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Objectives In this study, we compared left ventricular (LV) segmental strain measurements obtained with different ultrasound machines and post-processing software packages. Background Global longitudinal strain (GLS) has proven to be a reproducible and valuable tool in clinical practice. Data about the reproducibility and intervendor differences of segmental strain measurements, however, are missing. Methods We included 63 volunteers with cardiac magnetic resonance–proven infarct scar with segmental LV function ranging from normal to severely impaired. Each subject was examined within 2 h by a single expert sonographer with machines from multiple vendors. All 3 apical views were acquired twice to determine the test-retest and the intervendor variability. Segmental longitudinal peak systolic, end-systolic, and post-systolic strain were measured using 7 vendor-specific systems (Hitachi, Tokyo, Japan; Esaote, Florence, Italy; GE Vingmed Ultrasound, Horten, Norway; Philips, Andover, Massachusetts; Samsung, Seoul, South Korea; Siemens, Mountain View, California; and Toshiba, Otawara, Japan) and 2 independent software packages (Epsilon, Ann Arbor, Michigan; and TOMTEC, Unterschleissheim, Germany) and compared among vendors. Results Image quality and tracking feasibility differed among vendors (analysis of variance, p Conclusions In contrast to GLS, LV segmental longitudinal strain measurements have a higher variability on top of the known intervendor bias. The fidelity of different software to follow segmental function varies considerably. We conclude that single segmental strain values should be used with caution in the clinic. Segmental strain pattern analysis might be a more robust alternative.

Objectives The purpose of this study was to compare the accuracy of vendor-specific and independent strain analysis tools to detect regional myocardial function abnormality in a clinical setting. Background Speckle tracking echocardiography has been considered a promising tool for the quantitative assessment of regional myocardial function. However, the potential differences among speckle tracking software with regard to their accuracy in identifying regional abnormality has not been studied extensively. Methods Sixty-three subjects (5 healthy volunteers and 58 patients) were examined with 7 different ultrasound machines during 5 days. All patients had experienced a previous myocardial infarction, which was characterized by cardiac magnetic resonance with late gadolinium enhancement. Segmental peak systolic (PS), end-systolic (ES) and post-systolic strain (PSS) measurements were obtained with 6 vendor-specific software tools and 2 independent strain analysis tools. Strain parameters were compared between fully scarred and scar-free segments. Receiver-operating characteristic curves testing the ability of strain parameters and derived indexes to discriminate between these segments were compared among vendors. Results The average strain values calculated for normal segments ranged from −15.1% to −20.7% for PS, −14.9% to −20.6% for ES, and −16.1% to −21.4% for PSS. Significantly lower values of strain (p Conclusions The accuracy of identifying regional abnormality differs significantly among vendors.

With the approval of CD19-targeted chimeric antigen receptor (CAR) T cells for the treatment of B cell malignancies, clinicians have gained valuable insights into the power and challenges of cellular therapies. In this issue of the JCI, Maluski et al. showed that a CAR containing a CD28 costimulatory domain drives progeny differentiation to resemble that of NK cells, which have the potential for an off-the-shelf cell therapy. These CAR-induced killer (CARiK) cells displayed potent antitumor function and killed across the MHC barrier in vivo. After performing in vitro and in vivo mouse studies, the authors also successfully differentiated human umbilical cord blood-derived progenitor cells into CARiK cells. These unique cells may address some of the current challenges associated with first-generation CARs, such as prolonged production that requires patients to wait weeks for infusion. We believe this innovative progenitor gene-engineered lymphoid system has the potential for clinical translation.

Co-transplantation of hematopoietic stem cells with those engineered to express leukemia-reactive T cell receptors (TCRs) and differentiated ex vivo into precursor T cells (preTs) may reduce the risk of leukemia relapse. Since expression of potentially self-(leukemia-) reactive TCRs will lead to negative selection or provoke autoimmunity upon thymic maturation, we investigated a novel concept whereby TCR expression set under the control of an inducible promoter would allow timely controlled TCR expression. After in vivo maturation and gene induction, preTs developed potent anti-leukemia effects. Engineered preTs provided protection even after repeated leukemia challenges by giving rise to effector and central memory cells. Importantly, adoptive transfer of TCR-transduced allogeneic preTs mediated anti-leukemia effect without evoking graft-versus-host disease (GVHD). Earlier transgene induction forced CD8+ T cell development, was required to obtain a mature T cell subset of targeted specificity, allowed engineered T cells to efficiently pass positive selection and abrogated the endogenous T cell repertoire. Later induction favored CD4 differentiation and failed to produce a leukemia-reactive population emphasizing the dominant role of positive selection. Taken together, we provide new functional insights for the employment of TCR-engineered precursor cells as a controllable immunotherapeutic modality with significant anti-leukemia activity.

Recognizing the critical need for standardization in strain imaging, in 2010, the European Association of Echocardiography (now the European Association of Cardiovascular Imaging, EACVI) and the American Society of Echocardiography (ASE) invited technical representatives from all interested vendors to participate in a concerted effort to reduce intervendor variability of strain measurement. As an initial product of the work of the EACVI/ASE/Industry initiative to standardize deformation imaging, we prepared this technical document which is intended to provide definitions, names, abbreviations, formulas, and procedures for calculation of physical quantities derived from speckle tracking echocardiography and thus create a common standard.

What's known on the subject? and What does the study add? The development of side effects characteristic for the different treatment methods with impact on the patients' quality of life plays a growing role for individual patients with early stage prostate cancer. Using permanent brachytherapy a high dose to the prostate can be applied with a steep dose gradient to the normal tissue. However, small partial volumes of normal tissue may be exposed to high doses inducing special side effects including lower urinary tract symptoms and/or erectile dysfunction. In the literature there are only few publications so far regarding segmental dosimetry and its influence on side effects and the results are conflicting. We could not identify any dosimetric parameter in segmental dosimetry that may have an influence at certain time intervals on the development of side effects such as lower urinary tract symptoms or erectile dysfunction. However, we could state clearly that the preoperative situation is the most important factor for postoperative outcome. Objective To report on the side effects of patients with low to low–intermediate risk prostate cancer treated with permanent interstitial brachytherapy with special emphasis on segmental dosimetry. Patients and Methods A series of 186 consecutive patients treated for early stage prostate cancer receiving definitive I-125 brachytherapy (permanent seed implantation) between November 2001 and April 2005 at our institution were examined for the development of side effects. Morbidity was assessed prospectively using the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF-5) in a mean follow-up interval of 30 months. The scores were correlated with segmental dosimetry performed 6 weeks after the implantation. Results The mean postoperative dose to 90% of the prostate volume (D90) was 180.2 Gy, the mean preoperative IPSS 7.2 and the mean IIEF-5 14.35, with all scores showing a maximum deterioration after 6 weeks with normalization after 24 months. After correlating the segmental dosimetry and the scores at different time intervals, only the baseline scores remained statistically significant in multivariate regression analysis at all time intervals (P < 0.00). Conclusions We could not demonstrate a correlation of segmental dosimetry with induction of side effects. There is no relationship between dose exposure of partial volumes and the development of radiation-induced toxicities. The preoperative situation regarding lower urinary tract symptoms and erectile function are the most important factors for postoperative outcome.

Aims Speckle tracking echocardiography has already demonstrated its clinical potential. However, its use in routine practice is jeopardized by recent reports on high inter-vendor variability of the measurements. As such, the European Association of CardioVascular Imaging (EACVI) and the American Society of Echocardiography (ASE) set up a standardization task force, which was joined by all manufacturers of echocardiographic equipment as well as by companies offering software solutions only, with the ambition to tackle this problem by standardization and quality assurance (QA). Methods and results In this study, a first step towards QA of all commercially available tracking solutions based on computer-generated ultrasound images is presented. The accuracy of the products was acceptable with relative errors below 10% and intra-vendor reproducibility within 5%. Conclusion Whether these results can be extrapolated to the clinical setting is the topic of an ongoing study of the EACVI/ASE/Industry Task Force to standardize deformation imaging. This study was an important first step in the development of generally accepted tools for QA of speckle tracking echocardiography.

Objectives As the number of patients with prostate cancer treated with permanent radioactive implants is increasing world wide, long-term data on tumor control and treatment morbidity become available. Materials Biochemical and clinical tumor control appears to be as effective as after radical prostatectomy or external beam radiation therapy in early prostate cancer. Results The risk of posttreatment urinary incontinence and bowel dysfunction is low and erectile function can be preserved in the majority of patients. However, prostate brachytherapy requires a careful selection of patients as pretreatment factors predict for long-term outcome. The need for combined modality approaches in intermediate and high risk patients remains controversely discussed. The continuous refinement of intraoperative planning techniques and the elucidation of the etiology of urinary, sexual and bowel dysfunction should result in further improvements in biochemical outcomes and decreased morbidity. Conclusions Improved and standardized postimplantation evaluation will make outcome data more reliable and comparable.

Background Echocardiographic assessment of the right ventricle is difficult because of its complex shape. Three-dimensional echocardiographic (3DE) imaging allows more accurate and reproducible analysis of the right ventricle than two-dimensional methodology. However, three-dimensional volumetric analysis has been hampered by difficulties obtaining consistently high-quality coronal views, required by the existing software packages. The aim of this study was to test a new approach for volumetric analysis without coronal views by using instead right ventricle–focused three-dimensional acquisition with multiple short-axis views extracted from the same data set. Methods Transthoracic 3DE and cardiovascular magnetic resonance (CMR) images were prospectively obtained on the same day in 147 patients with wide ranges of right ventricular (RV) size and function. RV volumes and ejection fraction were measured from 3DE images using the new software and compared with CMR reference values. Comparisons included linear regression and Bland-Altman analyses. Repeated measurements were performed to assess measurement variability. Results Sixteen patients were excluded because of suboptimal image quality (89% feasibility). RV volumes and ejection fraction obtained with the new 3DE technique were in good agreement with CMR (end-diastolic volume, r = 0.95; end-systolic volume, r = 0.96; ejection fraction, r = 0.83). Biases were, respectively, −6 ± 11%, 0 ± 15%, and −7 ± 17% of the mean measured values. In a subset of patients with suboptimal 3DE images, the new analysis resulted in significantly improved accuracy against CMR and reproducibility, compared with previously used coronal view–based techniques. The time required for the 3DE analysis was approximately 4 min. Conclusions The new software is fast, reproducible, and accurate compared with CMR over a wide range of RV size and function. Because right ventricle–focused 3DE acquisition is feasible in most patients, this approach may be applicable to a broader population of patients who can benefit from RV volumetric assessment.

For craniospinal axis irradiation in young children sometimes anesthesia is required. In order to minimize risks from the anesthesist's point of view supine position would be preferable to standard prone position. In case of irradiation in supine position verification of the 3-field junction in the cervical region causes problems, because there is no direct visual control. For such situations the clinical application of a new technique is presented.

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The development of side effects characteristic for the different treatment methods with impact on the patients' quality of life plays a growing role for individual patients with early stage prostate cancer. Using permanent brachytherapy a high dose to the prostate can be applied with a steep dose gradient to the normal tissue. However, small partial volumes of normal tissue may be exposed to high doses inducing special side effects including lower urinary tract symptoms and/or erectile dysfunction. In the literature there are only few publications so far regarding segmental dosimetry and its influence on side effects and the results are conflicting. We could not identify any dosimetric parameter in segmental dosimetry that may have an influence at certain time intervals on the development of side effects such as lower urinary tract symptoms or erectile dysfunction. However, we could state clearly that the preoperative situation is the most important factor for postoperative outcome.To report on the side effects of patients with low to low-intermediate risk prostate cancer treated with permanent interstitial brachytherapy with special emphasis on segmental dosimetry.A series of 186 consecutive patients treated for early stage prostate cancer receiving definitive I-125 brachytherapy (permanent seed implantation) between November 2001 and April 2005 at our institution were examined for the development of side effects. Morbidity was assessed prospectively using the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF-5) in a mean follow-up interval of 30 months. The scores were correlated with segmental dosimetry performed 6 weeks after the implantation.The mean postoperative dose to 90% of the prostate volume (D90) was 180.2 Gy, the mean preoperative IPSS 7.2 and the mean IIEF-5 14.35, with all scores showing a maximum deterioration after 6 weeks with normalization after 24 months. After correlating the segmental dosimetry and the scores at different time intervals, only the baseline scores remained statistically significant in multivariate regression analysis at all time intervals (P0.00).We could not demonstrate a correlation of segmental dosimetry with induction of side effects. There is no relationship between dose exposure of partial volumes and the development of radiation-induced toxicities. The preoperative situation regarding lower urinary tract symptoms and erectile function are the most important factors for postoperative outcome.

Interventional bronchoscopy is the main treatment modality in managing benign airway obstructions following lung transplantation. We analyzed the effect of intraluminal brachytherapy on preventing recurrence of hyperplastic tissue.From September 2002 to September 2004, a total of 24 intraluminal brachytherapy applications were carried out on 12 lung transplant patients in 15 different locations. A single dose of 3 Gy was calculated at a 5-mm distance from the catheter surface; the target volume included a stenosis plus safety interval of 0.5-1.0 cm.All patients had a mean 10.6 local interventions (Argon plasma coagulation, balloon dilatations, stenting) over 4.4 months before the first application of endobronchial brachytherapy, with a mean amount of 2.4 applications per month. The mean forced expiratory volume in 1 s (FEV1) was 2,219 ml in the 3 months before application of brachytherapy. After endobronchial brachytherapy, all patients experienced improvement in clinical status and respiratory function. The mean level of FEV1 in the 3 months after application was 2,435 ml (p = 0.02), and the number of invasive interventions dropped to a mean rate of 5.2 interventions in the 5.1 months after the first intervention, with an amount of 1 application per month. No treatment-related complications were seen. Four patients were treated twice, 1 patient three times, and 1 patient four times at the same localization.Recurrent symptomatic benign airway obstruction from hyperplastic tissue in the bronchus after lung transplantation can be successfully treated with intraluminal high-dose-rate brachytherapy with a dose of 3 Gy at a 5-mm distance from the catheter surface and a longitudinal safety margin of 1 cm.

Purpose: An accurate and practical method to measure parameters like strain in myocardial tissue is of great clinical value, since it has been shown, that strain is a more sensitive and earlier marker for contractile dysfunction than the frequently used parameter EF. Current technologies for CMR are time consuming and difficult to implement in clinical practice. Feature tracking is a technology that can lead to more automization and robustness of quantitative analysis of medical images with less time consumption than comparable methods. Methods: An automatic or manual input in a single phase serves as an initialization from which the system starts to track the displacement of individual patterns representing anatomical structures over time. The specialty of this method is that the images do not need to be manipulated in any way beforehand like e.g. tagging of CMR images. Results: The method is very well suited for tracking muscular tissue and with this allowing quantitative elaboration of myocardium and also blood flow. Conclusions: This new method offers a robust and time saving procedure to quantify myocardial tissue and blood with displacement, velocity and deformation parameters on regular sequences of CMR imaging. It therefore can be implemented in clinical practice.

Changes in the rate of dentate granule cell neurogenesis and in the fate of newborn granule cells have been implicated in the development and progression of epilepsies. Strategies to normalize neurogenesis in chronic epilepsy models are thought to increase our understanding of the functional consequences of aberrant neurogenesis in the epileptic brain. Therefore, we modulated neurogenesis in an amygdala kindling paradigm in rats by targeted irradiation of the hippocampus using a medical linear accelerator device. Selective irradiation normalized the hippocampal cell proliferation rate in kindled animals. Both, in kindled and nonkindled rats the number of BrdU/NeuN-labeled newborn neurons was reduced in response to irradiation. Whereas kindling resulted in a pronounced increase in the number of neuroblasts identified based on doublecortin-labeling, irradiation prevented the expansion of the neuroblast population. Moreover, irradiation counteracted the kindling-associated increase in hilar basal dendrites, and kept the fraction of cells with basal dendrites at control levels. Despite the efficacious modulation of neurogenesis, irradiation did not affect the rate of kindling progression. Both, the number of stimulations as well as the cumulative afterdischarge duration to reach respective seizure stages were comparable in animals with and without irradiation. In addition, pre- and postkindling thresholds as well as seizure parameters recorded at threshold stimulation remained unaffected by irradiation. In conclusion, the fact that the efficacious modulation of neurogenesis by irradiation did not exert any effects on kindling acquisition and kindled seizures suggests that newborn neurons do not critically contribute to the hyperexcitable state in the chronic epilepsy model used.

Antigen-presenting cells (APCs) of host origin drive graft-versus-leukemia (GVL) effects but can also trigger life-threatening graft-versus-host disease (GVHD) after hematopoietic cell transplantation (HCT) across major histocompatibility complex (MHC) barriers. We show that in vitro priming of donor lymphocytes can circumvent the need of recipient-derived APCs in vivo for mediating robust GVL effects and significantly diminishes the risk of severe GVHD. In vitro, generated and expanded T cells (ETCs) mediate anti-leukemia effects only when primed on recipient-derived APCs. Loading of APCs in vitro with leukemia cell lysate, chimerism status of the recipient, and timing of adoptive transfer after HCT are important factors determining the outcome. Delayed transfer of ETCs resulted in strong GVL effects in leukemia-bearing full chimera (FC) and mixed chimera (MC) recipients, which were comparable with the GVL/GVHD rates observed after the transfer of naive donor lymphocyte infusion (DLI). Upon early transfer, GVL effects were more pronounced with ETCs but at the expense of significant GVHD. The degree of GVHD was most severe in MCs after transfer of ETCs that had been in vitro primed either on nonpulsed recipient-derived APCs or with donor-derived APCs.

Transforming growth factor beta1 gene (TGFB1) variant Leu10Pro (L10P) has previously been implicated in prostate cancer risk and radiation-induced side-effects. We investigated whether prevalence of this polymorphism is increased in prostate cancer patients and whether carriers are at increased risk for treatment-related side effects.A series of 445 consecutive patients treated for early-stage prostate cancer receiving definitive I-125 brachytherapy (permanent seed implantation) between 10/2000 and 10/2007 at our institution and a comparison group of 457 healthy male control individuals were screened for TGFB1 L10P (869TC) polymorphism. Morbidity was assessed prospectively and compared between carriers versus non-carriers using International Prostate Symptom Score (IPSS), disease-specific Quality-of-Life single question added to the IPSS and International Index of Erectile Function with its subgroups.The Leu/Leu genotype was found in 150 patients (34%) versus 180 controls (39%), the Pro/Pro genotype in 75 patients (17%) versus 65 controls (14%) and the Leu/Pro genotype in 220 patients (49%) versus 212 controls (46%) without any statistically significant differences between the two groups. There was a trend towards an increased prevalence of the L10P substitution among patients with a per allele odds ratio of 1.19 (95% CI 0.99-1.44; P = 0.08). After a median follow-up of 18 months (range 1-60 months) there were no statistically significant differences regarding morbidity.TGFB1 polymorphism L10P is not strongly associated with prostate cancer risk. After 18 months, there was no evidence for increased adverse radiotherapy responses in heterozygote or rare homozygote carriers. Longer follow-up may be necessary to detect a statistically significant difference.

Three-dimensional echocardiography (3DE) is a valuable tool to be used in addition to and not instead of two-dimensional echocardiography by providing complementary information and improved quantitative accuracy and reproducibility compared with two-dimensional techniques. 3DE has the potential to become the standard echocardiographic examination procedure for the assessment of valvular disease. This article describes applications of 3DE.

Permanent interstitial brachytherapy represents the most conformal form of radiation therapy of the prostate and the number of patients with prostate cancers treated with permanent radioactive implants is increasing world wide. In the meanwhile long-term data on tumor control and treatment morbidity become available. Biochemical and clinical tumor control appears to be as effective as after radical prostatectomy or external beam radiation therapy in early prostate cancer. The risk of postreatment urinary incontinence and bowel dysfunction is low and erectile function can be preserved in the majority of patients. However, prostate brachytherapy requires a careful selection of patients as pretreatment factors predict for long-term outcome. The need for combined modality approaches in intermediate and high-risk patients remains controversely discussed. The continous refinement of intraoperative planning techniques and the elucidation of the etiology of urinary, sexual, and bowel dysfunction should result in further improvements in biochemical outcomes and decreased morbidity. Improved and standardized postimplantation evaluation will make outcome data more reliable and comparable.

Background. A simplified conditioning protocol including single-dose preoperative thymic and low-dose whole body irradiation with or without subsequent donor bone marrow transplantation (BMTx) can be applied in porcine lung transplantation. We hypothesized that this protocol would prolong allograft survival. Methods. Left-sided single lung transplantation from major histocompatibility complex (MHC)-mismatched donors was performed in 27 minipigs. Recipients received whole body (1.5 Gy) and thymic irradiation (7 Gy) before transplantation (IRR group, n=6), intravenous immunosuppression with methylprednisolone, cyclosporine, and azathioprine for 27 postoperative days (IS group, n=5) or both (IRR+IS group, n= 10). BMTx group recipients were treated with irradiation, immunosuppression and a donor bone marrow infusion on postoperative day 1. Peripheral blood leukocyte phenotype and donor cell chimerism were monitored by flow cytometry. Purified CD25 + T cells from long-term survivors or rejecting animals were used for in vitro MLR suppression assays. Results. Median graft survival was: IRR 12 days, IS 55 days, IRR+IS 239 days, and BMTx 80 days (P

BACKGROUND: The co-transplantation of hematopoietic stem cells (HS) with those that have been engineered to express tumor-reactive T cell receptors (TCRs) and differentiated into precursor T cells (preTs) may optimize tumor reduction. Since expression of potentially self-(tumor-) reactive TCRs will lead to negative selection upon thymic maturation, we investigated whether preTs forced to express a leukemia-reactive TCR under the control of a tetracycline-inducible promoter would allow timely controlled TCR expression thereby avoiding thymic negative selection. METHODS: Using lentiviral vectors, murine LSK cells were engineered to express a Tetracycline-inducible TCR directed against a surrogate leukemia antigen. TCR-transduced LSK cells were co-cultured on T cell development-supporting OP9-DL1 cells to produce preTs. Lethally-irradiated B6/NCrl recipients received syngeneic T cell-depleted bone marrow and 8 × 106 syngeneic or allogeneic (B10.A) TCR-engineered preTs. An otherwise lethal leukemia cell (C1498) challenge was given 28 days later. RESULTS: After in vivo maturation and gene induction up to 70% leukemia free survival was achieved in recipients of syngeneic TCR-transduced preTs (p Figure 1 Figure 1. Co-transplantation of engineered preTs provides potent long-lasting anti-leukemia effects upon TCR-induction in vivo. (A) Lethally-irradiated B6 mice received syngeneic TCDBM cells and either non-transduced or TCR gene-transduced preTs. Doxycycline was given starting the day of transplantation. One month later, 1.2 x 106 C1498-OVA leukemia cells were injected via tail vein. Controls did not receive preTs. n = 10 to 15 per group. (B) Surviving mice of the co-transplantation experiments were re-challenged with C1498-OVA leukemia three months after the first challenge. Age matched non-transplanted mice were used as controls. Pooled data of two independent transplantations (n = 10) are shown. (C) 95 days after the second challenge, spleens of surviving animals were harvested (n = 4) and analyzed for the expression of T cell memory markers on the progenies of co-transplanted preTs. Disclosures No relevant conflicts of interest to declare.

To minimize anaesthesia related risks during craniospinal irradiation in children, treatment in supine position would be preferable. Verification especially of the cervical three-field junction causes problems, because direct visual control is not possible. We present clinical experiences with a new verification technique with all three fields exposed on one single film.

Purpose:Dose distribution in the base and apex of prostate and in the penile bulb in permanent seed implantations may influence the probability of urinary symptoms and erectile dysfunction. We compared the dose distribution in these partial volumes and the organs of risk in the intraoperative US‐ and the post‐implant CT‐planning. Method: More than 550 patients were implanted with I‐125 seeds following the recommendations of the ABS/ESTRO/EORTC for a permanent prostate brachytherapy. Base for the dosimetry was an ultrasound guided intraoperative interactive real‐time planning. Post‐implant CT dosimetry was performed in all patients 6 weeks after implantation. Looking for coherences between dose distribution and side effects a partial volume analysis was performed particularly in the apical and basal part of the prostate and in the penile bulb. Dosimetric data analyzed were among others V100, D90 and the mean dose both in the intraoperative planning and post‐implant CT‐plan. They were correlated with the IPSS‐, EF‐score and QLI. Results: Mean follow up was 32 months. The rectal V100 was significant higher in the post‐plan (0.25cc vs. 0.81cc) but still under 1.3cc. The D90 of the apical part of the prostate was 177Gy (median) in the ultrasound planning and 165Gy in the CT‐plan, D90 of the base of the prostate was 175Gy and 159Gy. The D90 of the penile bulb in the CT‐plan was 40 to 78Gy (median 56Gy) with a V100 of 0.02cc to 0.7cc. A significant correlation between dose distribution in the partial volumes and the IPSS‐, EF‐ and QLI data could be shown. Conclusion: A partial volume dosimetry analysis of the prostate may offer the possibility of lower side effects. Looking more into detail for the dose distribution a better dose homogeneity with a better QoL for the patient can be achieved. Intraoperative and post‐implant CT dosimetry data are well correlated.

Purpose: To determine clinically the fetal dose from irradiation of head and neck during pregnancy by a young woman using phantom measurements. Method: A 30 years old woman with medulloblastoma should receive a cranio spinal axis irradiation during pregnancy. Phantom measurements should show if the irradiation of head and neck as a first step of the radiotherapy is possible. Fetal dose was estimated with measurements at an Alderson‐phantom using thermoluminescent dosimeters(TLDs). Irradiation of typical fields (26×24 cm2, 8×8 cm2, 6 MV photons) were simulated, measuring points were used as in the AAPM report no 50. A special shielding was developed to reduce the dose at the foetus. Results: For single doses of 2 Gy the measurements at the phantom results in maximal doses between 6.04 mGy and 1.86 mGy for the large fields (0.95 mGy to 0.39 mGy for the smaller boost fields) at different points between fundus and pubis without any shielding. Using a specially designed shielding the doses were reduced to 3.90 mGy and 1.16 mGy. For a planned total dose for the patient of 30 + 24 Gy the fetal dose should be 0.03 Gy to 0.11 Gy without and 0.02 Gy to 0.07 Gy with the shielding. In vivo measurements during radiotherapy confirmed these values for a single irradiation. Conclusion: Irradiation during pregnancy should be avoided if anyway possible. To reduce the fetal dose a specially designed shielding should be used. Also for irradiation in the region of head and neck in any case measurements should be done to estimate the fetal dose before starting radiotherapy.

Purpose: LDR brachytherapy is a well established treatment method for low risk prostate cancer. Different techniques and radioactive sources are used. In this study I‐125 seeds from two different manufactures were compared regarding dosimetric properties and clinical outcome. Method: From 08/2000 to 04/2005 nearly 500 patients have been implanted with I‐125 seeds. The first 201 patients were implanted with loose seeds from the first manufacturer the other patients have been implanted with loose seeds from a second manufacturer. Both kinds of seeds have the same geometric dimensions, the same application system and method can be used. To compare the clinical outcome two subgroups of 101 consecutive patients were defined. In all cases the same treatment method was performed always by the same operating team. In both groups clinical dosimetric parameters (intraoperative and postoperative) were investigated, morbidity of the patients was analyzed. Individual nomograms were calculated to compare physically differences. Results:Dosimetric and clinical data of 202 patients were analyzed. No significant differences could be found in the number of seeds, prostate volume or implanted activity comparing the two subgroups. The intraoperative and postoperative D90 of the prostate was the same in both groups as well as the D30 of the urethra and the V100 of the rectum. Our clinical data show a very low probability of side effects in both groups of patients. Looking to the correlation of implanted activity and intraoperative prostate volume for both groups we found a small difference for prostate size greater than 50cc. Conclusion: LDR brachytherapy with I‐125 seeds is a well established treatment method. The quality of the implantation depends on the treatment method and the experience of the operating team. Different kinds of sources with the same isotope do not influence the clinical outcome and the quality of life for the patient significantly.

Purpose: Permanent seed implantation is a well accepted therapy for the treatment of low risk prostate cancer. In Europe the number of treated patients increases considerably. New techniques and planning systems allow a very safe intervention. A retrospective analysis is performed to show if there are additional parameters to optimize dose distribution and therefore to reduce side effects.Method and Materials: In our institution 304 patients were implanted with I‐125 radioactive seeds following the recommendations of the ABS and the ESTRO/EORTC for a permanent prostate brachytherapy. Basis for the dosimetry was an ultrasound guided intraoperative interactive real‐time planning (VariSeed 6.7/7.0/7.1). Looking for coherences between dose distribution and side effects a partial volume analysis was performed particularly in the apical and basal part of the prostate. Dosimetric data analyzed were V100, V150, D90 and the mean dose.Results: Postoperative follow‐up is 1–54 months (mean 24 months). Different types of side effects such as urinary retention, proctitis, and erectile dysfunction occurred in 4%, 8% and 24% of our patients. Looking to the group with and without side effects we found relevant differences in the apical part of the prostate. The median for the V150 (apex) is 40,5% and 28,8%, the mean dose in the apex is 283,1Gy and 257,5Gy. The D90 and V100 is comparable in both groups (184,1Gy/182,3Gy, 98,9%/99,2%). No significant differences were found in the basal part of the prostate. Conclusion: A partial volume analysis of the prostate during the implantation offers the possibility to lower side effects. It is not sufficient to look to the standard values such as V100, D90 for the prostate and D30 and V100 for the urethra and rectum. Looking more into detail for the dose distribution a better dose homogeneity with a better quality of life for the patient can be achieved.

A young woman had idiopathic autoimmune hemolytic anemia occurring in the last weeks of pregnancy. The hemolytic process was quite severe in the mother but responded to steroid therapy and transfusions. The baby was born with a mild form of hemolytic disease with elevated indirect bilirubin levels, increased normoblasts and reticulocytes, and a positive direct antiglobulin test. The child did not require any exchange transfusions, and although the hemoglobin fell to a low of 9.7 g/100 ml 1 mo after delivery, it continued to rise to normal levels after that. The child is developing normally. The antibody was an IgG globulin, presumably 7S, and crossed the placenta to react with the fetal red cells. The antibody showed no specificity when tested with a panel of cells, including Rh null cells.

ObjectivesWe undertook volumetric analysis of the right ventricle (RV) by real-time 3-dimensional echocardiography (RT3DE), cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT) on images obtained in RV-shaped phantoms and in patients with a wide range of RV geometry.BackgroundAssessment of the RV by 2-dimensional (2D) echocardiography remains challenging due to its unique geometry and limitations of the current analysis techniques. RT3DE, CMR, and CCT, which can quantify RV volumes, promise to overcome the limitations of 2D echocardiography.MethodsImages were analyzed using RV Analysis software. Volumes measured in vitro were compared with the true volumes. The human protocol included 28 patients who underwent RT3DE, CMR, and CT on the same day. Volumetric analysis of CMR images was used as a reference, against which RT3DE and CCT measurements were compared using linear regression and Bland-Altman analyses. To determine the reproducibility of the volumetric analysis, repeated measurements were performed for all 3 imaging modalities in 11 patients.ResultsThe in vitro measurements showed that: 1) volumetric analysis of CMR images yielded the most accurate measurements; 2) CCT measurements showed slight (4%) but consistent overestimation; and 3) RT3DE measurements showed small underestimation, but considerably wider margins of error. In humans, both RT3DE and CCT measurements correlated highly with the CMR reference (r = 0.79 to 0.89) and showed the same trends of underestimation and overestimation noted in vitro. All interobserver and intraobserver variability values were

Es wird uber eine flammenphotometrische Mikromethode zur Bestimmung von Na, K und Ca berichtet, bei der insgesamt 0,05 cm8 Serum ausreichen, um mit einem Gesamtfehler von ± 1 bis ± 2% Dreifach-Analysen von Na, K und Ca in etwa 1 min gleichzeitig durchzufuhren.

Die fruher von uns beschriebene Mikromethode zur Bestimmung der Serum-Elektrolyte Natrium, Kalium und Calcium wurde an der lebenden Ratten gepruft und ihre Brauchbarkeit zur fortlaufenden Analyse bewiesen.

Wir bestimmten die Serum-Elektrolytwerte Na, K und Ca beim Menschen sowohl aus venosem Blut (Makromethode) als auch gleichzeitig aus Capillarblut (Mikromethode), das der Pingerbeere bzw. dem OhrlAppchen entnommen wurde. Diese Bestimmungen zeigen, da\ die Ca-Konzentrationen mit genugender Genauigkeit aus Capillarblut wiedergegeben werden konnen. Hingegen lassen sich die K- und Na-Werte mit dieser Methode nicht exakt erfassen.

There is very limited published information testifying to the safety and possible complications of cell-based therapies. Accurately assessing the potential risks of translating novel, cell-based immunosuppressive protocols into clinical trials is therefore extremely difficult. This report describes the use of a pulmonary allograft model in outbred miniature pigs as a preliminary step in the development of a safe, clinically feasible, cell-based immunosuppressive protocol. Single lung transplants were performed in 22 MHC Class I-mismatched donor-recipient pairs, which were randomized between four treatment groups. For the first 28 days postoperatively, all animals were immunosuppressed with methylprednisilone and tacrolimus, with or without preoperative irradiation; subsequently, pharmacological immunosuppression was stopped in all treatment groups. Animals in two groups also received a central venous infusion of donor-derived 'transplant acceptance-inducing cells' (TAICs) on the seventh and 14th days postoperatively. Allograft survival was monitored by sequential chest X-rays, bronchoscopies and transbronchial biopsy histologies. No acute adverse events were associated with the administration of TAICs and there was no evidence of accelerated graft rejection. The observations presented in this report represent an important first step towards the development of a clinically applicable protocol for the use of TAIC therapy in lung transplantation.