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With the discovery of light beyond human visibility, scientists strove to extend the range of observation to invisible parts of the light’s spectrum. Realising that light of all frequencies is part the same physical phenomenon, brought a leap in understanding about electromagnetic waves. With the development of more advanced technology, detectors with higher sensitivity for adjacent frequencies to the visible were built. From this, with each new observable wavelength, more insight into otherwise invisible processes and phenomenons were observed. Hand in hand with this went the enhancement of the output power of corresponding sources. This has lead to higher sensitivity setups throughout the spectrum, leading to observations which have given a deeper understanding in various fields of science. Nowadays, detectors and emitters in many different regions of the invisible electro magnetic spectrum have found their way in our every day life. Innovations in technology has lead to practical applications such as X-rays in medicine, motion sensors and remote controls using infrared light, distance sensors and data transmission using radar and radio devices. The frequency regions above infrared are optically generated and below radar can be produced using electric methods. There is no straight line that separates these frequencies. There rather is a whole intermediate region known as the terahertz (THz) regime. Due to the lack of sensitive detectors and efficient sources, the THz frequency region has not been exploited for application use on a widespread basis so far. It combines properties from the surrounding frequency ranges which make it an ideal spectrum for various applications. Consequently, THz radiation and THz imaging are active fields of research.
The work presented in this thesis consists of the development and testing of novel THz imaging concepts, which uses a THz antenna coupled field effect transistor (TeraFET) detector. Two detection principles are applied using two different optical setups. The first uses a pulsed optical parametric oscillator (OPO) THz source where the optical output power is detected. The source relies on a nonlinear effect of a lithium niobate crystal to generate tunable THz pulses from a Q-switched pump laser. The THz signal is detected and amplified by a double stage operational amplifier for monitoring the real time 20 ns pulses on an oscilloscope where a signal to noise ratio (SNR) of ⇠ 25 at a frequency range from 0.75 to 1.1 THz is reached. Imaging of the area of interest with a resolution of 1.2 mm is achieved through raster scanning of the THz pulses. Also spectroscopy with a frequency resolution of ⇠ 50 GHz is demonstrated using a para-aminobenzoic acid sample. The second setup utilises two synchronised electronic multiplier chain sources where their output is mixed on the detector. To form a heterodyne detection setup, the intermediate frequency is fed to a lock-in amplifier which then amplifies the so called beat signal from the TeraFET detector. One source is fixed relative to the detector even through scanning to ensure a stable signal. This detection method allows for amplitude and phase detection for every scanning position, making numerical light field propagation and object reconstruction possible. Numerical focussing is a key feature achieving a lateral resolution of the input transmittance of ⇡ 2 mm.
After the introduction, the second chapter describes the setup, measurement results and challenges which arise using a TeraFET together with the pulsed THz source “Firefly-THz”. In the description of the setup, special attention is given to the shielding of the detector and the electronics. General findings discuss first the overall performance and later spectroscopy and imaging as application examples. Another subsection continues with potential noise sources before the chapter is concluded. Chapter three expands on the topic of Fourier optics from a theoretical point of view. First, parts of the theory of the Fourier Transform (FT) are set out for the reader and how the Fast Fourier Transform (FFT) results from the Discrete Fourier Transform (DFT). This approach is used for theoretical considerations and the implementation of a Fourier optic script that allows for numerical investigations on electro magnetic field propagation through an optical system. The boundary conditions are chosen to be practical relevant to make predictions on measurements presented in chapter four. The following fourth chapter describes the realisation of a heterodyne THz detection setup. Before the measurement results are presented, the setup and its electric configuration are shown. The results come close to the analytical predictions so that the same algorithm which propagates the field from an object to the Fourier plane is used to propagate the measured field back to the object. The influence of phase noise on the measurement results are discussed before simulation and measurement is compared. The last chapter in this thesis concludes on the findings in the pulsed THz detection and the heterodyne THz Fourier imaging and gives an outlook for both configurations.
Holographic imaging techniques, which exploit the coherence properties of light, enable the reconstruction of the 3D scenery being viewed. While the standard approaches for the recording of holographic images require the superposition of scattered light with a reference field, heterodyne detection techniques enable direct measurement of the amplitude and relative phase of the electric light field. Here, we explore heterodyne Fourier imaging and its capabilities using active illumination with continuous-wave radiation at 300 GHz and a raster-scanned antenna-coupled field-effect transistor (TeraFET) for phase-sensitive detection. We demonstrate that the numerical reconstruction of the scenery provides access to depth resolution together with the capability to numerically refocus the image and the capability to detect an object obscured by another object in the beam path. In addition, the digital refocusing capability allows us to employ Fourier imaging also in the case of small lens-object distances (virtual imaging regime), thus allowing high spatial frequencies to pass through the lens, which results in enhanced lateral resolution.
Background: Dexamethasone (Dex) is the most common corticosteroid to treat edema in glioblastoma (GBM) patients. Recent studies identified the addition of Dex to radiation therapy (RT) to be associated with poor survival. Independently, Tumor Treating Fields (TTFields) provides a novel anti-cancer modality for patients with primary and recurrent GBM. Whether Dex influences the efficacy of TTFields, however, remains elusive.
Methods: Human GBM cell lines MZ54 and U251 were treated with RT or TTFields in combination with Dex and the effects on cell counts and cell death were determined via flow cytometry. We further performed a retrospective analysis of GBM patients with TTFields treatment +/- concomitant Dex and analysed its impact on progression-free (PFS) and overall survival (OS).
Results: The addition of Dex significantly reduced the efficacy of RT in U251 and MZ54 cells. TTFields (200 kHz/250 kHz) induced massive cell death in both cell lines. Concomitant treatment of TTFields and Dex did not reduce the overall efficacy of TTFields. Further, in our retrospective clinical analysis, we found that the addition of Dex to TTFields therapy did not influence PFS nor OS.
Conclusion: Our translational investigation indicates that the efficacy of TTFields therapy in patients with GBM and primary GBM cell lines is not affected by the addition of Dex.
Purpose: Dexamethasone (Dex) is the most common corticosteroid to treat edema in glioblastoma (GBM) patients. Recent studies identified the addition of Dex to radiation therapy (RT) to be associated with poor survival. Independently, Tumor Treating Fields (TTFields) provides a novel anti-cancer modality for patients with primary and recurrent GBM. Whether Dex influences the efficacy of TTFields, however, remains elusive. Methods: Human GBM cell lines MZ54 and U251 were treated with RT or TTFields in combination with Dex and the effects on cell counts and cell death were determined via flow cytometry. We further performed a retrospective analysis of GBM patients with TTFields treatment +/- concomitant Dex and analysed its impact on progression-free (PFS) and overall survival (OS). Results: The addition of Dex significantly reduced the efficacy of RT in U251, but not in MZ54 cells. TTFields (200 kHz/250 kHz) induced massive cell death in both cell lines. Concomitant treatment of TTFields and Dex did not reduce the overall efficacy of TTFields. Further, in our retrospective clinical analysis, we found that the addition of Dex to TTFields therapy did not influence PFS nor OS. Conclusion: Our translational investigation indicates that the efficacy of TTFields therapy in patients with GBM and GBM cell lines is not affected by the addition of Dex.
Glioblastoma (GBM) is a cancer type with high thrombogenic potential and GBM patients are therefore at a particularly high risk for thrombotic events. To date, only limited data on anticoagulation management after pulmonary embolism (PE) in GBM is available and the sporadic use of DOACs remains off-label. A retrospective cohort analysis of patients with GBM and postoperative, thoracic CT scan confirmed PE was performed. Clinical course, follow-up at 6 and 12 months and the overall survival (OS) were evaluated using medical charts and neuroradiological data. Out of 584 GBM patients, 8% suffered from postoperative PE. Out of these, 30% received direct oral anticoagulants (DOACs) and 70% low-molecular-weight heparin (LMWH) for therapeutic anticoagulation. There was no significant difference in major intracranial hemorrhage (ICH), re-thrombosis, or re-embolism between the two cohorts. Although statistically non-significant, a tendency to reduced mRS at 6 and 12 months was observed in the LMWH cohort. Furthermore, patients receiving DOACs had a statistical benefit in OS. In our analysis, DOACs showed a satisfactory safety profile in terms of major ICH, re-thrombosis, and re-embolism compared to LMWH in GBM patients with postoperative PE. Prospective, randomized trials are urgent to evaluate DOACs for therapeutic anticoagulation in GBM patients with PE.
Chemotherapy and diffuse low-grade gliomas : a survey within the European Low-Grade Glioma Network
(2018)
Background: Diffuse low-grade gliomas (DLGGs) are rare and incurable tumors. Whereas maximal safe, functional-based surgical resection is the first-line treatment, the timing and choice of further treatments (chemotherapy, radiation therapy, or combined treatments) remain controversial.
Methods: An online survey on the management of DLGG patients was sent to 28 expert centers from the European Low-Grade Glioma Network (ELGGN) in May 2015. It contained 40 specific questions addressing the modalities of use of chemotherapy in these patients.
Results: The survey demonstrated a significant heterogeneity in practice regarding the initial management of DLGG patients and the use of chemotherapy. Interestingly, radiation therapy combined with the procarbazine, CCNU (lomustine), and vincristine regimen has not imposed itself as the gold-standard treatment after surgery, despite the results of the Radiation Therapy Oncology Group 9802 study. Temozolomide is largely used as first-line treatment after surgical resection for high-risk DLGG patients, or at progression.
Conclusions: The heterogeneity in the management of patients with DLGG demonstrates that many questions regarding the postoperative strategy and the use of chemotherapy remain unanswered. Our survey reveals a high recruitment potential within the ELGGN for retrospective or prospective studies to generate new data regarding these issues.
Background: Glioblastoma (GBM) patients are at particularly high risk for thrombotic complications. In the event of a postoperative pulmonary embolism, therapeutic anticoagulation (tAC) is indispensable. The impact of therapeutic anticoagulation on recurrence pattern in GBM is currently unknown. Methods: We conducted a matched-pair cohort analysis of 57 GBM patients with or without tAC that were matched for age, sex, gross total resection and MGMT methylation status in a ratio of 1:2. Patients’ characteristics and clinical course were evaluated using medical charts. MRI characteristics were evaluated by two independent authors blinded to the AC status. Results: The morphologic MRI appearance in first GBM recurrence showed a significantly higher presence of multifocal, midline crossing and sharp demarcated GBM recurrence patterns in patients with therapeutic tAC compared to the matched control group. Although statistically non-significant, the therapeutic tAC cohort showed increased survival. Conclusion: Therapeutic anticoagulation induced significant morphologic changes in GBM recurrences. The underlying pathophysiology is discussed in this article but remains to be further elucidated.
Background: Glioblastoma (GBM) is a cancer type with high thrombogenic potential and GBM patients are therefore at a particularly high risk for thrombotic events. To date only limited data on anticoagulation management after pulmonary embolism (PE) in GBM is available and the sporadic use of DOACs remains off-label.
Methods: A retrospective cohort analysis of patients with GBM and postoperative, thoracic CT-scan confirmed, PE was performed. Clinical course, follow-up at 6 and 12 months and the overall survival (OS) were evaluated using medical charts and neuroradiological data.
Results: Out of 584 GBM patients, 8% suffered from postoperative PE. Out of theses, 30% received direct oral anticoagulants (DOACs) and 70% low-molecular-weight heparin (LMWH) for therapeutic anticoagulation. There was no significant difference in major intracranial hemorrhage (ICH), re-thrombosis or re-embolism between the two cohorts. Although statistically non-significant, a tendency to reduced mRS at 6- and 12 months was observed in the LMWH cohort. Furthermore, patients receiving DOACs had a statistical benefit in OS.
Conclusion: In our analysis DOACs showed a satisfactory safety profile in terms of major ICH, re-thrombosis and re-embolism compared to LMWH in GBM patients with postoperative PE. Prospective, randomized trials are urgent to evaluate DOACs for therapeutic anticoagulation in GBM patients with PE.
Purpose: Seizures pose a significant burden in patients with primary and secondary brain tumors during the end-of-life period. A wide range of 6 to 56% of clinically observed epileptic seizures at the end of life has been reported. We aimed to analyse the incidence of epileptic seizures at the end of life in brain tumor patients more accurately using not only clinical but also electrophysiological findings.
Methods: This retrospective, single center study included brain tumor patients who died during the stay on the ward or within 7 days after discharge between 01/2015 and 08/2020. Clinical observation of seizures derived from the original medical records and EEG findings (within 45 days prior to death) were analyzed to determine the incidence of seizures in that period.
Results: Of the 68 eligible patients, 50 patients (73.5%) suffered from seizures within 45 days prior to death, of which n = 24 had a status epilepticus. The diagnosis of seizures/ status epilepticus was determined either by the presentation of clinical signs in 45 patients and if not, by the detection of a (possible) non-convulsive status epilepticus in the EEG of five patients.
Conclusion: In the presence of neurologically trained staff and with the frequent use of routine EEG, we were able to identify seizures and to distinguish status epilepticus from encephalopathy/ hypoactive delirium. We detected a higher incidence of seizures and status epilepticus at the end of life in neurooncological patients than previously reported.