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Purpose: Irreversible electroporation (IRE) uses high-voltage electric fields to achieve cell death. Although the mechanism of IRE is mainly designated as nonthermal, development of secondary Joule heating is inevitable. The study purpose was to gain understanding of temperature development and distribution during IRE.Materials and Methods: IRE was performed in a transparent polyacrylamide gel resembling soft tissue. Mechanical effects, changes in temperature gradient, and absolute temperature changes were measured with three different optical techniques (high-speed, color Schlieren, and infrared imaging) to investigate the effect on temperature of variations in voltage, pulse length, active tip length (ATL), interelectrode distance, electrode configuration (parallel, convergent, and divergent), and sequential pulsing (pulse delivery interrupted by breaks). The total delivered energy was calculated.Results: A temperature gradient, starting at the tips of both electrodes and expanding toward each other, developed immediately with pulse delivery. Temperatures increased with increasing voltage (by 2.5°C-40.4°C), pulse length (by 5.3°C-9.8°C), ATL (by 5.9°C-17.6°C), and interelectrode distance (by 7.6°C-21.5°C), in accordance with higher energy delivery. Nonparallel electrode placement resulted in heterogeneous temperature distribution with the peak temperature focused in the area with the shortest interelectrode distance. Sequential pulse delivery significantly reduced the temperature increase compared with continuous pulsing (4.3°C vs 11.7°C).Conclusions: Voltage, pulse length, interelectrode distance, ATL, and electrode configuration each have a strong effect on temperature development and distribution during IRE. Sequential pulsing reduces the extent and volume of thermal distribution and may prove beneficial with respect to procedural safety. [ABSTRACT FROM AUTHOR]

Abstract: Our objective was to explain the clinical presentations of sustained arteriovenous anastomotic transfusion of blood after incomplete laser therapy in twin-to-twin transfusion syndrome (TTTS). We extended our mathematical model of TTTS by adding the dynamics of hematocrit, and simulated incomplete laser therapy, first, by leaving one patent opposite arteriovenous anastomosis from the recipient to the donor and, second, by leaving one patent arteriovenous anastomosis from the donor to the recipient. In both simulations we reproduced the clinical observation of severe hematocrit discordance preceding delayed amniotic fluid imbalance. In conclusion, incomplete laser therapy may cause a severe circulatory imbalance between the twins which presents predominantly as discordant hematocrits rather than discordant amniotic fluid volumes as in primary TTTS. These results imply that the anemia-polycythemia sequence is a sensitive mechanism to identify transfusion reversal after complicated laser therapy, confirming the suggested role of middle cerebral artery peak systolic velocity Doppler measurements as a useful method of follow-up. [Copyright &y& Elsevier]

Objective: The purpose of this study was to compare monoamniotic-monochorionic and diamniotic-monochorionic twin placentas and to estimate the incidence of twin-twin transfusion syndrome in monoamniotic-monochorionic twin pregnancies.Study Design: We analyzed the angioarchitecture and cord insertion distance in 24 monoamniotic-monochorionic and 200 diamniotic-monochorionic placentas.Results: Compared with diamniotic-monochorionic placentas, monoamniotic-monochorionic placentas had significantly more arterioarterial anastomoses (20/20 vs 159/200, respectively; P=.013), significantly less opposite arteriovenous anastomoses (10/20 vs 165/200, respectively; P=.002), similar venovenous anastomoses (6/20 vs 46/200, respectively; P=.323), and arteriovenous anastomoses (20/20 vs 187/200 respectively; P=.279) and significantly shorter umbilical cord distances (median [+/-SD], 5.0+/-6.9 cm vs 17.5+/-6.8 cm; P<.001).Conclusion: Monoamniotic-monochorionic and diamniotic-monochorionic placentas have different anastomotic patterns. The (virtually) 100% incidence of arterioarterial anastomoses in monoamniotic-monochorionic placentas explains the reason that twin-twin transfusion syndrome rarely occurs in monoamniotic-monochorionic twin pregnancies and predicts that twin-twin transfusion syndrome manifestations are approximately 5 times less often recognized in monoamniotic-monochorionic pregnancies than in diamniotic-monochorionic pregnancies. [ABSTRACT FROM AUTHOR]

In the past 35 years many experimental studies have been performed to investigate the revascularization potential of transmyocardial revascularization and the possible working mechanisms underlying the observed clinical improvement in angina pectoris after this treatment. In this review of the experimental literature, the various methods that have been used to create transmyocardial channels and the most supported hypotheses on the working mechanism (channel patency, angiogenesis and myocardial denervation) are discussed and evaluated. [Copyright &y& Elsevier]

Analyzes fetal urine and amniotic fluid in monochorionic twins with twin-twin transfusion syndrome. Application of laser ablation for the cessation of placental anastomotic blood flows; Use of amnioreduction for the reduction of amniotic fluid pressure; Spontaneous abortion rate of laser ablation.

Abnormal growth of infants may indicate disease of the children, thus methods to identify growth disorders are wanted in medicine. We previously showed that two-time-points weight growth velocities at age t, calculated by a commercial software product as [Weight(t) - Weight(t - X)]/X, with X = 448 days, were erroneous due to the long separation of 448 days. We were convinced that shorter X-values would solve this accuracy problem. However, our hypothesis is that: "shorter time separations than 448 days cause a decreased accuracy of numerical weight velocity equations in realistic infant weights until an age of about three years". Supporting evidence comes from analyzing how shorter X-values will affect the accuracy of two-time-points weight velocity calculations. We systematically varied X between 1 and 448 days of various P50/0SD-related standard weight curves: (a) P50/0SD with the weights separated by 1 day and X = 1,28,224,448 days; (b) P50/0SD with the weights at variable ages and X = 14-448 days; and (c) case (b) and incorporating weight fluctuations typically occurring in infants. Cases (b) and (c) include details observed in a clinical case. Our results show that the combination of weight fluctuations and varying time intervals between consecutive weights make weight velocity predictions worse for shorter X values in children younger than three years. Because these two causes of failure occur naturally in infants whose weight is regularly measured, other weight velocity equations face the same causes for inaccuracy. In conclusion, our hypothesis suggests that any software that predicts weight velocities should be abandoned in infants < 3 years. Practically, it should require that when (commercial) software weight velocity prediction suggests a medical problem, careful clinical checking should be mandatory, e.g. by linking predicted and exact weight velocities at age t (the latter from the mathematical first derivative at age t of standard weight curves). [ABSTRACT FROM AUTHOR]

Abstract: Bloodstains at crime scenes are among the most important types of evidence for forensic investigators. They can be used for DNA-profiling for verifying the suspect''s identity or for pattern analysis in order to reconstruct the crime. However, until now, using bloodstains to determine the time elapsed since the crime was committed is still not possible. From a criminalistic point of view, an accurate estimation of when the crime was committed enables to verify witnesses’ statements, limits the number of suspects and assesses alibis. Despite several attempts and exploration of many technologies during a century, no method has been materialized into forensic practice. This review gives an overview of an extensive search in scientific literature of techniques that address the quest for age determination of bloodstains. We found that most techniques are complementary to each other, in short as well as long term age determination. Techniques are compared concerning their sensitivity for short and long term ageing of bloodstains and concerning their possible applicability to be used on a crime scene. In addition, experimental challenges like substrate variation, interdonor variation and environmental influences are addressed. Comparison of these techniques contributes to our knowledge of the physics and biochemistry in an ageing bloodstain. Further improvement and incorporation of environmental factors are necessary to enable age determination of bloodstains to be acceptable in court. [Copyright &y& Elsevier]

Motion of a moving laser light heat source in a confined volume has important applications such as in endovenous laser ablation (EVLA) of varicose veins. This light heats up the fluid and the wall volume by absorption and heat conduction. The present study compares the flow and temperature fields in a horizontal tube of 4 mm inner diameter in three idealizations of the EVLA procedure: water with a bare fiber tip, water with a carbonized layer on the fiber tip, and blood. Without boiling, the convection patterns in water and blood are similar and Grashof numbers are high enough to guarantee buoyancy induced flow and axial mixing, while preserving some stratification. A carbonized layer at the fiber tip promotes boiling in water at moderate laser powers. Boiling bubbles in water rapidly detach from the tip, with or without a carbonized layer, and promote mixing and a locally homogeneous temperature field. At 15 W laser power and 4 mm/s pullback speed in blood, a gas bubble may be formed that sticks at the fiber tip, causing strong local heating and possibly fiber damage. [ABSTRACT FROM AUTHOR]

Abstract: Blood stains can be crucial in reconstructing crime events. However, no reliable methods are currently available to establish the age of a blood stain on the crime scene. We show that determining the fractions of three hemoglobin derivatives in a blood stain at various ages enables relating these time varying fractions to the age of the blood stain. Application of light transport theory allows addressing the spectroscopic changes in ageing blood stains to changes in chemical composition, i.e. the transition of oxy-hemoglobin into met-hemoglobin and hemichrome. We have found in 20 blood stains that the chemical composition of the blood stain with age, called hemoglobin reaction kinetics, under controlled circumstances, shows a distinct time-dependent behavior, with a unique combination of the three hemoglobin derivatives at all moments in time. Finally, we employed the hemoglobin reaction kinetics inversely to assess the age of 20 other blood stains studied, again over a time period of 0–60 days. We estimated an age of e.g. 55 days correct within an uncertainty margin of 14 days. In conclusion, we propose that the results obtained under controlled conditions demand further evaluation of their possible value for age determination of blood stains on crime scenes. [Copyright &y& Elsevier]

• A metal stent will not be heated up by electrical pulses under clinical conditions. • Close to a stent, temperatures in a typical run remain lower than without the stent. • The experimentally observed rim of viable tissue around the stent is explained. • Accurate simplifications of the electric field generated by needles in are provided. Irreversible Electroporation (IRE) is a promising clinical ablation therapy for the treatment of cancer, but issues with the generation of heat must be solved before safe and effective clinical results can be obtained. In the present study, we show that a metal stent will not be noticeably heated up by IRE pulses under typical clinical conditions. Derivation of this non-intuitive result required the application of Maxwell's equations to the tissue-stent configuration. Subsequently, straightforward and arguably accurate simplifications of the electric field generated by two needles in tissue surrounding a metal stent have enabled the modeling of the heat generation and the transport of heat in IRE procedures. Close to a stent that is positioned in between two needles, temperatures in a typical run of 100 s, 1 Hz pulses, may remain notably lower than without the stent. This is the explanation of the experimentally observed low temperature rim of viable tissue around the stent, whereas all tissue was non-viable without stent, found in tissue model experiments. [ABSTRACT FROM AUTHOR]

Objective Although tissue ablation by irreversible electroporation (IRE) has been characterized as nonthermal, the application of frequent repetitive high-intensity electric pulses has the potential of substantially heating the targeted tissue and causing thermal damage. This study evaluates the risk of possible thermal damage by measuring temperature development and distribution during IRE of porcine kidney tissue. Methods The animal procedures were conducted following an approved Institutional Animal Ethics Committee protocol. IRE ablation was performed in 8 porcine kidneys. Of them, 4 kidneys were treated with a 3-needle configuration and the remaining 4 with a 4-needle configuration. All IRE ablations consisted of 70 pulses with a length 90 µs. The pulse frequency was set at 90 pulses/min, and the pulse intensity at 1,500 V/cm with a spacing of 15 mm between the needles. The temperature was measured internally using 4 fiber-optic temperature probes and at the surface using a thermal camera. Results For the 3-needle configuration, a peak temperature of 57°C (mean = 49±10°C, n = 3) was measured in the core of the ablation zone and 40°C (mean = 36±3°C, n = 3) at 1 cm outside of the ablation zone, from a baseline temperature of 33±1°C. For the 4-needle configuration, a peak temperature of 79°C (mean = 62±16°C, n = 3) was measured in the core of the ablation zone and 42°C (mean = 39±3°C, n = 3) at 1 cm outside of the ablation zone, from a baseline of 35±1°C. The thermal camera recorded the peak surface temperatures in the center of the ablation zone, reaching 31°C and 35°C for the 3- and 4-needle configuration IRE (baseline 22°C). Conclusions The application of repetitive high-intensity electric pulses during IRE ablation in porcine kidney causes a lethal rise in temperature within the ablation zone. Temperature monitoring should be considered when performing IRE ablation near vital structures. [ABSTRACT FROM AUTHOR]