pH inactivation of SARS-CoV-2 and SARS-CoV in virus spiked protein A eluates from a mAb purification process

Biopharmaceutical manufacturing processes may include a low pH treatment step as a means of inactivating enveloped viruses. Small scale virus clearance studies are routinely performed using model enveloped viruses such as murine leukemia virus to assess inactivation at the pH range used in the downstream manufacturing process. Further, as a means of bioburden reduction, chromatography resins may be cleaned and stored using sodium hydroxide and this can also inactivate viruses. The susceptibility of SARS-CoV-2 and SARS-CoV to low pH conditions using protein A eluate derived material from a monoclonal antibody production process as well as high pH cleaning conditions was addressed. SARS-CoV-2 was effectively inactivated at pH 3.0, moderately inactivated at pH 3.4, but not inactivated at pH 3.8. Low pH was less effective at inactivating SARS-CoV. Both viruses were inactivated at a high pH of ca.13.4. These studies provide important information regarding the effectiveness of viral clearance and inactivation steps of novel coronaviruses when compared to other enveloped viruses.

Investigation of the molecular switching process between spin crossover states of triazole complexes as basis for optical sensing applications

With the advent of the first laser sources and suitable detectors, optical sensor applications immediately also came into focus. During the last decades, a huge variety of optical sensor concepts were developed, yet the forecast for the future application potential appears even larger. In this context, the development of new sensor probes at different scales down to the atomic or molecular level open new avenues for research and development. We investigated an iron based triazole molecular spin-crossover complex changing its absorption characteristics significantly by varying environmental parameters such as humidity, temperature, magnetic or electric field, respectively, with respect to its suitability for a new class of versatile molecular sensor probes. Hereby, besides the investigation of synthesized pure bulk material using different analyzing methods, we also studied amorphous micro particles which were applied in or onto optical waveguide structures. We found that significant changes of the reflection spectra can also be obtained after combining the particles with different types of optical waveguides.The obtained results demonstrate the suitability of the material complex for a broad field of future sensor applications.

Non-invasive 3D imaging of human melanocytic lesions by combined ultrasound and photoacoustic tomography: a pilot study

The accurate determination of the size and depth of infiltration is critical to the treatment and excision of melanoma and other skin cancers. However, current techniques, such as skin biopsy and histological examination, pose invasiveness, time-consumption, and have limitations in measuring at the deepest level. Non-invasive imaging techniques like dermoscopy and confocal microscopy also present limitations in accurately capturing contrast and depth information for various skin types and lesion locations. Thus, there is a pressing need for non-invasive devices capable of obtaining high-resolution 3D images of skin lesions. In this study, we introduce a novel device that combines 18 MHz ultrasound and photoacoustic tomography into a single unit, enabling the acquisition of colocalized 3D images of skin lesions. We performed in vivo measurements on 25 suspicious human skin nevi that were promptly excised following measurements. The combined ultrasound/photoacoustic tomography imaging technique exhibited a strong correlation with histological Breslow thickness between 0.2 and 3 mm, achieving a coefficient of determination (R[Formula: see text]) of 0.93, which is superior to the coefficients from the individual modalities. The results procured in our study underscore the potential of combined ultrasound and photoacoustic tomography as a promising non-invasive 3D imaging approach for evaluating human nevi and other skin lesions. Furthermore, the system allows for integration of other optical modalities such as optical coherence tomography, microscopy, or Raman spectroscopy in future applications.

The potential of patient-based nurse staffing - a queuing theory application in the neonatal intensive care setting

Faced by a severe shortage of nurses and increasing demand for care, hospitals need to optimally determine their staffing levels. Ideally, nurses should be staffed to those shifts where they generate the highest positive value for the quality of healthcare. This paper develops an approach that identifies the incremental benefit of staffing an additional nurse depending on the patient mix. Based on the reasoning that timely fulfillment of care demand is essential for the healthcare process and its quality in the critical care setting, we propose to measure the incremental benefit of staffing an additional nurse through reductions in time until care arrives (TUCA). We determine TUCA by relying on queuing theory and parametrize the model with real data collected through an observational study. The study indicates that using the TUCA concept and applying queuing theory at the care event level has the potential to improve quality of care for a given nurse capacity by efficiently trading situations of high versus low workload.

Improved polarimetric analysis of human skin through stitching: advantages, limitations, and applications in dermatology

Polarimetry is a powerful tool for the analysis of the optical properties of materials and systems, such as human skin. However, in many polarimetric setups, the field of view is limited to a few square centimeters. In these cases, it is possible to resort to stitching techniques, which involve combining multiple Mueller matrix measurements obtained from different overlapping regions of the sample. In this paper, we propose a stitching technique for polarimetric data and discuss its advantages and limitations. We also describe the potential of image stitching for improving the accuracy and robustness ofin vivopolarimetry in the presence of random patient movement. We conducted our research using a diverse set of samples which included porcine skin, human skin from arms and fingers, cold cuts of chicken and gelatine, alongside synthetically created sample data. Our results demonstrate the effectiveness of this technique for the application in dermatology. Each additionalin vivomeasurement enhances the field of view by approximately one third, thereby considerably augmenting the total observation area. We show that stitching enables for the polarimetric assessment of large skin patches which is useful for the diagnosis of inflammatory skin diseases.

Universal Newborn Hearing Screening Program: 10-Year Outcome and Follow-Up from a Screening Center in Germany

Regular reporting of quality control is important in newborn hearing screening, ensuring early diagnosis and intervention. This study reports on a population-based newborn hearing screening program in North-Rhine, Germany and a hospital-based screening at a University Hospital for 2007-2016. The two-staged 'screening' and 'follow-up' program involving TEOAE and AABR recruited newborns through participating birth facilities. Results were sent to the regional tracking center, and the data were analyzed based on recommended benchmarks. The percentage of newborns from the participating birth facilities in the region increased from 1.4% in 2007 to 57.5% in 2016. The 10-year coverage rate for these newborns was 98.7%, the referral rate after a failed two-step screening was 3.4%, and the lost-to-follow-up rate was 1%. At the hospital, >95% of the screened newborns completed screening within 30 days, the 10-year referral rate was 5%, and 64% were referred within 3 months of age. The median time for screening completion was 6 days after birth, for referral it was 74 days after birth, and for diagnosis it was 55 days after birth. Regional-centralized tracking centers with uniform structure are necessary for proper quality control. Obligatory participation of birthing facilities and quality reports may improve performance, but the recommended quality criteria need considerable financial and infrastructural expenditure.

Combined ultrasound and photoacoustic C-mode imaging system for skin lesion assessment

Accurate assessment of the size and depth of infiltration is critical for effectively treating and removing skin cancer, especially melanoma. However, existing methods such as skin biopsy and histologic examination are invasive, time-consuming, and may not provide accurate depth results. We present a novel system for simultaneous and co-localized ultrasound and photoacoustic imaging, with the application for non-invasive skin lesion size and depth measurement. The developed system integrates an acoustical mirror that is placed on an ultrasound transducer, which can be translated within a flexible water tank. This allows for 3D (C-mode) imaging, which is useful for mapping the skin structure and determine the invasion size and depth of lesions including skin cancer. For efficient reconstruction of photoacoustic images, we applied the open-source MUST library. The acquisition time per 2D image is <1 s and the pulse energies are below the legal Maximum Permissible Exposure (MPE) on human skin. We present the depth and resolution capabilities of the setup on several self-designed agar phantoms and demonstrate in vivo imaging on human skin. The setup also features an unobstructed optical window from the top, allowing for simple integration with other optical modalities. The perspective towards clinical application is demonstrated.

Referral rate and false-positive rates in a hearing screening program among high-risk newborns

AIM

More studies exploring referral rates and false-positive rates are needed to make hearing screening programs in newborns better and cost-effective. Our aim was to study the referral and false-positivity rates among high-risk newborns in our hearing screening program and to analyze the factors potentially associated with false-positive hearing screening test results.

METHODS

A retrospective cohort study was done among the newborns hospitalized at a university hospital from January 2009 to December 2014 that underwent hearing screening with a two-staged AABR screening protocol. Referral rates and false-positivity rates were calculated and possible risk factors for false-positivity were analyzed.

RESULTS

4512 newborns were screened for hearing loss in the neonatology department. The referral rate for the two-staged AABR-only screening was 3.8% with false-positivity being 2.9%. Our study showed that the higher the birthweight or gestational age of the newborn, the lower the odds of the hearing screening results being false-positive, and the higher the chronological age of the infant at the time of screening, the higher the odds of the results being false-positive. Our study did not show a clear association between the mode of delivery or gender and false-positivity.

CONCLUSION

Among high-risk infants, prematurity and low-birthweight increased the rate of false-positivity in the hearing screening, and the chronological age at the time of the test seems to be significantly associated with false-positivity.

Analysis of SARS-CoV-2 spike RBD binding to ACE2 and its inhibition by fungal cohaerin C using surface enhanced Raman spectroscopy

The structure of the SARS-CoV-2 spike RBD and human ACE2 as well as changes in the structure due to binding activities were analysed using surface enhanced Raman spectroscopy. The inhibitor cohaerin C was applied to inhibit the binding between spike RBD and ACE2. Differences and changes in the Raman spectra were determined using deconvolution of the amide bands and principal component analysis. We thus demonstrate a fast and label-free analysis of the protein structures and the differentiation between bound and unbound states. The approach is suitable for sensing and screening and might be relevant to investigate other protein systems as well.

Detection of Melanin Influence on Skin Samples Based on Raman Spectroscopy and Optical Coherence Tomography Dual-modal Approach

Melanoma is responsible for more than half of the deaths related to skin cancer in the last few decades. A dual-modality optical biopsy system with Raman spectroscopy and optical coherence tomography approach was built with the goal of achieving non-invasive skin measurement. To mimic melanoma and evaluate the effect of melanin on skin, models have been created by dissolving synthetic melanin in dimethyl sulfoxide and adding to fresh skin samples. Compared to the untreated samples, morphological images showed that the imaging depth on melanin-treated skin has been increased from 250 μm to 350 μm due to the optical clearing effect of the DMSO solvent, and Raman analysis revealed that relative spectral intensities of melanin-treated samples were lower in the amide-I and CH₂ -deformation bands, and higher in the CH₂ -twist and C-C stretch bands. Using machine learning for skin type classification, an accuracy of 89% is achieved. This article is protected by copyright. All rights reserved.

Validation of the ABPMpro ambulatory blood pressure monitor in the general population according to AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018)

OBJECTIVE

The objective of this study is to evaluate the accuracy of the oscillometric upper-arm device ABPMpro (SOMNOmedics) for ambulatory blood pressure measurement in the general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018) at rest and during dynamic exercise.

METHODS

Subjects were recruited to fulfill the age, sex, blood pressure (BP) and cuff distribution criteria of the AAMI/ESH/ISO standard using the same arm sequential BP measurement method. Three appropriate cuff sizes (18-24, 24-34 and 34-46 cm) of the tested device were used for the arm-varying circumferences. The inflation and deflation measurement modes of the ABPMpro were investigated.

RESULTS

For the general validation study, 100 subjects were recruited and 90 were analyzed. For validation criterion (1), the mean ± SD of the differences between ABPMpro and reference BP was 0.7 ± 7.3/-0.7 ± 5.8 mmHg (systolic/diastolic) for inflation and 1.4 ± 7.7/-0.6 ± 6.1 mmHg for deflation measurements. For criterion (2), the SD of the averaged BP differences per subject was 5.98/5.10 mmHg for inflation and 6.46/5.36 mmHg for deflation measurements, thereby passing the threshold. In the ambulatory validation study (N = 36), the mean difference was -1.2 ± 7.9/ 2.4 ± 6.6 mmHg for inflation and -0.7 ± 7.6/3.1 ± 7.0 mmHg for deflation measurements.

CONCLUSION

The ABPMpro device fulfilled the ISO 81060-2:2018 requirements in the general population and in the ambulatory setting and can therefore be recommended for clinical use.

Mueller Matrix Microscopy for In Vivo Scar Tissue Diagnostics and Treatment Evaluation

Scars usually do not show strong contrast under standard skin examination relying on dermoscopes. They usually develop after skin injury when the body repairs the damaged tissue. In general, scars cause multiple types of distress such as movement restrictions, pain, itchiness and the psychological impact of the associated cosmetic disfigurement with no universally successful treatment option available at the moment. Scar treatment has significant economic impact as well. Mueller matrix polarimetry with integrated autofocus and automatic data registration can potentially improve scar assessment by the dermatologist and help to make the evaluation of the treatment outcome objective. Polarimetry can provide new physical parameters for an objective treatment evaluation. We show that Mueller matrix polarimetry can enable strong contrast for in vivo scar imaging. Additionally, our results indicate that the polarization stain images obtained form there could be a useful tool for dermatology. Furthermore, we demonstrate that polarimetry can be used to monitor wound healing, which may help prevent scarring altogether.

Focus stacking in non-contact dermoscopy

Dermoscopy is the main tool for early detection of skin cancer. Non-contact dermoscopes often suffer from a small depth of field leading to images of skin topographies with regions that are not in focus. We aim to provide an easy-to-implement focus stacking-based approach to ensure all-in-focus images from a non-contact dermoscope. Further, we aim to extract additional information about the skin topography from the image stacks. The focus stacking procedure itself is implemented in a non-contact dermoscope with an electrically adjustable focus realized by using a tunable liquid lens. We show that all-in-focus imaging is possible for non-contact dermoscopy and deliver a method to extract topographical information for dermatologists from the acquired image stacks. Our finding indicate that the approach can be valuable for non-contact dermoscopic examination as well as for the early detection of skin diseases such as cancer as it possible to derive hyperfocus images and information on the skin topography. With this, we were able to develop a software for the acquisition of the raw image data and its processing into a high resolution hyperresolution dermoscopic image. In the next steps, we plan to apply the approach in the clinical environment for skin cancer diagnostics or imaging of inflammatory skin diseases.

Multimodal system for optical biopsy of melanoma with integrated ultrasound, optical coherence tomography and Raman spectroscopy

We introduce a new single-head multimodal optical system that integrates optical coherence tomography (OCT), 18 MHz ultrasound (US) tomography and Raman spectroscopy (RS), allowing for fast (<2 min) and noninvasive skin cancer diagnostics and lesion depth measurement. The OCT can deliver structural and depth information of smaller skin lesions (<1 mm), while the US allows to measure the penetration depth of thicker lesions (≥4 mm), and the RS analyzes the chemical composition from a small chosen spot (≤300 μm) that can be used to distinguish between benign and malignant melanoma. The RS and OCT utilize the same scanning and optical setup, allowing for co-localized measurements. The US on the other side is integrated with an acoustical reflector, which enables B-mode measurements on the same position as OCT and RS. The US B-mode scans can be translated across the sample by laterally moving the US transducer, which is made possible by the developed adapter with a flexible membrane. We present the results on custom-made liquid and agar phantoms that show the resolution and depth capabilities of the setup, as well as preliminary ex vivo measurements on mouse models with ∼4.3 mm thick melanoma.

Registration of polarimetric images for in vivo skin diagnostics

SIGNIFICANCE

Mueller matrix (MM) polarimetry is a promising tool for the detection of skin cancer. Polarimetric in vivo measurements often suffer from misalignment of the polarimetric images due to motion, which can lead to false results.

AIM

We aim to provide an easy-to-implement polarimetric image data registration method to ensure proper image alignment.

APPROACH

A feature-based image registration is implemented for an MM polarimeter for phantom and in vivo human skin measurements.

RESULTS

We show that the keypoint-based registration of polarimetric images is necessary for in vivo skin polarimetry to ensure reliable results. Further, we deliver an efficient semiautomated method for the registration of polarimetric images.

CONCLUSIONS

Image registration for in vivo polarimetry of human skin is required for improved diagnostics and can be efficiently enhanced with a keypoint-based approach.

Multicentre randomised trial of invasive and less invasive surfactant delivery methods showed similar spirometry results at 5-9 years of age

AIM

We explored whether subnormal forced expiratory volume within one second (FEV₁ ) at 5-9 years of age was lower in children born preterm who received less invasive surfactant administration (LISA) rather than surfactant via an endotracheal tube.

METHODS

The multicentre, randomised Nonintubated Surfactant Application trial enrolled 211 preterm infants born at 23-26 weeks of gestation from 13 level III neonatal intensive care units from April 2009 to March 2012. They received surfactant via LISA (n=107) or after conventional endotracheal intubation (n=104). The follow-up assessments were carried out by a single team blinded to the group assignments. The main outcome was FEV₁ <80% of predicted values.

RESULTS

Spirometry was successful in 102/121 children. The other children died or were lost to follow up. Median FEV₁ was 93% (interquartile range 80-113%) of predicted values in the LISA group and 86% (interquartile range 77-102%) in the control group (p=0.685). Rates of FEV₁ < 80% were 11/57 (19%) and 15/45 (33 %) respectively, which was an absolute risk reduction of 14% (95% confidence interval -3.1% to 31.2%, p=0.235). There were no differences in other outcome measures.

CONCLUSION

The proportion of children aged 5-9 years with subnormal FEV₁ was not significantly different between the groups.

The benefit of adopting Microultrasound in the prostate cancer imaging pathway: A lesion-by-lesion analysis: Biopsies prostatiques guidée par micro-échographie, quel bénéfice ? Une analyse lésion par lésion

INTRODUCTION

- Microultrasound (MicroUS) is a novel imaging modality relying on a high-frequency transducer which confers a three-fold improvement in spatial resolution as compared with conventional transrectal ultrasound. We evaluated the diagnostic value of MRI-MicroUS fusion biopsy and determined the additional benefit of employing MicroUS.

METHODS

- Retrospective analysis of consecutive treatment-naïve men undergoing MRI-MicroUS fusion biopsy between May 2018 and March 2019. Pre-biopsy MRI was systematically reviewed in a dedicated meeting where suspicious lesions PIRADS ≥ 3 were registered and uploaded in the ExactVu MicroUS device. MRI and MicroUS lesions were individually marked in a PIRADS v2 scheme. The biopsy protocol included MRI-MicroUS fusion and MicroUS targeted biopsies; systematic biopsies were performed at clinician's discretion. The diagnostic value was evaluated in terms of detection rate of clinically significant prostate cancer, defined as Gleason pattern ≥ 4 at histology.

RESULTS

- In all, 148 patients with a median age of 69 years (IQR 63-74) and median PSA density of 0.16 ng/ml/cc (0.10-0.23) were included. Clinically significant cancer was detected in 42.5% (63/148) patients. MRI detected 89 lesions in the peripheral zone; 73% (65/89) were visible on MicroUS. Clinically significant cancer was detected in 46.1% (30/65) MRI and MicroUS visible lesions, and in 4.2% (1/24) lesions only visible on mpMRI. MicroUS additionally identified 35 suspicious lesions non-visible on MRI of which clinically significant cancer was present in 25.7% (9/35).

CONCLUSION

- Adding MicroUS to the conventional pathway seems to increase the detection rate of clinically significant disease in unselected men undergoing biopsy. © 2022 Elsevier Masson SAS. All rights reserved.

Self-made transparent optoacoustic detector for measurement of skin lesion thicknessin vivo

In skin cancer diagnosis and treatment, one of the key factors is tumor depth, which is connected to the severity and the required excision depth. Optoacoustical (OA) imaging is a relatively popular technique that provides information based on the optical absorption of the sample. Although often demonstrated withex vivomeasurements orin vivoimaging on parts of small animals,in vivomeasurements on humans are more challenging. This is presumably because it is too time consuming and the required excitation pulse energies and their number exceed the allowed maximum permissible exposure (MPE). Here, we demonstrate thickness measurements with a transparent optoacoustical detector of different suspicious skin lesionsin vivoon patients. We develop the signal processing technique to automatically convert the raw signal into thickness via deconvolution with the impulse response function. The transparency of the detector allows optical excitation with the pulsed laser to be performed perpendicularly on the lesion, in contrast to the conventional illumination from the side. For validation, the measured results were compared to the histological thickness determined after excision. We show that this simple transparent detector allows to determine the thickness of a lesion and thus, aid the dermatologist to estimate the excision depth in the future.

WITHDRAWN: The benefit of adopting Microultrasound in the prostate cancer imaging pathway : A lesion-by-lesion analysis

INTRODUCTION

Microultrasound (MicroUS) is a novel imaging modality relying on a high-frequency transducer which confers a three-fold improvement in spatial resolution as compared with conventional transrectal ultrasound. We evaluated the diagnostic value of MRI-MicroUS fusion biopsy and determined the additional benefit of employing MicroUS.

METHODS

Retrospective analysis of consecutive treatment-naïve men undergoing MRI-MicroUS fusion biopsy between May 2018 and March 2019. Pre-biopsy MRI was systematically reviewed in a dedicated meeting where suspicious lesions PIRADS≥3 were registered and uploaded in the ExactVu MicroUS device. MRI and MicroUS lesions were individually marked in a PIRADS v2 scheme. The biopsy protocol included MRI-MicroUS fusion and MicroUS targeted biopsies; systematic biopsies were performed at clinician's discretion. The diagnostic value was evaluated in terms of detection rate of clinically significant prostate cancer, defined as Gleason pattern≥4 at histology.

RESULTS

In all, 148 patients with a median age of 69 years (IQR 63-74) and median PSA density of 0.16ng/ml/cc (0.10-0.23) were included. Clinically significant cancer was detected in 42.5% (63/148) patients. MRI detected 89 lesions in the peripheral zone; 73% (65/89) were visible on MicroUS. Clinically significant cancer was detected in 46.1% (30/65) MRI and MicroUS visible lesions, and in 4.2% (1/24) lesions only visible on mpMRI. MicroUS additionally identified 35 suspicious lesions non-visible on MRI of which clinically significant cancer was present in 25.7% (9/35).

CONCLUSION

Adding MicroUS to the conventional pathway seems to increase the detection rate of clinically significant disease in unselected men undergoing biopsy.

Assuring Quality of Scaffolds in Musculoskeletal Tissue Engineering

In order to achieve the high quality required in medical products, reliable characterization methods and quality management systems are necessary. In the field of musculoskeletal Tissue Engineering (mTE), electrospinning is utilized to manufacture fibre scaffolds as implant material. Depending on the application, in this case the regeneration of tendon-bone junctions, properties like the degree of fibre orientation, homogeneity of fibre throughout the scaffold and reaction to external mechanical load are of particular importance. Currently, destructive methods, like scanning electron microscopy (SEM), are widely used to determine these properties. In addition to the destruction of the samples, these methods often only allow the investigation of very small sections. In this study, we present two new methods for the fast, non-destructive and contactless characterization of electrospun fibre scaffolds for mTE. These methods are based on Transillumination Imaging (TI) and Mueller Matrix Polarimetry (MMP), utilizing low-power laser sources or LED light sources, respectively, to determine the relative homogeneity (TI) and the degree of fibre orientation (MMP) in electrospun fibre scaffolds.

Real-time stimulated Raman spectroscopy with a non-collinear optical parametric oscillator

Ultrafast detection of microplastic particles is becoming a vital problem, as these particles are found in water sources worldwide. Ideally, a live analysis in flow is desirable to directly monitor the water quality for contaminations. Therefore, coherent Raman spectroscopy techniques require fast and broadband tunable lasers to address all relevant spectral regions of the investigated samples. In our work, we combine a high power non-collinear optical parametric oscillator with a real-time stimulated Raman scattering spectroscopy setup. The light source is continously tunable from 700 nm to 1030 nm in less than 10 ms, delivering an average output power of more than 500 mW with sub-ps pulses. We show the immediate observation of mixing processes and the detection of microplastic particles in water solution with a spectral window of more than 2000 cm^-1.

[Prioritization of intensive medical treatment places - Concept proposal]

In the situation of a shortage of ventilation beds, ethically justifiable, transparent and comprehensible decisions must be made. This concept proposes that all patients are first intubated depending on necessity and then assessed by a triage team afterwards. In this situation newly admitted COVID patients compete with newly admitted Non-COVID patients as well as patients already treated in intensive care units for a ventilator. The combination of short-term and long-term prognoses should enable the interprofessional triage team to make comprehensible decisions. The aim of the prioritization concept is to save as many human lives as possible and to relieve the treatment team of the difficult decision on prioritization.

UV-LED projection photolithography for high-resolution functional photonic components

The advancement of micro- and nanostructuring techniques in optics is driven by the demand for continuous miniaturization and the high geometrical accuracy of photonic devices and integrated systems. Here, UV-LED projection photolithography is demonstrated as a simple and low-cost approach for rapid generation of two-dimensional optical micro- and nanostructures with high resolution and accuracy using standard optics only. The developed system enables the projection of structure patterns onto a substrate with 1000-fold demagnification. Photonic devices, e.g., waveguides and microring resonators, on rigid or flexible substrates with varied geometrical complexity and overall structure dimensions from the nanometer to centimeter scale were successfully prepared. In particular, high-resolution gratings with feature sizes down to 150 nm and periods as small as 400 nm were realized for the first time by this approach. Waveguides made of doped laser active materials were fabricated, and their spontaneous emission was detected. The demonstrated superior performance of the developed approach may find wide applications in photonics, plasmonics, and optical materials science, among others.

Surgical site infections: guidance for elective surgery during the SARS-CoV-2 pandemic - international recommendations and clinical experience

BACKGROUND

The COVID-19 pandemic not only had an impact on public life and healthcare facilities in general, but also affected established surgical workflows for elective procedures. The strategy to protect patients and healthcare workers from infection by SARS-CoV-2 in surgical departments has needed step-by-step development. Based on the evaluation of international recommendations and guidelines, as well as personal experiences in a clinical 'hot spot' and in a 450-bed surgical clinic, an adapted surgical site infection (SSI) prevention checklist was needed to develop concise instructions, which described roles and responsibilities of healthcare professionals that could be used for wider guidance in pandemic conditions.

METHOD

Publications of COVID-19-related recommendations and guidelines, produced by health authorities and organizations, such as WHO, US-CDC, ECDC, the American College of Surgery and the Robert Koch Institute, were retrieved, assessed and referenced up to 31st January 2020. Additionally, clinical personal experiences in Germany were evaluated and considered.

RESULTS

Part 1 of this guidance summarizes the experience of a tertiary care, surgical centre which utilized redundant hospital buildings for immediate spatial separation in a 'hot spot' COVID-19 area. Part 2 outlines the successful screening and isolation strategy in a surgical clinic in a region of Germany with outbreaks in surrounding medical centres. Part 3 provides the synopsis of personal experiences and international recommendations suggested for implementation during the COVID-19 pandemic.

CONCLUSION

Understanding of COVID-19, and SARS-CoV-2-related epidemiology, is constantly and rapidly changing, requiring continuous adaptation and re-evaluation of recommendations. Established national and local guidelines for continuation of surgical services and prevention of SSI require ongoing scrutiny and focused implementation. This manuscript presents a core facility checklist to support medical institutions to continue their clinical and surgical work during the COVID-19 pandemic.

What matters most and for whom? A cross-sectional study exploring goals of health professionals in German neonatal intensive care units

OBJECTIVES

Quality of care largely depends on successful teamwork, which in turn needs effective communication between health professionals. To communicate successfully in a team, health professionals need to strive for the same goals. However, it has been left largely unaddressed which goals professionals consider to be important. In this study, we aim to identify these goals and analyse whether differences between (1) personal and organisational goals, (2) different professions and (3) hierarchical levels exist in neonatal intensive care units (NICUs).

DESIGN

Goals were identified based on a literature review and a workshop with health professionals and tested in a pilot study. Subsequently, in the main study, a cross-sectional employee survey was undertaken.

SETTING AND PARTICIPANTS

1489 nurses and 537 physicians from 66 German NICUs completed the questionnaire regarding personal and organisational goal importance between May and July 2013. Answers were given based on a 7-point Likert scale varying between none and exceptionally high importance.

RESULTS

Results show that the goals can be subdivided into three main goal dimensions: patients, parents and staff. Furthermore, our results reveal significant differences between different professions and different hierarchical level: physicians rated patient goals with a mean (95% CI) importance of 6.37 (3.32 to 6.43), which is significantly higher than nurses with a mean (95% CI) importance of 6.15 (6.12 to 6.19) (p<0.01). Otherwise, nurses classified parental goals as more important (p<0.01). Furthermore, professionals in leading positions rate patient goals significantly higher than professionals that are not in leading positions (6.36 (3.28 to 6.44) vs 6.19 (6.15 to 6.22), p<0.01).

CONCLUSIONS

Different employee goals need to be considered in decision-making processes to enhance employee motivation and the effectiveness of teamwork.

TRIAL REGISTRATION NUMBER

DRKS00004589.

Calcium carbonate deposits and microbial assemblages on microplastics in oligotrophic freshwaters

Microplastics are solid polymer particles with a wide variety of surface properties, found in most waterbodies, and known as carriers of distinct microbial communities affecting the fate of the particles in the environment. Little is known about the formation of mineral deposits on microplastics and how these deposits connect to microbial assemblages and affect the physicochemical properties of the particles. In addition, most of the available research on this topic is based on large microplastics with sizes between 100 μm and up to 5 mm, rather than the small microplastics often found in drinking water sources. To narrow this gap in our understanding of environmental effects on small microplastics, two types of small microplastics made of two distinct polymers, poly(methyl methacrylate) (PMMA) and poly(tetrafluoroethylene) (PTFE) with sizes ranging from 15 to 150 μm, were incubated for six months in unprocessed and processed drinking water with increasing ionic concentration to allow for the formation of mineral deposits and microbial assemblages. Spatially resolved analysis with fluorescent in situ hybridization and confocal Raman microscopic imaging revealed deposits of calcium carbonates and scattered microbial assemblages on all microplastics, with structure, extend, and microbial association with the carbonates depending on the respective microplastic. Notably, PTFE floatation was overcome after three months in unprocessed drinking water but remained unchanged in processed drinking water, whereas PMMA appeared unaffected, indicating that the fate of microplastics in the environment may depend on polymer type and the encountered aquatic conditions forming mineral and microbial attachments to the particle surface.

Developmental outcome of extremely preterm infants is improved after less invasive surfactant application: Developmental outcome after LISA

AIM

The aim of this study was to evaluate neurocognitive outcome at 24 months of corrected age after less invasive surfactant application (LISA) in preterm infants born at 23-26 weeks of gestational age.

METHODS

Surviving participants of a LISA trial conducted in 13 German level III neonatal intensive care units were reviewed for assessment of developmental outcome, hearing and vision problems, growth and rehospitalisation days. Maternal depression, breastfeeding rates and socio-economic factors were evaluated as potentially confounding factors.

RESULTS

In total, 156/182 infants took part in the study, 78 had received surfactant via LISA and 78 via endotracheal intubation. 22% of LISA infants compared to 42% of intubated infants had a psychomotor development index (PDI) <70 (0.012). A significant difference in mental development index (MDI) was observed in the stratum of more mature infants (25 and 26 weeks of GA). For this group, MDI < 70 was observed in 4% of LISA infants vs 21% of intubated infants (P = 0.008).

CONCLUSION

At 24 months of age, the LISA-treated infants scored less often PDI < 70 and had similar results in MDI. Infants born at 25 and 26 weeks treated with LISA had lower rates of severe disability. LISA is safe and may be superior.

Descriptive study of young disabled children aged 2-6, enrolled in mainstream schools, and benefiting from special needs assistants in the Bouches-du-Rhône in 2014

BACKGROUND

Since the law of February 11, 2005, in France, the number of children with disabilities enrolled in ordinary schools has increased steadily. As a result, the amount of personal support provided by a special needs assistant (personal support) is also increasing. The aim of the study was to describe the diseases and impairments of disabled children aged 2-6, enrolled in mainstream schools and benefiting from personal support for schooling by special needs assistants in the Bouches-du-Rhône (France) in 2014.

METHODS

A cross-sectional descriptive study was performed. Children included were benefiting from either an individual or shared personal support. Physicians from the territorial organization in charge of disability coded diseases and deficiencies using the International Classification of Diseases, 10th revision, and nomenclature inspired by the International Classification of Functioning, Disability and Health.

RESULTS

Medical data were coded for 990 children out of 1260 of the total population. These young disabled children were most frequently children with pervasive developmental disorders (23.3%), lack of expected normal physiological development (19.9%), or mixed specific developmental disorders (13.5%), and most often had behavioral, personality, and relational skills disorders (61.8%), psychomotor function impairments (51.9%), or written or oral language learning impairment (43.2%). Finally, the two main types of impairments most represented among these children were psychological impairments (86.7%) and language and speech impairments (79.8%). The children were most often supported by an individual personal support (for one child only) than by a shared personal support (60% vs. 40%). They were mainly boys (almost 75%).

CONCLUSION

This study provides working guidelines for the management of health policies relating to disability at the territorial or even national level.

Wavefront Shaping Concepts for Application in Optical Coherence Tomography-A Review

Optical coherence tomography (OCT) enables three-dimensional imaging with resolution on the micrometer scale. The technique relies on the time-of-flight gated detection of light scattered from a sample and has received enormous interest in applications as versatile as non-destructive testing, metrology and non-invasive medical diagnostics. However, in strongly scattering media such as biological tissue, the penetration depth and imaging resolution are limited. Combining OCT imaging with wavefront shaping approaches significantly leverages the capabilities of the technique by controlling the scattered light field through manipulation of the field incident on the sample. This article reviews the main concepts developed so far in the field and discusses the latest results achieved with a focus on signal enhancement and imaging.

Delivery room skin-to-skin contact in preterm infants affects long-term expression of stress response genes

Premature birth is a traumatic event that puts mother and child at risk for subsequent psychopathology. Skin-to-skin contact in the form of intermittent kangaroo mother care has been shown to positively affect the infant's stress response and cognitive development, but underlying mechanisms remain unclear. Moreover, first skin-to-skin contact is usually delayed for days after birth. In the delivery room skin-to-skin study (DR-SSC), a prospective randomized controlled trial conducted from 2/2012 to 7/2015, we set out to assess the effect of delivery room skin-to-skin contact on the infant's mRNA expression of six key molecules involved in stress response and neurobehavioral development at hospital discharge. 88 firstborn, singleton preterm infants (born at 25-32 weeks of gestational age) were included. In the delivery room after initial stabilization, infants were randomized to either 60 min of skin-to-skin or 5 min of visual contact with their mother. In this explorative add-on study on the original DR-SSC study, we determined the expression of six important stress response genes (CRHR1 and CRHR2, AVP, NR3C1, HTR2A, and SLC6A4) in peripheral white blood cells of infants during routine blood sampling upon hospital discharge (corrected gestational age of 40 weeks). Infants were followed up to six months corrected age. Relative mRNA expression of the corticotropin releasing hormone receptor 2 (CRH R2), the glucocorticoid receptor gene (NR3C1), and the serotonin transporter gene (SLC6A4) was significantly reduced in the delivery room SSC infants. Additionally, gene expression of CRH R2 showed a correlation with HPA axis reactivity and parameters of mother-child interaction at six months corrected age. Our results highlight the importance of delivery room mother-child skin-to-skin contact and underline the urgent need for in-depth studies on the underlying molecular mechanisms.

Pain response to vaccination in newborn infants of diabetic mothers

BACKGROUND

Response to pain is altered in infants who were exposed to pain- and stressful events in the neonatal period. Infants of diabetic mothers receive several heel sticks after birth for measuring blood glucose and thus may show changes in their behavioral and physiologic response to pain. Moreover, maternal hyperglycemia may alter activity of the hypothalamic pituitary adrenal (HPA) axis reactivity.

STUDY DESIGN

In total, 43 infants of diabetic mothers and 30 control infants were included into the study. Response to pain was assessed at 3 months of age following two intramuscular injections for vaccination. We assessed behavioral (Bernese pain scale), physiologic (heart rate) and hormonal (salivary cortisol) pain response to vaccination as well as spinal sensitization (flexion withdrawal reflex).

RESULTS

Infants of diabetic mothers received a median number of 5 [4-19] painful events compared to 1 [1-3] in the control group. Heart rate reactivity differed significantly between groups. Infants of diabetic mothers had higher peaks (p = 0.002) and needed more time to recover to baseline (p < 0.001). Moreover, infants of diabetic mothers showed higher peak cortisol (p = 0.001) and a higher relative cortisol increase (p = 0.015). Flexor withdrawal reflex thresholds were significantly lower in infants of diabetic mothers (p = 0.003).

CONCLUSION

The increase of physiologic and hormonal responses to pain in infants of diabetic mothers is probably caused by repeated painful events and an altered metabolic profile.

Effects of ketamine on neurogenesis, extracellular matrix homeostasis and proliferation in hypoxia-exposed HT22 murine hippocampal neurons

Ketamine is a widely used drug in pediatric anesthesia, and both neurotoxic and neuroprotective effects have been associated with its use. There are only a few studies to date which have examined the effects of ketamine on neurons under hypoxic conditions, which may lead to severe brain damage and poor neurocognitive outcomes in neonates. In the present study, the effects of ketamine on cellular pathways associated with neurogenesis, extracellular matrix homeostasis and proliferation were examined in vitro in hypoxia-exposed neurons. Differentiated HT22 murine hippocampal neurons were treated with 1, 10 and 20 µM ketamine and cultured under hypoxic or normoxic conditions for 24 h followed by quantitative PCR analysis of relevant candidate genes. Ketamine treatment did not exert any notable effects on the mRNA expression levels of markers of neurogenesis (neuronal growth factor and syndecan 1), extracellular matrix homeostasis (matrix-metalloproteinase 2 and 9, tenascin C and tenascin R) or proliferation markers (Ki67 and proliferating cell nuclear antigen) compared with the respective untreated controls. However, there was a tendency towards downregulation of multiple cellular markers under hypoxic conditions and simultaneous ketamine treatment. No dose-dependent association was found in the ketamine treated groups for genetic markers of neurogenesis, extracellular matrix homeostasis or proliferation. Based on the results, ketamine may have increased the vulnerability of hippocampal neurons in vitro to hypoxia, independent of the dose. The results of the present study contribute to the ongoing discussion on the safety concerns around ketamine use in pediatric clinical practice from a laboratory perspective.

Effect of image artefacts on phase conjugation with spectral domain optical coherence tomography

Recently the acquisition of the time-resolved reflection matrix was demonstrated based on spectral domain optical coherence tomography. In principle, the matrix describes the linear dependence of the OCT signal received from different depths on the field which is incident to the scattering sample. Knowledge of the matrix, hence, enables beam shaping to selectively enhance the received signal, for example to increase the penetration depth when imaging turbid media. We investigate the impact of image artefacts on the approach. Phase conjugation is shown to enhance the OCT signal, but not autocorrelation and mirror artefacts. Imaging applications are demonstrated indicating the potential for future in-vivo studies on biotissues.

Delivery room skin-to-skin contact for preterm infants-A randomized clinical trial

AIM

To investigate the effects of 60 minutes delivery room skin-to-skin contact (DR-SSC) compared with 5 minutes visual contact (VC) on mother-child interaction (MCI), salivary cortisol, maternal depression, stress and bonding at 6 months corrected age.

METHODS

A single-centre randomized controlled trial conducted in a German level III NICU. Eighty-eight preterm infants (25-32 weeks of gestational age) were randomized after initial stabilization to either 60 minutes DR-SSC or 5 minutes VC. Forty-five infants were allocated to DR-SSC, 43 to VC.

RESULTS

Delivery room skin-to-skin contact dyads showed a higher quantity of maternal motoric (18 vs 15, P = .030), infant's vocal (7 vs 5, P = .044) and motoric (20 vs 15, P = .032) responses. Moreover, the combined score of maternal and infant responsive behaviour was higher (86 vs 71, P = .041) in DR-SSC dyads. DR-SSC mothers had lower risk of both, early postpartum depression (15% vs 45%, P = .003) and impaired bonding (Score 3 vs 5, P = .031).

CONCLUSION

In addition to regular intermittent kangaroo mother care, DR-SSC promotes MCI and decreases risk of maternal depression and bonding problems. Thus, DR-SSC may have positive effects on preterm development.

Two-year outcome data suggest that less invasive surfactant administration (LISA) is safe. Results from the follow-up of the randomized controlled AMV (avoid mechanical ventilation) study

Less invasive surfactant administration (LISA) is a method to deliver surfactant to spontaneously breathing premature infants via a thin catheter. Here we report the two-year outcome from the AMV (avoid mechanical ventilation) study, the first randomized controlled trial on this mode of surfactant delivery. No statistically significant differences in weight, length or neurodevelopmental outcome (Bayley II scores) were found between the LISA intervention group (n = 95) and the control group (n = 84) that received standard treatment.Conclusion: No differences in outcome were observed at 2 years. LISA seems safe in that aspect. What is Known: • LISA is a method that is in increasing use for surfactant delivery to spontaneously breathing infants. LISA reduces the need for mechanical ventilation. What is New: • Outcome data at 2 years from the first randomized study with LISA raise no safety concerns in comparison to a group of infants that received standard treatment.

Experimental and theoretical study of the formation process of photopolymer based self-written waveguides

The realization of optical interconnects between multimode (MM) optical fibers and waveguides based on a self-writing process in photopolymer media represents an efficient approach for fast and easy-to-implement connection of light-guiding elements. When light propagates through photopolymer media, it modulates the material properties of the media and confines the spreading of the light beam to create a waveguide along the beam propagation direction. This self-writing process can be realized with a single photopolymer medium and is also suited to connect optical fibers or waveguides with active elements such as light sources and detectors. Numerical simulations of the underlying light-induced polymerization process is carried out by using a diffusion based material model which takes account both monomer diffusion and its conversion to polymer chains in regions exposed to light fields. In this work experimental results obtained from a one-polymer approach are validated with theoretical predictions from the diffusion model. The study involved the demonstration of temporal dynamics and transmittance from self-written waveguide (SWW) couplers during the self-writing process. The measured attenuation coefficient from experiment α_experiment = (8.43 ± 0.3) × 10^-5 dB/µm showed good agreement with the theoretically predicted attenuation coefficient α_simulation = 7.93 × 10^-5 dB/µm, thus demonstrating a successful application of the diffusion model to epoxy based acrylate SWWs. For comparison, attenuation measurements between optical fibers with SWWs as interconnects and one without SWW, i.e. with an air gap in between, were performed. The obtained results reveal that the theoretical approach correctly describes the waveguide formation process so that in the next step the studies can be extended towards including further relevant parameters such as temperature.

Soliton Molecules with Two Frequencies

We demonstrate a peculiar mechanism for the formation of bound states of light pulses of substantially different optical frequencies, in which pulses are strongly bound across a vast frequency gap. This is enabled by a propagation constant with two separate regions of anomalous dispersion. The resulting soliton compound exhibits moleculelike binding energy, vibration, and radiation and can be understood as a mutual trapping providing a striking analogy to quantum mechanics. The phenomenon constitutes an intriguing case of two light waves mutually affecting and controlling each other.

Characterization of an Aptamer Directed against 25-Hydroxyvitamin D for the Development of a Competitive Aptamer-Based Assay

Detection of the small molecule 25-hydroxyvitamin D (25(OH)D) as the most relevant marker for vitamin D supply suffers from a high variability of results using the current detection methods, such as high-performance liquid chromatography (HPLC) and immunoassays. A new detection approach using a highly specific aptamer directed against 25(OH)D was established in this study based on the target-induced dissociation (TID) sensing approach. In this work, the aptamer was investigated regarding its structural properties as well as its binding affinity by using microscale thermophoresis (MST). Moreover, complementary oligonucleotides were designed based on the aptamer structure and were evaluated in MST experiments. Binding experiments of immobilized aptamers were conducted in microarray experiments. It could be shown that the aptamer exhibited the usual B-DNA structure and did not form any G-quadruplexes. The design of complementary oligonucleotides for the TID assay identified a putative 25(OH)D binding site within the aptamer. The limit of detection of the established competitive assay was determined to be 5.4 nM, which sets the stage for the development of a biosensor system.

Prevalence and risk factors for hearing loss in high-risk neonates in Germany

AIM

Hearing loss in infants is often diagnosed late, despite universal screening programmes. Risk factors of hearing impairment in high-risk neonates, identified from population-based studies, can inform policy around targeted screening. Our aim was to determine the prevalence and the risk factors of hearing loss in a high-risk neonatal population.

METHODS

This was a retrospective cohort study of neonates hospitalised at the University Hospital Cologne, Germany from January 2009 to December 2014 and were part of the newborn hearing screening programme. Multivariable regression analyses using the lasso approach was performed.

RESULTS

Data were available for 4512 (43% female) neonates with a mean gestational age at birth of 35.5 weeks. The prevalence of hearing loss was 1.6%, and 42 (0.9%) neonates had permanent hearing loss. Craniofacial anomalies, hyperbilirubinaemia requiring exchange transfusion, oxygen supplementation after 36 weeks of gestation and hydrops fetalis showed associations with permanent hearing loss.

CONCLUSION

Our findings of risk factors for hearing loss were consistent with other studies. However, some commonly demonstrated risk factors such as perinatal infections, meningitis, sepsis and ototoxic drugs did not show significant associations in our cohort. Targeted screening based on risk factors may help early identification of hearing loss in neonates.

Comparison of suspension MDCK cells, adherent MDCK cells, and LLC-MK2 cells for selective isolation of influenza viruses to be used as vaccine seeds

BACKGROUND

Cell-based influenza vaccines can solve the problem of the frequent occurrence of egg adaptation-associated antigenic changes observed in egg-based vaccines. Seed viruses for cell-based vaccines can be prepared from clinical specimens by cell culture; however, clinical samples risk harboring respiratory viruses other than influenza virus. Therefore, it is necessary to investigate the patterns of co-infection in clinical samples and explore whether cell culture technology can selectively propagate influenza viruses from samples containing other respiratory viruses.

METHODS

A total of 341 clinical specimens were collected from patients with influenza or influenza-like illness and analyzed by ResPlex II assay to detect 18 respiratory viruses. The patterns of co-infection were statistically analyzed with Fisher's exact test. The samples with double or triple infections were passaged in suspension MDCK cells (MDCK-S), adherent MDCK cells (MDCK-A), and LLC-MK2D cells. Cell-passaged samples were analyzed by ResPlex II assay again to investigate whether each cell line could amplify influenza viruses and eliminate other respiratory viruses.

RESULTS

Double infections were detected in 8.5% and triple infections in 0.9% of the collected clinical specimens. We identified four pairs of viruses with significant correlation. For all samples with double and triple infection, MDCK-S and MDCK-A could selectively propagate influenza viruses, while eliminating all contaminating viruses. In contrast, LLC-MK2D showed lower isolation efficiency for influenza virus and higher isolation efficiency for coxsackievirus/echovirus than MDCK-S and MDCK-A.

CONCLUSIONS

Both MDCK-S and MDCK-A are considered suitable for the preparation of influenza vaccine seed viruses without adventitious agents or egg-adaptation mutations.