Photodynamic therapy: superficial and interstitial illumination.

Photodynamic therapy (PDT) is reviewed using the treatment of skin tumors as an example of superficial lesions and prostate cancer as an example of deep-lying lesions requiring interstitial intervention. These two applications are among the most commonly studied in oncological PDT, and illustrate well the different challenges facing the two modalities of PDT-superficial and interstitial. They thus serve as good examples to illustrate the entire field of PDT in oncology. PDT is discussed based on the Lund University group's over 20 yr of experience in the field. In particular, the interplay between optical diagnostics and dosimetry and the delivery of the therapeutic light dose are highlighted. An interactive multiple-fiber interstitial procedure to deliver the required therapeutic dose based on the assessment of light fluence rate and sensitizer concentration and oxygen level throughout the tumor is presented

Design and validation of a fiber optic point probe instrument for therapy guidance and monitoring

Abstract in Undetermined ABSTRACT. Optical techniques for tissue diagnostics currently are experiencing tremendous growth in biomedical applications, mainly due to their noninvasive, inexpensive, and real-time functionality. Here, we demonstrate a hand-held fiber optic probe instrument based on fluorescence/reflectance spectroscopy for precise tumor delineation. It is mainly aimed for brain tumor resection guidance with clinical adaptation to minimize the disruption of the standard surgical workflow and is meant as a complement to the state-of-the-art fluorescence surgical microscopy technique. Multiple light sources with fast pulse modulation and detection enable precise quantification of protoporphyrin IX (PpIX), tissue optical properties, and ambient light suppression. Laboratory measurements show the system is insensitive to strong ambient light. Validation measurements of tissue phantoms using nonlinear least squares support vector machines (LS-SVM) regression analysis demonstrate an error of <5% for PpIX concentration ranging from 400 to 1000 nM, even in the presence of large variations in phantom optical properties. The mean error is 3% for reduced scattering coefficient and 5% for blood concentration. Diagnostic precision of 100% was obtained by LS-SVM classification for in vivo skin tumors with topically applied 5-aminolevulinic acid during photodynamic therapy. The probe could easily be generalized to other tissue types and fluorophores for therapy guidance and monitoring

System for integrated interstitial photodynamic therapy and dosimetric monitoring

Photodynamic therapy for the treatment of cancer relies on the presence of light, sensitizer and oxygen. By monitoring these three parameters during the treatment a better understanding and treatment control could possibly be achieved. Here we present data from in vivo treatments of solid skin tumors using an instrument for interstitial photodynamic therapy with integrated dosimetric monitoring. By using intra-tumoral ALA-administration and interstitial light delivery solid tumors are targeted. The same fibers are used for measuring the fluence rate at the treatment wavelength, the sensitizer fluorescence and the local blood oxygen saturation during the treatment. The data presented is based on 10 treatments in 8 patients with thick basal cell carcinomas. The fluence rate measurements at 635 nm indicate a major treatment induced absorption increase, leading to a limited light penetration at the treatment wavelength. This leads to a far from optimal treatment since the absorption increase prevents peripheral tumor regions from being fully treated. An interactive treatment has been implemented assisting the physician in delivering the correct light dose. The absorption increase can be compensated for by either prolonging the treatment time or increasing the output power of each individual treatment fiber. The other parameters of importance, i.e. the sensitizer fluorescence at 705 nm and the local blood oxygen saturation, are monitored in order to get an estimate of the amount of photobleaching and oxygen consumption. Based on the oxygen saturation signal, a fractionized irradiation can be introduced in order to allow for a re-oxygenation of the tissu

Clinical system for interstitial photodynamic therapy with combined on-line dosimetry measurements

A system for interstitial photodynamic therapy with delta-aminolaevulinic acid and multiple optical fibers has been developed. The system enables photodynamic treatment of large embedded tumor volumes and utilizes real-time measurements to allow on-line dosimetry. Important parameters such as light fluence rate, sensitizer fluorescence intensity, and changes in local blood oxygen saturation are measured with the same fibers that deliver the therapeutic light. Data from the first clinical treatments on nodular basal cell carcinomas indicate a major treatment-induced light absorption increase, rapid sensitizer photo-bleaching, and a relatively constant global tissue oxygen saturation level during the treatment

Impact of smoking and preoperative electrophysiology on outcome after open carpal tunnel release

Background: The aim was to evaluate the influence of smoking and preoperative electrophysiology on the outcome of open carpal tunnel release. Methods: This retrospective observational study evaluated the outcome in 493 patients (531 hands) primary operated for carpal tunnel syndrome. Data were collected from medical records, health evaluations, and QuickDASH questionnaires before surgery and 1 year after. Results: Smokers had a higher QuickDASH score preoperatively as well as postoperatively, but the change in total score did not differ. The odds of having a postoperative QuickDASH score >10 were 2.5 times higher in smoking patients than in non-smoking patients. In 124/493 patients (25%), no clinically significant improvement was seen. Normal and extreme preoperative electrophysiology values were associated with higher postoperative scores. No correlation was found between preoperative QuickDASH scores and preoperative electrophysiology values. Conclusions: Smokers with carpal tunnel syndrome experience more symptoms preoperatively. Smokers have remaining symptoms after surgery. There is no correlation between preoperative QuickDASH scores and preoperative electrophysiology values. Patients with normal or near to normal preoperative electrophysiology results have limited improvement after surgery

Outcome after carpal tunnel release : impact of factors related to metabolic syndrome

Objective: The standard surgical treatment of carpal tunnel syndrome (CTS), with an open carpal tunnel release, is reported to relieve symptoms in most patients. In a retrospective observational study, outcome after open carpal tunnel release was evaluated, focusing on factors related to the metabolic syndrome: diabetes, hypertension, obesity (BMI ≥30) and statin treatment. Methods: Results from 493 out of 962 patients (531/1044 hands) operated for CTS during 18 months that had filled in QuickDASH questionnaires before and 1-year after surgery were included in the study. Results: Patients with diabetes (n = 76) had higher QuickDASH scores pre- (56 [36–77]; i.e. median [interquartile range]) and postoperatively (31 [9–61]) compared to patients without diabetes (48 [32–66]; p 10 (74% vs 61%;

No Strings Attached: Force and Vibrotactile Feedback in a Guitar Simulation

In this paper we propose a multisensory simulation of plucking guitar strings in virtual reality. The auditory feedback is generated by a physics-based simulation of guitar strings, and haptic feedback is provided by a combination of high fidelity vibrotactile actuators and a Phantom Omni haptic device. Moreover, we present a user study (n=29) exploring the perceived realism of the simulation and the relative importance of force and vibrotactile feedback for creating a realistic experience of plucking virtual strings. The study compares four conditions: no haptic feedback, vibrotactile feedback, force feedback, and a combination of force and vibrotactile feedback. The results indicate that the combination of vibrotactile and force feedback eliits the most realistic experience, and during this condition, the participants were less likely to inadvertently hit strings after the intended string had been plucked. Notably, no statistically significant differences were found between the conditions involving either vibrotactile or force feedback, which points towards an indication that haptic feedback is important but does not need to be high fidelity in order to enhance the quality of the experience

Beta: an experiment in funded undergraduate start up

This paper reports on an evaluation of a funded undergraduate project designed to enable student business start-up. The programme, entitled 'Beta', provides undergraduate students with £1,500 of seed-corn funding. The key objective of the project is for the participants to exit it with a viable and legal business entity through which they can start trading on completion of the course. The study adopts a case study approach and evaluates all aspects of the Beta programme, the actors involved and its processes and practices. The authors examine the development of the project and the challenges and hurdles that were identified and overcome to realize the project's goals