Problems and pitfalls in vulvar and cervical cancer sentinel node scintigraphy

After the introduction for penile cancer, the sentinel lymph node imaging is increasingly applied in various types of cancer. After the initial learning phase, 105 patients with vulvar and 24 with cervical cancer have been investigated. In vulvar cancer all the imaged sentinel nodes were discovered by the portable probe intraoperatively. No false negative sentinel node was observed. The most critical issue is the tracer application. Performed strictly intradermally, the sentinel node shows up immediately. Concomitant use of isosulfan blue dye did not improve the results and was stopped therefore. Similarly, more superficial (intra/subendothelial) application brings up better results as compared to deeper injection in cervical cancer patients. No false negative results were seen. Apparently, an almost 100% detection is possible. Our findings clearly show that tracer application is the key for successful imaging. If not done properly, sentinel node may appear later or may even more likely be missed.<br>Após a introdução para câncer do pênis, a imagem do linfonodo sentinela é cada vez mais aplicada nos diversos tipos de câncer. Após a fase inicial de aprendizagem, 105 pacientes com câncer vulvar e 24 com câncer cervical foram investigados. No câncer vulvar todas as imagens de nodos sentinela foram descobertas por sonda portátil durante o exame. Nenhum nodo sentinela falso negativo foi observado. A questão mais crítica é a aplicação do traçador. Realizada pela via intradérmica, o nodo sentinela surge imediatamente. O corante isosulfan blue não melhora os resultados e seu uso concomitante foi abandonado. Do mesmo modo, a aplicação mais superficial (intra/subendotelial) apresenta melhores resultados quando comparada com a administração mais profunda em pacientes com câncer cervical. Não foram observados resultados falsos negativos. Aparentemente, uma detecção de aproximadamente 100% é possível. Nossos achados mostram claramente que a administração do traçador é um ponto chave para uma imagem com qualidade. Se não for feita corretamente, o nodo sentinela pode aparecer tardiamente ou pode até ser perdido

Linking Hydraulic Properties to Hemolytic Performance of Rotodynamic Blood Pumps

In rotodynamic blood pumps (RBPs) a substantial proportion of input energy is dissipated into the blood. This energy may propel damaging work on blood constituents. To date, the link between this hydraulic energy dissipation and respective hemolytic action in RBPs remains vastly unknown. In this study, computational fluid dynamics is applied to compute the hydraulic energy dissipation at 9 operating conditions in two RBPs (HM3: HeartMate 3; HVAD: HeartWare Ventricular Assist Device). Respective interrelations with hemolytic pump performance are elucidated by comparing these computations with in silico predicted and in vitro measured hemolysis. Despite different pump geometries, hydraulic loss magnitudes, and distributions, global hydraulic energy dissipation shows strong correlation (r > 0.95) to in vitro hemolysis with scaling factors in the same order of magnitude for both devices (phi(HM3) = 0.599 (mL g) (J 100L)(-1); phi(HVAD) = 0.716 (mL g) (J 100L)(-1)). The analytical description of hydraulic energy dissipation reveals to be a function of shear stresses and exposure time, unmasking its analogy to the power-law formulation of hemolysis. This hydraulics-based analysis may denote a step ahead to relate turbomachinery to bioengineering and may provide mechanistic insights into the relation between RBP design, hydraulic properties, and hemolytic performance

T-regulatory cells predict clinical outcome in soft tissue sarcoma patients: a clinico-pathological study

BACKGROUND: Soft tissue sarcomas (STS) are generally considered non-immunogenic, although specific subtypes respond to immunotherapy. Antitumour response within the tumour microenvironment relies on a balance between inhibitory and activating signals for tumour-infiltrating lymphocytes (TILs). This study analysed TILs and immune checkpoint molecules in STS, and assessed their prognostic impact regarding local recurrence (LR), distant metastasis (DM), and overall survival (OS). METHODS: One-hundred and ninety-two surgically treated STS patients (median age: 63.5 years; 103 males [53.6%]) were retrospectively included. Tissue microarrays were constructed, immunohistochemistry for PD-1, PD-L1, FOXP3, CD3, CD4, and CD8 performed, and staining assessed with multispectral imaging. TIL phenotype abundance and immune checkpoint markers were correlated with clinical and outcome parameters (LR, DM, and OS). RESULTS: Significant differences between histology and all immune checkpoint markers except for FOXP3+ and CD3−PD-L1+ cell subpopulations were found. Higher levels of PD-L1, PD-1, and any TIL phenotype were found in myxofibrosarcoma as compared to leiomyosarcoma (all p < 0.05). The presence of regulatory T cells (Tregs) was associated with increased LR risk (p = 0.006), irrespective of margins. Other TILs or immune checkpoint markers had no significant impact on outcome parameters. CONCLUSIONS: TIL and immune checkpoint marker levels are most abundant in myxofibrosarcoma. High Treg levels are independently associated with increased LR risk, irrespective of margins