Consequences of additional use of PET information for target volume delineation and radiotherapy dose distribution for esophageal cancer.

BACKGROUND AND PURPOSE: To determine the consequences of target volume (TV) modifications, based on the additional use of PET information, on radiation planning, assuming PET/CT-imaging represents the true extent of the tumour. MATERIALS AND METHODS: For 21 patients with esophageal cancer, two separate TV's were retrospectively defined based on CT (CT-TV) and co-registered PET/CT images (PET/CT-TV). Two 3D-CRT plans (prescribed dose 50.4 Gy) were constructed to cover the corresponding TV's. Subsequently, these plans were compared for target coverage, normal tissue dose-volume histograms and the corresponding normal tissue complication probability (NTCP) values. RESULTS: The addition of PET led to the modification of CT-TV with at least 10% in 12 of 21 patients (57%) (reduction in 9, enlargement in 3). PET/CT-TV was inadequately covered by the CT-based treatment plan in 8 patients (36%). Treatment plan modifications resulted in significant changes (p<0.05) in dose distributions to heart and lungs. Corresponding changes in NTCP values ranged from -3% to +2% for radiation pneumonitis and from -0.2% to +1.2% for cardiac mortality. CONCLUSIONS: This study demonstrated that TV's based on CT might exclude PET-avid disease. Consequences are under dosing and thereby possibly ineffective treatment. Moreover, the addition of PET in radiation planning might result in clinical important changes in NTCP.

Prevention of pin tract infection in external stainless steel fixator frames using electric current in a goat model.

Pin tract infections of external fixators used in orthopaedic reconstructive bone surgery are serious complications that can eventually lead to periostitis and osteomyelitis. In vitro experiments have demonstrated that bacteria adhering to stainless steel in a biofilm mode of growth detach under the influence of small electric currents, while remaining bacteria become less viable upon current application. Therefore, we have investigated whether a 100microA electric current can prevent signs of clinical infection around percutaneous pins, implanted in the tibia of goats. Three pins were inserted into the lateral right tibia of nine goats, of which one served for additional frame support. Two pins were infected with a Staphylococcus epidermidis strain of which one pin was subjected to electric current, while the other pin was used as control. Pin sites were examined daily. The wound electrical resistance decreased with worsening of the infection from a dry condition to a purulent stage. After 21 days, animals were sacrificed and the pins taken out. Infection developed in 89% of the control pin sites, whereas only 11% of the pin sites in the current group showed infection. These results show that infection of percutaneous pin sites of external fixators in reconstructive bone surgery can be prevented by the application of a small DC electric current.

Electric current-induced detachment of Staphylococcus epidermidis biofilms from surgical stainless steel.

Biomaterial-centered infections of orthopedic percutaneous implants are serious complications which can ultimately lead to osteomyelitis, with devastating effects on bone and surrounding tissues, especially since the biofilm mode of growth offers protection against antibiotics and since removal frequently is the only ultimate solution. Recently, it was demonstrated that as a possible pathway to prevent infections of percutaneous stainless steel implants, electric currents of 60 to 100 microA were effective at stimulating the detachment of initially adhering staphylococci from surgical stainless steel. However, initially adhering bacteria are known to adhere more reversibly than bacteria growing in the later stages of biofilm formation. Hence, the aim of this study was to examine whether a growing Staphylococcus epidermidis biofilm can be stimulated to detach from surgical stainless steel by the use of electric currents. In separate experiments, four currents, i.e., 60 and 100 microA of direct current (DC) and 60 and 100 microA of block current (50% duty cycle, 1 Hz), were applied for 360 min to stimulate the detachment of an S. epidermidis biofilm that had grown for 200 min. A 100-microA DC yielded 78% detachment, whereas a 100-microA block current under the same experimental conditions yielded only 31% detachment. The same trend was found for 60 microA, with 37% detachment for a DC and 24% for a block current. Bacteria remaining on the surface after the current application were less viable than they were prior to the current application, as demonstrated by confocal laser scanning microscopy. In conclusion, these results suggest that DCs are preferred for curing infections.

Influence of extracellular polymeric substances on deposition and redeposition of Pseudomonas aeruginosa to surfaces.

In this study, the role of extracellular polymeric substances (EPS) in the initial adhesion of EPS-producing Pseudomonas aeruginosa SG81 and SG81R1, a non-EPS-producing strain, to substrata with different hydrophobicity was investigated. The release of EPS by SG81 was concurrent with a decrease in surface tension of a bacterial suspension from 70 to 45 mJ m(-2) that was absent for SG81R1. Both strains adhered faster and in higher numbers to a hydrophilic than to a hydrophobic substratum, but the initial deposition rates and numbers of adhering bacteria in a stationary-end point were highest for the non-EPS-producing strain SG81R1, regardless of substratum hydrophobicity. Both strains adhered less to substrata pre-coated with isolated EPS of strain SG81. Furthermore, it was investigated whether bacteria, detached by passing air-bubbles, had left behind 'footprints' with an influence on adhesion of newly redepositing bacteria. Redeposition on glass was highest for non-EPS-producing SG81R1 and decreased linearly with the number of times these cycles of detachment and deposition were repeated to become similar to the redeposition of SG81 after six cycles. This indicates that P. aeruginosa SG81 leaves the substratum surface nearly completely covered with EPS after detachment, while SG81R1 releases only minor amounts of surface active EPS, completely covering the substratum after repeated cycles of detachment and adhesion. Atomic force microscopy showed a thick and irregular EPS layer (up to 32 nm) after the first detachment cycle of EPS-producing strain SG81, whereas the putatively non-EPS-producing strain SG81R1 left a 9 nm thin layer after one cycle. X-ray photoelectron spectroscopy indicated that the bacterial footprints consisted of uronic acids, the prevalence of which increased with the number of detachment and deposition cycles.