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CT-guided high-dose-rate brachytherapy in the interdisciplinary treatment of patients with liver metastases of pancreatic cancer

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Hepatobiliary & Pancreatic Diseases International 2015年第5期14卷 530-538页

作者： Gero wieners Alexander christian Schippers Federico Collettini Dirk Schnapauff Bernd hamm Peter wust Hanno Riess Bernhard Gebauer Department of Diagnostic and Interventional Radiology Charité-Universit?tsmedizin Berlin Campus Virchow-Klinikum Department of Radiation Oncology Charité-Universit?tsmedizin Berlin Campus Virchow-Klinikum Department of Oncology Charité-Universit?tsmedizin Berlin Campus Virchow-Klinikum

BACKGROUND： CT-guided high-dose-rate brachytherapy（CT-HDRBT） is an interventional radiologic technique for local ablation of primary and secondary malignomas applying a radiation source through a brachycatheter percutaneously into the targeted lesion. The aim of this study was to assess local tumor control, safety and efficacy of CT-HDRBT in the treatment of liver metastases of pancreatic cancer. METHODS： Twenty consecutive patients with 49 unresectable liver metastases of pancreatic cancer were included in this retrospective trial and treated with CT-HDRBT, applied as a single fraction high-dose irradiation（15-20 Gy） using a 192 Irsource. Primary endpoint was local tumor control and secondary endpoints were complications, progression-free survival and overall ***： The mean tumor diameter was 29 mm（range 10-73）. The mean irradiation time was 20 minutes（range 7-42）. The mean coverage of the clinical target volume was 98%（range 88%-100%）. The mean D100 was 18.1 Gy and the median D100 was 19.78 Gy. Three major complications occurred with post-interventional abscesses, three of which were seen in 15 patients with biliodigestive anastomosis（20%）and overall 15%. The mean follow-up time was 13.7 months（range 1.4-55.0）. The median progression-free survival was 4.9 months（range 1.4-42.9, mean 9.4）. Local recurrence occurred in 5（10%） of 49 metastases treated. The median overall survival after CT-HDRBT was 8.6 months（range 1.5-55.3）. Eleven patients received chemotherapy after ablation with a median progression-free survival of 4.9 months（mean 12.9）. Nine patients did not receive chemotherapy after intervention with a median progression-free survival of 3.2 months（mean 5.0）. The rate of local tumor control was 91% in both groups after 12 ***： CT-HDRBT was safe and effective for the treatment of liver metastases of pancreatic cancer.

关键词： brachytherapy pancreatic cancer liver metastases CT intervention

Pathologic Q waves and Prolonged QTc Time in Preoperative ECG Are Predictive for Perioperative Cardiovascular Events

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world Journal of Cardiovascular Diseases 2014年第10期4卷 498-509页

作者： Thomas wolters Michael weber Thomas Neumann Hans-Georg Strauß Andreas Luchner Manfred Seeberger christian Mueller Christoph Liebetrau Svetlana Apostolovic Radmilo Jankovic Dragic Bankovic Marina Jovic Vesselin Mitrovic Holger Nef Helge Mollmann Karl werdan christian.w. hamm Axel Schlitt Department of Medicine III University Clinic Halle (Saale) Halle Germany Department of Medicine Clinic Grabs Grabs Switzerland Department of Cardiology Kerckhoff Heart and Thorax Center Bad Nauheim Germany Department of Medicine II Clinic Gro&szlig -Umstadt Gro&szlig -Umstadt Germany Department of Medicine II University of Regensburg Regensburg Germany Department of Cardiology University of Basel Basel Switzerland University Cardiology Clinic Ni&scaron Serbia Department of Mathematical Sciences University of Kragujevac Kragujevac Serbia Department of Medicine I University Clinic of Gie&szlig en and Marburg Gie&szlig en Germany Department of Medicine I Paracelsus-Harz-Clinic Bad Suderode Quedlinburg Germany

Aims: The value of ECG in the perioperative risk stratification under modern treatment options is uncertain. The main objective of the present analysis was to determine the usefulness of a pre-operative ECG derivation for evaluating the risk of perioperative morbidity and mortality. Methods: we performed a secondary analysis of the prospective, international, multicenter, observational “No-Risk” Study (N-terminal B-type natriuretic peptide [NT-proBNP] for the assessment of the perioperative cardiac risk after major noncardiac surgery) to determine the prognostic value of 12-lead ECG. Inclusion criteria were age >55 years and at least one of the following cardiovascular risk factors: arterial hypertension, diabetes mellitus, dyslipidemia, active smoking, and family history positive for coronary heart disease. The combined primary endpoint included total mortality, acute myocardial infarction (NSTEMI and STEMI), cardiopulmonary resuscitation, heart failure, and asystole or ventricular fibrillation during hospitalization. ECGs from 616 patients enrolled from 2006 to 2009 prior to noncardiac surgery in the No-Risk Study were analyzed. Results: The mean age was 67.6 (±8.1) years;300 (48.7%) patients were male. Fourteen (2.3%) patients suffered from the combined primary endpoint while in the hospital. In Kaplan-Meier analyses, a pathologic Q wave and QTc > 500 ms were significantly related to the incidence of the primary endpoint (p p = 0.042, respectively), whereas other ECG parameters such as LBBB, RBBB, PQ interval, QRS interval, and others were not related to worse in-hospital outcome. Conclusion: The 12-lead ECG is still an important diagnostic tool for perioperative risk assessment of cardiovascular events in noncardiac surgery in patients at risk.

关键词： ECG Perioperative Risk Cardiovascular Risk

High Sensitivity CRP Predicts Long-Term Mortality in Patients with Atrial Fibrillation and Evident Acute Coronary Syndrome

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International Journal of Clinical Medicine 2013年第3期4卷 137-144页

作者： Christoph Liebetrau Luise Gaede Sebastian Szardien Johannes Rixe Oliver Doerr Matthias willmer Michael weber Andreas Rolf Helge Mollmann Albrecht Elsasser christian hamm Holger Nef Department of Cardiology Kerckhoff Heart and Thorax CenterBad NauheimGermany Department of Cardiology and Angiology Faculty of MedicineJustus-Liebig University of GiessenGiessenGermany

Background: Atrial fibrillation (AF) is a frequent arrhythmia associated with an adverse prognostic value in patients with ACS. Risk stratification as well as diagnosis of ACS is strongly supported by biomarkers. High sensitivity CRP (hs-CRP) is known to be elevated in patients presenting with ACS as well as with ***: In total, 2034 consecutive patients with an ACS were analysed. The incidence of AF in the setting of ACS, the prognostic value of hs-CRP and the clinical outcome within 6 months were subject of the study. Death after 6 months was considered as primary endpoint. Results: The frequency of AF among patients admitted with suspected ACS was 124 (6.1%). During 6-month follow-up the mortality rate among patients with AF was significantly higher (20 [16.1%] vs 133 [6.9%];log-rank 13.72;p 0.001) compared to patients without AF. Cox regression analysis revealed an increased risk for ACS patients with AF with an adjusted HR of 2.63 (95% CI 1.48 - 3.78;p 0.001). Patients with AF showed significant higher levels of hs-CRP than patients without AF (6.01mg/dl IQR [1.7 - 17.8] vs 3.3mg/dl IQR [1.37 - 9.83];p = 0.003). By the use of multivariate Cox regression analysis, risk of mortality was higher when AF patients had higher concentrations of hs-CRP (HR 1.076;95% CI 1.02 - 1.13;p = 0.002).Conclusions: AF is a strong and independent indicator for increased mortality in patients presenting with ACS. hs-CRP predicts mortality in AF patients and should be considered for risk stratification in clinical routine.

关键词： Acute Coronary Syndrome Atrial Fibrillation Risk Stratification High-Sensitivity CRP

X-ray focusing with efficient high-NA multilayer Laue lenses

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Light(Science & Applications) 2017年第1期6卷 95-103页

作者： Saša Bajt Mauro Prasciolu Holger Fleckenstein Martin Domaracký Henry N Chapman Andrew J Morgan Oleksandr Yefanov Marc Messerschmidt Yang Du Kevin T Murray Valerio Mariani Manuela Kuhn Steven Aplin Kanupriya Pande Pablo Villanueva-Perez Karolina Stachnik Joe PJ Chen Andrzej Andrejczuk Alke Meents Anja Burkhardt David Pennicard Xiaojing Huang Hanfei Yan Evgeny Nazaretski Yong S Chu christian E hamm Photon Science DESYNotkestrasse 85Hamburg 22607Germany Center for Free-Electron Laser Science DESYNotkestrasse 85Hamburg 22607Germany Department of Physics University of HamburgLuruper Chaussee 149Hamburg 22607Germany Centre for Ultrafast Imaging Luruper Chaussee 149Hamburg 22607Germany National Science Foundation BioXFEL Science and Technology Center 700 Ellicott StreetBuffaloNY 14203USA Department of Physics Arizona State UniversityTempeAZ 85287USA Faculty of Physics University of BialystokCiolkowskiego 1L Str.Bialystok 15-245Poland National Synchrotron Light Source II Brookhaven National LaboratoryUptonNY 11973USA Alfred-wegener Institute Helmholtz Center for Polar and Marine ResearchBussestr.27Bremerhaven 27570Germany

Multilayer Laue lenses are volume diffraction elements for the efficient focusing of *** a new manufacturing technique that we introduced,it is possible to fabricate lenses of sufficiently high numerical aperture(NA)to achieve focal spot sizes below 10 *** alternating layers of the materials that form the lens must span a broad range of thicknesses on the nanometer scale to achieve the necessary range of X-ray deflection angles required to achieve a high *** poses a challenge to both the accuracy of the deposition process and the control of the materials properties,which often vary with layer *** introduced a new pair of materials—tungsten carbide and silicon carbide—to prepare layered structures with smooth and sharp interfaces and with no material phase transitions that hampered the manufacture of previous *** a pair of multilayer Laue lenses(MLLs)fabricated from this system,we achieved a two-dimensional focus of 8.4×6.8 nm2 at a photon energy of 16.3 keV with high diffraction efficiency and demonstrated scanning-based imaging of samples with a resolution well below 10 *** high NA also allowed projection holographic imaging with strong phase contrast over a large range of *** error analysis indicates the possibility of achieving 1 nm focusing.

关键词： multilayer Laue lenses multilayers ptychography X-ray holography X-ray optics