Solvation of cationic copper clusters in molecular hydrogen

Multiply charged superfluid helium nanodroplets are utilized to facilitate the growth of cationic copper clusters (Cun+, where n = 1-8) that are subsequently solvated with up to 50 H2 molecules. Production of both pristine and protonated cationic Cu clusters are detected mass spectrometrically. A joint effort between experiment and theory allows us to understand the nature of the interactions determining the bonding between pristine and protonated Cu+ and Cu2+ cations and molecular hydrogen. The analysis reveals that in all investigated cationic clusters, the primary solvation shell predominantly exhibits a covalent bonding character, which gradually decreases in strength, while for the subsequent shells an exclusive non-covalent behaviour is found. Interestingly, the calculated evaporation energies associated with the first solvation shell markedly surpass thermal values, positioning them within the desirable range for hydrogen storage applications. This comprehensive study not only provides insights into the solvation of pristine and protonated cationic Cu clusters but also sheds light on their unique bonding properties.

3D electro-anatomical mapping to guide conduction system pacing in complex cardiac anatomies

Background

Conduction System Pacing (CSP) includes both His Bundle Pacing (HBP) and Left Bundle Branch Pacing (LBBP). It guarantees physiological cardiac activation and it is essential to avoid pacing-induced dyssynchrony. Markedly dilated atria, up-grading to CRT, and congenital cardiopathies still represent complex anatomical scenarios in which the available tools could often result inadequate and graved by suboptimal results.

Objective

To evaluate the feasibility and effectiveness of 3D electro-anatomical mapping (EAM) to guide CSP (both HBP and LBBP) in patients with characteristics that allows “a priori” classification as complex anatomical scenario with low probability of success using only fluoroscopic guidance and available tools. Left atrium area >40 cm2; post-PICM up-grading and congenital heart disease were considered signs of anatomical complexity.

Methods and results

The study includes 25 patients (19 males, mean age 76–11 years; mean baseline EF 34.2–12.6%; 17 BBB; 5 post-PICM up-grading), candidates for CSP. 16 and 9 were respectively implanted with PM and ICD (13/12 dual/three-chamber devices). CARTO system was used in 6 ptss and EnsiteTM Precision in 19. EAM involved reconstruction of the right atrium and sub-tricuspid septum with the use of a decapolar catheter. Several “tags” have been placed on the His signals, in order to reconstruct the “His Cloud” and distinguish within it the proximal, medium, and distal area (Fig. 1). The sub-tricuspid septum was always reconstructed so that intra-procedurally operator could easily move from HBP to LBBP based on electrical parameters or paced QRS morphology. The mapping catheter was removed after the mapping phase and replaced with the pacing lead. Both exposed fixed screw 3830 leads and standard stylet-driven leads were used. HBP was achieved in 10 pts and LBBP in 13 pts. Three failures were resolved by CS lead implant. The time spend for His cloud mapping was 18±7 min. The mean threshold was 1.1±0.5 V; sensing 11.6±9.3 mV and impedance 786±339 ohm. Baseline QRS 155±19 ms and paced QRS 119±7 ms. In cases of LBBP we were also able to measure on the EAM map the depth of the catheter within the septum, resulting in 11.5±3.1 mm and the distance of the initial screw site from the His of 26.5±10.3 mm.

Conclusions

The electro-anatomical mapping allows the accurate reconstruction of “His cloud” by properly distinguishing proximal, middle, distal His. The sub-tricuspid zone of the interventricular septum is also reconstructed in high definition, so that intra-procedurally it is possible to easily move from HBP to LBBP and vice-versa based on the electrical parameters and paced QRS morphology. This method appears safe and effective even in complex cardiac anatomies possibly saving time and fluoroscopy use. The tags on the His cloud and sub-tricuspid septum can satisfactorily guide lead placement with high reproducibly.

Funding Acknowledgement

Type of funding sources: None. Figure 1. 3D-EAM used to guide HBP implant

Left bundle branch pacing: 2 year single-centre experience

Background

Left Bundle Branch Pacing (LBBP) ensures a physiologic ventricular activation and shows better electrical parameters compared to His bundle pacing (HBP). A growing body of experience is encouraging a large applicability.

Objective

To analyse feasibility and technical outcomes of LBBP in the daily clinical practice.

Methods

During 2019 and 2020, 132 patients (mean age 79±10 years; 72 males) with standard indication for pacing, received the lead deeply intraseptal aiming to pace the left bundle. The indication for pacing were AV block 72 (55%) pts, SND 14 (11%), AF and slow ventricular rate 21 (16%), ablate&pace in 4 (3%); HF in 10 (7.5%), PICM 6 (4%) pts, lead revision in 5 (3.5%). 75% of pts had ischemic cardiopathy; 82% hypertension, 30% diabetes and 21% severe kidney disease. Baseline QRS was 141±38 ms and 68% of pts had bundle branch block. The basal mean EF 49±15%. 91 (69%) of the pts were in sinus rhythm at implant. Criteria for LBBP were: RBB morphology in V1 together with left ventricular activation time (LVAT)<80 ms in V6. Final lead position was always confirmed with injection of 5 ml of dye contrast in left anterior oblique view.

Results

The lead was successfully implanted in the left bundle in 129 (97,7%) patients. In the remaining 3 patients the cathode only penetrated the septum. In 90 cases LBBP was the first choice, in the remaining 42 patients LBBP was aimed after unsatisfactory HBP (His threshold>2V or paced QRS>140 ms). In 107 cases we utilized the 3830 4Fr lumenless lead; in 25 cases the stylet-driven 6 Fr leads. The LBBP lead was connected to the RV port in the 92 dual-chamber PMs; in the LV port in the 22 three-chamber devices as part of cardiac resynchronization therapy; in the only port in 18 single-chamber PM. Mean fluoroscopy time was 10±6 min including implant of all leads. Electrical parameters were highly favourable (R wave sensing 10,5±5 mV; threshold 0,9±0,2 V@0,5 ms; impedance 829±234 ohm). Paced QRS duration was 114±20 ms (P<0.005). The devices were checked 48 hours after implant and 1 month later. Thereafter were remotely monitored. At the 1-month in clinic interrogation all LB lead showed good performance and QRS morphology and duration like the post implant one (115±21 ms). Mean VP% was 81% and mean AP% 28%. VP ≥90% was detected in 42 (32%) of patients. Chronic AF (AT/AF 100%) in 24 (18%) of patients. In 3 cases the LB lead showed early dislodgement requiring lead revision (1 macroscopic dislodgement and 2 rise in threshold), all of them within 7 days after implant.

Conclusion

The new technique of pacing the left bundle of the conduction system (LBBP), is safe and feasible in the clinical practice. It is applicable in all pacing indications including heart failure and resynchronization. In our experience lead dislodgement were 2,2% (3/132, all in the first week after implant) whereas paced QRS duration was significantly shortened and ejection fraction remained normal.

Funding Acknowledgement

Type of funding sources: None.

Selectra 3D- guided conduction system pacing: single-center experience

Background

Conduction system pacing (CSP)is becoming increasingly popular thanks to the ability to both maintain physiological electrical activation in patients with narrow QRS and restore ventricular synchrony in patients with bundle branch block (BBB). The Selectra3D introducer is a new tool able to support the correct positioning and screwing of the catheter on the bundle of His (HBP) or on the left branch (LBBP). It does exist in 3 different shapes: S, M, L (Fig. 1) based on the radius of main curvature. The internal diameter of 7.3 Fr allows it to support both the 3830 lumen-less catheter historically used for CSP, as well as standard 6Fr stylet-driven leads.

Objective

To evaluate the effectiveness of the Selectra3D introducer for CSP (including both HBP and LBBP), considering the procedural success rate and the lead stability (stability of electrical parameters or need for implant revision) in the medium-term follow-up.

Methods and results

The Selectra3D introducer was used in 56 patients' candidates for CSP (mean age 80±6 years). Pacing indications included A-V block in 21 patients, AF with slow ventricular response in 9 patients; SND in 8 patients and HF and severe ventricular dysfunction in 18 patients (of which 4 were PICM). The mean baseline EF was 40±15%. A PM was implanted in 40 patients and an ICD in 16. A standard stylet-driven lead was used in 48 cases, a fixed exposed screw lead was used in 8 patients. HBP was obtained in 21 cases and LBBP in 30 cases, while in 5 cases (8.9%) neither HBP nor LBBP could be obtained. Implants were performed via a left-sided approach in 55 cases and a right-sided approach in 1 case. The baseline QRS duration was 144±38 ms and the paced QRS duration was 118±21 ms. The electrical parameters were optimal with sensing 8.7±8 mV; impedance 625±276 ohm; threshold 1±0.5 V. During follow-up, 2 lead dislodgement (3.9%) (1 HBP and 1 LBBP) were recorded, both within 7 days after implantation. All the others showed stability of the electrical parameters at a mean follow-up of 8.4±4.2 months.

Conclusions

The new Selectra3D introducer supports effectively and safely the lead implant on conduction system catheters (HBP and LBBP), allowing the implant of both exposed fixed screw leads and standard stylet-driven leads, leading to procedural success>90%. The electrical parameters were optimal at implantation and remained stable during follow-up.

Funding Acknowledgement

Type of funding sources: None. Figure 1

Impact of the SARS-CoV2 pandemic dissemination on the management of neuroendocrine neoplasia in Italy: a report from the Italian Association for Neuroendocrine Tumors (Itanet)

INTRODUCTION

The organization of the healthcare system has significantly changed after the recent COVID-19 outbreak, with a negative impact on the management of oncological patients. The present survey reports data collected by the Italian Association for Neuroendocrine Tumors on the management of patients with neuroendocrine neoplasia (NEN) during the pandemic dissemination.

METHODS

A survey with 57 questions was sent to NEN-dedicated Italian centers regarding the management of patients in the period March 9, 2020, to May 9, 2020 RESULTS: The main modification in the centers' activity consisted of decreases in newly diagnosed NEN patients (- 76.8%), decreases in performed surgical procedures (- 58%), delays to starting peptide receptor radionuclide therapy (45.5%), postponed/canceled follow-up examinations (26%), and canceled multidisciplinary teams' activity (20.8%). A low proportion of centers (< 10%) reported having to withdraw systemic anti-tumor medical treatment due to concerns about the pandemic situation, whereas PRRT was withdrawn from no patients.

CONCLUSION

Although the COVID-19 outbreak induced the centers to reduce some important activities in the management of NEN patients, the Italian network was able to provide continuity in care without withdrawing anti-tumor treatment for the majority of patients.

Aggregation of coronene: the effect of carboxyl and amine functional groups

The aggregation of coronene is relevant to understand the formation of carbon nanomaterials, including graphene quantum dots (GQDs) that show exceptional photophysical properties. This article evaluates the influence of carboxyl and amine substituting groups on the aggregation of coronene by performing a global optimization study based on a new potential energy surface. The structures of clusters with substituted coronene are similar to those formed by un-substituted monomers, that is, stacked (non-stacked) motifs are favoured for small-size (large-size) clusters. Nonetheless, the presence of carboxyl and amine groups leads to an increase of the number of local minima of comparable energy. The clusters with substituted monomers have also shown to enhance the attractive component interaction, which can be attributed to weak induction and charge transfer effects and to stronger electrostatic contributions. Moreover, the calculated height of magic-number structures of the clusters in this work is compatible with the morphology of the GQDs reported in the literature.

Aggregation enhancement of coronene molecules by seeding with alkali-metal ions

Microsolvation constitutes the first step in the formation of cluster structures of molecules that surround a solute in the bulk and it allows for a deep insight into the relationship between the structure of the solvation shells and other physical properties. We propose semiempirical potential energy functions that are able to describe the interaction between K+ or Cs+ with coronene. Such functions were calibrated through the comparison with accurate estimations of the interaction between the cation and the planar hydrocarbon, obtained by means of ab initio electronic-structure calculations. By employing the potential energy functions and an evolutionary algorithm (EA), we have investigated the structure and energetics of the clusters resulting from the microsolvation of either K+ or Cs+ with coronene molecules. The reliability of the results for smaller clusters was checked by performing geometry re-optimization exploiting a suitable DFT level of theory. This has allowed for the characterization of the first solvation shells of planar molecules of coronene around an alkali-metal ion. It has also been found that the presence of metal ion impurities considerably enhances the formation of small coronene clusters leading to much stronger binding energies for heterogeneous with respect to homogeneous aggregates. These clusters could represent relevant species involved in the early stages of soot nucleation.

A global optimization perspective on molecular clusters

Although there is a long history behind the idea of chemical structure, this is a key concept that continues to challenge chemists. Chemical structure is fundamental to understanding most of the properties of matter and its knowledge for complex systems requires the use of state-of-the-art techniques, either experimental or theoretical. From the theoretical view point, one needs to establish the interaction potential among the atoms or molecules of the system, which contains all the information regarding the energy landscape, and employ optimization algorithms to discover the relevant stationary points. In particular, global optimization methods are of major importance to search for the low-energy structures of molecular aggregates. We review the application of global optimization techniques to several molecular clusters; some new results are also reported. Emphasis is given to evolutionary algorithms and their application in the study of the microsolvation of alkali-metal and Ca²⁺ ions with various types of solvents.This article is part of the themed issue 'Theoretical and computational studies of non-equilibrium and non-statistical dynamics in the gas phase, in the condensed phase and at interfaces'.

Enhanced Flexibility of the O2 + N2 Interaction and Its Effect on Collisional Vibrational Energy Exchange

Prompted by a comparison of measured and computed rate coefficients of Vibration-to-Vibration and Vibration-to-Translation energy transfer in O2 + N2 non-reactive collisions, extended semiclassical calculations of the related cross sections were performed to rationalize the role played by attractive and repulsive components of the interaction on two different potential energy surfaces. By exploiting the distributed concurrent scheme of the Grid Empowered Molecular Simulator we extended the computational work to quasiclassical techniques, investigated in this way more in detail the underlying microscopic mechanisms, singled out the interaction components facilitating the energy transfer, improved the formulation of the potential, and performed additional calculations that confirmed the effectiveness of the improvement introduced.

Efficiency of Collisional O2 + N2 Vibrational Energy Exchange

By following the scheme of the Grid Empowered Molecular Simulator (GEMS), a new O2 + N2 intermolecular potential, built on ab initio calculations and experimental (scattering and second virial coefficient) data, has been coupled with an appropriate intramolecular one. On the resulting potential energy surface detailed rate coefficients for collision induced vibrational energy exchanges have been computed using a semiclassical method. A cross comparison of the computed rate coefficients with the outcomes of previous semiclassical calculations and kinetic experiments has provided a foundation for characterizing the main features of the vibrational energy transfer processes of the title system as well as a critical reading of the trajectory outcomes and kinetic data. On the implemented procedures massive trajectory runs for the proper interval of initial conditions have singled out structures of the vibrational distributions useful to formulate scaling relationships for complex molecular simulations.

Low-energy structures of benzene clusters with a novel accurate potential surface

The benzene-benzene (Bz-Bz) interaction is present in several chemical systems and it is known to be crucial in understanding the specificity of important biological phenomena. In this work, we propose a novel Bz-Bz analytical potential energy surface which is fine-tuned on accurate ab initio calculations in order to improve its reliability. Once the Bz-Bz interaction is modeled, an analytical function for the energy of the Bzn clusters may be obtained by summing up over all pair potentials. We apply an evolutionary algorithm (EA) to discover the lowest-energy structures of Bzn clusters (for n=2-25), and the results are compared with previous global optimization studies where different potential functions were employed. Besides the global minimum, the EA also gives the structures of other low-lying isomers ranked by the corresponding energy. Additional ab initio calculations are carried out for the low-lying isomers of Bz3 and Bz4 clusters, and the global minimum is confirmed as the most stable structure for both sizes. Finally, a detailed analysis of the low-energy isomers of the n = 13 and 19 magic-number clusters is performed. The two lowest-energy Bz13 isomers show S6 and C3 symmetry, respectively, which is compatible with the experimental results available in the literature. The Bz19 structures reported here are all non-symmetric, showing two central Bz molecules surrounded by 12 nearest-neighbor monomers in the case of the five lowest-energy structures.

Chemical Interactions and Spin Structure in (O2)4: Implications for the ε-O2 Phase

The chemical interactions and spin structure of (O2)4 in its ground singlet state are analyzed by means of Quantum Chemical Topology descriptors. The energetic contributions of the Interacting Quantum Atoms approach are used to obtain information about the class of interactions displayed along the dissociation path of (O2)4. The exchange-correlation contribution to the binding energy is non-negligible for the O2-O2 interactions at intermolecular distances close to those found for the pressure induced ε phase of solid (O2) and this strengthening of the intermolecular bonding is built up from a simultaneous weakening of the intramolecular bond. This result is of interest in connection with the observed softening of the IR vibron frequency in the lower pressure range of the ε phase. The spin structure in the real space along the dissociation process is interpreted with the help of the so-called electron number distribution functions. At large distances, the four triplet O2 molecules are arranged in a way consistent with an antiferromagnetic structure, whereas at short distances, a significant spin redistribution is driven by the exchange process and it involves a propensity toward a null magnetic moment per molecule. Such probability behavior can be related with the magnetic evolution of solid oxygen across the δ → ε phase transition. Additional calculations of (O2)4 excited states support the conclusion that the relative stabilization and magnetic features of the ground singlet state are due to the onset of the new intermolecular bonds, and not to an exclusive modification of the electronic character within the O2 molecules.

Quantitative evaluation on [⁹⁰Y] DOTATOC PET and SPECT imaging by phantom acquisitions and clinical applications in locoregional and systemic treatments

AIM

The aim of this paper was to compare [⁹⁰Y]-PET and SPECT imaging quantification for dosimetric applications in targeted radionuclide therapy.

METHODS

Imaging studies were carried out by SPECT-CT and PET equipment performing phantom tests first. [⁹⁰Y]-SPECT and PET scans were compared in terms of sensitivity, minimum detectable activity concentration, recovery coefficients (RCs) and system spatial resolution (FWHM). Quantitative evaluations by PET and SPECT acquisitions were then assessed in patients who received therapeutic activity of [⁹⁰Y]-DOTATOC directly injected into the surgical cavity by locoregional route in glioma treatment and by systemic route in neuroendocrine tumour patients who underwent intravenous infusion. Finally 3D-dose distributions by SPECT and PET images were obtained.

RESULTS

Sensitivity was proven to be about fivefold higher for SPECT than for PET. To obtain a good-quality PET imaging, the minimum detectable activity concentration was determined to be equal to 1 MBq/mL compared with 0.05 MBq/mL that was sufficient to assess adequate SPECT imaging. RCs were 100% for volume ≥ 25.5 mL for PET and ≥ 110 mL for SPECT. FWHM was 7 mm for PET and 19 mm for SPECT scans. With regard to locoregional therapy, excellent imaging was obtained with both PET and SPECT. On the contrary, systemic administration did not permit us to obtain suitable PET imaging. PET and SPECT images were affected by considerable noise, whose influence is much more important in the quantitative evaluation of dose volume histograms rather than in the visual interpretation of images.

CONCLUSION

[⁹⁰Y]-activity quantification is feasible by SPECT and PET imaging. For clinical applications, SPECT-CT is the best technique for visualizing the radiopharmaceuticals following systemic infusion, while both SPECT and PET scans are effective in analyzing locoregional distribution. Nevertheless PET study demonstrates the best spatial definition.

Dosimetry for treatment with radiolabelled somatostatin analogues. A review

Peptide Receptor Radionuclide Therapy (PRRT) has proven its efficacy in the treatment of neuroendocrine and other somatostatin receptor expressing tumours (SR-tumours). Several clinical trials have confirmed that adverse effects are represented by possible renal impairment, which is the major concern, and low but not absent hematological toxicity. High kidney irradiation is a constant, despite the sparing of dose obtained by renal protectors. Hematological toxicity, although low, needs to be monitored. The clinical and dosimetry results collected in more than a decade have recognized weak points to unravel, increased knowledge, offering new views. When planning therapy with radiopeptides, the large patients' variability as for biodistribution and tumour uptake must be taken into account in order to tailor the therapy, or at least to avoid foreseeable gross treatments. Reliable and personalized dosimetry is more and more requested. This paper reviews through the literature the methods to study the biokinetics, the dosimetry outcomes, some clue information and correlations obtained once applying the radiobiological models. Special focus is given on recent improvements and indications for critical organ protection that light up challenging perspectives for PRRT.

Efficacy of 90Y ibritumomab-tiuxetan treatment in a case of resistant gastric MALT non-Hodgkin's lymphoma

Treatment modalities for resistant/relapsing gastric mucosa associated lymphoid tissue (MALT) non-Hodgkin's lymphoma (NHL) are not yet well standardized. In the past, most patients were treated surgically with a gastrectomy, while, more recently, radiotherapy and systemic approaches (chemotherapy and immunotherapy) have been used with improving results.Here, we report the case of a patient affected by MALT NHL resistant to antibiotics, chemotherapy and immunotherapy, who achieved a durable complete remission after radio-immunotherapy treatment with Zevalin ((90)Y ibritumomab-tiuxetan), administered in a single-standard dose. This observation must be confirmed on a larger series but suggests that radio-immunotherapy may be a valid approach in treating relapsing MALT NHL patients, or those resistant to conventional therapies, so avoiding more aggressive and toxic approaches.

Institutional guidelines and ongoing studies in management of liver tumours: the experience of the European Institute of Oncology

BACKGROUND

An institutional task force on upper gastrointestinal tumours is active at the European Institute of Oncology (EIO). Members decided to collate the institutional guidelines on management of liver tumours (primary and metastatic) into a document. This article is aimed at presenting the current treatment guidelines as well as ongoing research protocols and trials in this field at the EIO.

METHODS

A steering committee convened to assign tasks to individual members. Contributions from experts in each treatment area were collated in a single document, in order to produce a draft for subsequent review from the aforementioned committee. Six drafts have been discussed and the final version approved.

RESULTS

Surgical, medical oncology, interventional radiology, nuclear medicine and radiation therapy approaches, their roles in management of liver tumours and ongoing research trials are presented and discussed in this article.

CONCLUSIONS

At the EIO a multi-disciplinary integrated approach to liver tumours is standard and several ongoing research projects are currently active in this field.

Carcinoid crisis induced by receptor radionuclide therapy with 90Y-DOTATOC in a case of liver metastases from bronchial neuroendocrine tumor (atypical carcinoid)

SS receptors are overexpressed in many tumors, mainly of neuroendocrine origin, thus enabling the treatment with SS analogs. The clinical experience of receptor radionuclide therapy with the new analog [90Y-DOTA0-Tyr3 ]-octreotide [90Y-DOTATOC] has been developed over the last decade and is gaining a pivotal role in the therapeutic workout of these tumors. It is well known that some procedures performed in diagnostic and therapeutic management of endocrine tumors, such as agobiopsy and hepatic chemoembolization, can be associated with the occurrence of symptoms related to the release of vasoactive amines and/or hormonal peptides from tumor cell lysis. This is the first report of a severe carcinoid crisis developed after receptor radionuclide therapy with 90Y-DOTATOC administered in a patient affected by liver metastases from bronchial neuroendocrine tumor (atypical carcinoid). Despite protection with H1 receptor antagonists, octreotide and corticosteroids, few days after the therapy the patient complained of persistent flushing of the face and upper trunk, severe labial and periocular oedema, diarrhoea and loss of appetite. These symptoms increased and required new hospitalisation. The patient received iv infusion of octreotide associated with H1 and H2 receptor antagonists and corticosteroid therapy, which induced symptom remission within few days. The case here reported confirms that radionuclide therapy is highly effective in determining early rupture of metastatic tissue and also suggests that pre-medication should be implemented before the radiopeptide administration associated with a close monitoring of the patient in the following days.

[Liver haemangioma: current surgical indications. Our experience]

Hemangiomas are the more frequent benign liver tumours. Therapeutic approach at these neoplasms is changed in the last years because has resulted that massive haemoperitoneum from a spontaneous rupture of the hemangiomas is a rare occurrence. From a personal review of 124 liver resection performed for traumatic and organic, benign and malignant, pathologies, the Authors present two cases of symptomatic liver haemangioma surgically treated Excluding emergency induced by tumour hemorrhage, actually indications to surgical treatment are controversial. In all patients the right approach is choice by the integrated evaluation of general conditions of the patient, liver functionality and from anatomical location of the neoplasm.

[Appendicectomy: laparoscopic versus open treatment. A case survey]

AIM

Laparoscopy is actually the gold standard approach in many surgical procedures: this consideration is still controversial as to appendectomy.

METHODS

From 2000 to 2004 we have performed 257 appendectomies: 51 (20%) in laparoscopic approach. Preoperative diagnosis has been formulated on blood parameters, abdominal or, sometimes, transvaginal ultrasonography.

RESULTS

Two hundred and fifty-seven surgical operations, 62 laparoscopic, have been performed for suspicious appendicitis. In the laparoscopic procedures, 11 revealed various diseases without appendicitis. In the remaining 51 cases, appendectomy has been performed totally intra-abdominal and none case turned to laparotomic conversion. Operative times were between 27 and 105 min in the laparoscopic appendectomies (LA) and between 18 and 46 min in the laparotomic appendectomies (OA). In 7.3% of OA and in 3.9% of LA wall infections occurred, as well as abdominal abscesses in 1% of OA and in 4% of LA. Postoperative discharge was after 3.3 days and bowel canalization appeared at 10-18 hours from the surgery, in OA and in LA.

CONCLUSIONS

On the basis of these results, the conclusion is drawn that, although discordant opinions in the literature, the advantages of the laparoscopic approach compared to laparotomic approach is still to be demonstrated, both in advantages for the patient and in costs. Laparoscopy is the better surgical technique when the preoperative diagnosis is not clear, particularly in young women or in elderly, in whom a colic neoplasm may be suspected.

Combined treatment of glioblastoma patients with locoregional pre-targeted 90Y-biotin radioimmunotherapy and temozolomide

AIM

In a previous phase I-II study, the safety profile and anti-tumor efficacy of pre-targeting locoregional radioimmunotherapy (LR-RIT), based on the ''3 step'' method, was assessed in 24 high-grade glioma patients. The encouraging results in terms of low toxicity and objective response rate (25%) prompted us to continue our study.

METHODS

An analysis of 73 patients with hystologically confirmed glioblastoma multiforme (GBM), treated with the ''3 step'' (90)Y-biotin based LR-RIT, is herein reported. All patients had a catheter implanted at 2(nd) surgery and underwent at least 2 cycles of LR-RIT (range 2-7) with 2 months interval. Thirty-five out of 73 patients were also treated with Temozolomide (TMZ). Two cycles of TMZ (200 mg/m(2)/day, for 5/28 days) were administered in between each course of LR-RIT. Overall survival (OS) and progression free survival (PFS) were retrospectively calculated.

RESULTS

Stabilization of disease was achieved in 75% of patients, while 25% progressed. In the 38 patients treated with LR-RIT alone, median OS and PFS were respectively 17.5 months (95%CI=[17-20]) and 5 months (95%CI=[4-8]), while in the 35 treated with the combined treatment (LR-RIT+TMZ) respective values were 25 months (95%CI=[23-30]) and 10 months (95%CI=[9-18] (p<0.01). The addition of TMZ to LR-RIT did not increase neurological toxicity, and no major hematological toxicity was observed.

CONCLUSION

These results confirm the safety and the efficacy of (90)Y LR-RIT in recurrent GBM patients; the addition of TMZ significantly improved the overall outcomes; a further controlled prospective, randomized study is fully justified.

New approach in delivering chemotherapy: locoregional treatment for recurrent glioblastoma (rGBM)

The treatment of GBM tumor recurrence is generally a hopeless challenge, since recurred tumor is resistant to the most common therapeutic efforts. Some partial results can be achieved by targeting local disease control, in view of the fact that 95% of recurrences occur locally. We present results concerning three pilot studies, all performed in recurrent GBM patients who underwent second surgery and have been treated systemically with temozolomide and locally through an Ommaya reservoire according to the following schedules: a) in 20 rGBM, 4 mg novantrone was delivered day 1,5 every 30 days; in 26 rGBM, 4 mg novantrone was delivered every 20 days in association with locoregional radioimmunotherapy (RIT); in 12 rGBM pegylated liposomal doxorubicin 4 mg was delivered day 1,5,10,15,20 with 20 days interval. Results seem very promising since there is an extension of disease free and survival, both of more than 50 % if results are evaluated in relation with the most frequent data of the literature.

[Management of the neoplastic stenosis of the left colon with self-expandable endoprosthesis]

Malignant tumors of the large bowel develop colonic obstruction in 10-30% cases. Recently many authors have employed self-expandable stents to resolve the colonic obstruction. During 2002, seven patients affected by neoplastic malignant stenosis of the left colon underwent endoscopic placement of self-expandable enteral stent. The technique succeeded in relieving the obstruction in 6 patients, while in a woman affected by malignant tumor of the splenic flexure, colonic stenting was unsuccessful. The Authors didn't observe any procedure related complications; sign and symptoms of intestinal obstruction resolved within 24-72 hours from placement. Four patients needed hydro-electrolitemic correction, intestinal cleaning and R0 resection with one stage anastomosis within 5 and 9 days. Bowel decompression of the neoplastic stenosis relieved by self expandable metallic stents is useful to avoid emergency surgery and provide time for a complete preoperative staging, a metabolic correction and a mechanical bowel preparation. Complications of stent placement are common in many reports and include minor rectal bleeding (2%) and perforations (4%). Stenting is contraindicated in cases of enlarged colon with diameter superior to 8 cm or in flogistic lesions.

90Y-DOTA-D-Phe1-Try3-octreotide in therapy of neuroendocrine malignancies

Somatostatin receptors type 2 (sst(2)) are expressed in high concentration on numerous neudoendocrine tumors. The successful use of radiolabeled somatostatin analogs in imaging promoted further studies in utilizing them in radiopeptide therapy. The somatostatin analog [(90)Y-DOTA-D-Phe(1)-Try3]octreotide (DOTATOC) (DOTA: 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid) possesses favorable characteristic for its therapeutic use; shows high affinity for sst(2), moderately high affinity for sst(5), and intermediate affinity for sst(3); high hydrophilicity; stable and facile labeling with (111) In and (90) Y. In this article we report our experience with (90)Y-DOTATOC in neuroendocrine tumors. Eighty-seven patients with neuroendocrine tumors were treated with a cumulated activity ranging from 7.4 to 20.2 GBq. Most patients responded with stabilization of disease (48%); however, objective responses were observed in 28% of patients (5% complete response). No major acute reactions were observed up to the activity of 5.55 GBq per cycle. The dose limiting was bone marrow toxicity and the maximal tolerated dose was defined as 5.18 GBq.

Pretargeted adjuvant radioimmunotherapy with yttrium-90-biotin in malignant glioma patients: a pilot study

In a previous study we applied a three-step avidin-biotin pretargeting approach to target 90Y-biotin to the tumour in patients with recurrent high grade glioma. The encouraging results obtained in this phase I-II study prompted us to apply the same approach in an adjuvant setting, to evaluate (i) time to relapse and (ii) overall survival. We enrolled 37 high grade glioma patients, 17 with grade III glioma and 20 with glioblastoma, in a controlled open non-randomized study. All patients received surgery and radiotherapy and were disease-free by neuroradiological examinations. Nineteen patients (treated) received adjuvant treatment with radioimmunotherapy. In the treated glioblastoma patients, median disease-free interval was 28 months (range=9-59); median survival was 33.5 months and one patient is still without evidence of disease. All 12 control glioblastoma patients died after a median survival from diagnosis of 8 months. In the treated grade III glioma patients median disease-free interval was 56 months (range=15-60) and survival cannot be calculated as only two, within this group, died. Three-step radioimmunotherapy promises to have an important role as adjuvant treatment in high grade gliomas, particularly in glioblastoma where it impedes progression, prolonging time to relapse and overall survival. A further randomized trial is justified.

Receptor-mediated radiotherapy with 90Y-DOTA-D-Phe1-Tyr3-octreotide

A newly developed somatostatin radioligand, DOTA-[D-Phe1-Tyr3]-octreotide (DOTATOC), has been synthesised for therapeutic purposes, because of its stable and easy labelling with yttrium-90. The aim of this study was to determine the dosage, safety profile and therapeutic efficacy of 90Y-DOTATOC in patients with cancers expressing somatostatin receptors. We recruited 30 patients with histologically confirmed cancer. The main inclusion criterion was the presence of somatostatin receptors as documented by 111In-DOTATOC scintigraphy. 90Y-DOTATOC was injected intravenously using a horizontal protocol: patients received equivalent-activity doses in each of three cycles over 6 months. The first six patients received 1.11 GBq per cycle and the four successive groups of six patients received doses increasing in 0.37-GBq steps. Toxicity was evaluated according to WHO criteria. No patient had acute or delayed adverse reactions up to 2.59 GBq 90Y-DOTATOC per cycle (total 7.77 GBq). After a total dose of 3.33 GBq, one patient developed grade II renal toxicity 6 months later. The maximum tolerated dose per cycle has not yet been reached, although transient lymphocytopenia has been observed. Total injectable activity is limited by the fact that the maximum dose tolerated by the kidneys has been estimated at 20-25 Gy. Complete or partial tumour mass reduction occurred in 23% of patients; 64% had stable and 13% progressive disease. It is concluded that high activities of 90Y-DOTATOC can be administered with a low risk of myelotoxicity, although the cumulative radiation dose to the kidneys is a limiting factor and requires careful evaluation. Objective therapeutic responses have been observed.

Pre-targeted locoregional radioimmunotherapy with 90Y-biotin in glioma patients: phase I study and preliminary therapeutic results

The aim of this study was to determine the maximum-tolerated dose, of a pre-targeting three-step (3-S) method employing 90Y-biotin in the locoregional radioimmunotherapy (RIT) of recurrent high grade glioma, and to investigate the antitumor efficacy of this new treatment. Twenty-four patients with recurrent glioma underwent second surgical debulking and implantation of a catheter into the surgical resection cavity (SRC), in order to introduce the radioimmunotherapeutic agents [biotinylated monoclonal antibody (MoAb), avidin and 90Y-biotin]. Eight patients with anaplastic astrocytoma (AA) and 16 patients with glioblastoma (GBM) were injected with biotinylated anti-tenascin MoAb (2 mg), then with avidin (10 mg; 24 h later) and finally 90Y-biotin (18 h later). Each patient received two of these treatments 8-10 weeks apart. The injected activity ranged from 0.555 to 1.110 GBq (15-30 mCi). Dosage was escalated by 0.185 GBq (5 mCi) in four consecutive groups. The treatment was well tolerated without acute side effects up to 0.740 GBq (20 mCi). The maximum tolerated activity was 1.110 GBq (30 mCi) limited by neurological toxicity. None of the patients developed hematologic toxicity. In three patients infection occurred around the catheter. The average absorbed dose to the normal brain was minimal compared with that received at the SRC interface. At first control (after 2 months), partial (PR) and minor (MR) responses were observed in three GBM (1 PR; 2 MR) and three AA patients (1 PR; 2 MR) with an overall objective response rate of 25%. Stable disease (SD) was achieved in seven GBM and five AA patients (50%). There was disease progression in six GBM patients (25%), but in none of the AA patients. At the dosage of 0.7-0.9 GBq per cycle, locoregional 3-S-RIT was safe and produced an objective response in 25% of patients. Based on these encouraging results, phase II studies employing 3-S-RIT soon after first debulking are justified.

Orientation of benzene in supersonic expansions, probed by IR-laser absorption and by molecular beam scattering

This work represents the first experimental demonstration that planar molecules tend to travel as a "frisbee" when a gaseous mixture with lighter carriers expands into a vacuum, the orientation being due to collisions. The molecule is benzene, the prototype of aromatic chemistry. The demonstration is via two complementary experiments: interrogating benzene by IR-laser light and controlling its orientation by selective scattering on rare gas targets. The results cast new light on the microscopic mechanisms of collisional alignment and suggest a useful way to produce intense beams of aligned molecules, permitting studies of steric effects in gas-phase processes and in surface catalysis.