Clinical workflow of sonographers performing fetal anomaly ultrasound scans: deep-learning-based analysis

OBJECTIVE

Despite decades of obstetric scanning, the field of sonographer workflow remains largely unexplored. In the second trimester, sonographers use scan guidelines to guide their acquisition of standard planes and structures; however, the scan-acquisition order is not prescribed. Using deep-learning-based video analysis, the aim of this study was to develop a deeper understanding of the clinical workflow undertaken by sonographers during second-trimester anomaly scans.

METHODS

We collected prospectively full-length video recordings of routine second-trimester anomaly scans. Important scan events in the videos were identified by detecting automatically image freeze and image/clip save. The video immediately preceding and following the important event was extracted and labeled as one of 11 commonly acquired anatomical structures. We developed and used a purposely trained and tested deep-learning annotation model to label automatically the large number of scan events. Thus, anomaly scans were partitioned as a sequence of anatomical planes or fetal structures obtained over time.

RESULTS

A total of 496 anomaly scans performed by 14 sonographers were available for analysis. UK guidelines specify that an image or videoclip of five different anatomical regions must be stored and these were detected in the majority of scans: head/brain was detected in 97.2% of scans, coronal face view (nose/lips) in 86.1%, abdomen in 93.1%, spine in 95.0% and femur in 92.3%. Analyzing the clinical workflow, we observed that sonographers were most likely to begin their scan by capturing the head/brain (in 24.4% of scans), spine (in 23.2%) or thorax/heart (in 22.8%). The most commonly identified two-structure transitions were: placenta/amniotic fluid to maternal anatomy, occurring in 44.5% of scans; head/brain to coronal face (nose/lips) in 42.7%; abdomen to thorax/heart in 26.1%; and three-dimensional/four-dimensional face to sagittal face (profile) in 23.7%. Transitions between three or more consecutive structures in sequence were uncommon (up to 13% of scans). None of the captured anomaly scans shared an entirely identical sequence.

CONCLUSIONS

We present a novel evaluation of the anomaly scan acquisition process using a deep-learning-based analysis of ultrasound video. We note wide variation in the number and sequence of structures obtained during routine second-trimester anomaly scans. Overall, each anomaly scan was found to be unique in its scanning sequence, suggesting that sonographers take advantage of the fetal position and acquire the standard planes according to their visibility rather than following a strict acquisition order. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Self-healable fiber-reinforced vitrimer composites: overview and future prospects

To achieve sustainable development goals, approaches towards the preparation of recyclable and healable polymeric materials is highly attractive. Self-healing polymers and thermosets based on bond-exchangeable dynamic covalent bonds, so called "vitrimers" could be a great effort in this direction. In order to match the industrial importance, enhancement of mechanical strength without sacrificing the bond exchange capability is a challenging issue, however, such concerns can be overcome through the developments of fiber-reinforced vitrimer composites. This article covers the outstanding features of fiber-reinforced vitrimer composites, including their reprocessing, recycling and self-healing properties, together with practical applications and future perspectives of this unique class of materials.

An Intelligent Sensor Based Decision Support System for Diagnosing Pulmonary Ailment through Standardized Chest X-ray Scans

Academics and the health community are paying much attention to developing smart remote patient monitoring, sensors, and healthcare technology. For the analysis of medical scans, various studies integrate sophisticated deep learning strategies. A smart monitoring system is needed as a proactive diagnostic solution that may be employed in an epidemiological scenario such as COVID-19. Consequently, this work offers an intelligent medicare system that is an IoT-empowered, deep learning-based decision support system (DSS) for the automated detection and categorization of infectious diseases (COVID-19 and pneumothorax). The proposed DSS system was evaluated using three independent standard-based chest X-ray scans. The suggested DSS predictor has been used to identify and classify areas on whole X-ray scans with abnormalities thought to be attributable to COVID-19, reaching an identification and classification accuracy rate of 89.58% for normal images and 89.13% for COVID-19 and pneumothorax. With the suggested DSS system, a judgment depending on individual chest X-ray scans may be made in approximately 0.01 s. As a result, the DSS system described in this study can forecast at a pace of 95 frames per second (FPS) for both models, which is near to real-time.

945 Are Extended Criteria Donor Kidneys from 70 years-old and above Good Enough to Accept? A Single Centre Experience

Aim

As a result of increasing demand in recent years in organ donation and transplantation, the transplant community has been utilizing organs previously considered unsuitable for transplantation, including organs from extended criteria donors (ECD) and donors after circulatory arrest (DCD). This has led to higher rates of non-functioning and poorer outcomes, increasing the uncertainty when to accept or decline a donor organ. Our objective is to measure patient and graft outcomes of kidney transplants from ECDs aged 70 years and older.

Method

A retrospective study of 104 renal transplanted patients from ECDs between April 2010 and March 2014. Recipients referred to other centres were excluded from the study. Follow-up period was 7 years.

Results

At 7 years follow up, graft survival among recipients from ECDs older were 42.5%(n=17/40) while from ECDs younger were 58% (n=37/64) (P = 0.1594). Death censored graft survival (patient died with functioning graft). ECDs older death censored graft survival was 80% (n=32/40) and 82.8% (n=53/64) for ECDs younger (P = 0.7963).

Patient survival

70.3% of recipients from ECDs younger and 60% of recipients from ECDs older were alive at seven years post-transplant. (P = 0.2945).

Conclusions

There was no significant difference between the two cohorts in graft and patient survival. The use of kidneys from donors aged ≥70 years has yielded generally satisfactory results when compared to younger ECDs 50–69 years old donors.

Association between Quality of Life and Physical Functioning in a Gardening Intervention for Cancer Survivors

Purpose: To examine potential factors associated with maintaining or improving self-reported physical function (PF) among older cancer survivors participating in a gardening intervention impacted by the Coronavirus 2019 (COVID-19) pandemic. Methods: Thirty cancer survivors completed a home-based gardening intervention to encourage a healthier diet and a more active lifestyle. Device-based measures of physical activity (PA) and surveys to evaluate quality of life (QOL; PROMIS-57 questionnaire) were administered at baseline, mid-intervention (6 months), and post-intervention (9 months). Results: Depression, fatigue, and sleeplessness at baseline were significantly associated with worse average PF scores across follow-up (2.3 to 4.9 points lower for every decrease of 5 points in the QOL score; p-values < 0.02). Worsening of these QOL domains during the intervention was also associated with an additional decrease of 2.1 to 2.9 points in PF over follow-up (p values < 0.01). Better social participation and PA at baseline were significantly associated with better average PF scores during the intervention (2.8 to 5.2 points higher for every 5-point increase in social participation or 30 min more of PA; p values < 0.05). Every 5-point increase in pain at baseline, or increases in pain during the intervention, was associated with decreases of 4.9 and 3.0 points, respectively, in PF. Conclusions: Worse QOL scores before and during the intervention were significantly associated with worse PF over follow-up. Encouraging social participation and PA through interventions such as home-based gardening may improve long-term health among older cancer survivors.

Progesterone limits the tumor-promoting effects of the beta-subunit of human chorionic gonadotropin via non-nuclear receptors

The post-menopausal state in women is associated with increased cancer incidence, the reasons for which remain obscure. Curiously, increased circulating levels of beta-hCG (human chorionic gonadotropin) (a hormonal subunit linked with tumors of several lineages) are also often observed post-menopause. This study describes a previously unidentified interplay between beta-hCG and progesterone in tumorigenesis. Progesterone mediated apoptosis in beta-hCG responsive tumor cells via non-nuclear receptors. The transgenic expression of beta-hCG, particularly in the absence of the ovaries (a mimic of the post-menopausal state) constituted a potent pro-tumorigenic signal. Significantly, the administration of progesterone had significant anti-tumor effects. RNA-seq profiling identified molecular signatures associated with these processes. TCGA analysis revealed correlates between the expression of several newly identified genes and poor prognosis in post-menopausal patients of lung adenocarcinoma, colon adenocarcinoma, and glioblastoma. Specifically in these women, the detection of intra-tumoral/extra-tumoral beta-hCG may serve as a useful prognostic indicator, and treatment with progesterone on its detection may prove beneficial.

P-070 Comparison of Microfluidic Sperm Sorting (MFSS) versus Physiological Intracytoplasmic Sperm Injection (PICSI) versus Density Gradient versus Swim Up in high DNA fragmentation index sperm samples

Study question

To evaluate the effectiveness of using Microfluidic Sperm Sorting (MFSS) over other technique in patient with high DNA fragmentation index (DFI) sperm samples?

Summary answer

Microfluidic is not only correlated with better DNA integrity but also with the better reproductive outcome.

What is known already

DNA damage is unrecognisable in living sperm prior to insemination and an increased sperm DNA fragmentation index has been associated with lower fertilization rates, impaired embryo development and reduced pregnancy rates. Standard semen processing techniques are associated with centrifugation, which may induce reactive oxygen species and DNA damage.

In strategies to minimize sperm DNA fragmentation, Physiological ICSI can relatively reduce sperm DNA fragmentation by 67.9% (Parmegiani et al., 2010) while new technique Microfluidic sperm sorter technique also demonstrate sperm selection with significantly reduced DNA damage

Study design, size, duration

A prospective randomised study was conducted from 1st January 2019 to 1st December 2021. Four hundred patients were randomised by computer generated list and divided into 4 groups. Group A (n = 100) , in which sperm were processed by microfluidic sperm sorter (MFSS) while in group B (n = 100), sperm were selected by Physiological Intracytoplasmic Sperm Injection (PICSI), Group C (n = 100), sperm were processed by density gradient and Group D (n = 100), sperm were processed by swim-up technique.

Participants/materials, setting, methods

The study period included all normozoospermic patients with high DNA fragmentation index (&gt;25%) while oligospermic, asthenozoospermic samples, patients with poor ovarian reserve and advanced age were excluded from the study. All A grade embryos were vitrified and transferred in frozen embryo replacement cycle. All the 3 groups were compared on the basis of fertilisation rate, day 3 grade A embryo development rate, clinical pregnancy rate and miscarriage rate.

Main results and the role of chance

Cycle characteristics (female age, length of stimulation, gonadotrophin dose, number of oocytes and number of transferred embryos) were similar among all 4 groups.

Among 4 groups, There was a statistically significant increase observed in Group A (Microfluidic Sperm Sorting), day 3 grade A embryo development rate (60% vs. 42% vs. 38% vs. 40%, p-0.016) and clinical pregnancy rate (62% vs. 46% vs. 41% vs 43%, p-0.049), while no statistical significant difference observed in fertilisation rate (82% vs. 78% vs. 76% vs. 78%, p-0.80) comparing group B, group C and group D. But significantly higher miscarriage rate (12% vs. 11% vs. 25%, 12%) observed in density gradient (Group C) technique.

Limitations, reasons for caution

Larger randomised control studies are needed to strengthen these results.

Wider implications of the findings

We have demonstrated that sperm sorted by microfluidic helps in selection of sperm with better DNA integrity over Physiological ICSI, Density Gradient and Swim-up techniues. Using it in routine practice can help in reducing the negative effect of reactive oxygen species and thus improve pregnancy rate and live birth rate.

Trial registration number

MCDH/2019/35

Hypertriton Production in p-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

The study of nuclei and antinuclei production has proven to be a powerful tool to investigate the formation mechanism of loosely bound states in high-energy hadronic collisions. The first measurement of the production of _{Λ}^{3}H in p-Pb collisions at sqrt[s_{NN}]=5.02  TeV is presented in this Letter. Its production yield measured in the rapidity interval -1<y<0 for the 40% highest-multiplicity p-Pb collisions is dN/dy=[6.3±1.8(stat)±1.2(syst)]×10^{-7}. The measurement is compared with the expectations of statistical hadronization and coalescence models, which describe the nucleosynthesis in hadronic collisions. These two models predict very different yields of the hypertriton in charged particle multiplicity environments relevant to small collision systems such as p-Pb, and therefore the measurement of dN/dy is crucial to distinguish between them. The precision of this measurement leads to the exclusion with a significance larger than 6.9σ of some configurations of the statistical hadronization model, thus constraining the theory behind the production of loosely bound states at hadron colliders.

Outcomes of responders to PD-1/PD-L1 inhibitors who discontinue therapy after sustained disease control

2586

Background: PD-1/PD-L1 immune checkpoint inhibitors (ICIs) are widely used in the treatment of metastatic malignancies. Judiciously balancing disease control (DC) against development of immune-related adverse events (irAE) remains a crucial aspect of treatment. The effect of treatment discontinuation after sustained disease control (SDC) is unknown. The purpose of this analysis was to evaluate outcomes of responders to ICI who discontinue treatment after a minimum of 12 months (SDC). Methods: We retrospectively reviewed the database of the University of New Mexico Comprehensive Cancer Center between 2014 and 2021 and identified patients who had received ICI. Patients with metastatic solid tumors who had stopped ICI therapy after achieving SDC [stable disease, partial response, complete response (SD,PR,CR)] were selected and outcomes reviewed from their electronic health records. Results: We identified 204 patients who were treated with ICI for various solid cancers. Forty-four patients (21.6%) met the criteria, of whom 35 with follow-up data were included in the final analysis; including 11 melanoma, 5 non-small cell lung, 4 head & neck, 8 renal, 4 urothelial, 1 anal, 1 Merkel cell carcinoma, and 1 liposarcoma. Patients were divided into two groups: those who stopped ICI due to an irAE [irAE group, n=14, median treatment time (MTT), 16.6 mo] and those who stopped due to other reasons (eg completion of 2 years of therapy, n=20, non-cancer related surgery, n=1) (non-irAE group, n=21, MTT, 23.7 mo). Among the irAE group, the most common irAE included pneumonitis, rash, transaminitis, and fatigue. As of data cutoff date, 10 of 14 (71%) patients continued to show SDC. Only 4 of 14 (28.6%) patients in this group experienced progression of disease (PD), one of whom was re-challenged with nivolumab and achieved DC (median follow-up of 19.2 mo after last dose of treatment, range 3-50.2 mo). Among the non-irAE group, 13 of 21 (62%) continued to have SDC. Eight of 21 (38%) experienced PD after stopping treatment, 7 of whom received ICI rechallenge, with 2 of 7 achieving DC (median follow-up of 22.2 mo, range 3.6-54.8 mo). At a median follow-up of 21.3 mo from stopping ICI therapy (range, 3-54.8 mo), 10 patients (71%) from the irAE group and 13 (61.9%) from the non-irAE group are in DC and have not experienced PD. Conclusions: We demonstrate that 23 (66%) patients experienced SDC, regardless of cancer type or development of irAE. After including patients who were re-challenged with ICI due to PD, 26 (74%) remain in DC. Future prospective malignancy-specific trials such as NCT04637594 are warranted to evaluate optimal treatment duration. [Table: see text]

AB1015 SUSTAINED SYNERGISTIC EFFECT ON BONE MINERAL DENSITY TREND WITH SHORT TERM COMBINATION OF TERIPARATIDE AND DENOSUMAB FOLLOWED BY DENOSUMAB ALONE IN POSTMENOPAUSAL WOMEN - A SINGLE INDIAN CENTRE EXPERIENCE

Background

Use of Teriparatide (PTH) with Denosumab (Dmab) have shown to have a synergistic effect on the bone mineral density (BMD) of both Hip and Spine1 because Dmab completely inhibits the PTH induced bone resorption and does not interfere with the bone formation.

Objectives

Since PTH has a limited period of approved use, a short term (6 months) use of PTH in combination with Dmab followed by continued use of Dmab may show a sustained synergistic effect of the combination.

Methods

The BMD trends from real time data from a central dual-energy x-ray absorptiometry (DXA) at our centre in India was studied retrospectively to see if the effect was sustained. Women with postmenopausal osteoporosis who were treated with a combination of Dmab 60 mg via subcutaneous injection (sc) at 6 monthly interval along with PTH 20 mcg sc daily for the first 6 months (Combo), followed by Dmab alone for the next six months were inculded in the study group. Average BMD at L2, L3 and L4 (sp BMD), and Right and Left Hip (hip BMD) were studied from before treatment (a BMD), after the Combo treatment (b BMD) and after 6 months of the second injection of Dmab (c BMD). The mean percentage trend change between a-b BMD and b-c BMD were evaluated. Out of the patients treated with the protocol, 25 were randomly chosen for the retrospective analysis. The least significant change (LSC) 2 from a single centre DXA was used to validate the findings.

Results

The percentage change after the treatment for 6 months with the Combo was found to be 5.22% in the Spine (LSC= 2.6%)2 and 4.13% in the hip (LSC=3.6%)2. The trend after use of Dmab alone was 5.39% in the spine and 2.93% in the hip showing sustained synergistic effect of the Combo for at least 6 months with the use of Dmab alone. The effect was more profound in the spine than the hip. A p>0.05 was considered statistically significant. Table 1 shows the percentage BMD changes.

Table 1.

Percentage BMD changes

BMD trend (n=25)sp BMD (LSC – 2.6%)hip BMD (LSC – 3.6%)a-b BMD5.22%4.13%b-c BMD5.39%2.93%

sp BMD - Mean of L2,L3 & L4 Spine BMD, hip BMD - Mean of Right and Left Hip BMD, a-b BMD - Percent change in BMD from before treatment to 6 months of PTH & Dmab, b-c BMD -Percentage change in BMD form after 6 of Dmab & PTH to next 6 mths Dmab alone and LSC – Least significant change from a single DXA machine.

Conclusion

These findings suggest that a short term combination of Dmab and PTH for 6 months followed by Dmab alone shows sustained synergistic effect on the BMD trend which was more profound in the spine than the hip.

This would help in judicious and cost effective utilisation of the limited period of PTH use.

References

[1]Tsai JN et al: Teriparatide and denosumab, alone or combined, in women with postmenopausal osteoporosis: the DATA study randomised trial. Lancet. 2013; 382: 50-56

[2]Shepherd JA1, Lu Y. A generalized least significant change for individuals measured on different DXA systems.

Disclosure of Interests

None declared

Real-world data on outcomes using taxane, trastuzumab, and pertuzumab (THP) in patients with early stage HER2+ breast cancer

e12630

Background: In HER2+ early breast cancer, dual HER2 targeted combination of trastuzumab and pertuzumab with chemotherapy achieved higher rates of pathologic complete response (pCR) and improved long term outcomes. However, the optimal chemotherapy backbone is still under investigation. While neoadjuvant taxane in combination with trastuzumab and pertuzumab (THP) has been investigated in NEOSPHERE, patients received anthracycline-based regimen in the adjuvant setting. We report real-world data on long-term patient outcomes after neoadjuvant THP. Methods: An IRB-approved retrospective chart review at 2 academic centers was conducted using EMR to identify women with stage I-III HER2+ breast cancer who exclusively received neoadjuvant THP between 2013-2020. Clinicopathological characteristics and follow up information were extracted from surgical pathology and medical records. Results: 71 patients met criteria (median, 55 years). At presentation, 56 (79%) patients had stage II - III disease and 45 (63%) were lymph node negative. The majority of tumors were ER+ (43 patients, 61%) and received paclitaxel (46 patients, 65%) as their taxane backbone. pCR was achieved in 40 (56%) patients (Table); 38 (95%) continued with adjuvant HER2 therapy alone; 1 received adjuvant endocrine therapy only and 1 received no further treatment. Of the 31 (44%) patients without pCR, 9 received additional adjuvant chemotherapy in addition to HER2 directed therapy while 18 continued with HER2 therapy alone. During the follow-up period (median 34.7 mo, range 6.8-98.9 mo), 3 patients with lymph node positive disease on presentation had disease relapse. Two of the patients with pCR had local recurrence and one without pCR had distant metastasis (brain, lung). The 2 patients with local recurrence were successfully treated with salvage therapy and remain in remission. The patient with metastatic disease remains alive and on treatment. Conclusions: We showed that a real world HER2+ patient population treated with neoadjuvant THP achieved pCR rates consistent with what has been previously reported. In addition, with a median follow up of ̃ 3 years, only 3 patients had relapse supporting the utility of THP as potential de-escalation treatment in the neoadjuvant setting. Ongoing prospective trials, like NCT03716180, will further confirm the efficacy of this regimen in a prospective setting.[Table: see text]

AB1028 REGRESSIVE BONE MINERAL DENSITY TRENDS SEEN WITH DELAY IN FOLLOW UP OF DENOSUMAB TREATMENT DUE TO THE PANDEMIC INDUCED LOCKDOWN - A SINGLE CENTRE INDIAN EXPERIENCE

Background

Denosumab (Dmab), a fully human monoclonal antibody that inhibits receptor activator of nuclear factor kappa-β ligand (RANKL), which selectively inhibits osteoclastogenesis can be used for a long period unlike the relatively short period with Teriparatide.1-2 However the effects of Dmab can quickly regress if the treatment is delayed.3

Objectives

The pandemic led to multiple prolonged lockdowns since March 2020 to Jan 2022 in India. This resulted in follow up Dmab treatment delays. The retrospective study was aimed to look for the effect of the delays.

Methods

The bone mineral density (BMD) trends from the central dual-energy x-ray absorptiometry (DXA) at our centre were studied. The trends of patients under Dmab for one year and delay in follow up for 10 - 12 months for the forth dose were evaluated. 21 postmenopausal women who had been under treatment with Dmab 60 mg subcutaneous injection at 6 monthly interval for one year followed up with such delays. 6 were excluded because of history of sars-cov-2 infection and glucocorticoid use. In the study group of 15 (n=15), the mean BMD at L2, L3 & L4 (sp BMD) and Right and Left Hip (hip BMD) were studied from before treatment (a BMD), 6 months after 1st and at the time of 2nd injection (b BMD), 6 months of the 2nd and at the time of 3 rd injection of Dmab (c BMD), and that due to delay in follow up of 10-12 months (d BMD). The mean percentage trend change between a-b, b-c, and c-d BMDs was evaluated. The least significant change (LSC) 4 from a single centre DXA was used to validate the findings.

Results

The mean percentage change after the treatment for the 1st 6 months of Dmab (a-b BMD) was 4.08% and 3.60% and the second injection resulted in a further change (b-c BMD) of 5.98% and 4.52% in the sp BMD & hip BMD respectively. The delay in follow up of 10-12 months resulted in a change (c-d BMD) of -7.81% in the sp BMD and -2.96% in the hip BMD. The LSC from a single centre DXA is 2.6% and 3.6% for sp BMD and hip BMD respectively. A p>0.05 was considered statistically significant. Table 1 shows the BMD changes.

Table 1.

Percentage BMD changes

BMD trend (n=15)sp BMD (LSC – 2.6%)hip BMD (LSC – 3.6%)a-b BMD4.08%3.60%b-c BMD5.98%4.52%c-d BMD-7.81%-2.96%

sp BMD - Mean of L2,L3 & L4 Spine BMD, hip BMD - Mean of Right and Left Hip BMD, a-b BMD - Percent change in BMD from before to 6 months after Ist & at the time of 2nd Dmab, b-c BMD - Percentage change in BMD 6 months after 2nd & at the time of 3rd Dmab, c-d BMD - Percentage change in BMD after 3rd Dmab & follow up after delay of 10-12 months and LSC – Least significant change.

Conclusion

These findings suggest that regressive trend in BMD are seen when the treatment with Dmab is delayed even as early as 10 to 12 months. It was seen much faster in the spine compared to the hip.

It is therefore advised that short term treatment with Dmab without follow up could lead to loss of all gains and may also worsen the osteoporosis.

References

[1]Anastasilakis A.D., Polyzos S.A., Makras P. Therapy of Endocrine Disease: Denosumab vs bisphosphonates for the treatment of postmenopausal osteoporosis. Eur. J. Endocrinol. 2018;179:R31–R45. doi: 10.1530/EJE-18-0056.

[2]Anastasilakis A.D., Polyzos S.A., Yavropoulou M.P., Makras P. Combination and sequential treatment in women with postmenopausal osteoporosis. Expert Opin. Pharmacother. 2020;21:477–490. doi: 10.1080/14656566.2020.1717468.

[3]Bone H.G., Bolognese M.A., Yuen C.K., Kendler D.L., Miller P.D., Yang Y.-C., Grazette L., Martin J.S., Gallagher J.C. Effects of Denosumab Treatment and Discontinuation on Bone Mineral Density and Bone Turnover Markers in Postmenopausal Women with Low Bone Mass. J. Clin. Endocrinol. Metab. 2011;96:972–980. doi: 10.1210/jc.2010-1502.

[4]Shepherd JA1, Lu Y. A generalized least significant change for individuals measured on different DXA systems.

Disclosure of Interests

None declared

Efficient recall of Omicron-reactive B cell memory after a third dose of SARS-CoV-2 mRNA vaccine

We examined antibody and memory B cell responses longitudinally for ∼9-10 months after primary 2-dose SARS-CoV-2 mRNA vaccination and 3 months after a 3rd dose. Antibody decay stabilized between 6 and 9 months, and antibody quality continued to improve for at least 9 months after 2-dose vaccination. Spike- and RBD-specific memory B cells remained durable over time, and 40%-50% of RBD-specific memory B cells simultaneously bound the Alpha, Beta, Delta, and Omicron variants. Omicron-binding memory B cells were efficiently reactivated by a 3rd dose of wild-type vaccine and correlated with the corresponding increase in neutralizing antibody titers. In contrast, pre-3rd dose antibody titers inversely correlated with the fold-change of antibody boosting, suggesting that high levels of circulating antibodies may limit the added protection afforded by repeat short interval boosting. These data provide insight into the quantity and quality of mRNA-vaccine-induced immunity over time through 3 or more antigen exposures.

Polarization of Λ and Λ[over ¯] Hyperons along the Beam Direction in Pb-Pb Collisions at sqrt[s]_{NN}=5.02 TeV

The polarization of the Λ and Λ[over ¯] hyperons along the beam (z) direction, P_{z}, has been measured in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV recorded with ALICE at the Large Hadron Collider (LHC). The main contribution to P_{z} comes from elliptic flow-induced vorticity and can be characterized by the second Fourier sine coefficient P_{z,s2}=⟨P_{z}sin(2φ-2Ψ_{2})⟩, where φ is the hyperon azimuthal emission angle and Ψ_{2} is the elliptic flow plane angle. We report the measurement of P_{z,s2} for different collision centralities and in the 30%-50% centrality interval as a function of the hyperon transverse momentum and rapidity. The P_{z,s2} is positive similarly as measured by the STAR Collaboration in Au-Au collisions at sqrt[s_{NN}]=200  GeV, with somewhat smaller amplitude in the semicentral collisions. This is the first experimental evidence of a nonzero hyperon P_{z} in Pb-Pb collisions at the LHC. The comparison of the measured P_{z,s2} with the hydrodynamic model calculations shows sensitivity to the competing contributions from thermal and the recently found shear-induced vorticity, as well as to whether the polarization is acquired at the quark-gluon plasma or the hadronic phase.

Self-Selected Walking Cadence after 16-Week Light-Intensity Physical Activity Intervention for Older Cancer Survivors

In this secondary analysis of a light-intensity physical activity intervention, we hypothesized that older cancer survivors would self-select a faster walking cadence to meet their daily step goals. Average steps/day and free-living walking cadence were measured in 41 participants (age 69 ± 3.1 years) with an ActivPAL monitor worn 7 days pre- and post-intervention. Besides peak and average walking cadence, stepping patterns associated with ambulatory intensity were sorted in cadence bands of 20 steps/min from 40−59 (incidental movement) to ≥120 steps/min (fast locomotor movement). Compared to the waitlist Control group (n = 17), the Intervention group (n = 24) increased their peak 30-min cadence (4.3 vs. 1.9 steps/minute; p = 0.03), average 10-min cadence (4.1 vs. −6.6 steps/minute; p = 0.04), and average 30-min cadence (5.7 vs. −0.8 steps/minute, p = 0.03). Steps taken in cadence bands denoting moderate-intensity physical activity (100−119 steps/min) increased by 478 (interquartile range (IQR): −121 to 1844) compared to decreasing by 92 (IQR: −510 to 181) steps/day for the intervention and Control groups, respectively (p < 0.01). Evaluation of free-living walking cadence and patterns of ambulatory behavior can inform future interventions targeting behavior change, especially in those populations most at risk for reduced physical activity and vulnerable to mobility deficits and loss of independence.

An Overview on Carbon Fiber-Reinforced Epoxy Composites: Effect of Graphene Oxide Incorporation on Composites Performance

Carbon fiber-reinforced polymer (CFRP) composites are used in a variety of applications such as aircraft, automobiles, body armors, and the sports sector owing to their ultra-strong and lightweight characteristics. However, the incorporation of an untreated pristine carbon fiber surface leads to a weak interfacial interaction with the polymeric matrix, thus triggering catastrophic failure of the composite material. Graphene oxide, a 2D-macromolecule consisting of several polar functional groups such as hydroxyl, carboxyl, and carbonyl on the basal planes and edges, tends to increase the surface area and has thus been applied between the fiber and matrix, helping to improve CFRP properties. Herein, we condense different routes of functionalization of GO nanosheets and their incorporation onto a fiber surface or in a carbon fiber-reinforced epoxy matrix, helping to improve the interfacial adhesion between the fiber and matrix, and thus allowing effective stress transfer and energy absorption. The improvement of the interfacial adhesion between the fiber and carbon fiber-reinforced epoxy matrix is due to the peculiar structure of GO nanoparticles composed of polar groups, especially on the edges of the nanosheets, able to provide strong interaction with the hosting cured epoxy matrix, and the "core" part similar to the structure of CFs, and hence able to establish strong π-π interactions with the reinforcing CFs. The article also covers the effect of functionalized graphene oxide incorporation on the mechanical, thermal, electrical, and viscoelastic properties of composite materials reinforced with carbon fibers.

Pattern of Male Hypogonadism and Outcome of Treatment in South Rajasthan

Male reproductive functions are governed by hypothalamic pituitary testicular axis. If any component of this axis malfunctions, then hypogonadism will develop which is characterized by ill-defined secondary sexual features and low serum testosterone. The common patterns seen are primary and secondary testicular failure in the young; and late onset hypogonadism in the elderly. All such cases can be virilized and managed by androgen supplementation. Spermatogenesis can be induced by use of appropriate gonadotropins in selected cases. The aim of the study was to find out the pattern, management and outcome of male hypogonadism.

MATERIAL

It was a prospective questionnaire based observational study, carried out on infertile hypogonadic males, attending medicine outdoor at medical college hospital from January 2015 to December 2020. There were 50 males with hypogonadic features, cases of late onset of hypogonadism were excluded. Sexual maturity rating, semen analysis, serum testosterone and FSH level were estimated in all patients at baseline and at 6 months duration of treatment. Testicular biopsy, Karyotyping and MRI brain were performed in selected cases. Azoospermic patients having hypogonadotropic hypogonadism were treated with long-acting testosterones and gonadotropins.

OBSERVATION

The study subjects were infertile azoospermic males. On the basis of serum FSH and testosterone levels, they were classified into two groups. Group A (n=42) cases were hypergonadotropic hypogonadism or primary testicular failure; of these 32 were Klinefelter syndrome (XXY), 7 chronic orchitis and 3 empty scrotal syndrome including one case of anorchia. These patients also developed other systemic illnesses in addition to hypogonadism. Group B (n=8) hypogonadotropic hypogonadism or secondary testicular failure; of these 2 were Kallman syndrome and the rest were idiopathic. After testosterone replacement all patients were virilized and there was marked improvement in libido and androgenization.

CONCLUSION

The study brings out that primary testicular failure is more common than secondary testicular failure. Both pattern of hypogonadism should receive lifelong androgen replacement therapy; otherwise, they will be a basket of multiple systemic disorders. Presently testosterone undecanoate once in every three months is the agent of choice.

Measurement of the Groomed Jet Radius and Momentum Splitting Fraction in pp and Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

This article presents groomed jet substructure measurements in pp and Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV with the ALICE detector. The soft drop grooming algorithm provides access to the hard parton splittings inside a jet by removing soft wide-angle radiation. We report the groomed jet momentum splitting fraction, z_{g}, and the (scaled) groomed jet radius, θ_{g}. Charged-particle jets are reconstructed at midrapidity using the anti-k_{T} algorithm with resolution parameters R=0.2 and R=0.4. In heavy-ion collisions, the large underlying event poses a challenge for the reconstruction of groomed jet observables, since fluctuations in the background can cause groomed parton splittings to be misidentified. By using strong grooming conditions to reduce this background, we report these observables fully corrected for detector effects and background fluctuations for the first time. A narrowing of the θ_{g} distribution in Pb-Pb collisions compared to pp collisions is seen, which provides direct evidence of the modification of the angular structure of jets in the quark-gluon plasma. No significant modification of the z_{g} distribution in Pb-Pb collisions compared to pp collisions is observed. These results are compared with a variety of theoretical models of jet quenching, and provide constraints on jet energy-loss mechanisms and coherence effects in the quark-gluon plasma.

Efficient recall of Omicron-reactive B cell memory after a third dose of SARS-CoV-2 mRNA vaccine

Despite a clear role in protective immunity, the durability and quality of antibody and memory B cell responses induced by mRNA vaccination, particularly by a 3 ^rd dose of vaccine, remains unclear. Here, we examined antibody and memory B cell responses in a cohort of individuals sampled longitudinally for ∼9-10 months after the primary 2-dose mRNA vaccine series, as well as for ∼3 months after a 3 ^rd mRNA vaccine dose. Notably, antibody decay slowed significantly between 6- and 9-months post-primary vaccination, essentially stabilizing at the time of the 3 ^rd dose. Antibody quality also continued to improve for at least 9 months after primary 2-dose vaccination. Spike- and RBD-specific memory B cells were stable through 9 months post-vaccination with no evidence of decline over time, and ∼40-50% of RBD-specific memory B cells were capable of simultaneously recognizing the Alpha, Beta, Delta, and Omicron variants. Omicron-binding memory B cells induced by the first 2 doses of mRNA vaccine were boosted significantly by a 3rd dose and the magnitude of this boosting was similar to memory B cells specific for other variants. Pre-3 ^rd dose memory B cell frequencies correlated with the increase in neutralizing antibody titers after the 3 ^rd dose. In contrast, pre-3 ^rd dose antibody titers inversely correlated with the fold-change of antibody boosting, suggesting that high levels of circulating antibodies may limit reactivation of immunological memory and constrain further antibody boosting by mRNA vaccines. These data provide a deeper understanding of how the quantity and quality of antibody and memory B cell responses change over time and number of antigen exposures. These data also provide insight into potential immune dynamics following recall responses to additional vaccine doses or post-vaccination infections.

GRAPHICAL SUMMARY