - Centre de Protonthérapie d'Orsay, Campus Universitaire, Bât. 101, Orsay, 91898, France
| | - Catherine Nauraye
- Institut Curie - Centre de Protonthérapie d'Orsay, Campus Universitaire, Bât. 101, Orsay, 91898, France
| | - Judith Bergs
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS); Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Wilfredo González
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS); Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Consuelo Guardiola
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS); Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Marjorie Juchaux
- Laboratoire d'Imagerie et Modélisation en Neurobiologie et Cancérologie (IMNC), Centre National de la Recherche Scientifique (CNRS); Universités Paris 11 and Paris 7, Campus d'Orsay, 91405, Orsay, France
| | - Dalila Labiod
- Institut Curie, PSL Research University, Translational Research Department, Experimental Radiotherapy Platform, Orsay, France
- Paris Sud University, Paris -Saclay University, 91405, Orsay, France
| | - Remi Dendale
- Institut Curie - Centre de Protonthérapie d'Orsay, Campus Universitaire, Bât. 101, Orsay, 91898, France
| | - Laurène Jourdain
- Imagerie par Résonance Magnétique Médicale et Multi-modalités (IR4M-UMR8081), Université Paris Sud, 91405, Orsay, France
| | - Catherine Sebrie
- Imagerie par Résonance Magnétique Médicale et Multi-modalités (IR4M-UMR8081), Université Paris Sud, 91405, Orsay, France
| | - Frederic Pouzoulet
- Institut Curie, PSL Research University, Translational Research Department, Experimental Radiotherapy Platform, Orsay, France
- Paris Sud University, Paris -Saclay University, 91405, Orsay, France
| |
Collapse
|
11
|
Prezado Y, Jouvion G, Patriarca A, Nauraye C, Heinrich S, Bergs J, Labiod D, Jourdain L, Gonzalez-Infantes W, Juchaux M, Sebrie C, Pouzoulet F. OC-0246: Proton minibeam radiation therapy spares normal rat brain. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30689-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
12
|
Affiliation(s)
- D. Vandijck
- Research Group Patient Safety & Health Economics, Hasselt University
- Department of Public Health, Ghent University
| | - J. Bergs
- Research Group Patient Safety & Health Economics, Hasselt University
| | | |
Collapse
|
13
|
Affiliation(s)
- J. Bergs
- Research Group Patient Safety & Health Economics, faculty of Business Economics, Hasselt University, Hasselt, Belgium
| | - J. Hellings
- Research Group Patient Safety & Health Economics, faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - I. Cleemput
- Research Group Patient Safety & Health Economics, faculty of Business Economics, Hasselt University, Hasselt, Belgium
| | - P. Simons
- Research Group Patient Safety & Health Economics, faculty of Business Economics, Hasselt University, Hasselt, Belgium
| | - Ö. Zurel
- Research Group Patient Safety & Health Economics, faculty of Business Economics, Hasselt University, Hasselt, Belgium
| | - S. Vertriest
- Research Group Patient Safety & Health Economics, faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - D. Vandijck
- Research Group Patient Safety & Health Economics, faculty of Business Economics, Hasselt University, Hasselt, Belgium
- Department of Public Health and Health Economics,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
14
|
Verschoore T, Vandecandelaere S, Vandecandelaere P, Vanderplancke T, Bergs J. Risk factors for complications and mortality related to endoscopic procedures in adults. Acta Gastroenterol Belg 2016; 79:39-46. [PMID: 26852762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND AIM The objective of this study is to identify and describe risk factors and complications in endoscopic procedures. METHODS This review presents the complications and the accompanying risk factors that were described in the selected full-text articles. The relevant full-text articles were found in Pubmed, ISI Web of Science and the CINAHL database. RESULTS The search resulted in 238 abstracts, 50 of which were finally selected for full-text analysis. The different types of endoscopic procedures each have specific complications, but bleeding and perforation occur in all procedures. It was found that bleeding, perforation, cardiovascular and respiratory complications were common complications.Furthermore, morbidity and mortality have been associated with risk factors such as older age, high ASA class and sedation. CONCLUSION Endoscopy is not without risk, although the prevalence of complications is low. Most complications seenin this analysis, are linked to known risk factors. Some complications might be preventable or avoidable, given a more systematic and comprehensive approach pre-, per- and postprocedural. The creation and implementation of an endoscopic safety checklist could be an -important supportive tool in lowering complications.
Collapse
|
15
|
Bergs J, Hellings J, Cleemput I, Vandijck D. The World Health Organisation's Surgical Safety Checklist in Belgian Operating Theatres: a Content-Driven Evaluation. Acta Chir Belg 2015; 115:147-54. [PMID: 26021949 DOI: 10.1080/00015458.2015.11681085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE It is unclear which items of the WHO surgical safety checklist are most -crucial for producing its associated benefits. Thoughtless modification, especially removing items, can therefore potentially lead to reduced effectiveness of the instrument. This study describes the modifications made by Belgian hospitals. METHODS An online survey was used to find out which checklists are used. An expert panel conducted a content-driven evaluation of the retrieved checklists by verifying the presence of the WHO items and evaluating any modifications made. RESULTS All hospitals participating in the survey (n=36) reported the use of a surgical safety checklist. Based on self-report, 69.4% (n=25) of hospitals reported to use all WHO items. The expert panel determined that 17.1% (n=6) of checklists included all WHO items. Inclusion ranged from 7 to 22 items (mean=16.6, Std. Dev.=4.48). Detailing on the functional parts of the checklist, 48.6% (n=17) of checklists contained all sign-in items, 25.7% (n=9) contained all time-out items and 37.1% (n=13) enclosed all sign-out items. Sixty percent (n=21) of checklists added items not -mentioned in the original WHO checklist. CONCLUSIONS The modifications made to the WHO checklist vary between hospitals. Only a small number of hospitals included all 22 WHO items. It is unknown whether these modified checklists will be equally effective in decreasing the number of postoperative complications, including mortality. More detailed recommendations and guidance regarding the modification of the WHO surgical checklist is required.
Collapse
|
16
|
Vandijck D, Bergs J. The WHO Surgical Safety Checklist : an Innovative or an Irrelevant Tool ? Acta Chir Belg 2014; 114:225-227. [PMID: 26021415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- D Vandijck
- Research Group Patient Safety & Health Economics, Hasselt University, Hasselt, Belgium
| | | |
Collapse
|
17
|
Bergs J, Hellings J, Cleemput I, Simons P, Zurel Ö, Vertriest S, Vandijck D. Surgical safety checklists : an update. Acta Chir Belg 2014; 114:219-224. [PMID: 26021414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Surgical safety checklists aim to improve patient safety by prompting the attention of the surgical team towards critical steps during the operation. The checklist's items are aimed to improve compliance with proven interventions, and to facilitate multidisciplinary communication and teamwork. Based on the current literature, corroborated by systematic reviews and meta-analysis, surgical safety checklists have a positive impact on communication and reduce postoperative complications including mortality. However, despite their effectiveness, the implementation of these checklists is not straightforward. Several determinants leading to behaviour were checklists are checked but not properly executed have been highlighted. As surgical safety checklists are in essence complex sociological interventions, they must be implemented accordingly. Key factors for the implementation of these checklists have been suggested in the literature, although, the most profound way of implementation remains unclear.
Collapse
Affiliation(s)
- J Bergs
- Research Group Patient Safety & Health Economics, faculty of Business Economics, Hasselt University, Hasselt, Belgium
| | | | | | | | | | | | | |
Collapse
|
18
|
Bergs J, Hellings J, Cleemput I, Zurel Ö, De Troyer V, Van Hiel M, Demeere JL, Claeys D, Vandijck D. Systematic review and meta-analysis of the effect of the World Health Organization surgical safety checklist on postoperative complications. Br J Surg 2014; 101:150-8. [DOI: 10.1002/bjs.9381] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2013] [Indexed: 11/07/2022]
Abstract
Abstract
Background
The World Health Organization (WHO) surgical safety checklist (SSC) was introduced to improve the safety of surgical procedures. This systematic review evaluated current evidence regarding the effectiveness of this checklist in reducing postoperative complications.
Methods
The Cochrane Library, MEDLINE, Embase and CINAHL were searched using predefined inclusion criteria. The systematic review included all original articles reporting a quantitative measure of the effect of the WHO SSC on postoperative complications. Data were extracted for postoperative complications reported in at least two studies. A meta-analysis was conducted to quantify the effect of the WHO SSC on any complication, surgical-site infection (SSI) and mortality. Yule's Q contingency coefficient was used as a measure of the association between effectiveness and adherence with the checklist.
Results
Seven of 723 studies identified met the inclusion criteria. There was marked methodological heterogeneity among studies. The impact on six clinical outcomes was reported in at least two studies. A meta-analysis was performed for three main outcomes (any complication, mortality and SSI). Risk ratios for any complication, mortality and SSI were 0·59 (95 per cent confidence interval 0·47 to 0·74), 0·77 (0·60 to 0·98) and 0·57 (0·41 to 0·79) respectively. There was a strong correlation between a significant decrease in postoperative complications and adherence to aspects of care embedded in the checklist (Q = 0·82; P = 0·042).
Conclusion
The evidence is highly suggestive of a reduction in postoperative complications and mortality following implementation of the WHO SSC, but cannot be regarded as definitive in the absence of higher-quality studies.
Collapse
Affiliation(s)
- J Bergs
- Department of Patient Safety and Health Economics, Faculty of Business Economics, Hasselt, Belgium
| | - J Hellings
- Patient Safety Group, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - I Cleemput
- Department of Patient Safety and Health Economics, Faculty of Business Economics, Hasselt, Belgium
| | - Ö Zurel
- Department of Patient Safety and Health Economics, Faculty of Business Economics, Hasselt, Belgium
| | | | - M Van Hiel
- Operating Theatre, Imelda Hospital, Bonheiden, Belgium
| | - J-L Demeere
- Department of Anaesthesiology, Kliniek St Jan, Brussels, Belgium
| | - D Claeys
- Department of Surgery, AZ Maria Middelares, Ghent, Belgium
| | - D Vandijck
- Department of Patient Safety and Health Economics, Faculty of Business Economics, Hasselt, Belgium
- Department of Public Health and Health Economics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
19
|
Vandijck D, Bergs J. The WHO surgical safety checklist: an innovative or an irrelevant tool? Acta Anaesthesiol Belg 2014; 65:51-53. [PMID: 25223163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
20
|
Bergs J, Zurel O, Cleemput I, Hellings J, Vandijck D. The implementation of a perioperative checklist increases patients' perioperative safety and staff satisfaction. Acta Anaesthesiol Scand 2013; 57:675. [PMID: 23078596 DOI: 10.1111/j.1399-6576.2012.02795.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
21
|
Bergs J, Haveman J, Ten Cate R, Medema J, Franken N, van Bree C. Effect of 41°C and 43°C on cisplatin radiosensitization in two human carcinoma cell lines with different sensitivities for cisplatin. Oncol Rep 2007. [DOI: 10.3892/or.18.1.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
22
|
Bergs J, Kaden P, Birkle G, Richter H. ZELLADHÄSIONSUNTERSUCHUNGEN AUF POLYMEREN MITTELS ZENTRIFUGATION IN VITRO. BIOMED ENG-BIOMED TE 1991. [DOI: 10.1515/bmte.1991.36.s1.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
23
|
Birkle G, Kaden P, Bergs J, Mittermayer C. TISSUE CULTURE ADHESIVE SYSTEM FOR BIOMATERIALS - TCAB. BIOMED ENG-BIOMED TE 1991. [DOI: 10.1515/bmte.1991.36.s1.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|