Real-Time In Vivo Characterization of Primary Liver Tumors With Diffuse Optical Spectroscopy During Percutaneous Needle Interventions: Feasibility Study in Woodchucks

OBJECTIVE This study presents the first in vivo real-time optical tissue characterization during image-guided percutaneous intervention using near-infrared diffuse optical spectroscopy sensing at the tip of a needle. The goal of this study was to indicate transition boundaries from healthy tissue to tumors, namely, hepatic carcinoma, based on the real-time feedback derived from the optical measurements. MATERIALS AND METHODS Five woodchucks with hepatic carcinoma were used for this study. The woodchucks were imaged with contrast-enhanced cone beam computed tomography with a flat panel detector C-arm system to visualize the carcinoma in the liver. In each animal, 3 insertions were performed, starting from the skin surface toward the hepatic carcinoma under image guidance. In 2 woodchucks, each end point of the insertion was confirmed with pathologic examination of a biopsy sample. While advancing the needle in the animals under image guidance such as fluoroscopy overlaid with cone beam computed tomography slice and ultrasound, optical spectra were acquired at the distal end of the needles. Optical tissue characterization was determined by translating the acquired optical spectra into clinical parameters such as blood, water, lipid, and bile fractions; tissue oxygenation levels; and scattering amplitude related to tissue density. The Kruskal-Wallis test was used to study the difference in the derived clinical parameters from the measurements performed within the healthy tissue and the hepatic carcinoma. Kurtoses were calculated to assess the dispersion of these parameters within the healthy and carcinoma tissues. RESULTS Blood and lipid volume fractions as well as tissue oxygenation and reduced scattering amplitude showed to be significantly different between the healthy part of the liver and the hepatic carcinoma (P < 0.05) being higher in normal liver tissue. A decrease in blood and lipid volume fractions and tissue oxygenation as well as an increase in scattering amplitude were observed when the tip of the needle crossed the margin from the healthy liver tissue to the carcinoma. The kurtosis for each derived clinical parameter was high in the hepatic tumor as compared with that in the healthy liver indicating intracarcinoma variability. CONCLUSIONS Tissue blood content, oxygenation level, lipid content, and tissue density all showed significant differences when the needle tip was guided from the healthy tissue to the carcinoma and can therefore be used to identify tissue boundaries during percutaneous image-guided interventions.

Final Results of a Prospective Evaluation of the Predictive Value of Interim Positron Emission Tomography in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP-14 (SAKK 38/07)

PURPOSE Our main objective was to prospectively determine the prognostic value of [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) after two cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone given every 14 days (R-CHOP-14) under standardized treatment and PET evaluation criteria. PATIENTS AND METHODS Patients with any stage of diffuse large B-cell lymphoma were treated with six cycles of R-CHOP-14 followed by two cycles of rituximab. PET/CT examinations were performed at baseline, after two cycles (and after four cycles if the patient was PET-positive after two cycles), and at the end of treatment. PET/CT examinations were evaluated locally and by central review. The primary end point was event-free survival at 2 years (2-year EFS). RESULTS Median age of the 138 evaluable patients was 58.5 years with a WHO performance status of 0, 1, or 2 in 56%, 36%, or 8% of the patients, respectively. By local assessment, 83 PET/CT scans (60%) were reported as positive and 55 (40%) as negative after two cycles of R-CHOP-14. Two-year EFS was significantly shorter for PET-positive compared with PET-negative patients (48% v 74%; P = .004). Overall survival at 2 years was not significantly different, with 88% for PET-positive versus 91% for PET-negative patients (P = .46). By using central review and the Deauville criteria, 2-year EFS was 41% versus 76% (P < .001) for patients who had interim PET/CT scans after two cycles of R-CHOP-14 and 24% versus 72% (P < .001) for patients who had PET/CT scans at the end of treatment. CONCLUSION Our results confirmed that an interim PET/CT scan has limited prognostic value in patients with diffuse large B-cell lymphoma homogeneously treated with six cycles of R-CHOP-14 in a large prospective trial. At this point, interim PET/CT scanning is not ready for clinical use to guide treatment decisions in individual patients.

CD34+ selected versus unselected autologous stem cell transplantation in patients with advanced-stage mantle cell and diffuse large B-cell lymphoma

Novel strategies aiming to increase survival rates in patients with advanced-stage mantle cell lymphoma (MCL) and relapsing diffuse large B-cell lymphoma (DLBCL) are a clinical need. High-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) has improved progression-free (PFS) and overall survival (OS) in MCL and relapsed DLBCL. However, the role of CD34+ cell selection before ASCT in MCL and DLBCL is unclear. We retrospectively analyzed the outcome of 62 consecutive patients with advanced-stage MCL or relapsed DLBCL undergoing ASCT with (n=31) or without (n=31) prior CD34+ selection. All patients had stage III or IV disease, with 47% having DLBCL and 53% MCL. The median duration for neutrophil and platelet recovery was 12 and 16 days in CD34+ selected patients, and 11 (P<.001) and 14 days (P=.012) in the group without selection, respectively. No differences in toxicities were observed. The 5-year PFS for CD34+ selected versus not selected patients was 67% and 39% (P=.016), and the 5-year OS was 86% and 54% (P=.007). Our data suggest that using CD34+ selected autografts for ASCT in advanced stage MCL and DLBCL is associated with longer PFS and OS without increased toxicity.

Prediction of improvement in skin fibrosis in diffuse cutaneous systemic sclerosis: a EUSTAR analysis

OBJECTIVES Improvement of skin fibrosis is part of the natural course of diffuse cutaneous systemic sclerosis (dcSSc). Recognising those patients most likely to improve could help tailoring clinical management and cohort enrichment for clinical trials. In this study, we aimed to identify predictors for improvement of skin fibrosis in patients with dcSSc. METHODS We performed a longitudinal analysis of the European Scleroderma Trials And Research (EUSTAR) registry including patients with dcSSc, fulfilling American College of Rheumatology criteria, baseline modified Rodnan skin score (mRSS) ≥7 and follow-up mRSS at 12±2 months. The primary outcome was skin improvement (decrease in mRSS of >5 points and ≥25%) at 1 year follow-up. A respective increase in mRSS was considered progression. Candidate predictors for skin improvement were selected by expert opinion and logistic regression with bootstrap validation was applied. RESULTS From the 919 patients included, 218 (24%) improved and 95 (10%) progressed. Eleven candidate predictors for skin improvement were analysed. The final model identified high baseline mRSS and absence of tendon friction rubs as independent predictors of skin improvement. The baseline mRSS was the strongest predictor of skin improvement, independent of disease duration. An upper threshold between 18 and 25 performed best in enriching for progressors over regressors. CONCLUSIONS Patients with advanced skin fibrosis at baseline and absence of tendon friction rubs are more likely to regress in the next year than patients with milder skin fibrosis. These evidence-based data can be implemented in clinical trial design to minimise the inclusion of patients who would regress under standard of care.

Photosynthetic parameters, chlorophyll concentration, and diffuse attenuation coefficients in the Rhode River, Maryland (USA), 1990-2009

Parameters in the photosynthesis-irradiance (P-E) relationship of phytoplankton were measured at weekly to bi-weekly intervals for 20 yr at 6 stations on the Rhode River, Maryland (USA). Variability in the light-saturated photosynthetic rate, PBmax, was partitioned into interannual, seasonal, and spatial components. The seasonal component of the variance was greatest, followed by interannual and then spatial. Physiological models of PBmax based on balanced growth or photoacclimation predicted the overall mean and most of the range, but not individual observations, and failed to capture important features of the seasonal and interannual variability. PBmax correlated most strongly with temperature and the concentration of dissolved inorganic carbon (IC), with lesser correlations with chlorophyll a, diffuse attenuation coefficient, and a principal component of the species composition. In statistical models, temperature and IC correlated best with the seasonal pattern, but temperature peaked in late July, out of phase with PBmax, which peaked in September, coincident with the maximum in monthly averaged IC concentration. In contrast with the seasonal pattern, temperature did not contribute to interannual variation, which instead was governed by IC and the additional lesser correlates. Spatial variation was relatively weak and uncorrelated with ancillary measurements. The results demonstrate that both the overall distribution of PBmax and its relationship with environmental correlates may vary from year to year. Coefficients in empirical statistical models became stable after including 7 to 10 yr of data. The main correlates of PBmax are amenable to automated monitoring, so that future estimates of primary production might be made without labor-intensive incubations.

Diffuse Soil Co2 Flux To Assess The Reliability Of Co2 Storage In The Mazarrón-Gañuelas Tertiary Basin (Spain)

Geological storage of CO2 is nowadays internationally considered as the most effective method for greenhouse gas emission mitigation, in order to minimize its effects on the global climatology. One of the main options is to store the CO2 in deep saline aquifers at more than 800 m depth, because it achieves its supercritical state. Among the most important aspects concerning the performance assessment of a deep CO2 geological repository is the evaluation of the CO2 leakage rate from the chosen storage geological formation. Therefore, it is absolutely necessary to increase the knowledge on the interaction among CO2, storage and sealing formations, as well as on the flow paths for CO2 and the physico-mechanical resistance of the sealing formation. Furthermore, the quantification of the CO2 leakage rate is essential to evaluate its effects on the environment. One way to achieve this objective is to study of CO2 leakage on natural analogue systems, because they can provide useful information about the natural performance of the CO2, which can be applied to an artificial CO2 geological storage. This work is focused on the retention capacity of the cap-rock by measuring the diffuse soil CO2 flux in a site selected based on: i) the presence of a natural and deep CO2 accumulation; ii) its structural geological characteristics; and iii) the nature of the cap-rocks. This site is located in the so-called Mazarrón-Gañuelas Tertiary Basin, in the Guadalentin Valley, province of Murcia (Spain) Therefore the main objective of this investigation has been to detect the possible leakages of CO2 from a deep saline aquifer to the surface in order to understand the capability of this area as a natural analogue for Carbon Capture and Sequestration (CCS). The results obtained allow to conclude that the geological sealing formation of the basin seems to be appropriate to avoid CO2 leakages from the storage formation.

Diffuse illuminance availability on horizontal and vertical surfaces at Madrid, Spain

The overall objective of this work is to provide diffuse illuminance availability at Madrid (Spain) through a statistical analysis of illuminance values corresponding to a long-term data series. The illuminance values are obtained from irradiance measurements by means of different empirical models for luminous efficacy. The values of diffuse illuminance on a horizontal and on vertical surfaces facing the four cardinal points are estimated and the different aspects related to daylight availability in an area with specific climatic conditions are analyzed. The experimental data consist of global and diffuse irradiance measurements on a horizontal surface provided by the National Meteorological Agency in Spain (AEMET) for Madrid. These data consist of hourly values measured in the period of 1980–2005. The statistical results derived correspond to a daylight typical year for the five surfaces considered. This information will be useful to building experts to estimate natural illumination availability when daylighting techniques are applied in building design with the main aim of electric energy savings.

Doctrinale mortis / venerandi patris artiu[m] ac sacre pagine p[ro]fessoris Parisien[sis] Ioa[n]nis Raulin ordinis Cluniacen[sis] ; opus egregium corporalis mortis doctrinas leges et co[n]comita[n]tia ; ac detestabilis culpe mirabilia ; necno[n] gehenne docume[n]ta vías horribiles et tormenta diffuse complecte[n]s ... ; iamiam diligenti accuratione recognitum et a multis me[n]dis castigatu[m]

Pie de imp. tomado del colofón

Diffuse soil CO2 flux to assess the reliability of CO2 storage the reliability of CO2 storage in the Mazarrón-Gañuelas Tertiary Basin (Spain)

In the framework of a global investigation of the Spanish natural analogues of CO2 storage and leakage, four selected sites from the Mazarrón?Gañuelas Tertiary Basin (Murcia, Spain) were studied for computing the diffuse soil CO2 flux, by using the accumulation chamber method. The Basin is characterized by the presence of a deep, saline, thermal (?47 ?C) CO2-rich aquifer intersected by two deep geothermal exploration wells named ?El Saladillo? (535 m) and ?El Reventón? (710 m). The CO2 flux data were processed by means of a graphical?statistical method, kriging estimation and sequential Gaussian simulation algorithms. The results have allowed concluding that the Tertiary marly cap-rock of this CO2-rich aquifer acts as a very effective sealing, preventing any CO2 leak from this natural CO2 storage site, being therefore an excellent scenario to guarantee, by analogy, the safety of a CO2 storage.

Bifurcation diagrams for polymer blends with diffuse interfaces in confined and adaptive geometries

Dynamics of binary mixtures such as polymer blends, and fluids near the critical point, is described by the model-H, which couples momentum transport and diffusion of the components [1]. We present an extended version of the model-H that allows to study the combined effect of phase separation in a polymer blend and surface structuring of the film itself [2]. We apply it to analyze the stability of vertically stratified base states on extended films of polymer blends and show that convective transport leads to new mechanisms of instability as compared to the simpler diffusive case described by the Cahn- Hilliard model [3, 4]. We carry out this analysis for realistic parameters of polymer blends used in experimental setups such as PS/PVME. However, geometrically more complicated states involving lateral structuring, strong deflections of the free surface, oblique diffuse interfaces, checkerboard modes, or droplets of a component above of the other are possible at critical composition solving the Cahn Hilliard equation in the static limit for rectangular domains [5, 6] or with deformable free surfaces [6]. We extend these results for off-critical compositions, since balanced overall composition in experiments are unusual. In particular, we study steady nonlinear solutions of the Cahn-Hilliard equation for bidimensional layers with fixed geometry and deformable free surface. Furthermore we distinguished the cases with and without energetic bias at the free surface. We present bifurcation diagrams for off-critical films of polymer blends with free surfaces, showing their free energy, and the L2-norms of surface deflection and the concentration field, as a function of lateral domain size and mean composition. Simultaneously, we look at spatial dependent profiles of the height and concentration. To treat the problem of films with arbitrary surface deflections our calculations are based on minimizing the free energy functional at given composition and geometric constraints using a variational approach based on the Cahn-Hilliard equation. The problem is solved numerically using the finite element method (FEM).

Ongoing immunoglobulin somatic mutation in germinal center B cell-like but not in activated B cell-like diffuse large cell lymphomas

B cell diffuse large cell lymphoma (B-DLCL) is a heterogeneous group of tumors, based on significant variations in morphology, clinical presentation, and response to treatment. Gene expression profiling has revealed two distinct tumor subtypes of B-DLCL: germinal center B cell-like DLCL and activated B cell-like DLCL. In a separate study, we determined that B-DLCL can also be subdivided into two groups based on the presence or absence of ongoing Ig gene hypermutation. Here, we evaluated the correlation between these B-DLCL subtypes established by the two different methods. Fourteen primary B-DLCL cases were studied by gene expression profiling using DNA microarrays and for the presence of ongoing mutations in their Ig heavy chain gene. All seven cases classified as germinal center B cell-like DLCL by gene expression showed the presence of ongoing mutations in the Ig genes. Five of the seven cases classified by gene expression as activated B cell-like DLCL had no ongoing somatic mutations, whereas, in the remaining two cases, a single point mutation was observed in only 2 of 15 and 21 examined molecular clones of variable heavy (VH) chain gene, respectively. These two cases were distantly related to the rest of the activated B cell-like DLCL tumors by gene expression. Our findings validate the concept that lymphoid malignancies are derived from cells at discrete stages of normal lymphocyte maturation and that the malignant cells retain the genetic program of those normal cells.