Measurement of the Lifetime and Λ Separation Energy of _{Λ}^{3}H

The most precise measurements to date of the _{Λ}^{3}H lifetime τ and Λ separation energy B_{Λ} are obtained using the data sample of Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV collected by ALICE at the LHC. The _{Λ}^{3}H is reconstructed via its charged two-body mesonic decay channel (_{Λ}^{3}H→^{3}He+π^{-} and the charge-conjugate process). The measured values τ=[253±11(stat)±6(syst)]  ps and B_{Λ}=[102±63(stat)±67(syst)]  keV are compatible with predictions from effective field theories and confirm that the _{Λ}^{3}H structure is consistent with a weakly bound system.

Is the process of withdrawal of life-sustaining measures in the intensive care unit different for deceased organ donors compared with other dying patients? A secondary analysis of prospectively collected data

OBJECTIVE

To investigate whether observable differences exist between patterns of withdrawal of life-sustaining measures (WLSM) for patients eligible for donation after circulatory death (DCD) in whom donation was attempted compared with those patients in whom no donation attempts were made.

SETTING

Adult intensive care units from 20 centres in Canada, the Czech Republic and the Netherlands.

DESIGN

Secondary analysis of quantitative data collected as part of a large, prospective, cohort study (the Death Prediction and Physiology after Removal of Therapy study).

PARTICIPANTS

Patients ≥18 years of age who died after a controlled WLSM in an intensive care unit. Patients were classified as not DCD eligible, DCD eligible with DCD attempted or DCD eligible but DCD was not attempted.

PRIMARY AND SECONDARY OUTCOME MEASURES

The process of WLSM (timing and type and, if applicable, dosages of measures withdrawn, dosages of analgesics/sedatives) was compared between groups.

RESULTS

Of the 635 patients analysed, 85% had either cardiovascular support stopped or were extubated immediately on WLSM. Of the DCD eligible patients, more were immediately extubated at the initiation of WLSM when DCD was attempted compared with when DCD was not attempted (95% vs 61%, p<0.0001). Initiation of WLSM with the immediate cessation of cardiovascular measures or early extubation was associated with earlier time to death, even after adjusting for confounders (OR 2.94, 95% CI 1.39 to 6.23, at 30 min). Other than in a few patients who received propofol, analgesic and sedative dosing after WLSM between DCD attempted and DCD eligible but not attempted patients was not significantly different. All patients died.

CONCLUSIONS

Patients in whom DCD is attempted may receive a different process of WLSM. This highlights the need for a standardised and transparent process for end-of-life care across the spectrum of critically ill patients and potential organ donors.

Measurement of the J/ψ Polarization with Respect to the Event Plane in Pb-Pb Collisions at the LHC

We study the polarization of inclusive J/ψ produced in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV at the LHC in the dimuon channel, via the measurement of the angular distribution of its decay products. We perform the study in the rapidity region 2.5 Collapse

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First Measurement of Antideuteron Number Fluctuations at Energies Available at the Large Hadron Collider

The first measurement of event-by-event antideuteron number fluctuations in high energy heavy-ion collisions is presented. The measurements are carried out at midrapidity (|η|<0.8) as a function of collision centrality in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV using the ALICE detector. A significant negative correlation between the produced antiprotons and antideuterons is observed in all collision centralities. The results are compared with a state-of-the-art coalescence calculation. While it describes the ratio of higher order cumulants of the antideuteron multiplicity distribution, it fails to describe quantitatively the magnitude of the correlation between antiproton and antideuteron production. On the other hand, thermal-statistical model calculations describe all the measured observables within uncertainties only for correlation volumes that are different with respect to those describing proton yields and a similar measurement of net-proton number fluctuations.

Enhanced Deuteron Coalescence Probability in Jets

The transverse-momentum (p_{T}) spectra and coalescence parameters B_{2} of (anti)deuterons are measured in p-p collisions at sqrt[s]=13  TeV for the first time in and out of jets. In this measurement, the direction of the leading particle with the highest p_{T} in the event (p_{T}^{lead}>5  GeV/c) is used as an approximation for the jet axis. The event is consequently divided into three azimuthal regions, and the jet signal is obtained as the difference between the toward region, that contains jet fragmentation products in addition to the underlying event (UE), and the transverse region, which is dominated by the UE. The coalescence parameter in the jet is found to be approximately a factor of 10 larger than that in the underlying event. This experimental observation is consistent with the coalescence picture and can be attributed to the smaller average phase-space distance between nucleons in the jet cone as compared with the underlying event. The results presented in this Letter are compared to predictions from a simple nucleon coalescence model, where the phase-space distributions of nucleons are generated using pythia8 with the Monash 2013 tuning, and to predictions from a deuteron production model based on ordinary nuclear reactions with parametrized energy-dependent cross sections tuned on data. The latter model is implemented in pythia8.3. Both models reproduce the observed large difference between in-jet and out-of-jet coalescence parameters, although the almost flat trend of the B_{2}^{Jet} is not reproduced by the models, which instead give a decreasing trend.

Development of submicromolar 17β-HSD10 inhibitors and their in vitro and in vivo evaluation

17β-hydroxysteroid dehydrogenase type 10 (17β-HSD10) is a multifunctional mitochondrial enzyme and putative drug target for the treatment of various pathologies including Alzheimer's disease or some types of hormone-dependent cancer. In this study, a series of new benzothiazolylurea-based inhibitors were developed based on the structure-activity relationship (SAR) study of previously published compounds and predictions of their physico-chemical properties. This led to the identification of several submicromolar inhibitors (IC₅₀ ∼0.3 μM), the most potent compounds within the benzothiazolylurea class known to date. The positive interaction with 17β-HSD10 was further confirmed by differential scanning fluorimetry and the best molecules were found to be cell penetrable. In addition, the best compounds weren't found to have additional effects for mitochondrial off-targets and cytotoxic or neurotoxic effects. The two most potent inhibitors 9 and 11 were selected for in vivo pharmacokinetic study after intravenous and peroral administration. Although the pharmacokinetic results were not fully conclusive, it seemed that compound 9 was bioavailable after peroral administration and could penetrate into the brain (brain-plasma ratio 0.56).

Significantly longer time to deterioration of quality of life due to CANKADO PRO-React eHealth support in HR+ HER2- metastatic breast cancer patients receiving palbociclib and endocrine therapy: Primary outcome analysis of the multicenter randomized AGO-B WSG PreCycle trial

BACKGROUND

The multicenter, randomized phase IV intergroup AGO-B WSG PreCycle trial (NCT03220178) evaluated the impact of CANKADO-based ePRO (electronic patient-reported outcomes) assessment on quality of life (QoL) in HR+ HER2- locally advanced or metastatic breast cancer (MBC) patients receiving palbociclib (P) and an aromatase inhibitor or P+fulvestrant. CANKADO PRO-React, an EU-registered medical device, is an interactive autonomous application reacting to patient self-reported observations.

PATIENTS AND METHODS

Between 2017 and 2021, 499 patients (median age 59 years) from 71 centers were randomized (2:1, stratified by therapy line) between an active version of CANKADO PRO-React (CANKADO-active arm) or a version with limited functionality (CANKADO-inform arm). 412 patients (271 CANKADO-active; 141 CANKADO-inform) were available for analysis of the primary endpoint, time to deterioration (TTD) of QoL (10-point drop on FACT-G), using an Aalen-Johansen estimator for cumulative incidence function of TTD DQoL with 95% pointwise confidence intervals (CI). Secondary endpoints included PFS, OS, and DQoL (QoL deterioration).

RESULTS

In all pts (ITT-ePRO), cumulative incidence of DQoL was significantly more favorable (lower) in the CANKADO-active arm (HR=0.698, 95%CI [0.506 - 0.963]). Among 1^stL patients (n=295), the corresponding HR was 0.716 (0.484-1.060; p=0.09), and in 2^ndL patients (n=117) it was 0.661 (0.374-1.168; p=0.2). Absolute patient numbers declined in later visits; FACT-G completion rates were 80% and higher until about visit 30; mean FACT-G scores showed steady decline from baseline and an offset in favor of CANKADO-active. No significant differences in clinical outcome were observed between arms: Median PFS (ITT population) was 21.4 (95%CI 19.4-23.7) (CANKADO-active) and 18.7 (15.1-23.5) months (CANKADO-inform); median OS was not reached (CANKADO-active) and 42.6 months (CANKADO-inform).

CONCLUSIONS

PreCycle is the first multicenter randomized eHealth trial demonstrating a significant benefit for MBC patients receiving oral tumor therapy when using an interactive autonomous patient empowerment application.

Enhancement of the magnetocaloric effect in geometrically frustrated cluster spin glass systems

In this work, we theoretically demonstrate that a strong enhancement of the magnetocaloric effect is achieved in geometrically frustrated cluster spin-glass systems just above the freezing temperature. We consider a network of clusters interacting randomly which have triangular structure composed of Ising spins interacting antiferromagnetically. The intercluster disorder problem is treated using a cluster spin glass mean-field theory, which allows exact solution of the disordered problem. The intracluster part can be solved using exact enumeration. The coupling between the inter and intracluster problem incorporates the interplay between effects coming from geometric frustration and disorder. As a result, it is shown that there is the onset of cluster spin glass phase even with very weak disorder. Remarkably, it is exactly within a range of very weak disorder and small magnetic field that is observed the strongest isothermal release of entropy.

Depth of anesthesia, temperature, and postoperative delirium in children and adolescents undergoing cardiac surgery

BACKGROUND

After pediatric cardiosurgical interventions, postoperative delirium can occur, which can be associated with undesirable consequences during and after the hospital stay. It is therefore important to avoid any factors causing delirium as far as possible. Electroencephalogram (EEG) monitoring can be used during anesthesia to individually adjust dosages of hypnotically acting drugs. It is necessary to gain knowledge about the relationship between intraoperative EEG and postoperative delirium in children.

METHODS

In a dataset comprising 89 children (53 male, 36 female; median age: 0.99 (interquartile range: 0.51, 4.89) years) undergoing cardiac surgery involving use of a heart-lung machine, relationships between depth of anesthesia as measured by EEG (EEG index: Narcotrend Index (NI)), sevoflurane dosage, and body temperature were analyzed. A Cornell Assessment of Pediatric Delirium (CAP-D) score ≥ 9 indicated delirium.

RESULTS

The EEG could be used in patients of all age groups for patient monitoring during anesthesia. In the context of induced hypothermia, EEG monitoring supported individually adjusted sevoflurane dosing. The NI was significantly correlated with the body temperature; decreasing temperature was accompanied by a decreasing NI. A CAP-D score ≥ 9 was documented in 61 patients (68.5%); 28 patients (31.5%) had a CAP-D < 9. Delirious patients with an intubation time ≤ 24 h showed a moderate negative correlation between minimum NI (NImin) and CAP-D (rho = -0.41, 95% CI: -0.70 - -0.01, p = 0.046), i.e., CAP-D decreased with increasing NImin. In the analysis of all patients' data, NImin and CAP-D showed a weak negative correlation (rho = -0.21, 95% CI: -0.40 - 0.01, p = 0.064). On average, the youngest patients had the highest CAP-D scores (p = 0.002). Patients with burst suppression / suppression EEG had a longer median intubation time in the intensive care unit than patients without such EEG (p = 0.023). There was no relationship between minimum temperature and CAP-D score.

CONCLUSIONS

The EEG can be used to individually adjust sevoflurane dosing during hypothermia. Of the patients extubated within 24 h and classified as delirious, patients with deeper levels of anesthesia had more severe delirium symptoms than patients with lighter levels of anesthesia.

Long-term survival of breast cancer patients with brain metastases: subanalysis of the BMBC registry

BACKGROUND

Up to 30% of metastatic breast cancer (BC) patients develop brain metastases (BM). Prognosis of patients with BM is poor and long-term survival is rare. Identification of factors associated with long-term survival is important for improving treatment modalities.

PATIENTS AND METHODS

A total of 2889 patients of the national registry for BM in BC (BMBC) were available for this analysis. Long-term survival was defined as overall survival (OS) in the upper third of the failure curve resulting in a cut-off of 15 months. A total of 887 patients were categorized as long-term survivors.

RESULTS

Long-term survivors compared to other patients were younger at BC and BM diagnosis (median 48 versus 54 years and 53 versus 59 years), more often had HER2-positive tumors (59.1% versus 36.3%), less frequently luminal-like (29.1% versus 35.7%) or triple-negative breast cancer (TNBC) (11.9% versus 28.1%), showed better Eastern Cooperative Oncology Group (ECOG) performance status (PS) at the time of BM diagnosis (ECOG 0-1, 76.9% versus 51.0%), higher pathological complete remission rates after neoadjuvant chemotherapy (21.6% versus 13.7%) and lower number of BM (n = 1, BM 40.9% versus 25.4%; n = 2-3, BM 26.5% versus 26.7%; n ≥4, BM 32.6% versus 47.9%) (P < 0.001). Long-term survivors had leptomeningeal metastases (10.4% versus 17.5%) and extracranial metastases (ECM, 73.6% versus 82.5%) less frequently, and asymptomatic BM more often at the time of BM diagnosis (26.5% versus 20.1%), (P < 0.001). Median OS in long-term survivors was about two times higher than the cut-off of 15 months: 30.9 months [interquartile range (IQR) 30.3] overall, 33.9 months (IQR 37.1) in HER2-positive, 26.9 months (IQR 22.0) in luminal-like and 26.5 months (IQR 18.2) in TNBC patients.

CONCLUSIONS

In our analysis, long-term survival of BC patients with BM was associated with better ECOG PS, younger age, HER2-positive subtype, lower number of BM and less extended visceral metastases. Patients with these clinical features might be more eligible for extended local brain and systemic treatment.

A262 NEONATAL ACUTE LIVER FAILURE DUE TO PRESUMED GESTATIONAL ALLOIMMUNE LIVER DISEASE - A CASE REPORT

Background

Neonatal acute liver failure (NALF) is a rare disease that is distinct from acute liver failure seen in older children and adults. Gestational alloimmune liver disease (GALD) is the most frequent cause, is initiated in utero by sensitization of the maternal immune system to a fetal hepatocyte antigen and subsequent production of maternal immunoglobulin G antibodies that cross the placenta. Maternal IgG binds to a fetal hepatocyte antigen and initiates an innate immune response involving the terminal complement cascade and membrane attach complex. The understanding of the alloimmune origin has led to the use of intravenous immunoglobulin (IVIG) treatment and exchange transfusion, significantly increasing survival. However, approximately 25% of patients may not respond and require salvage liver transplantation. In spite of an increased rate of comorbidities, concern for technical difficulties and limited graft availability, young infants eligible for transplant have been shown to have similar overall patient and graft survival rates compared to older children with other indications for liver transplant.

Purpose

The primary aim of our study is to report a case of NALF with successful liver transplant.

Method

We present the case of a preterm girl with NALF due to GALD refractory to medical management, requiring liver transplantation.

Result(s)

This is a 35-week preterm girl, with scant pre-natal care, birth weight of 1.825 kg and Apgar 9/9. She is the seventh child of non-consanguineous parents, with healthy siblings. On day-of-life (DOL) 1 she presented with acute kidney injury, progressive worsening metabolic acidosis and hyperammonemia and was found to be profoundly coagulopathic (INR 6), with normal liver enzymes and liver failure was diagnosed. Initial investigation ruled out congenital infections, sepsis, neonatal hemophagocytic lymphohistiocytosis and metabolic diseases. Magnetic resonance imaging of the body demonstrated findings in keeping with iron deposition in the thyroid, liver and pancreas, suggestive of GALD. Completed double volume exchange transfusion and IVIG on DOL 9 and repeat IVIG on DOL 13 and 15, with partial improvement in INR. Due to persistent ascites, conjugated hyperbilirubinemia and hyperammonemia she was transferred for urgent liver transplant assessment. Persistent liver dysfunction in the form of hyperammonemia, hypoglycemia and progressive coagulopathy led to transplant listing on DOL 30. ABO incompatible deceased donor liver transplant was completed on DOL 62 (4.075 kg, estimated dry weight 3.5 kg). The procedure was uncomplicated, liver enzymes normalized, coagulopathy and hypoglycemia resolved. She was transferred to the ward on post-operative day (POD) 6. and weaned off sedatives and transitioned to oral feeds within 2 weeks of transplant, with complex abdominal wound closure on POD 29.

Conclusion(s)

Successful liver transplantation is possible in neonates with acute liver failure due to GALD refractory to medical management and weighing 4kg or less.

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Disclosure of Interest

None Declared

MICROBIOME & MICROBIAL THERAPY

Work-Related Dermatoses of the Feet in Professional Dancers: A Pilot Study

OBJECTIVE

The feet of professional dancers are exposed to high work-related stresses. To date, data from the professional dance sector concerning this matter are lacking. The aim of this exploratory project was to analyze and evaluate skin health in the foot area with regard to the prevalence of dermatoses, their locations, as well as gender-specific and load-specific differences.

METHODS

Professional classical and neo-classical ballet dancers were examined at two time points: in a phase with increased stress (T0: daily training sessions, rehearsals, and high performance frequency) (n=51, 35 females, 16 males) and after a 24-day rest phase (T1: n=35, 28 females, 7 males). In addition, gender-specific and load-specific (T0 and T1) differences were evaluated.

RESULTS

All professional dancers were affected by skin lesions of the feet at T0. Hyperkeratosis (96.1%), onychomycosis (27.5%), and subungual hematoma (11.8%) were the most frequent dermatoses of the feet of professional dancers. Onychomycosis affected the nails of the big toes in particular (right 15.7%; left 13.7%), and subungual hematomas were found exclusively on the nails of the first toe (right 7.8%; left 7.8%). Women tended to be more frequently affected by hyperkeratosis, men more frequently by onychomycosis. There were no load-specific differences between the stress and rest phases.

CONCLUSION

The prevalence of work-related dermatoses is equally high among female and male dancers. The results can be used for further research and serve as a basis for specific measures of behavioral and environmental prevention in dance.

[Frontal sinus anatomical scanographic study of transgender patients for feminization frontoorbitoplasty surgery]

INTRODUCTION

Little is known about the anatomical elements that allow safe and predictable performance of fronto orbital surgery for facial feminization. The primary objective of this study was to analyze the characteristics (dimensions, pneumatization rate, and anterior wall thickness) of the frontal sinus in MtF transgender patients. The secondary objective was to establish reproducible criteria for CT measurements that could guide preoperative planning of frontal impaction in feminization frontoplasty (FF).

MATERIALS

Fifty preoperative facial mass scans of FF surgery patients were included. The mean age of the operated patients was 34 years. The F line represented the ideal forehead tilt in the absence of a frontal hump.

RESULTS

The height, width, depth, and thickness of the anterior sinus wall were 26.6mm (±5.7), 49.5mm (±11.3), 10.9mm (±3.3), and 3mm (±0.7), respectively. The mean sinus width to skull width ratio was 0.73 (±0.12). Six percent of patients had bilateral frontal sinus agenesis. An osteotomy of the anterior wall of the frontal sinus was performed in the 64% of patients with frontal sinus projection anterior to the F-line. The emergence of the supraorbital nerves from the frontal bone was through a bony notch in 73.8% of cases.

CONCLUSIONS

Knowledge of the anatomy of the frontal sinus and preoperative study of the scans of the facial mass is essential for planning the FF. These characteristics guide the surgical technique of bone remodeling as well as the procedure for releasing the supraorbital nerves.

A multicentre, randomised, double-blind, phase II study to evaluate the tolerability of an induction dose escalation of everolimus in patients with metastatic breast cancer (DESIREE)

BACKGROUND

Stomatitis is one of the main reasons to discontinue everolimus in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (mBC). To decrease stomatitis and subsequently early treatment discontinuations or dose reductions, the DESIREE trial investigated the use of a stepwise dose-escalation schedule of everolimus (EVE esc).

PATIENTS AND METHODS

DESIREE is a phase II, multicentre, randomised, double-blind, placebo-controlled trial in patients with HR+/HER2- mBC and progression/relapse after nonsteroidal aromatase inhibitor treatment. Patients were randomised to EVE esc (2.5 mg/day, week 1; 5 mg/day, week 2; 7.5 mg/day, week 3; 10 mg/day, weeks 4-24) or everolimus 10 mg/day (EVE 10mg) for 24 weeks plus exemestane. The primary endpoint was the incidence of stomatitis episodes grade ≥2 within 12 weeks of treatment. The secondary endpoints included toxicity, relative total dose intensity (RTDI) and quality of life (QoL).

RESULTS

A total of 160 patients were randomised and 156 started treatment (EVE esc: 80; EVE 10mg: 76). The median age of patients was 64 years (range 33-85), 56.3% patients in the EVE esc arm versus 42.1% in the EVE 10mg arm had liver metastasis (P = 0.081) and 62.5% versus 51.3% received over one metastatic therapy line (P = 0.196). Within 12 weeks, the incidence of stomatitis episodes grade ≥2 was significantly lower in the EVE esc arm compared with the EVE 10mg arm (28.8% versus 46.1%; odds ratio 0.47, 95% confidence interval 0.24-0.92; P = 0.026). Toxicity was in line with the known safety profile without new safety concerns. The median RTDI was 91.1% in the EVE esc arm versus 80.0% in the EVE 10mg arm (P = 0.329). Discontinuation rate in the first 3 weeks was 6.3% versus 15.8%, respectively (P = 0.073). QoL was comparable between the two treatment arms.

CONCLUSIONS

A dose-escalation schema of everolimus over 3 weeks can be successfully used to reduce the incidence of high-grade stomatitis in the first 12 weeks of treatment in patients with HR+/HER2- mBC.

TRIAL REGISTRATION

ClinicalTrials.govNCT02387099; https://clinicaltrials.gov/ct2/show/NCT02387099.

Home care provision and nursing home admission after myocardial infarction in relation to cardiogenic shock and out-of-hospital cardiac arrest status

Background

Autonomy is of great importance for quality of life. There is a paucity of data on autonomy for those who survive myocardial infarction (MI) with and without cardiogenic shock (CS) and out-of-hospital arrest (OHCA).

Purpose

To examine the association between CS, OHCA, and need for home care provision or nursing home admission as a proxy for impaired autonomy in a first-time MI population.

Methods

Danish nationwide registries were used to identify patients with first-time MI (2009–2019), who prior to the event were living at home without home care and discharged alive. The patients were stratified according to CS and OHCA status. We report 1-year cumulative incidence of a composite outcome of home care provision or nursing home admission with competing risk of death and as a secondary outcome all-cause mortality. Cause specific Cox regression models were used to estimate adjusted hazard ratios (HR) with patients without CS or OHCA as reference.

Results

We identified 61,451 patients in the period with MI (by groups: −OHCA/−CS: 59,316, −OHCA/+CS: 1,597, +OHCA/−CS: 913, and +OHCA/+CS: 669). The 1-year cumulative incidences of home care/nursing home were 6.9% for patients with −OHCA/−CS, 21.1% for −OHCA/+CS, 5.2% for +OHCA/−CS, and 8.1% for those with +OHCA/+CS. With the −OHCA/−CS as reference, the adjusted HRs for home care/nursing home were 3.12 (95% CI: 2.78–3.49) for patients with −OHCA/+CS, 1.27 (95% CI: 0.95–1.70) for +OHCA/−CS, and 2.31 (95% CI: 1.76–3.03) for +OHCA/+CS (Figure). The 1-year cumulative incidences of mortality were 4.8% for patients with −OHCA/−CS, 10.0% for −OHCA/+CS, 2.8% for +OHCA/−CS, and 3.7% for those with +OHCA/+CS (adjusted HRs: 2.81 (95% CI: 2.55–3.10), 1.09 (95% CI: 0.85–1.39) and 1.81 (95% CI: 1.42–2.30) (Figure 1).

Conclusion

In a selected cohort of patients with MI, without previous need for home care/nursing home and surviving until discharge date, patients with CS were independent of OHCA status associated with less autonomy after discharge with a more than two-fold higher 1-year incidence of home care provision or nursing home admission. Further, patients with CS were associated with a two-fold higher 1-year mortality compared with MI patients without CS independent of OHCA status.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): The work was supported by Rigshospitalets Research Foundation, Master cabinetmaker Sophus Jacobsen and Wife Astrid Jacobsen Foundation, and Director Jacob Madsen and Wife Olga Madsens Foundation. The funding source had no role in the design, conduct, analysis, or reporting of the study.