Oligometastatic disease in biochemical recurrence of prostate cancer: Prevalence on PSMA PET/CT and consecutive metastasis-directed therapy - Experience at a tertiary referral center.

AIM: The aim of our study was to address the prevalence of oligometastatic recurrent prostate cancer (PCa) on PSMA-PET and the associated practice of metastasis-directed therapy (MDT). Next, we aimed to determine a PSA threshold below which most patients had local and/or oligometastatic recurrence on PSMA-PET. METHODS: One hundred and ten consecutive patients with biochemical recurrence (BCR) after radical prostatectomy (RP) ± radiation were referred for 68Ga-PSMA-11 or 18F-DCFPyL PET/CT. We correlated the location and number of PSMA-positive lesions against the treatment choice after imaging. Detection rates were stratified by PSA levels at the time of PET/CT. The study design was monocentric retrospective. RESULTS: Thirty-four patients (30.9%) had a PSMA-negative scan, while 17 (15.5%) had local recurrence and 59 (53.6%) had metastatic recurrence on PSMA-PET. ROC analysis revealed a cut-off of ≤3 metastatic lesions on PSMA-PET for the steering of treatment decisions towards MDT rather than solely systemic therapy (AUC: 0.88). Defined as 3 or fewer metastatic lesions, oligometastatic recurrent PCa was found in up to 30% (33/110) of all patients. At PSA levels below 3.5 ng/ml, the rate of PSMA-positive disease that was locally confined or oligometastatic was 76% (45/59), dropping significantly to 29.4% (5/17) above this threshold (p<0.001) as polymetastatic findings became more frequent. CONCLUSION: The detection of ≤3 oligometastases on PSMA-PET encouraged the consecutive pursuit of MDT instead of systemic therapy alone. PSMA-PET predominantly captured patients at recurrence stages amenable to localized treatment when initiated at PSA levels below 3.5 ng/ml.

Residual solvent analysis with hyper-fast gas chromatography-mass spectrometry and a liquid carbon dioxide cryofocusing in less than 90 s.

A new hyper-fast gas chromatography method with less than 90 s runtime including the column cool down was developed for the analysis of four gases and 16 residual solvents, combining a CO2 cryofocusing with a flow-field thermal gradient gas chromatograph (FF-TG-GC) and ToF-MS. The extremely low analysis time can be achieved by combining the new FF-TG-GC and a very short Rxi-624 Sil MS separation column with a small inner diameter and small film thickness (2.05 m × 0.1 mm × 1.0 µm). The column is inserted into a low thermal mass, resistively heated stainless steel capillary. This enables fast temperature programs with heating rates up to 3000 °C/min and a column cool down within a few seconds. In addition to temporal temperature gradients, the FF-TG-GC can generate a spatial temperature gradient that leads to an improved peak shape. Further, an external liquid CO2 cryo-trap was designed in order to reduce the injection bandwidths of analytes and to take full advantage of the resolving power of the separation column. No modifications are required to the FF-TG-GC for the use of the cryogenic trap, as the cooled spot is heated by the resistively heated stainless steel capillary during the temperature program. With cryofocusing, analyzed residual solvents are baseline separated. R2 values over 0.99 for calibration curves and low relative standard deviations (mainly < 3%) for repeatability tests were obtained.

Simulation of spatial thermal gradient gas chromatography.

A model to simulate the gas chromatographic separation in the presence of a spatial thermal gradient is presented. This model is developed from existing models for the prediction of retention times in temperature programmed GC. It is based on basic fluid mechanics of gasses in capillaries to describe the properties of the mobile phase and a thermodynamic model to describe retention of solutes in a stationary phase. This model is expanded to incorporate a spatial thermal gradient. The development of the peak width during the chromatographic separation is modeled by a differential equation, which uses the solute residency, the inverse of the solute velocity, instead of the solute velocity. The presented model is compared to measurements of n-alkanes with conventional temperature programmed GC-FID and to measurements with a hyper-fast flow-field thermal gradient GC (FF-TG-GC) coupled with a MS. The FF-TG-GC enables the use of a spatial thermal gradients. For temperature programmed GC-FID, without spatial thermal gradients, calculated retention times are mostly within 1% of measured values. For the FF-TG-GC-MS with a thermal gradient the simulation showed a deviation of the spatial thermal gradient from a linear to a nonlinear gradient, which could be confirmed by measuring the shape of the spatial gradient. The calculated retention times for the nonlinear gradient are also mostly within 1% of measured values. Calculated peak widths are smaller than measured peak widths by 10 to 15% in the case of the conventional GC-FID and by 30 to 50% for the FF-TG-GC-MS. The relation between the measured and calculated variances shows a linear correlation which can be used to correct the calculated variance and peak width. With this correction the difference for the peak widths is reduced to 4-10% for the conventional GC and below 10% for the majority of solutes with exceptions for early and late eluted n-alkanes (up to 25% difference).

Intra-articular injections of high-molecular-weight hyaluronic acid have biphasic effects on joint inflammation and destruction in rat antigen-induced arthritis.

To assess the potential use of hyaluronic acid (HA) as adjuvant therapy in rheumatoid arthritis, the anti-inflammatory and chondroprotective effects of HA were analysed in experimental rat antigen-induced arthritis (AIA). Lewis rats with AIA were subjected to short-term (days 1 and 8, n = 10) or long-term (days 1, 8, 15 and 22, n = 10) intra-articular treatment with microbially manufactured, high-molecular-weight HA (molecular weight, 1.7 x 10(6) Da; 0.5 mg/dose). In both tests, 10 buffer-treated AIA rats served as arthritic controls and six healthy animals served as normal controls. Arthritis was monitored by weekly assessment of joint swelling and histological evaluation in the short-term test (day 8) and in the long-term test (day 29). Safranin O staining was employed to detect proteoglycan loss from the epiphyseal growth plate and the articular cartilage of the arthritic knee joint. Serum levels of IL-6, tumour necrosis factor alpha and glycosaminoglycans were measured by ELISA/kit systems (days 8 and 29). HA treatment did not significantly influence AIA in the short-term test (days 1 and 8) but did suppress early chronic AIA (day 15, P < 0.05); however, HA treatment tended to aggravate chronic AIA in the long-term test (day 29). HA completely prevented proteoglycan loss from the epiphyseal growth plate and articular cartilage on day 8, but induced proteoglycan loss from the epiphyseal growth plate on day 29. Similarly, HA inhibited the histological signs of acute inflammation and cartilage damage in the short-term test, but augmented acute and chronic inflammation as well as cartilage damage in the long-term test. Serum levels of IL-6, tumour necrosis factor alpha, and glycosaminoglycans were not influenced by HA. Local therapeutic effects of HA in AIA are clearly biphasic, with inhibition of inflammation and cartilage damage in the early chronic phase but with promotion of joint swelling, inflammation and cartilage damage in the late chronic phase.