Attosecond-pump attosecond-probe x-ray spectroscopy of liquid water

Attosecond-pump/attosecond-probe experiments have long been sought as the most straightforward method for observing electron dynamics in real time. Although there has been much success with overlapped near-infrared femtosecond and extreme ultraviolet attosecond pulses combined with theory, true attosecond-pump/attosecond-probe experiments have been limited. We used a synchronized attosecond x-ray pulse pair from an x-ray free-electron laser to study the electronic response to valence ionization in liquid water through all x-ray attosecond transient absorption spectroscopy (AX-ATAS). Our analysis showed that the AX-ATAS response is confined to the subfemtosecond timescale, eliminating any hydrogen atom motion and demonstrating experimentally that the 1b1 splitting in the x-ray emission spectrum is related to dynamics and is not evidence of two structural motifs in ambient liquid water.

KM3NeT/ARCA Sensitivity to Starburst Galaxies

In this work, the expectations of the full detector KM3NeT/ARCA are presented for particular starburst galaxies signals. For the point-like search approach, we considered the most promising local starburst galaxies to be observed as point-like neutrino excesses: NGC 1068, the Small Magellanic Cloud and the Circinus Galaxy. In both cases, we provide the energy-integrated sensitivity for two ARCA building blocks in the energy range 100 GeV − 10 PeV. In the diffuse scenario, both track and shower events were considered. For the point like analysis, only νµ charge current events were taken into account. Interestingly, ARCA has the potential to constrain the selected phenomenological scenarios, providing evidence of the link between star-forming processes and hadronic emissions.

DNA methylation-based classification of sinonasal tumors

The diagnosis of sinonasal tumors is challenging due to a heterogeneous spectrum of various differential diagnoses as well as poorly defined, disputed entities such as sinonasal undifferentiated carcinomas (SNUCs). In this study, we apply a machine learning algorithm based on DNA methylation patterns to classify sinonasal tumors with clinical-grade reliability. We further show that sinonasal tumors with SNUC morphology are not as undifferentiated as their current terminology suggests but rather reassigned to four distinct molecular classes defined by epigenetic, mutational and proteomic profiles. This includes two classes with neuroendocrine differentiation, characterized by IDH2 or SMARCA4/ARID1A mutations with an overall favorable clinical course, one class composed of highly aggressive SMARCB1-deficient carcinomas and another class with tumors that represent potentially previously misclassified adenoid cystic carcinomas. Our findings can aid in improving the diagnostic classification of sinonasal tumors and could help to change the current perception of SNUCs.

Stereotactic ablative body radiotherapy of ventricular tachycardia. Single italian centre experience

Funding Acknowledgements

Type of funding sources: None.

Background

Ventricular tachycardia (VT) is a life-threatening condition. Usual management of VT is based on anti-arrhythmic drugs or catheter ablation. In this scenario, stereotactic body radiation therapy (SBRT) is arising as an attractive non-invasive alternative for the treatment of VT in some patients (pts).

Purpose

The aim of this study was to assess safety, feasibility and outcomes of SBRT in fragile pts admitted in our centre for VT storms.

Methods

Pts with implantable cardioverter-defibrillator (ICD), presenting with VT storms and not responsive to drugs or suitable for catheter ablation were enrolled for SBRT. All pts underwent a computed tomography (CT) and an 18F-fluorodeoxyglucose positron emission (FDG PET)-CT scan in order to detect a possible area of scar responsible of the VT. All pts had also an electrophysiological study and ventricular programmed stimulation inducing clinical VT while wearing a multi-electrodes ECG vest. Merging the CT scan imagines and the VT 3D reconstruction, we identified the possible circuit of the VT and its exit sites. Treatment planning was performed for a total dose of 21-25 Gy delivered in a single session. For the first year, follow-up (FU) were scheduled every 3 months since the SBRT treatment. Toxicity was prospectively assessed.

Results

From January 2020 to March 2021, we treated 6 (5 males) pts. Mean age was 78±4. NYHA class was II for 3 pts, 2 were class III and only one pts was class IV. Four pts had an ischaemic heart disease background, two had dilated cardiomyopathy (DCM). Mean ejection fraction (EF) was 31±6%. The mean FU was 17 months, with the longest of 23 months. Of these 6 pts, only one died because of end stage heart failure, no VT/VF were recorded on his ICD. This was the pts with DCM and class NYHA IV at the time of procedure. Of the 5 pts remaining, 2/5 reported new therapies delivered by their ICDs. One pts had a single ICD shock during acute urine tract infection and sepsis at one month since SBRT. ICD interrogation documented inappropriate shock on fast conducted atrial fibrillation. No VTs have been recorded after 7 months. The other pts was admitted after 5 months since SBRT. The ICD showed appropriate therapies on VTs. This pts had the biggest scar volume compared to the others (anterior wall of the left ventricle with aneurysmatic apex). On the other 3 pts, no VTs were recorded by ICDs. Of these 3 pts, interestingly, 2 had class NYHA III and the mean EF 28.6±3%. The overall outcome with no appropriate ICD shocks due to VTs is above 70%. No radiotherapy toxicity was documented.

Conclusion

To the best of our knowledge this is one of the biggest groups of pts treated with this technology and the longest FU so far, of a single centre in Italy. SBRT seems to be a safe and feasible approach to treat fragile pts with VTs when not suitable for standard catheter ablation or responsive to medications. It also shows a good outcome even in pts with more advanced heart failure.

C2 STEREOTACTIC ABLATIVE RADIOTHERAPY (STAR) IN PATIENTS WITH ICD AND ARRHYTHMIC STORMS

Background

The current therapy of recurrent ventricular tachycardia (VT) and arrhythmic storms is the radiofrequency catheter ablation (RFCA). The first experiences of stereotaxic radioablation of arrhythmia (STAR) as an alternative in patients (pts) with defibrillator (ICD) and Arrhythmic Storms are emerging. However, a standardized method for STAR is not yet available and many issues are still under discussion. We present the preliminary results of STAR in the pts of our Center.

Material and method

Pts with ICDs and Arrhythmic Storms, excluded from RFCA, were referred to STAR. Diagnostics performed were Electrophysiological study (EPS) using 3D electroanatomical mapping (3DEAM) using CardioInsightTM vest (Medtronic, Minneapolis, MN), cardio–CT scan and 18F–fluorine–2–deoxy–D–glucose positron emission tomography (18FDG – PET scan) in order to identify the target area of the ventricle. In all pts a sustained monomorphic VT was induced during EPS, and 3DEAM was used to identify the exit point of the VT (Fig. 1). In all cases, a 3 mm thick 4D CT scan was used (Fig. 2) with the aid of an abdominal thermoplastic mask. Each patient was treated with a TrueBeam Linac (Varian Medical Systems, Palo Alto, CA). The prescription of the dose from 21 to 25 Gy in a single delivery. Ethics committee approval was obtained prior to each treatment.

Results

From January 2020 to March 2021, 6 patients (5 M, 1 F), mean age 78 years (58–80) were treated with STAR. The median delivered dose was 25 Gy (range 21–25 Gy). In follow–up (FU) one patient died from end–stage heart failure after 30 days. At a median FU of 13 months, STAR treatment efficacy was observed in 3/5 patients, in whom no defibrillator activation was recorded. 2/5 patients had recurrence of TV, 2 and 6 months after STAR. No severe acute toxicity was recorded after radiotherapy.

Conclusions

Arrhythmic stereotaxic radioablation appears to be a safe and effective therapy in PTS with ICDs and arrhythmic storms. Completely non–invasive diagnostics and therapy make it very interesting and ambitious. Additional data is needed to improve the definition of the target zone and to standardize it in patients not eligible for RFCA.

A Root in Synapsis and the Other One in the Gut Microbiome-Brain Axis: Are the Two Poles of Ketogenic Diet Enough to Challenge Glioblastoma?

Glioblastoma is the most frequent and aggressive brain cancer in adults. While precision medicine in oncology has produced remarkable progress in several malignancies, treatment of glioblastoma has still limited available options and a dismal prognosis. After first-line treatment with surgery followed by radiochemotherapy based on the 2005 STUPP trial, no significant therapeutic advancements have been registered. While waiting that genomic characterization moves from a prognostic/predictive value into therapeutic applications, practical and easy-to-use approaches are eagerly awaited. Medical reports on the role of the ketogenic diet in adult neurological disorders and in glioblastoma suggest that nutritional interventions may condition outcomes and be associated with standard therapies. The acceptable macronutrient distribution of daily calories in a regular diet are 45-65% of daily calories from carbohydrates, 20-35% from fats, and 10-35% from protein. Basically, the ketogenic diet follows an approach based on low carbohydrates/high fat intake. In carbohydrates starvation, body energy derives from fat storage which is used to produce ketones and act as glucose surrogates. The ketogenic diet has several effects: metabolic interference with glucose and insulin and IGF-1 pathways, influence on neurotransmission, reduction of oxidative stress and inflammation, direct effect on gene expression through epigenetic mechanisms. Apart from these central effects working at the synapsis level, recent evidence also suggests a role for microbiome and gut-brain axis induced by a ketogenic diet. This review focuses on rationales supporting the ketogenic diet and clinical studies will be reported, looking at future possible perspectives.

Voltage bridge mapping in atrioventricular nodal reentry tachycardia ablation in adult population: results from a multicenter registry

Funding Acknowledgements

Type of funding sources: None.

Background

The presence of Low Voltage Bridge (LVB) in Atrioventricular Nodal Reentry Tachycardia (AVNRT) ablation has been described in children populations. Slow pathway ablations visualizing and targeting the LVB has been described to be safe and effective. However, the incidence of LVB in AVNRT ablation has not been widely explored in adult population.

Purpose

We aim to investigate the presence of LVB in adult patients (pts) undergoing AVNRT ablation, and the relationship between the LVB and the successful ablation site. We have also investigated the correlations between the Koch’s triangle (KT) anatomy and biophysical pts data.

Methods

The observational registry prospectively collected data of 165 pts. undergoing AVNRT ablation guided by 3D electroanatomical mapping system (EnSite - Abott, St Paul, MN) in 6 EP centers. Gender: 90F – 75M (55% - 45%) - Age: 57 ± 17 ys (min 15 – max 87) - Weight: 73 ± 15 kgs (min 42 - max 150)  Prior of ablation a voltage map of KT was created using diagnostic and ablation catheters.

We define as Type I LVB a clear, long area of low voltage within the KT between the CS ostium and the AV node with the base on the edge of the tricuspid annulus and Type II LVB a narrow low voltage channel between normal-voltage regions with the base on the edge of the tricuspid annulus.

The relationship between LVB and successful site was evaluated at the end of the procedure. KT anatomical data were correlated to gender, age and weight.

Results

The LVB was identified in 134 pts (81%) with a prevalence of type I (91 - 68%) over type II (33 - 25%). In 10 pts (7%) the LVB did not match type I nor type II. When an LVB was identified, the correspondence between the LVB and the successful ablation site was verified in 117 pts (87%). In addition, a shorter RF time was applied when an LVB was found (396s vs 298s; p = 0.03). Strong correlations between KT anatomy and biophysical pts data were not identified. The distance between His electrograms and the successful ablation site weakly correlated (ρ = -0.24, p < 0.01) with pts age suggesting a shortening in the distance with age progression.

Conclusion

The visualization of the Low Voltage Bridge may be a helpful tool to guide AVNRT ablation in a large cohort of pts; furthermore it is associated with reduced RF applications time. The KT characteristics are difficult to be predicted a priori according to patient gender, age or weight.

Cancer Immunotherapy Using Chimeric Antigen Receptor Expressing T-Cells: Present and Future Needs of Clinical Cancer Centers

Chimeric Antigen Receptor-T cells (CAR-T) are considered novel biological agents, designed to selectively attack cancer cells expressing specific antigens, with demonstrated clinical activity in patients affected with relapsed/refractory B-cell malignancies. In consideration of their complexity, the use of CAR-T requires dedicated clinical setting and health care practitioners with expertise in the selection, treatment, and management of toxicities and side effects. Such issue appears particularly important when contextualized in the rapid progress of CAR-T cell treatment, translating into a constant need of updating and evolution. Moreover, the clinical grade manufacturing of CAR-T cells is complex and implies articulated regulatory and organizational aspects. The main goal of this review is to summarize and provide an accurate analysis of the clinical, logistic, and regulatory requirements of CAR-T cell centers. Finally, we describe a new occupational figure called “CAR-T specialist” devoted to the establishment and coordination of the required facilities and regulatory landscape in the context of cancer centers.

A high-power, high-repetition-rate THz source for pump-probe experiments at Linac Coherent Light Source II

Experiments using a THz pump and an X-ray probe at an X-ray free-electron laser (XFEL) facility like the Linac Coherent Light Source II (LCLS II) require frequency-tunable (3 to 20 THz), narrow bandwidth (∼10%), carrier-envelope-phase-stable THz pulses that produce high fields (>1 MV cm^-1) at the repetition rate of the X-rays and are well synchronized with them. In this paper, a two-bunch scheme to generate THz radiation at LCLS II is studied: the first bunch produces THz radiation in an electromagnet wiggler immediately following the LCLS II undulator that produces X-rays from the second bunch. The initial time delay between the two bunches is optimized to compensate for the path difference in THz transport. The two-bunch beam dynamics, the THz wiggler and radiation are described, as well as the transport system bringing the THz pulses from the wiggler to the experimental hall.

Predictors of efficacy of androgen-receptor-axis-targeted therapies in patients with metastatic castration-sensitive prostate cancer: A systematic review and meta-analysis

BACKGROUND

Both docetaxel and androgen-receptor-axis-targeted (ARAT) agents are approved in metastatic castration-sensitive prostate cancer (mCSPC) patients. Predictive factors of therapy efficacy are lacking.

METHODS

We included articles reporting data about randomized-controlled clinical trials (RCTs) testing an ARAT agent plus ADT vs. ADT. We aimed to obtain pooled estimates of efficacy outcomes and assess differences in pooled estimates of efficacy outcomes between sub-groups.

RESULTS

A total of 5427 mCSPC patients enrolled in five RCTs were evaluable for OS (Overall Survival) and PFS (Progression-free survival). Pooled OS-HR (Hazard Ratio) was 0.66 (95 % CI: 0.60-0.74), while pooled PFS-HR was 0.46 (95 % CI: 0.40-0.53). Combined treatment with docetaxel was associated with differential OS outcomes, while tumor volume according to the CHAARTED criteria and visceral metastasis were associated with differential PFS outcomes.

CONCLUSION

Our results add evidence that ARAT agents improve OS in mCSPC and discourage their combined use with docetaxel in this setting.

P2831Safety of atrial fibrillation catheter ablation in the elderly

Background

Catheter ablation for drug refractory, symptomatic atrial fibrillation (AF), is becoming increasingly common and can be beneficial in alleviating symptoms. However, in the elderly, there are concerns about the risks an invasive procedure poses, with limited published data available in those aged over 80 years.

Purpose

To determine the complication risk of AF catheter ablation in the elderly

Methods

Complications were identified from patient records in 3156 consecutive patients who underwent radiofrequency catheter ablation for AF, at a tertiary cardiology centre between 2013–2017. All cases were performed under general anesthesia.

Results

In this cohort of 3156 patients (mean age= 62.9±11.0 years, female = 29.9%), 90 (2.85%) (mean age= 66±10.0 years, female = 49.5%) complications were identified. In patients aged ≥80 years, complications occurred in 5 out of 99 patients (5.05%) (mean age= 82.6±1.2, female=100%), compared to 85 out of 3057 patients (2.78%) in those aged <80 years (mean age= 65±10.3, female = 49.4%). The difference was not significant p=0.18. Complications in the elderly all occurred acutely, and included groin haematoma (2.02%), pneumonia (2.02%) and pericardial effusion (1.01%).

Conclusion

Catheter ablation for AF in patients ≥80 years of age, is not associated with a significant increase in complication risk, compared to those who are younger.

Biweekly fotemustine schedule for recurrent glioblastoma in the elderly: activity and toxicity assessment of a multicenter study

Aim: To assess the efficacy and safety of alternative fotemustine administration schedule in elderly patients with recurrent glioblastoma. Patients & methods: Patients aged >65 years with recurrent glioblastoma received fotemustine (80 mg/m2; days 1, 15, 30, 45 and 60, and subsequently every 4 weeks). Primary end point was progression-free survival (PFS) rate at 6 months. Main secondary end point was safety. Results: 58 patients were enrolled at two centers. PFS at 6 months was 47% (27 patients) and overall response rate was 29%. Median PFS and survival were 6 and 7 months, respectively, and longer in responders versus nonresponders. No grade 3-4 hematological toxicities occurred. Conclusion: The alternative fotemustine administration schedule was an effective and safe treatment for recurrent glioblastoma in elderly patients.

Abstract GS4-01: Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer patients: 10 year follow up results of the EORTC AMAROS trial (EORTC 10981/22023)

Background: Sentinel node biopsy (SNB) is standard in assessing axillary lymph node status in patients with clinically node-negative breast cancer. The 5-year analysis of AMAROS trial showed that if locoregional treatment is advised after a tumor-positive axillary SNB, axillary radiotherapy (ART) is a reasonable alternative for an axillary lymph node dissection (ALND) with less side effects, though follow up was relatively short. Here we present the 10-year follow up data.

Methods: From February 2001 to April 2010, patients with primary breast cancer stage cT1-2N0M0 were enrolled in the EORTC phase III non-inferiority AMAROS trial by 34 European sites. Patients were randomized between ALND and ART in case of a tumor-positive SNB. The primary endpoint, axillary recurrence rate (AxR) is now assessed at 10 years in the ITT population using Fine and Gray cumulative incidence method with deaths as competing risks, as well as secondary endpoints: overall survival (OS), distant metastasis free survival (DMFS), second primaries (including cancers other than breast cancers and contralateral DCIS) and locoregional recurrences (LRR). Little extra information beyond 5 years was available concerning Quality of Life and morbidity. Data collection is still ongoing and will be presented later.

Results:Of the 4806 patients entered, 1425 patients had a tumor-positive SNB: 744 in the ALND-arm and 681 in the ART-arm, 60% with a macrometastasis. Both treatment-arms achieved a median 10-year follow-up and were comparable regarding age, tumor size, grade, tumor type and adjuvant systemic treatment. In the group who had ALND, the 5-year AxR was 0.41% (95%CI: 0.00;0.88) (4/744) and the 10-year AxR was 0.93% (95%CI:0.18;1.68) (7/744). In the group who had ART, the 5-year AxR was 1.04% (95%CI: 0.27;1.81) (7/681) and the 10-year AxR was 1.82% (95%CI: 0.74;2.94) (11/681) (HR 1.71, 95%CI: 0.67;4.39, p = 0.37). Sensitivity analysis, considering deaths and distant recurrences as competing risks, revealed consistent results. There were no significant differences between treatment arms regarding OS (ALND: 84.6% (95%CI: 81.5;87.1), ART: 81.4% (95%CI: 77.9;84.4), HR 1.17, 95%CI: 0.89;1.52, p= 0.26) and DMFS (ALND: 81.7% (95%CI: 78.5;84.4), ART: 78.2% (95%CI: 74.6;81.3), HR 1.18, 95%CI: 0.92;1.50, p=0.19). Cumulative incidence estimates of 10-year LRR are 3.59% (95%CI: 2.12;5.06) (ALND) versus 4.07% (95%CI: 2.49;5.65) (ART) (p= 0.69). More second primaries were observed after ART: 75/681 (21 contralateral breast) as compared to ALND: 57/744 (11 contralateral breast) (p = 0.035). All results are consistent in the per protocol analysis of patients with a tumor-positive SNB.

Conclusion: Axillary recurrence after 10 years in patients with a tumor-positive SNB who were treated with ART is extremely rare and not significantly different from patients who were treated with ALND. OS, DMFS and locoregional control are also comparable. Second primaries including contralateral breast cancers are more frequently encountered after ART, but the difference is still low in absolute numbers. Thus, ART is a safe treatment for breast cancer patients with a tumor-positive SNB.

Citation Format: Rutgers EJ, Donker M, Poncet C, Straver ME, Meijnen P, van de Velde CJ, Mansel RE, Blanken C, Orzalesi L, Klinkenbijl JH, van der Mijle HC, Veltkamp SC, van 't Riet M, Albregts M, Marinelli A, Rijna H, Tobon Morales R, Snoj M, Bundred N, Chauvet MP, Merkus JW, Petignat P, Schinagl DA, Coens C, Peric A, Bogaerts J, van Tienhoven G. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer patients: 10 year follow up results of the EORTC AMAROS trial (EORTC 10981/22023) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS4-01.

The cosmic ray shadow of the Moon observed with the ANTARES neutrino telescope

One of the main objectives of the ANTARES telescope is the search for point-like neutrino sources. Both the pointing accuracy and the angular resolution of the detector are important in this context and a reliable way to evaluate this performance is needed. In order to measure the pointing accuracy of the detector, one possibility is to study the shadow of the Moon, i.e. the deficit of the atmospheric muon flux from the direction of the Moon induced by the absorption of cosmic rays. Analysing the data taken between 2007 and 2016, the Moon shadow is observed with 3.5 σ statistical significance. The detector angular resolution for downward-going muons is 0 . 73 ∘ ± 0 . 14 ∘ . The resulting pointing performance is consistent with the expectations. An independent check of the telescope pointing accuracy is realised with the data collected by a shower array detector onboard of a ship temporarily moving around the ANTARES location.

High-dose fotemustine in temozolomide-pretreated glioblastoma multiforme patients: A phase I/II trial

BACKGROUND

Glioblastoma multiforme (GBM) is a rare and deadly disease, with a reported average incidence rate of 3.19 cases per 100,000 inhabitants. Fotemustine, a third-generation nitrosourea with an alanine phosphor carrier that facilitates cellular penetration, has been extensively investigated in the setting of recurrent/progressive disease after initial treatment. Fotemustine is usually administered following a schedule consisting of 3 doses every week, followed by maintenance doses administered every 3 weeks.

METHODS

In this phase I/II trial, we aimed to assess whether the use of a biweekly regimen allowed administration of higher dose than the standard 100 mg/m dose approved per label indication in a population of patients with recurrent GBM. In this phase I/II trial, fotemustine was administered intravenously over 1 hour every 2 weeks at either 120 or 140 mg/m doses for up to 1 year, until disease progression, unacceptable toxicity, or patient's request to withdraw from the study. The phase I part of the trial was conducted following the classic 3+3 study design. The phase II part of the trial was a single-arm study. The primary efficacy endpoint was the percentage of patients who had not progressed after 24 weeks (PFS-24).

RESULTS

Thirty-seven patients were enrolled in this phase I/II trial from August 2006 to November 2011. Treatment was well tolerated in the overall population. Main severe toxicity was grades 3 and 4 thrombocytopenia, which occurred in 4 of 6 patients treated at the 140 mg/m dose level and in 3 of 31 patients treated at 120 mg/m. Median PFS and overall survival were 12.1 (1-40.2) weeks and 19.7 (1-102) weeks, respectively.

CONCLUSION

We conclude that fotemustine can be safely administered at 120 mg/m biweekly. The efficacy of such modified schedule and doses should be compared to the biweekly schedule at 80 mg and the standard weekly schedule at 80 to 100 mg/m.

Hypothalamic-Pituitary-Ovarian Axis in Women with Operable Breast Cancer Treated with Adjuvant CMF and Tamoxifen

The effect of adjuvant CMF (cyclophopshamide, methotrexate, and 5-fluorouracil) and tamoxifen (TM) on hypothalamic-pituitary-ovarian function was studied in 120 women with stage I-II operable breast cancer. Sixty patients were premenopausal, of whom 25 were treated with CMF for 9 cycles, 25 with CMF for 9 cycles + TM for 2 years, started concurrently, and 10 with TM alone for 2 years. Sixty patients were postmenopausal and they were all treated with TM alone for 2 years. In all groups treatment was started within 4 weeks of mastectomy. Plasma levels of estrone (E1), estradiol-17β (E2), follicle-stimulating hormone, luteinizing hormone (LH), prolactin (Prl), testosterone (T) and thyroid-stimulating hormone (TSH) were determined in all patients before surgery and again at 3-month intervals from initiation of the adjuvant therapy. In ten patients of each treatment group FSH-LH and Prl-TSH release was determined following stimulation with releasing hormones. CMF and CMF + TM therapy resulted in amenorrhea in 42/50 premenopausal patients with decrease of E1 + E2 (p < 0.001) and elevation of FSH (p < 0.001) and LH (p < 0.01) plasma concentration to postmenopausal levels. In premenopausal women treated with TM a marked increase of E1 + E2 (p < 0.001) was observed with unaltered FSH-LH plasma concentration. A significant fall of Prl also occurred in these patients. In postmenopausal women and premenopausal patients with CMF-induced amenorrhea TM produced a marked fall of FSH-LH and a decrease of Prl plasma level. Plasma TSH and T were not affected in any patient by any of the treatment regimens. The results of the stimulatory tests are in agreement with the hormonal changes observed under basal conditions and indicate that, whereas CMF suppresses the ovary and does not alter hypothalamic-pituitary function, TM induces profound changes of the hypothalamic-pituitary-ovarian axis.

Isoquercetin as an Adjunct Therapy in Patients With Kidney Cancer Receiving First-Line Sunitinib (QUASAR): Results of a Phase I Trial

Sunitinib is the most commonly prescribed drug for advanced renal cell carcinoma in the first-line setting and has been associated with multiple adverse events related to its on–and off–target effects, including hand and foot syndrome and fatigue. It was hypothesized that sunitinib-induced fatigue may be related to off target inhibition of the AMPK enzyme, which results in impairment of energy-producing processes at a systemic level. Quercetin is a naturally occurring flavonol with established AMPK-stimulating activity. While clinical use of quercetin is limited by its poor bio-availability, quercetin-3-O-β-d-glucopyranoside, that is isoquercetin, has an improved pharmacokinetic profile. On the grounds of the in vitro stimulatory activity with respect to AMPk, we hypothesized that oral isoquercetin could improve fatigue in kidney cancer patients receiving sunitinib. Given the lack of data on the safety of isoquercetin given concomitantly with sunitinib, we conducted a phase I trial to assess the safety of GMP manufactured isoquercetin given at two dose levels (450 and 900 mg a day). In the 12-patient study cohort included in this study, isoquercetin was administered concomitantly with 50 mg sunitinib for a median 81 days (IQR, 75.5, 86.5). None of the 12 patients required isoquercetin suspension or isoquercetin dose reduction because of adverse events. No abnormalities in ECG, heart or lower limbs doppler ultrasound were detected. A statistically significant improvement was reported for the FACIT fatigue score (6.8 points; 95% CI: 2.8–10.8; p = 0.002) and for the FACIT Adverse Events score (18.9 points; 95% CI: 9.1–28.8; p < 0.001) after isoquercetin consumption vs. baseline. In this phase I trial, isoquercetin was remarkably safe, with a preliminary signal of activity in terms of improvement of sunitinib adverse events.

Abstract P2-11-10: Toxicity analysis of elderly breast cancer patients using different accelerated partial breast irradiation techniques

PURPOSE We investigated the acute toxicity of Accelerated Partial Breast Irradiation using external beam (EB-APBI) and intraoperative radiotherapy (IORT) technique.

MATERIALS AND METHODS Women ≥60 years with unifocal breast tumors of ≤30 mm undergoing breast conserving therapy were eligible for this prospective multi-centre cohort study. After informed consent, patients were treated with IORT in one institute, EB-APBI was applied in other institutes. IORT was applied with electrons directly on the tumor bed following lumpectomy (21 Gy at 90% isodose). EB-APBI was delivered using 3D-conformal radiotherapy or IMRT in 10 daily fractions of 3.85 Gy. Acute toxicity was scored using the CTCAE v.3, initially by the treating physician and retrospectively by blinded researchers. The highest reported toxicity until 3 months after treatment was used. Patient reported symptoms were analysed using Visual Analogue Scales (VAS) for pain and fatigue (scale 0-10), and single items from the EORTC QLQ-C30 and Breast Cancer module questionnaires at different time points up till 3 months. P&lt;0.01 was deemed significant.

RESULTS Between January 2011 and August 2016, 622 patients were eligible, eventually 268 patients underwent IORT and 207 underwent EB-APBI. Of those, 267 (IORT) and 206 (EB-APBI) were available for toxicity analysis. Patient characteristics are shown in table 1. Although more patients experienced &gt;grade 2 acute toxicity in the IORT group (10.4% IORT and 4.9% EB-APBI; p=0.027), grade 3 toxicity was low and did not significantly differ between groups (3.3% IORT and 1.5% EB-APBI). No grade 4 toxicity occurred. After IORT more wound infections requiring oral antibiotics (5.2% versus 1.5%) and more seroma requiring aspiration (2.2% versus 0.5%) were observed.

Results for EORTC symptoms and VAS scores are displayed in table 2. Patients treated with EB-APBI experienced significantly less fatigue direct postoperatively (EORTC p=0.003, VAS p&lt;0.001). After 3 months, this difference dissolved, and only pain according to the VAS scale was significantly worse in the EB-APBI group (p=0.003).

Table 1. Patient characteristics  IORT, n=267EB-APBI, n=206p-valueAge(median; range) 68; 59-9067; 59-860.683pT stagepTis7%13%0.020 pT184%74%  pT29%13% pN stagepN093%97%0.092 pN17%3% ER statusPositive93%93%0.122Systemic therapyNo59%62%0.509

Table 2. EORTC and VAS scores BaselinePostoperativeAfter EB-APBI3 months after treatment IORTEB-APBIIORTEB-APBIEB-APBIIORTEB-APBIPain771920111013Fatigue1192916241723Breast pain4425211068Swollen breast122516554Oversensitive breast33362715811Skin side effects1147835VAS pain(median)  3.03.02.02.03.0VAS fatigue(median)  4.03.04.03.04.0EORTC: Scores of “quite a bit” and “very much” were scored positive. Percentage of patients that scored positive is shown.

CONCLUSION Even though more clinically relevant toxicity is seen in IORT treatment direct postoperatively, acute toxicity in both IORT and EB-APBI treatment is acceptable. IORT patients seem to recover more rapidly regarding fatigue than EB-APBI patients. This may be explained by the fact that IORT treatment is completed in one day.

Citation Format: Jacobs DHM, Marijnen CAM, Speijer G, Straver M, Marinelli A, Merkus J, Roelofzzen EMA, Zwanenburg LAG, Fisscher U, Petoukhova AL, Mast ME, Koper P. Toxicity analysis of elderly breast cancer patients using different accelerated partial breast irradiation techniques [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-11-10.

Generating Single-Spike Hard X-Ray Pulses with Nonlinear Bunch Compression in Free-Electron Lasers

A simple method for generating single-spike hard x-ray pulses in free-electron lasers (FELs) has been developed at the Linac Coherent Light Source (LCLS). This is realized by nonlinear bunch compression using 20-pC bunch charge, demonstrated in the hard x-ray regime at 5.6 and 9 keV, respectively. Measurements show about half of the FEL shots containing a single-spike spectrum. At 5.6-keV photon energy, the single-spike shots have a mean pulse energy of about 10  μJ with 70% intensity fluctuation and the pulse full width at half maximum is evaluated to be at 200-as level.

Radial head prosthesis: surgical tips and tricks

Radial head prostheses (RHP) have been developed to decrease the complications rate following a radial head resection surgery. The aim of the RHP is to replicate the physiological radiocapitellar tracking, reproducing the mechanical function of the native radial head: to stabilize the elbow and to shear the forces passing through the elbow along with the other stabilizers. The currently used RHP models try to achieve this target with three different prosthesis' strategies: (a) loose fit stem, (b) bipolar radial head or (c) anatomical radial head. Even if the radial head fixation is the preferred technique in every possible case and the resection can be still considered a possible option, in the last years there has been a growing worldwide consensus in using the radial head replacement in patients with unfixable radial head fractures, especially if associated with complex elbow instability. However, complications after a RHP are not uncommon, and their rate is raising as long as the implants number are increasing. The main difficulties are due to the implantation technique that needs to be performed with the same attention and precision used for the replacement of all the other joints, and to the concurrent treatment of the associated lesions. A personalized postoperative rehabilitation program is essential for obtaining good results and decreasing the complications rate. Concern exists for the young age of the patients that often require a RHP: personal experience and literature analysis suggest that if the clinical and radiographic results are positive after a 6-12-month follow-up, good outcomes can be also expected at a medium- or long-term follow-up.

Diffuse Cosmic Rays Shining in the Galactic Center: A Novel Interpretation of H.E.S.S. and Fermi-LAT γ-Ray Data

We present a novel interpretation of the γ-ray diffuse emission measured by Fermi-LAT and H.E.S.S. in the Galactic center (GC) region and the Galactic ridge (GR). In the first part we perform a data-driven analysis based on PASS8 Fermi-LAT data: We extend down to a few GeV the spectra measured by H.E.S.S. and infer the primary cosmic-ray (CR) radial distribution between 0.1 and 3 TeV. In the second part we adopt a CR transport model based on a position-dependent diffusion coefficient. Such behavior reproduces the radial dependence of the CR spectral index recently inferred from the Fermi-LAT observations. We find that the bulk of the GR emission can be naturally explained by the interaction of the diffuse steady-state Galactic CR sea with the gas present in the central molecular zone. Although we confirm the presence of a residual radial-dependent emission associated with a central source, the relevance of the large-scale diffuse component prevents to claim a solid evidence of GC pevatrons.

An algorithm for the reconstruction of high-energy neutrino-induced particle showers and its application to the ANTARES neutrino telescope

A novel algorithm to reconstruct neutrino-induced particle showers within the ANTARES neutrino telescope is presented. The method achieves a median angular resolution of [Formula: see text] for shower energies below 100 TeV. Applying this algorithm to 6 years of data taken with the ANTARES detector, 8 events with reconstructed shower energies above 10 TeV are observed. This is consistent with the expectation of about 5 events from atmospheric backgrounds, but also compatible with diffuse astrophysical flux measurements by the IceCube collaboration, from which 2-4 additional events are expected. A [Formula: see text] C.L. upper limit on the diffuse astrophysical neutrino flux with a value per neutrino flavour of [Formula: see text] is set, applicable to the energy range from 23 TeV to 7.8 PeV, assuming an unbroken [Formula: see text] spectrum and neutrino flavour equipartition at Earth.

Accurate prediction of X-ray pulse properties from a free-electron laser using machine learning

Free-electron lasers providing ultra-short high-brightness pulses of X-ray radiation have great potential for a wide impact on science, and are a critical element for unravelling the structural dynamics of matter. To fully harness this potential, we must accurately know the X-ray properties: intensity, spectrum and temporal profile. Owing to the inherent fluctuations in free-electron lasers, this mandates a full characterization of the properties for each and every pulse. While diagnostics of these properties exist, they are often invasive and many cannot operate at a high-repetition rate. Here, we present a technique for circumventing this limitation. Employing a machine learning strategy, we can accurately predict X-ray properties for every shot using only parameters that are easily recorded at high-repetition rate, by training a model on a small set of fully diagnosed pulses. This opens the door to fully realizing the promise of next-generation high-repetition rate X-ray lasers.

Dietary cyanidin 3-glucoside from purple corn ameliorates doxorubicin-induced cardiotoxicity in mice

BACKGROUND AND AIMS

Anthracyclines are effective anticancer drugs that have improved prognosis of hundred thousand cancer patients worldwide and are currently the most common chemotherapeutic agents used for the treatment of blood, breast, ovarian and lung cancers. However, their use is limited because of a cumulative dose-dependent and irreversible cardiotoxicity that can cause progressive cardiomyopathy and congestive heart failure. Aim of the present study was to determine the cardioprotective activity of a dietary source of cyanidin 3-glucoside (C3G), such as purple corn, against doxorubicin (DOX)-induced cardiotoxicity in mice.

METHODS AND RESULTS

In vitro studies on murine HL-1 cardiomyocytes showed that pretreatment with both pure C3G and purple corn extract improved survival upon DOX treatment. However, C3G and purple corn extract did not affect the cytotoxic effect of DOX on human cancer cell lines. We then validated in vivo the protective role of a C3G-enriched diet against DOX-induced cardiotoxicity by comparing the effect of dietary consumption of corn isogenic lines with high levels of anthocyanins (purple corn - Red diet - RD) or without anthocyanins (yellow corn - Yellow diet - YD) incorporated in standard rodent diets. Results showed that mice fed RD survived longer than mice fed YD upon injection of a toxic amount of DOX. In addition, ultrastructural analysis of hearts from mice fed RD showed reduced histopathological alterations.

CONCLUSION

Dietary intake of C3G from purple corn protects mice against DOX-induced cardiotoxicity.

Sperm whale long-range echolocation sounds revealed by ANTARES, a deep-sea neutrino telescope

Despite dedicated research has been carried out to adequately map the distribution of the sperm whale in the Mediterranean Sea, unlike other regions of the world, the species population status is still presently uncertain. The analysis of two years of continuous acoustic data provided by the ANTARES neutrino telescope revealed the year-round presence of sperm whales in the Ligurian Sea, probably associated with the availability of cephalopods in the region. The presence of the Ligurian Sea sperm whales was demonstrated through the real-time analysis of audio data streamed from a cabled-to-shore deep-sea observatory that allowed the hourly tracking of their long-range echolocation behaviour on the Internet. Interestingly, the same acoustic analysis indicated that the occurrence of surface shipping noise would apparently not condition the foraging behaviour of the sperm whale in the area, since shipping noise was almost always present when sperm whales were acoustically detected. The continuous presence of the sperm whale in the region confirms the ecological value of the Ligurian sea and the importance of ANTARES to help monitoring its ecosystems.

Elbow instability: Are we able to classify it? Review of the literature and proposal of an all-inclusive classification system

BACKGROUND

In the recent years, considerable improvements have come in biomechanical knowledge about the role of elbow stabilizers. In particular, the complex interactions among the different stabilizers when injured at the same time have been better understood. Anyway, uncertainties about both nomenclature and classification still exist in the definition of the different patterns of instability.

MATERIAL AND METHODS

The authors examine the literature of the last 130 years about elbow instability classification, analyzing the intuitions and the value of each of them. However, because of the lack of a satisfactory classification, in 2015 a working group has been created inside SICSeG (Italian Society of Shoulder and Elbow Surgery) with the aim of defining an exhaustive classification as simple, complete and reproducible as possible.

RESULTS

A new all-inclusive elbow instability classification is proposed. This classification considers two main parameters: timing (acute and chronic forms) and involved stabilizers (simple and complex forms), and four secondary parameters: etiology (traumatic, rheumatic, congenital…), the involved joint (radius and ulna as a single unit articulating with the humerus or the proximal radio-ulnar joint), the degree of displacement (dislocation or subluxation) and the mechanism of instability or dislocation (PLRI, PMRI, direct axial loading, pure varus or valgus stress).

CONCLUSIONS

This classification is at the same time complete enough to include all the instability patterns and practical enough to be effectively used in the clinical practice. This classification can help in defining a shared language, can improve our understanding of the disorder, reduce misunderstanding of diagnosis and improve comparison among different case series.

Circular dichroism measurements at an x-ray free-electron laser with polarization control

A non-destructive diagnostic method for the characterization of circularly polarized, ultraintense, short wavelength free-electron laser (FEL) light is presented. The recently installed Delta undulator at the LCLS (Linac Coherent Light Source) at SLAC National Accelerator Laboratory (USA) was used as showcase for this diagnostic scheme. By applying a combined two-color, multi-photon experiment with polarization control, the degree of circular polarization of the Delta undulator has been determined. Towards this goal, an oriented electronic state in the continuum was created by non-resonant ionization of the O2 1s core shell with circularly polarized FEL pulses at hν ≃ 700 eV. An also circularly polarized, highly intense UV laser pulse with hν ≃ 3.1 eV was temporally and spatially overlapped, causing the photoelectrons to redistribute into so-called sidebands that are energetically separated by the photon energy of the UV laser. By determining the circular dichroism of these redistributed electrons using angle resolving electron spectroscopy and modeling the results with the strong-field approximation, this scheme allows to unambiguously determine the absolute degree of circular polarization of any pulsed, ultraintense XUV or X-ray laser source.

Modulation of Costimulatory Molecules CD80/CD86 on B Cells and Macrophages by Stress Proteins GroEL, GroES and DnaK

The aim of this study was to evaluate the effect of the Heat Shock Proteins GroES, GroEL and DnaK on the expression of the costimulatory molecules CD80/CD86 in B cells and macrophages. The interactions among these molecules are able to highly influence the immune response through the regulation of cytokine liberation which, on their own, are able to regulate the immunological response by a feedback mechanism. Our results showed that, on B cells, GroES and GroEL stimulated the expression of CD86 but did not induce the increase of the CD80 expression. CD86 peak expression showed a peak after 24–48 h of culture and decreaseed 60h after the stimulation. GroES and GroEL also stimulated the expression of CD80 and CD86 on macrophages. The same HSPs did not modify the expression of CD80 and CD86 on cells having characteristics of activated macrophages, the A-THP-1 cell line. DnaK did not induce any increase in the expression of CD80 and CD86 on lymphocytes or macrophages.

Optical Shaping of X-Ray Free-Electron Lasers

In this Letter we report the experimental demonstration of a new temporal shaping technique for x-ray free-electron lasers (FELs). This technique is based on the use of a spectrally shaped infrared (IR) laser and allows optical control of the x-ray generation process. By accurately manipulating the spectral amplitude and phase of the IR laser, we can selectively modify the electron bunch longitudinal emittance thus controlling the duration of the resulting x-ray pulse down to the femtosecond time scale. Unlike other methods currently in use, optical shaping is directly applicable to the next generation of high-average power x-ray FELs such as the Linac Coherent Light Source-II or the European X-FEL, and it enables pulse shaping of FELs at the highest repetition rates. Furthermore, this laser-shaping technique paves the way for flexible tailoring of complex multicolor FEL pulse patterns required for nonlinear multidimensional x-ray spectroscopy as well as novel multicolor diffraction imaging schemes.

Hetero-site-specific X-ray pump-probe spectroscopy for femtosecond intramolecular dynamics

New capabilities at X-ray free-electron laser facilities allow the generation of two-colour femtosecond X-ray pulses, opening the possibility of performing ultrafast studies of X-ray-induced phenomena. Particularly, the experimental realization of hetero-site-specific X-ray-pump/X-ray-probe spectroscopy is of special interest, in which an X-ray pump pulse is absorbed at one site within a molecule and an X-ray probe pulse follows the X-ray-induced dynamics at another site within the same molecule. Here we show experimental evidence of a hetero-site pump-probe signal. By using two-colour 10-fs X-ray pulses, we are able to observe the femtosecond time dependence for the formation of F ions during the fragmentation of XeF2 molecules following X-ray absorption at the Xe site.

High-intensity double-pulse X-ray free-electron laser

The X-ray free-electron laser has opened a new era for photon science, improving the X-ray brightness by ten orders of magnitude over previously available sources. Similar to an optical laser, the spectral and temporal structure of the radiation pulses can be tailored to the specific needs of many experiments by accurately manipulating the lasing medium, that is, the electron beam. Here we report the generation of mJ-level two-colour hard X-ray pulses of few femtoseconds duration with an XFEL driven by twin electron bunches at the Linac Coherent Light Source. This performance represents an improvement of over an order of magnitude in peak power over state-of-the-art two-colour XFELs. The unprecedented intensity and temporal coherence of this new two-colour X-ray free-electron laser enable an entirely new set of scientific applications, ranging from X-ray pump/X-ray probe experiments to the imaging of complex biological samples with multiple wavelength anomalous dispersion.

Two-colour X-ray pulses from free-electron lasers can be used to probe ultrafast dynamics, but the total power is a fraction of the saturation power. Here, Marinelli et al. use twin electron bunches to reach full saturation power and increase the two-colour intensity by an order of magnitude at hard-X-ray energies.

Experimental demonstration of a soft x-ray self-seeded free-electron laser

The Linac Coherent Light Source has added a self-seeding capability to the soft x-ray range using a grating monochromator system. We report the demonstration of soft x-ray self-seeding with a measured resolving power of 2000-5000, wavelength stability of 10(-4), and an increase in peak brightness by a factor of 2-5 across the photon energy range of 500-1000 eV. By avoiding the need for a monochromator at the experimental station, the self-seeded beam can deliver as much as 50-fold higher brightness to users.

Demonstration of single-crystal self-seeded two-color x-ray free-electron lasers

A scheme for generating two simultaneous hard-x-ray free-electron laser pulses with a controllable difference in photon energy is described and then demonstrated using the self-seeding setup at the Linac Coherent Light Source (LCLS). The scheme takes advantage of the existing LCLS equipment, which allows two independent rotations of the self-seeding diamond crystal. The two degrees of freedom are used to select two nearby crystal reflections, causing two wavelengths to be present in the forward transmitted seeding x-ray pulse. The free-electron laser system must support amplification at both desired wavelengths.

Correlated energy-spread removal with space charge for high-harmonic generation

We study the effect of longitudinal space charge on the correlated energy spread of a relativistic high-brightness electron beam that has been density modulated for the emission of coherent, high-harmonic radiation. We show that, in the case of electron bunching induced by a laser modulator followed by a dispersive chicane, longitudinal space charge forces can act to strongly reduce the induced energy modulation of the beam without a significant reduction in the harmonic bunching content. This effect may be optimized to enhance the output power and overall performance of free-electron lasers that produce coherent light through high-gain harmonic generation. It also increases the harmonic number achievable in these devices, which are otherwise gain-limited by the induced energy modulation from the laser.

High grade glioblastoma is associated with aberrant expression of ZFP57, a protein involved in gene imprinting, and of CPT1A and CPT1C that regulate fatty acid metabolism

The diagnosis of glioblastoma is still based on tumor histology, but emerging molecular diagnosis is becoming an important part of glioblastoma classification. Besides the well-known cell cycle-related circuitries that are associated with glioblastoma onset and development, new insights may be derived by looking at pathways involved in regulation of epigenetic phenomena and cellular metabolism, which may both be highly deregulated in cancer cells. We evaluated if in glioblastoma patients the high grade of malignancy could be associated with aberrant expression of some genes involved in regulation of epigenetic phenomena and lipid metabolism. We measured the mRNA levels of ZFP57, TRIM28, CPT1A, CPT1B, and CPT1C in a cohort of 80 patients divided in two groups: grade II and grade IV. We evidenced that high grade glioblastoma is associated with increased level of ZFP57, a protein involved in gene imprinting, and aberrant expression of CPT1A and CPT1C, regulators of fatty acid oxidation. Our study may pave the way to identify new markers that could be potentially useful for diagnosis and/or prognosis of glioblastoma.

Multicolor operation and spectral control in a gain-modulated x-ray free-electron laser

We show that the spectral properties of a self-amplified spontaneous emission x-ray free-electron laser can be controlled by modulating the gain in magnetic undulators, thus producing one or several spectral lines within a single few femtosecond pulse. By varying the magnetic field along the undulator and the electron beam transport line, the system we demonstrate can tailor the x-ray spectrum to optimally meet numerous experimental requirements for multicolor operation.

Generation of coherent broadband photon pulses with a cascaded longitudinal space-charge amplifier

The longitudinal space-charge amplifier has been recently proposed by Schneidmiller and Yurkov as an alternative to the free-electron laser instability for the generation of intense broadband radiation pulses [Phys. Rev. ST Accel. Beams 13, 110701 (2010)]. In this Letter, we report on the experimental demonstration of a cascaded longitudinal space-charge amplifier at optical wavelengths. Although seeded by electron beam shot noise, the strong compression of the electron beam along the three amplification stages leads to emission of coherent undulator radiation pulses exhibiting a single spectral spike and a single transverse mode. The on-axis gain is estimated to exceed 4 orders of magnitude with respect to spontaneous emission.