Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Race, ethnicity, and experienced racism are associated with adverse physical and mental health outcomes among cancer survivors

INTRODUCTION

Survivors of cancer are at risk for adverse mental and physical health outcomes. It is not well understood, however, how these outcomes are differentially experienced according to an individual's exposure to racism. This study sought to evaluate associations of race/ethnicity, and experiences of racism, with adverse health outcomes in survivors of cancer.

METHODS

Using the Behavioral Risk Factor Surveillance System database, data from 48,200 survivors between 2014 and 2020 were evaluated. Survey items included negative physical and emotional symptoms as a result of race-based treatment. Outcomes of interest included days of poor mental and physical health, activity limitations, depression, and inadequate sleep. Associations using prevalence ratios were evaluated.

RESULTS

All historically marginalized racial/ethnic groups were more likely to experience at least one adverse health outcome compared with non-Hispanic White survivors. Those who physically experienced racism were 2.1 (95% CI, 1.64-2.69) times as likely to report poor physical health, 3.51 (95% CI, 2.61-4.71) times as likely to report poor mental health, 2.14 (95% CI, 1.77-2.58) times as likely to report inadequate sleep, 2.33 (95% CI: 1.91-2.83) times as likely to report depression, and 1.42 (95% CI, 1.04-1.93) times as likely to report activity limitations compared with those who have not experienced racism. Similar associations were observed for emotionally experienced racism.

DISCUSSION

Racial inequities in health outcomes for survivors of cancer from marginalized racial/ethnic groups are well-established. Experienced racism contributes to adverse health outcomes and widens these disparities. Improving outcomes for survivors of cancer may require screening for experienced racism.

PLAIN LANGUAGE SUMMARY

Survivors of cancer from marginalized racial/ethnic populations are more likely to have poor mental and physical health than their non-Hispanic White counterparts. Whether survivors from certain racial/ethnic populations of smaller size also have poorer health is less well understood. Generally, individuals who report experienced racism also report poor health, this association has not been studied in survivors of cancer. This study, from a national survey of survivors of cancer, describes disparities in health outcomes experienced by a variety of racial and ethnic populations. Our findings suggest racism is associated with poor mental and physical health in survivors of cancer.

Design and simulation of multilayer coatings for a multi-channel Wolter-like x-ray imager with large field of view and high resolution

X-ray diagnostics are key instruments for understanding the physics behind inertial confinement fusion experiments. We report on the multilayer design optimization for the Toroidal X-ray Imager (TXI), a hard x-rays microscope instrument designed by Commissariat à l'énergie atomique (CEA) and Laboratoire Charles Fabry (LCF) to be installed on the National Ignition Facility. TXI includes six channels designed for three different energy bands centered on 8.7, 13, and 17.5 keV. Each channel is made up of two toroidal mirrors arranged in a Wolter-like configuration. The required field of view is 800 × 400 µm2, and the resolution should be better than 5 µm. In addition, we seek to estimate the spatial distribution of the temperature, which requires no spectral overlap of the different energy bands and a good spectral homogeneity of the image produced. The development of the multilayer coatings was performed in a two-step method. First, the coatings were optimized to obtain proper energy bands. Then, an x-ray tracing code was used to calculate the integrated optical response of each channel and adjust the response of the mirror to fulfill the requirements. To fulfill all the specifications, we propose an original design using a combination of two aperiodic coatings, one with a narrow bandwidth and the other one with a larger bandwidth.

Opioid-free Pain Management after Cleft Lip Repair

Background

Side effects of opioid pain management after surgical repair of cleft lips are numerous and affect postoperative course. We compared opioid versus opioid-free pain management regimens for infants who underwent cleft lip repair to evaluate the impact on postoperative recovery.

Methods

Cleft lip repairs at our institution from December 2016 to February 2021 were retrospectively reviewed, comparing patients who received opioids to patients receiving a nonopioid pain control regimen. Data collected include length of stay, oral morphine equivalents (OME) received on day of surgery (DOS)/postoperative day (POD) 1, time to and volume of first oral feed, and Face/Legs/Activity/Cry/Consolability (FLACC) scores.

Results

Seventy-three infants were included (47 opioid and 26 nonopioid). The opioid group received average 1.75 mg OME on DOS and 1.04 mg OME on POD1. Average DOS FLACC scores were similar between groups [1.57 ± 1.18 nonopioid versus 1.76 ± 0.94 (SD) opioid; P = 0.46]. Average POD1 FLACC scores were significantly lower for the nonopioid group (0.73 ± 1.05 versus 1.35 ± 1.06; P = 0.022). Median time to first PO (min) was similar [178 (interquartile range [IQR] 66-411) opioid versus 147 (IQR 93-351) nonopioid; P = 0.65]. Median volume of first feed (mL) was twice as high for the nonopioid group [90 (IQR 58-120) versus 45 (IQR 30-60); P = 0.003].

Conclusions

Nonopioid postoperative pain management was more effective than opioids for pain management in infants after cleft lip repair, as evidenced by FLACC scores and increased volume of the first oral feed.

Systems of Care Implications in Hawai'i: Sexual and Gender Minorities

Sexual and gender minorities (SGM) are diverse groups of people who do not identify as heterosexual or cisgender. SGM communities include Lesbian, Gay, Bisexual, and Transgender (LGBT) individuals as well as people of other sexual orientations and gender identities. SGM communities are disproportionately affected by substance use disorders, with differential use of specific substances among persons based on sexual or gender identity. As understood through the minority stress model, substance use and misuse among SGM people are tied to risk and resiliency factors at all levels of the social ecological paradigm. Despite the disproportionate burden of substance use disorders on SGM people in Hawai'i, very few resources or programs exist to ameliorate the impact of substance use on this community. Although some models of care could be useful for SGM people, community-specific interventions are scarce, especially in Hawai'i. To successfully meet the needs of SGM people in Hawai'i, multi-level transformation of the substance use prevention and treatment landscape must address: culturally appropriate service delivery; workforce recruitment and development; nimble and adequate financing; consistent data collection and reporting; and systems-level policy updates.

Fresnel zone plate point spread function approximation for zeroth order mitigation in millimetric field of view x-ray imaging

High spatial and temporal resolution x-ray radiography images are required at the National Ignition Facility (NIF) for high-energy density experiments. One technique that is in development to achieve the required resolution uses Fresnel zone plate (FZP) optics to image an object that is backlit by an x-ray source. The multiple FZP diffraction orders do not focus on the same plane, which increases the background and reduces the contrast. Understanding the point spread function of the different diffraction orders will allow the prediction of the expected background using simulations. We find that the two-dimensional point spread function of the FZP can be approximated by the addition of a sharp Gaussian with a disk. This allowed for the estimation of the background in NIF experimental images of Rayleigh-Taylor spikes and their interpretation. An alternative design of FZP is discussed to allow the inclusion of a zeroth order blocker to reduce the background.

A rapid review of end-of-life needs in the LGBTQ+ community and recommendations for clinicians

BACKGROUND

Lesbian, gay, bisexual, transgender, and queer plus (LGBTQ+) adults face challenges accessing end-of-life care. Understanding the experiences of LGBTQ+ persons within the end-of-life context is crucial in addressing their needs and supporting equity at end of life.

AIM

Review recent literature documenting the experiences of LGBTQ+ adults nearing end-of-life, identifying needs, barriers to care, and translating this into clinical recommendations.

DESIGN

A rapid review design was chosen for prompt results. The process was streamlined by limiting the literature search to peer-reviewed articles, dissertations, theses, by date and language. Data collection used a predetermined set of items based on Meyer's Minority Stress and Bronfenbrenner's Ecological Models including participants' voices, needs, and barriers. Thematic analysis of collected data was conducted and presented results in a narrative summary.

DATA SOURCES

We searched six electronic databases (PubMed, Medline, ProQuest Dissertations and Theses A&I, ProQuest Dissertations and Theses, Open Access Theses and Dissertations, CINAHL, and Google Scholar) for articles published from 2016 to 2020.

RESULTS

We included and appraised for quality 33 articles. We uncovered three latent themes: systemic barriers, a lack of lived experience within the literature, and treatment of LGBTQ+ as one homogeneous group.

CONCLUSIONS

The hybrid Meyer's Minority Stress and Bronfenbrenner Ecological model elucidated how stressors and social contexts may impact LGBTQ+ adults when accessing end-of-life care. Incorporating LGBTQ+ cultural competence training into continuing education and ensuring that LGBTQ+ individuals participate in the development of end-of-life care programming may better attend to the needs of this population.

VCP/p97 inhibitor CB-5083 modulates muscle pathology in a mouse model of VCP inclusion body myopathy

BACKGROUND

Pathogenic gain of function variants in Valosin-containing protein (VCP) cause a unique disease characterized by inclusion body myopathy with early-onset Paget disease of bone and frontotemporal dementia (also known as Multisystem proteinopathy (MSP)). Previous studies in drosophila models of VCP disease indicate treatment with VCP inhibitors mitigates disease pathology. Earlier-generation VCP inhibitors display off-target effects and relatively low therapeutic potency. New generation of VCP inhibitors needs to be evaluated in a mouse model of VCP disease. In this study, we tested the safety and efficacy of a novel and potent VCP inhibitor, CB-5083 using VCP patient-derived myoblast cells and an animal model of VCP disease.

METHODS

First, we analyzed the effect of CB-5083 in patient-derived myoblasts on the typical disease autophagy and TDP-43 profile by Western blot. Next, we determined the maximum tolerated dosage of CB-5083 in mice and treated the 2-month-old VCPR155H/R155H mice for 5 months with 15 mg/kg CB-5083. We analyzed motor function monthly by Rotarod; and we assessed the end-point blood toxicology, and the muscle and brain pathology, including autophagy and TDP-43 profile, using Western blot and immunohistochemistry. We also treated 12-month-old VCPR155H/+ mice for 6 months and performed similar analysis. Finally, we assessed the potential side effects of CB-5083 on retinal function, using electroretinography in chronically treated VCPR155H/155H mice.

RESULTS

In vitro analyses using patient-derived myoblasts confirmed that CB-5083 can modulate expression of the proteins in the autophagy pathways. We found that chronic CB-5083 treatment is well tolerated in the homozygous mice harboring patient-specific VCP variant, R155H, and can ameliorate the muscle pathology characteristic of the disease. VCP-associated pathology biomarkers, such as elevated TDP-43 and p62 levels, were significantly reduced. Finally, to address the potential adverse effect of CB-5083 on visual function observed in a previous oncology clinical trial, we analyzed retinal function in mice treated with moderate doses of CB-5083 for 5 months and documented the absence of permanent ocular toxicity.

CONCLUSIONS

Altogether, these findings suggest that long-term use of CB-5083 by moderate doses is safe and can improve VCP disease-associated muscle pathology. Our results provide translationally relevant evidence that VCP inhibitors could be beneficial in the treatment of VCP disease.

The Historical Role of the Plastic Surgeon in Spine Reconstruction

Wound complications occur in up to 19% of patients undergoing complex spine surgery. The role of the plastic surgeon in complex and redo spine surgery is important and evolving. Classically, plastic surgeons have been involved in the management of patients who develop wound complications following surgery. This involves reconstruction of posterior trunk defects with locoregional fasciocutaneous, muscle, and free tissue transfers. There has also been an increasing role for plastic surgeons to become involved in prophylactic closures of complex and/or redo spine surgeries for high-risk populations. Identification of patients with comorbidities and likelihood for multiple reoperations who are prophylactically treated with complex closure with or without local muscle flaps could significantly decrease the postoperative wound complications.

X-ray imaging of Rayleigh-Taylor instabilities using Fresnel zone plate at the National Ignition Facility

Being able to provide high-resolution x-ray radiography is crucial in order to study hydrodynamic instabilities in the high-energy density regime at the National Ignition Facility (NIF). Current capabilities limit us to about 20 μm resolution using pinholes, but recent studies have demonstrated the high-resolution capability of the Fresnel zone plate optics at the NIF, measuring 2.3 μm resolution. Using a zinc He_α line at 9 keV as a backlighter, we obtained a radiograph of Rayleigh-Taylor instabilities with a measured resolution of under 3 μm. Two images were taken with a time integrated detector and were time gated by a laser pulse duration of 600 ps, and a third image was taken with a framing camera with a 100 ps time gate on the same shot and on the same line of sight. The limiting factors on image quality for these two cases are the motion blur and the signal to noise ratio, respectively. We also suggest solutions to increase the image quality.

Design of multilayer-based diagnostics for measurement of high energy x rays and gamma rays

We investigate several possible multilayer-based optic designs for future hard x-ray and gamma ray diagnostics, including the detection and measurement of the positron annihilation radiation at 511 keV. The focus is set on increasing the photon efficiency and signal-to-noise ratio, compared to a previous multilayer-based system that was successfully employed to measure spectra in the 55 keV-100 keV range. Several possible designs using multilayer coatings are discussed, including mirror-based optics and multilayer Laue lenses.

Foil backlighter development at the OMEGA laser facility for extended x-ray absorption fine structure experiments

Extended x-ray absorption fine structure (EXAFS) measurements require a bright and continuous x-ray source and a detection system with high spectral resolution to capture the modulations of the absorption coefficient above the material absorption edge. When performing EXAFS measurements under laser-driven dynamic compression, it is hence critical to optimize the backlighter x-ray emission. A series of experiments has been conducted at the OMEGA laser facility to characterize titanium (Z = 22), iron (Z = 26), germanium (Z = 32), molybdenum (Z = 42), silver (Z = 47), and gold (Z = 79) foil backlighters irradiated with 3 kJ-12 kJ of laser energy. The spectra have been recorded using a dual crystal spectrometer (DCS), a two-channel transmission spectrometer covering 11 keV-45 keV and 19 keV-90 keV energy bands. The DCS has been calibrated so that the spectral intensities can be compared between different campaigns.

Two-channel high-resolution quasi-monochromatic X-ray imager for Al and Ti plasma

High-resolution, high-sensitivity X-ray imaging is a real challenge in high-energy density plasma experiments. We present an improved design of the Fresnel ultra high-resolution imager instrument. Using an Ultra-High-Intensity (UHI) laser to generate hot and dense plasma in a small volume of an Al-Ti mixed target provides simultaneous imaging of both Al and Ti X-ray emission. Specifically, the Al He_β (or Ly_β) and the Ti He_α lines are imaged with a resolution of (2.7 ± 0.3) μm and (5.5 ± 0.3) μm, respectively. It features two transmission Fresnel phase zone plates fabricated on the same substrate, each associated with a multilayer mirror for spectral selection. Their spatial resolution has been measured on the PTB synchrotron radiation facility laboratory at BESSY II and on the EQUINOX laser facility. Results obtained on an UHI experiment highlight the difference of emission zone sizes between Al and Ti lines and the versatility of this instrument.

Characterization of a two-channel, high resolution hard x-ray microscope using Fresnel zone plates for laser-plasma interaction experiments

New X-ray imaging techniques are currently being developed at the "Commissariat à l'énergie atomique et aux énergies alternatives" in the context of Inertial Confinement Fusion. Fresnel zone plates (FZPs) are being considered as they can perform high-resolution and high-flux imaging in the X-ray domain. Here we present the characterization of a bi-lens FZPs resolution used in an imager prototype, designed for the LULI2000 laser facility. Characterization was performed on a synchrotron radiation facility and on a femtosecond laser facility. The resolution of the two FZP channels was measured to be between 2.4 μm and 5.2 μm and the expected total resolution for the diagnostic was to be 3.3 μm.

Esthesioneuroblastoma with widespread distant metastasis: Case report and literature review

Esthesioneuroblastoma (ENB) is an uncommon sinonasal tract tumor, and it is even more uncommon among all neoplasms. Literature regarding the incidence and spread of the disease is limited. The prognosis of metastatic disease is poor. In this report, we present a case of recurrent ENB in a young woman involving metastasis to the neck, lungs, and ovary. Metastasis to the cervical lymph nodes is relatively common, but metastasis to the lungs is rare. Furthermore, to our knowledge, no cases of ovarian metastases of ENB have been reported. This case highlights the potential for widespread metastatic disease, suggesting the need for more frequent and thorough surveillance of patients diagnosed with recurrences of this tumor.

Textured Breast Implants: A Closer Look at the Surface Debris Under the Microscope

BACKGROUND

Texturing of breast implants is done to decrease the risk of associated complications. Each manufacturer utilizes unique and at times proprietary techniques to texture the surface of their implants. Little is known about the integrity of this surface structure texturing or the propensity for the surfaces to shed particulate matter. This study aimed to determine the extent of surface particulate shedding from 3 textured implants approved by the US Food and Drug Administration (FDA), which are manufactured by Allergan, Mentor, and Sientra.

METHODS

Control images of each of the 3 textured breast implants were obtained with scanning electron microscopy (SEM). A liquid adhesive, ethylene vinyl acetate (EVA) copolymer was then applied to the external shell of the implants, allowed to cool, and peeled from the surface. Images of the EVA copolymer were taken with SEM to qualitatively analyze displacement of surface particulate debris. Scanning electron microscopy imaging of the implants was repeated for qualitative comparisons with the control images.

RESULTS

The peeled copolymer of the 3 implants exhibited surface shedding. Comparison of the 3 breast implants showed the shedding to be greatest for the Allergan implant.

CONCLUSIONS

This study highlights the dynamic surface material properties of the 3 FDA-approved breast implants. Shedding of particulate matter from the implant surfaces can be precipitated by moderate adhesion. Our qualitative examination of SEM findings showed more debris shed from the Allergan breast implants than from the Mentor or Sientra implants.

High-resolution quasi-monochromatic X-ray imaging using a Fresnel phase zone plate and a multilayer mirror

High-resolution, high-sensitivity X-ray imaging is a real challenge in laser plasma diagnostic to attain reliable data in high-energy density plasma experiments. In this context, ultra-high-intensity lasers generate hot and dense plasma but only in a small volume. An experiment has been performed at the LULI2000 laser facility to diagnose such plasma conditions from thermal spectroscopic data. To image the emission zone plasma's Al He_β, a Fresnel-lens-based X-ray imager has been developed. It features a 846 μm-diameter Fresnel Phase Zone Plate (FPZP) and a Pd/B₄C multilayer mirror (thickness d = 5.1 nm). This association can be used between 1500 eV and 2100 eV. The FPZP's efficiency was measured on a synchrotron facility (SOLEIL) and its spatial resolution in a laser facility (EQUINOX). The mirror reflectivity was measured on the synchrotron facility BESSY II. With experimental conditions, the system resolution reaches 3.8 ± 0.6 μm with an adequate efficiency in the 1800 eV-1900 eV energy range with a solid angle of 9 × 10^-6 sr. Consequently, a FPZP is an excellent optics setup for high-resolution quasi-monochromatic X-ray imaging and provides a good collection angle. Bragg-Fresnel lenses, based on the principle of FPZP and mirrors, are currently designed for an X-ray imager at the Laser MégaJoule facility.

A decade of burn unit experience with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Clinical pathological diagnosis and risk factor awareness

Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) is a rare and often fatal spectrum of mucocutaneous diseases usually attributable to severe adverse drug reactions. Burn units are referral centers for patients at the most extreme end of the disease continuum. Our burn center admits a much higher percentage of TEN (>30% BSA) cases than reported in most prior reviews. The purpose of this study was to analyze the diagnostic and prognostic value of variables collected on referred SJS/TEN patients. We retrospectively analyzed 94 patients admitted to our unit with a presumptive SJS/TEN diagnosis made in most cases by the referring center. Most of the diagnoses were clinical. Fifty of the 94 patients underwent biopsy when the clinical diagnosis was questionable. Of the 50 patients who underwent biopsy, 18 (36%) received an alternative diagnosis. Analysis was therefore limited to 76 patients, i.e. 44 patients felt to have firm clinical diagnoses plus 32 patients with diagnoses confirmed by biopsy. Mean age was 54.3 years (17-93) and overall gender ratio was 43 F vs. 33 M (56.6% vs. 43.4%). Mean LOS was 15.2 days (1-48) and overall mortality was 23.7% (18/76). Univariate analysis revealed percent body surface area (%BSA) did not show statistically significant association with mortality. Histopathological correlation for diagnosis is not standardized across institutions worldwide. Due to challenges in the diagnosis of SJS/TEN and the high incidence of error in clinical diagnosis, it is recommended that all patients with presumed SJS/TEN receive skin biopsies with H&E and direct immunofluorescence. We propose a diagnostic approach in order to address this need. Lack of association between %BSA and mortality suggests that all biopsy-proven SJS/TEN cases belong in specialty centers due to the unstable nature of the disease and risk for rapid progression.

DQX1, an RNA-dependent ATPase homolog with a novel DEAQ box: expression pattern and genomic sequence comparison of the human and mouse genes

DQX1 is a novel gene related to the RNA-dependent ATPases. The gene was classified as a member of the DEAD/H family on the basis of the conserved order and spacing of ten short protein motifs. The unique features of DQX1 include replacement of the signature DEAH motif with DEAQ and the absence of the helicase motif. We determined the coding sequences of human and mouse DQX1, which encode proteins of 717 and 718 amino acids with 84% amino acid sequence identity. The 3.2-kb Dqx1 transcript has highest expression in muscle and liver. DQX1 is located between AUP1 and HOX11L1 in a gene-dense region of human Chromosome (Chr) 2p13 and mouse Chr 6. Although DQX1 is within the nonrecombinant region for the mouse neuromuscular mutant mnd2, no difference in coding sequence, transcript length, or transcript abundance was observed between normal mice and mnd2 mutant mice. The ubiquitous expression of DQX1 and its close phylogenetic relationship to the yeast pre-mRNA processing (Prp) proteins suggest a role in cellular RNA metabolism.

Centrosome abnormalities and genomic instability by episomal expression of human papillomavirus type 16 in raft cultures of human keratinocytes

Primary human keratinocytes with ectopic expression of high-risk human papillomavirus (HPV) E6 and E7 oncoproteins display abnormal centrosome numbers, multipolar mitoses, and aneusomy. However, it has not been explored whether these abnormalities can occur in cells containing HPV episomes where E6 and E7 expression is under viral transcriptional control. Here, we demonstrate that centrosome abnormalities and genomic instability occur in organotypic raft cultures of human keratinocytes with episomal HPV-16 even at low copy numbers. We conclude that HPV-16 DNA, when maintained as an episome, can disturb centrosome homeostasis and subvert genomic integrity of the host cell during early stages of the viral infection.

Chromosome evolution: the junction of mammalian chromosomes in the formation of mouse chromosome 10

During evolution, chromosomes are rearranged and become fixed into new patterns in new species. The relatively conservative nature of this process supports predictions of the arrangement of ancestral mammalian chromosomes, but the basis for these rearrangements is unknown. Physical mapping of mouse chromosome 10 (MMU 10) previously identified a 380-kb region containing the junction of material represented in human on chromosomes 21 (HSA 21) and 22 (HSA 22) that occurred in the evolutionary lineage of the mouse. Here, acquisition of 275 kb of mouse genomic sequence from this region and comparative sequence analysis with HSA 21 and HSA 22 narrowed the junction from 380 kb to 18 kb. The minimal junction region on MMU 10 contains a variety of repeats, including an L32-like ribosomal element and low-copy sequences found on several mouse chromosomes and represented in the mouse EST database. Sequence level analysis of an interchromosomal rearrangement during evolution has not been reported previously.