Compact Color Biofinder (CoCoBi): Fast, Standoff, Sensitive Detection of Biomolecules and Polyaromatic Hydrocarbons for the Detection of Life.

We have developed a compact instrument called the "COmpact COlor BIofinder", or CoCoBi, for the standoff detection of biological materials and organics with polyaromatic hydrocarbons (PAHs) using a nondestructive approach in a wide area. The CoCoBi system uses a compact solid state, conductively cooled neodymium-doped yttrium aluminum garnet (Nd:YAG) nanosecond pulsed laser capable of simultaneously providing two excitation wavelengths, 355 and 532 nm, and a compact, sensitive-gated color complementary metal-oxide-semiconductor camera detector. The system is compact, portable, and determines the location of biological materials and organics with PAHs in an area 1590 cm2 wide, from a target distance of 3 m through live video using fast fluorescence signals. The CoCoBi system is highly sensitive and capable of detecting a PAH concentration below 1 part per billion from a distance of 1 m. The color images provide the simultaneous detection of various objects in the target area using shades of color and morphological features. We demonstrate that this unique feature successfully detected the biological remains present in a 150-million-year-old fossil buried in a fluorescent clay matrix. The CoCoBi was also successfully field-tested in Hawaiian ocean water during daylight hours for the detection of natural biological materials present in the ocean. The wide-area and video-speed imaging capabilities of CoCoBi for biodetection may be highly useful in future NASA rover-lander life detection missions.

Detecting Minerals and Organics Relevant to Planetary Exploration Using a Compact Portable Remote Raman System at 122 Meters.

Raman spectroscopy is a technique that can detect and characterize a range of molecular compounds such as water, water ice, water-bearing minerals, and organics of particular interest to planetary science. The detection and characterization of these molecular compounds, which are indications of habitability on planetary bodies, have become an important goal for planetary exploration missions spanning the solar system. Using a compact portable remote Raman system consisting of a 532 nm neodymium-doped yttrium aluminum garnet- (Nd:YAG-) pulsed laser, a 3-in. (7.62 cm) diameter mirror lens and a compact spectrograph with a miniature intensified charge coupled device (mini-ICCD), we were able to detect water (H2O), water ice (H2O-ice), CO2-ice, hydrous minerals, organics, nitrates, and an amino acid from a remote distance of 122 m in natural lighting conditions. To the best of our knowledge, this is the longest remote Raman detection using a compact system. The development of this uniquely compact portable remote Raman system is applicable to a range of solar system exploration missions including stationary landers for ocean worlds and lunar exploration, as they provide unambiguous detection of compounds indicative of life as well as resources necessary for further human exploration.

Remote Raman Detection of Chemicals from 1752 m During Afternoon Daylight.

The detection and identification of materials from a distance is highly desirable for applications where accessibility is limited or there are safety concerns. Raman spectroscopy can be performed remotely and provides a very high level of confidence in detection of chemicals through vibrational modes. However, the remote Raman detection of chemicals is challenging because of the very weak nature of Raman signals. Using a remote Raman system, we performed fast remote detection of various solid and liquid chemicals from 1752 m during afternoon hours on a sunny day in Hawaii. Remote Raman systems with kilometer target range could be useful for chemical detection of volcanic gases, methane clathrate icebergs or fire ice, toxic gas clouds and toxic waste, explosives, and hazardous chemicals. With this successful test, we demonstrate the feasibility of developing future mid-size remote Raman systems suitable for long range chemical detection using helicopters and light airplanes.

A primary care approach to cutaneous T-cell lymphoma.

Approximately 1,000 new cases of cutaneous T-cell lymphoma are definitively diagnosed each year. Mycosis fungoides and Sézary syndrome are the primary lymphomas in this group. Mycosis fungoides can begin in the patch, plaque, or tumor stage or in a combination. Less commonly, its initial presentation is erythrodermic. Because the initial appearance of cutaneous T-cell lymphoma can be subtle and the histopathologic evidence nonspecific, the disease is commonly misdiagnosed as a common dermatologic condition such as chronic eczema. Misdiagnosis can severely affect treatment and prognosis. Clinicians must be able to recognize this disease and know when to include it in the differential diagnosis. This article provides an overview of cutaneous T-cell lymphoma, discusses differential diagnoses, and outlines management considerations.

Photopheresis: clinical applications and mechanism of action.

Photopheresis is a leukapheresis-based therapy that utilizes 8-methoxypsoralen and ultraviolet A irradiation. Photopheresis is currently available at approximately 150 medical centers worldwide. Recent evidence suggests that this therapy used as a single agent may significantly prolong life, as well as induce a 50%-75% response rate among individuals with advanced cutaneous T cell lymphoma (CTCL). Furthermore, a 20%-25% complete response rate with photopheresis alone, or in combination with other biologic response modifiers, has been obtained at our institution among patients with Sezary syndrome. These complete responses have been characterized by the complete disappearance of morphologically atypical cells from the skin and blood. The use of sensitive molecular techniques has also confirmed the sustained disappearance of the malignant T cell clone from the blood of patients with complete responses. In addition to the treatment of CTCL, numerous reports indicate that photopheresis is a potent agent in the therapy of acute allograft rejection among cardiac, lung, and renal transplant recipients. Chronic graft versus host disease also appears to be quite responsive to photopheresis therapy. Likewise, there may also be a potential role for photopheresis in the therapy of certain autoimmune diseases that are poorly responsive to conventional therapy. The immunologic basis for the responses of patients with these conditions is likely due to the induction of anticlonotypic immunity directed against pathogenic clones of T lymphocytes. Treatment-induced apoptotic death of pathogenic T cells and activation of antigen presenting cells are postulated to have important effects in this therapeutic process.

Dermatology and the World Wide Web.

The internet is a global network of computer databases. Over the last decade the fastest growing area of the internet has been the World Wide Web. The World Wide Web now offers a vast array of dermatologic resources that can be used to support the delivery of patient care. The purpose of this article is to provide a brief explanation of the World Wide Web, and to list some of the dermatologic resources that are available there.

Treatment of cutaneous T-cell lymphoma with extracorporeal photopheresis monotherapy and in combination with recombinant interferon alfa: a 10-year experience at a single institution.

BACKGROUND: Extracorporeal photopheresis is a pheresis-based therapy that permits the direct targeting of psoralen-mediated photochemotherapy to circulating pathogenic T cells. Although photopheresis is currently used to treat cutaneous T-cell lymphoma (CTCL), limited data are available regarding overall response rates and durability of responses among patients with advanced disease. Furthermore, little is known about the effectiveness and tolerability of combined regimens employing other biologic response modifiers including interferon alfa. OBJECTIVE: Our purpose was to determine the efficacy of photopheresis among 41 patients with the clinical and laboratory diagnosis of CTCL; the majority of patients had stage III or IV disease with the presence of circulating malignant T cells. METHODS: A retrospective chart review during a 10-year period at a single university hospital was performed for all patients receiving either photopheresis monotherapy on two consecutive days every 4 weeks (one cycle) and for an additional 12 patients who also received interferon alfa 1.5 to 5 million U subcutaneously three to five times weekly. RESULTS: Thirty-one of 41 patients (76%) were treated for six or more cycles. The remaining 10 were treated with less than six cycles because of rapidly progressing disease (n = 6), death unrelated to CTCL (n = 2), or withdrawal from treatment (n = 1); one of the 10 patients had only received five cycles of treatment but is still receiving therapy. Twenty-eight of the 31 patients treated for six or more cycles received photopheresis alone. Among the 28, seven patients (25%) had a complete remission, 13 (46%) had a partial remission defined as more than 50% clearing of skin disease, and eight (29%) did not respond to treatment. The presence of Sézary cells in the peripheral blood was associated with a favorable response. Median time to treatment failure was 18 months, whereas median survival from initiation of therapy was 77 months and from the time of diagnosis exceeded 100 months. Nine of these 28 patients went on to receive combination therapy with interferon alfa and, in some cases, other agents. Among these nine patients, five had an enhanced clinical response to the combination therapy compared with treatment with photopheresis monotherapy. The combined regimen was well tolerated. CONCLUSION: These results indicate that patients with advanced CTCL can achieve a high response rate for an extended period with photopheresis and that interferon alfa combined with photopheresis is a well-tolerated regimen that appears to produce higher response rates than photopheresis alone.

Interferon: an overview for dermatology nurses.

Interferons are glycoproteins that have numerous immunologic effects. Over the last decade the use of interferon has grown dramatically. Interferon preparations are now commonly used in many dermatologic conditions. The types of interferon that are commercially available, their therapeutic applications, and the nursing care of patients who receive interferon are reviewed.

Photopheresis and the role of the nurse.

Extracorporeal photochemotherapy (ECP, photopheresis) is a form of pheresis therapy approved by the federal Food and Drug Administration for treating the systemic manifestations of cutaneous T-cell lymphoma. Increasing evidence suggests that it may also be useful in treating many immune-related diseases, as well as in preventing and treating organ transplant rejection. Because the precise mechanism of action for photopheresis has not been clearly defined, research to determine future applications for this treatment is needed. It is important for dermatology nurses to understand photopheresis, to whom it is given, the nursing care for patients receiving photopheresis, and the current research and potential applications of this therapy.

Use of extracorporeal photochemotherapy in heart transplant recipients during acute rejection: a case study.

Despite the growing availability of improved immunosuppressive agents, acute and chronic rejection episodes remain a major complication in heart transplant recipients. The rejection of allografts is a normal part of the body's response to foreign antigens. The key to controlling this response is to administer a regimen of multiple immunosuppressive drugs. Evidence indicates that by adding extracorporeal photochemotherapy to a standard immunomodulatory regimen, the rejection process can be reversed without significantly increasing patient risk. In this case study we examine extracorporeal photochemotherapy and the care of patients receiving this therapy.

Cutaneous T-cell lymphoma: a case study, treatment, and nursing implications.

In this case study, the course and treatment of fatal cutaneous T-cell lymphoma (CTCL) in an adult male is presented. Following diagnosis, the patient received multiple therapeutic regimens, including extracorporeal photochemotherapy, also known as photopheresis. The different treatments for CTCL are described. Photopheresis is useful in the care of CTCL patients, and nurses will play a large part in their care.

Treatment of autoimmune disease with extracorporeal photochemotherapy: pemphigus vulgaris--preliminary report.

Extracorporeal photochemotherapy is a new form of immunotherapy which involves the extracorporeal photoinactivation of peripheral blood cells by 8-methoxypsoralen in the presence of ultraviolet A irradiation, followed by readministration of the cells. To explore the efficacy of this therapy in the treatment of autoimmune disease, four patients with a lengthy history of corticosteroid and immunosuppressive drug-resistant pemphigus vulgaris were initiated on extracorporeal photochemotherapy. Three patients experienced a complete remission in cutaneous disease expression, permitting discontinuation of medications in two and a substantial decrease in the third. Significant reductions in serum antiepidermal cell antibody titers occurred in all four patients. The treatments were well tolerated without the occurrence of adverse events. These results in a small number of patients suggest that extracorporeal photochemotherapy may prove to be a useful tool in the treatment of aggressive autoimmune disease.

Extracorporeal photochemotherapy in the treatment of cutaneous T cell lymphoma and autoimmune disorders affecting the skin.

Extracorporeal photochemotherapy (ECPCT) is a new form of chemoimmunotherapy which involves the ex vivo exposure of malignant peripheral blood cells to 8-methoxypsoralen (8-MOP) and ultraviolet A (UVA) radiation followed by reinfusion of the treated cells. This treatment has resulted in an unprecedented number of prolonged remissions in patients with therapeutically resistant forms of cutaneous T cell lymphoma (CTCL) characterized by the systemic dissemination of a clonal population of malignant helper T lymphocytes. Although the mechanism of the beneficial effect is uncertain, an immune reaction to the reinfused modified T cells probably results in tumour regression. Because the T cell antigen receptor (TCR) is an immunogenic structure and because an identical TCR is present on the entire clonal population of malignant T cells in each individual with CTCL, modification of this structure represents the most likely target for the effects of 8-MOP and UVA. Understanding of the precise events leading to tumour regression in CTCL during treatment with ECPCT may lead to the expanded use of this therapy for other lethal haemopoietic malignancies.