Fusion of freehand SPECT and ultrasound: First experience in preoperative localization of sentinel lymph nodes.

PURPOSE: Radioguided sentinel lymph node biopsy (SLNB) is the standard of care in breast cancer and melanoma. Additional preoperative Single-photon emission computed tomography (SPECT/CT) for improved anatomical co-registration of the SLNs causes additional radiation exposure and is time-consuming and expensive. The aim of this prospective study was to evaluate a novel approach involving real-time fusion of freehand SPECT (fhSPECT) and ultrasound (US) for anatomical co-registration of SLNs. METHODS: From February 2015 to February 2016, 153 patients were included in this prospective study. All patients underwent lymphoscintigraphy according to practical guidelines and 151 (118 cases of breast cancer, 30 cutaneous malignancies, and three cases of vulvar cancer) of the 153 patients were additionally investigated with fhSPECT-US. FhSPECT connected to a hand-held gamma detector generates three-dimensional images of the radioactivity distribution in the scanned area. For co-registration and real-time fusion of fhSPECT and subsequently performed US, an infrared stereo tracking system was used. RESULTS: In all patients an SLN was found on lymphoscintigraphy, and the fhSPECT detected corresponding hotspots in all but one patient. In 72 % of patients and 73 % of lymph node basins, real-time anatomical co-registration with US was feasible. The rate of success in achieving good co-registration increased from 60 to 75 % after training by a radiologist specialized in breast imaging. A higher co-registration rate (78 %) was observed in patients with only one SLN than in those with two SLNs (68 %) or three or more SLNs (0 %). CONCLUSIONS: Real-time fusion of fhSPECT and US for preoperative anatomical co-registration of SLNs is feasible. However, before this approach can completely replace preoperative lymphatic imaging, further technical developments are needed.

iROLL: does 3-D radioguided occult lesion localization improve surgical management in early-stage breast cancer?

PURPOSE: To prospectively evaluate the feasibility of 3-D radioguided occult lesion localization (iROLL) and to compare iROLL with wire-guided localization (WGL) in patients with early-stage breast cancer undergoing breast-conserving surgery and sentinel lymph node biopsy (SLNB). METHODS: WGL (standard procedure) and iROLL in combination with SLNB were performed in 31 women (mean age 65.1 ± 11.2 years) with early-stage breast cancer and clinically negative axillae. Patient comfort in respect of both methods was assessed using a ten point scale. SLNB and iROLL were guided by freehand SPECT (fhSPECT). The results of the novel 3-D image-based method were compared with those of WGL, ultrasound-based lesion localization, and histopathology. RESULTS: iROLL successfully detected the malignant primary and at least one sentinel lymph node in 97% of patients. In a single patient (3%), only iROLL, and not WGL, enabled lesion localization. The variability between fhSPECT and ultrasound-based depth localization of breast lesions was low (1.2 ± 1.4 mm). Clear margins were achieved in 81% of the patients; however, precise prediction of clear histopathological surgical margins was not feasible using iROLL. Patients rated iROLL as less painful than WGL with a pain score 0.8 ± 1.2 points (p < 0.01) lower than the score for iROLL. CONCLUSION: iROLL is a well-tolerated and feasible technique for localizing early-stage breast cancer in the course of breast-conserving surgery, and is a suitable replacement for WGL. As a single image-based procedure for localization of breast lesions and sentinel nodes, iROLL may improve the entire surgical procedure. However, no advantages of the image-guided procedure were found with regard to prediction of complete tumour resection.

Ferrihydrite coating reduces microplastic induced soil water repellency.

Addition of microplastics (MP) to soil has the potential to increase soil water repellency. However, coating of MP with soil abundant substances e.g., iron compounds, can reduce this effect. Here, we tested if pre-coating or in situ coating of MP with ferrihydrite (Fh) reduces soil water repellency. We applied hotspots of pristine and coated MP (20-75 µm, PS and PET) to sand and imaged capillary rise via neutron radiography. Capillary rise experiments in wetting-drying cycles were conducted using water and Fh suspension. Pristine MP hotspots were not wettable. Capillary rise of water into coated MP hotspots differed in wettability depending on polymer type. While coated PS was still non-wettable, water imbibed into the coated PET hotspot. Capillary rise of Fh suspensions in wetting and drying cycles also showed varying results depending on polymer type. MP hotspots were still non-wettable and local water content increased only marginally. Our results indicate that Fh coating of MP changes MP surface wettability depending on polymer type and therefore counteracts the hydrophobic properties of pristine MP. However, MP coating is likely to be slowed down by the initial hydrophobicity of pristine MP. Dynamics of MP coating and increasing wettability are key factors for biotic and abiotic degradation processes.

Biogenic amorphous silica as main driver for plant available water in soils.

More frequent and longer drought periods are predicted threatening agricultural yield. The capacity of soils to hold water is a highly important factor controlling drought stress intensity for plants. Biogenic amorphous silica (bASi) pools in soils are in the range of 0-6% and are suggested to help plants to resist drought. In agricultural soils, bASi pools declined to values of ~1% or lower) due to yearly crop harvest, decreasing water holding capacity of the soils. Here, we assessed the contribution of bASi to water holding capacity (WHC) of soil. Consequently, ASi was mixed at different rates (0, 1, 5 or 15%) with different soils. Afterwards, the retention curve of the soils was determined via Hyprop method. Here we show that bASi increases the soil water holding capacity substantially, by forming silica gels with a water content at saturation higher than 700%. An increase of bASi by 1% or 5% (weight) increased the water content at any water potential and plant available water increased by up to > 40% or > 60%, respectively. Our results suggest that soil management should be modified to increase bASi content, enhancing available water in soils and potentially decreasing drought stress for plants in terrestrial ecosystems.

Glucose metabolism and angiogenesis in granulosa cell tumors of the ovary: activation of Akt, expression of M2PK, TKTL1 and VEGF.

OBJECTIVES: Very little is known about the biology of granulosa cell tumors of the ovary. A hallmark of granulosa cell tumors of the ovary is extensive growth, distant metastases however, are rarely found. We hypothesise that granulosa cell tumors of the ovary on the one hand need to stimulate vascularisation; on the other hand glucose metabolism has to be altered to ensure the supply of nutrients and metabolites. Increased glycolysis, the main source of energy supply, is considered to be important during malignant transformation. Thus, we focussed on a selection of key factors in angiogenesis and tumor glycolysis to study metabolic characteristics of granulosa cell tumors of the ovary. STUDY DESIGN: We analysed 32 tumor specimens for immunohistochemical expression of vascular endothelial growth factor, phosphorylated Akt, M2 pyruvate kinase isoenzyme, and transketolase-like enzyme 1. As controls, we stained 10 samples of normal ovaries. RESULTS: We found expression of vascular endothelial growth factor in 94%, transketolase-like enzyme 1 in 81%, and phosphorylated Akt as well as M2 pyruvate kinase isoenzyme in 53% of the specimens. There were no significant differences between the expression levels in primary and those in recurrent tumors. Temporal analysis of marker expression in primary tumors and recurrences in the same patients revealed no increase or decrease of marker expression overtime. In contrast to granulosa cell tumors, normal ovaries showed no expression of the markers analysed in granulosa cells. CONCLUSION: Our results show that granulosa cell tumors of the ovary express vascular endothelial growth factor as an important stimulator of tumor angiogenesis as well as several molecular markers for glycolysis. The dependence of granulosa cell tumors of the ovary on the glycolytic pathway may provide a biochemical basis for therapeutic strategies involving glycolytic inhibitors.

Traumatic retinopathy presenting as acute macular neuroretinopathy.

AIM: Traumatic retinopathy presenting as acute macular neuroretinopathy (AMNR) is an uncommon disease causing paracentral scotomas after indirect trauma. METHODS: We report on five patients (six eyes) with AMNR with a temporary reduction of visual acuity and persistent paracentral scotomas after indirect trauma. The findings were documented using multimodal imaging and the follow-up was up to 32 months. RESULTS: Initially, fundoscopy was unremarkable in all patients while visual acuity (Snellen equivalents) varied between 0.03 and 1.0, and a paracentral scotoma was present in all patients. During follow-up, visual acuity recovered to 1.0 in all patients while the paracentral scotomas persisted. Spectral-domain optical coherence tomography revealed a disruption of the inner/outer segment junction within the macular lesion and changes in the outer nuclear layer, which slowly recovered partly during the follow-up. CONCLUSIONS: These findings suggest that indirect trauma can cause changes in the outer retina resembling those seen in AMNR, resulting in persisting paracentral scotomas.

Measurement of the sound velocity in fluids using the echo signals from scattering particles.

With conventional methods the sound velocity c in fluids can be determined using the back wall echo. This paper proposes a novel technique, in which the signals reflected by scattering particles suspended in a fluid are analysed instead. The basic idea is that the particles generate the strongest echo signal when being located in the sound field maximum. Therefore the position of the echo signal maximum is a measure for the propagation time to the sound field maximum. Provided that calibration data or sound field simulations for the ultrasonic transducer are available, this propagation time suffices to determine both sound velocity and the location of the sound field maximum. The feasibility of the new approach is demonstrated by different kinds of experiments: (i) Measurements of the sound velocity c in four fluids covering the wide range between 1116 and 2740m/s. The results show good agreement with values published elsewhere. (ii) Using the dependence of the sound velocity on temperature, it is possible to vary c over the comparatively small range between 1431 and 1555m/s with increments of less than 10m/s. The measured statistical variation of 1.4m/s corresponds to a relative uncertainty not worse than 0.1%. (iii) The focus position, i.e. the distance of the maximum of the sound field from the transducer, was varied by time-shifted superposition of the receive signals belonging to the different elements of an annular array. The results indicate that the novel method is even capable of measuring profiles of the sound velocity along the ultrasonic beam non-invasively.

Expression of CD56 isoforms in primary and relapsed adult granulosa cell tumors of the ovary.

BACKGROUND: Adult granulosa cell tumors of the ovary (GCTs) are sex cord stromal tumors of unpredictable behaviour. Up to now, the prediction of the relapsing/malignant potential remains difficult. CD56 (NCAM) in GCTs was previously described in only two studies. However, the expression of its isoforms was not examined. METHODS: 30 GCTs (16 primaries, 14 relapses) were investigated immunohistochemically with antibodies against Pan-CD56 (CD56Pan) and the isoform with 140/180 kDa length (CD56140/180 kDa). The reaction was assessed with respect to percentage of positive cells and intensity of staining. RESULTS: In all GCTs, CD56Pan was expressed, but differences were found between primaries and relapses. The percentage of CD56Pan positive tumor cells was lower in relapses, whereas CD56140/180 kDa showed a higher staining intensity in the latter. CONCLUSION: Expression of CD56 is an additional sensitive and helpful immunohistochemical tool for histopathologists diagnosing a GCT. It does not seem possible to provide a validly individual risk assessment. However, the different expression of CD56 isoforms might indicate important changes in the course to a more malignant behaviour.