In vivo optical characterization of human prostate tissue using near-infrared timeresolved spectroscopy.Svensson, Tomas; Andersson-Engels, Stefan; Einarsdóttír, Margrét; Svanberg, Katarina General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.In vivo optical characterization of human prostate tissue using near-infrared time-resolved spectroscopy Tomas Svensson Stefan Andersson-EngelsLund University Department of Physics SE-221 00 Lund Sweden Margrét Einarsdóttír Katarina SvanbergLund University Hospital Department of Oncology SE-221 00 Lund Sweden Abstract. The development of photodynamic therapy into a modality for treatment of prostate cancer calls for reliable optical dosimetry. We employ, for the first time, interstitial time-resolved spectroscopy to determine in vivo optical properties of human prostate tissue. Nine patients are included in the study, and measurements are conducted prior to primary brachytherapy treatment of prostate cancer. Intrasubject variability is examined by measuring across three tissue volumes within each prostate. The time-resolved instrumentation proves its usefulness by producing good signal levels in all measurements. We are able to present consistent values on reduced scattering coefficients ͑ s Ј͒, absorption coefficients ͑ a ͒, and effective attenuation ͑ eff ͒ at the wavelengths 660, 786, and 916 nm. At 660 nm, s Ј is found to be 9±2 cm −1 , and a is 0.5± 0.

The recent interest in photodynamic therapy of human prostate cancer is accompanied by a need for techniques for in vivo monitoring of optical and physiological characteristics. We propose time-of-flight (TOF) spectroscopy in combination with Monte Carlo evaluation as a reliable optical technique for quantitative assessment of absorption, scattering, hemoglobin content and tissue oxygenation in the human prostate. For the first time, we demonstrate Monte Carlo-based evaluation of in vivo TOF photon migration data. We show that this approach is crucial in order to avoid the large errors associated with the use of time-resolved diffusion theory of light propagation in prostate-like tissues. This progress also allows us to present the first in vivo scattering spectroscopy of human prostate tissue. Furthermore, TOF spectroscopy, in contrast to the more common steady-state approach, is insensitive to bleedings, and has been found highly reliable (100% success rate).

Objective Glucocorticoids (GCs) are a cornerstone in treating various common and uncommon diseases. The aim of this study was to estimate the prevalence of GC use in terms of doses associated with risk of tertiary adrenal insufficiency in adults and children, and treatment indications. Methods This was a retrospective cohort study. Information on dispensed prescriptions was obtained from the Swedish Prescribed Drug Register. Patients with prescriptions of prednisolone (or equivalent dose of other GCs) ≥5 mg daily for ≥21 days between 2007 and 2014 were included. Information on concurrent diseases was obtained from the Swedish National Patient Register and the Västra Götaland Regional Healthcare Database. Results Of 1 585 335 inhabitants in Västra Götaland County, 223 211 were included in the study (women 55.6%). Mean age was 48 ± 24 years. Period prevalence of oral GC use during the 8‐year study period was 14.1%. The highest prevalence (27.4%) was in men aged 80‐89 years and lowest (7.5%) in men 10‐19 years of age. The period prevalence in children 0‐9 years of age was 10.6%. COPD and asthma were the most common indications for treatment (17.2%) followed by allergy (12.5%) and malignant neoplasms (11.5%). Allergy was the most frequent indication (20.5%) in children and adolescents. Conclusion Between 2007 and 2014, every seventh inhabitant in western Sweden received a GC prescription at doses associated with risk of developing tertiary adrenal insufficiency. These findings illustrate the importance of awareness of the potential development of tertiary adrenal insufficiency in both paediatric and adult patients.

ObjectiveThe aim of the study was to investigate all-cause and disease-specific mortality in a large population-based cohort of oral glucocorticoid (GC) users.MethodsThis was a retrospective, matched cohort study. Information on dispensed prescriptions was obtained from the Swedish Prescribed Drug Register. The cause of death was obtained from the Swedish Cause-of-Death Registry. Patients receiving prednisolone ≥5 mg/day (or equivalent dose of other GC) for ≥21 days between 2007-2014 were included. For each patient, one control subject matched for age and sex was included. The study period was divided into 3-month periods and patients were divided into groups according to a defined daily dose (DDD) of GC used per day. The groups were: Non-users (0 DDD per day), low-dose users (>0 but <0.5 DDD per day), medium-dose users (0.5-1.5 DDD per day) and high-dose users (>1.5 DDD per day). Hazard ratios (HRs), unadjusted and adjusted for age, sex and comorbidities, were calculated using a time-dependent Cox proportional hazard model.ResultsCases (n=223 211) had significantly higher all-cause mortality compared to controls (HR adjusted for age, sex and comorbidities 2.08, 95% confidence interval 2.04 to 2.13). After dividing the cases into subgroups, adjusted HR was 1.31 (1.28 to 1.34) in non-users, 3.64 (3.51 to 3.77) in low-dose users, 5.43 (5.27 to 5.60) in medium-dose users and, 5.12 (4.84 to 5.42) in high-dose users. The highest adjusted hazard ratio was observed in high-dose users for deaths from sepsis 6.71 (5.12 to 8.81) and pulmonary embolism 7.83 (5.71 to 10.74).ConclusionOral GC users have an increased mortality rate compared to the background population, even after adjustment for comorbidities. High-dose users have an increased risk of dying from sepsis, and pulmonary embolism compared to controls. Whether the relationship between GC exposure and the excess mortality is causal remains to be elucidated.