Rico Rutkowski

Visible tumor surface response to physical plasma and apoptotic cell kill in head and neck cancer

The aim of the study was to learn, whether clinical application of cold atmospheric pressure plasma (CAP) is able to cause (i) visible tumor surface effects and (ii) apoptotic cell kill in squamous cell carcinoma and (iii) whether CAP-induced visible tumor surface response occurs as often as CAP-induced apoptotic cell kill. Twelve patients with advanced head and neck cancer and infected ulcerations received locally CAP followed by palliative treatment. Four of them revealed tumor surface response appearing 2 weeks after intervention. The tumor surface response expressed as a flat area with vascular stimulation (type 1) or a contraction of tumor ulceration rims forming recesses covered with scabs, in each case surrounded by tumor tissue in visible progress (type 2). In parallel, 9 patients with the same kind of cancer received CAP before radical tumor resection. Tissue specimens were analyzed for apoptotic cells. Apoptotic cells were detectable and occurred more frequently in tissue areas previously treated with CAP than in untreated areas. Bringing together both findings and placing side by side the frequency of clinical tumor surface response and the frequency of analytically proven apoptotic cell kill, detection of apoptotic cells is as common as clinical tumor surface response. There was no patient showing signs of an enhanced or stimulated tumor growth under influence of CAP. CAP was made applicable by a plasma jet, kINPen(®) MED (neoplas tools GmbH, Greifswald, Germany).

Triterpenes for Well-Balanced Scar Formation in Superficial Wounds

Triterpenes are demonstrably effective for accelerating re-epithelialisation of wounds and known to improve scar formation for superficial lesions. Among the variety of triterpenes, betuline is of particular medical interest. Topical betuline gel (TBG) received drug approval in 2016 from the European Commission as the first topical therapeutic agent with the proven clinical benefit of accelerating wound healing. Two self-conducted randomized intra-individual comparison clinical studies with a total of 220 patients involved in TBG treatment of skin graft surgical wounds have been screened for data concerning the aesthetic aspect of wound healing. Three months after surgery wound treatment with TBG resulted in about 30% of cases with more discreet scars, and standard of care in about 10%. Patients themselves appreciate the results of TBG after 3 months even more (about 50%) compared to standard of care (about 10%). One year after surgery, the superiority of TBG counts for about 25% in comparison with about 10%, and from the patients’ point of view, for 25% compared to 4% under standard of care. In the majority of wound treatment cases, there is no difference visible between TBG treatment and standard of care after 1 year of scar formation. However, in comparison, TBG still offers a better chance for discreet scars and therefore happens to be superior in good care of wounds.

Clinical Studies Applying Physical Plasma in Head and Neck Cancer - Key Points and Study Design

Cold atmospheric pressure plasma (CAP) is known to very effectively inactivate multi-resistant strains of microorganisms. Whether or not application of CAP also inactivates cancer cells is a matter of intense clinical interest. There is a need for prospective, randomized, blindly evaluated clinical trials. This paper outlines the key points of such a study program.

Perspectives in Aesthetic Medicine

The clinical application of cold plasma in aesthetic medicine is at present adjuvant and adds to the laser and scalpel to prevent or treat surgical site infections or chronic wounds as the nearly worst case in procedures without medical necessity. The further development of aesthetic plasma medicine however is promising. Case studies show that physical plasma treatment of skin lesions after laser ablation clearly leads to healing with aesthetically pleasing results and ideally with a normal skin complexion. Cold physical plasma increases the permeability of the skin to chemical substances which can be used in aesthetic medicine and improves their penetration deeper into the tissues. The histological examination of biopsies showed that cold physical plasma, under laboratory conditions, can tighten the skin. The long-term effects of the application of physical plasma in the aesthetic medicine are under observations, especially when it comes to safety and the durability of the results.

Cold Atmospheric Plasma in Context of Surgical Site Infection

Based on an increasing understanding of cellular and molecular effects clinical use of cold atmospheric shows a constantly and rapidly expanding application horizon. In particular, the field of antimicrobial efficacy can reference to in vitro and in vitro assured treatment successes, opening up interdisciplinary approaches and potentials. Despite all medical advances, surgical site infections are among the most common nosocomial infections worldwide. While the typical causal pathogen spectrum depends on the type of surgery several endogenous and exogenous risk factors have been identified. The chapter provides an overview of selected prevention measures and illustrates current approaches to integrate cold atmospheric plasma into existing anti SSI prevention and therapy concepts. While there is still a need for further evidence-based research the interim evaluation demonstrates the comprehensive potential of cold atmospheric plasma in the fight against this kind of healthcare-associated nosocomial infection including all medical and economic challenges.

Hyperspectral imaging: innovative diagnostics to visualize hemodynamic effects of cold plasma in wound therapy

Abstract An important clinical potential of cold atmospheric plasma (CAP) lies in tumor and wound treatment, whereby the last-mentioned is well-referenced already. However, the underlying mechanisms of improved wound healing have not been sufficiently clarified yet, in particular the influence of CAP on microcirculation. Hyperspectral imaging (HSI) enables the visualization of microcirculation of large tissue areas, thus this technique seems to be a candidate to examine CAP effects on perfusion and oxygen saturation in wounds. During clinical wound management, one chronic wound caused by peripheral arterial occlusive disease and one acute wound after surgical removal of cervical lymph nodes were examined using HSI before and after CAP treatment. HSI was able to demonstrate CAP effects on microcirculation showing a relevant increase of superficial and deeper cutaneous oxygen saturation together with elevated hemoglobin concentration in treated and also surrounding wound area. For the first time, it was shown that CAP improves the superficial and deeper oxygenation and hemoglobin perfusion in and around the treated area of acute and chronic wounds. This effect may contribute to healing support by CAP in wounds. HSI seems suitable for evaluating and monitoring CAP effects in clinical settings.

Qualitätssicherung in Laser- und Plasmamedizin

Im prozessorientierten Qualitätsmanagement der ästhetisch orientierten Lasermedizin ist das Studienprogramm des Diploma in Aesthetic Laser Medicine (D.A.L.M.) ein wichtiges Instrument.