Observation of dichotomic field-tunable electronic structure in twisted monolayer-bilayer graphene

Twisted bilayer graphene (tBLG) provides a fascinating platform for engineering flat bands and inducing correlated phenomena. By designing the stacking architecture of graphene layers, twisted multilayer graphene can exhibit different symmetries with rich tunability. For example, in twisted monolayer-bilayer graphene (tMBG) which breaks the C2z symmetry, transport measurements reveal an asymmetric phase diagram under an out-of-plane electric field, exhibiting correlated insulating state and ferromagnetic state respectively when reversing the field direction. Revealing how the electronic structure evolves with electric field is critical for providing a better understanding of such asymmetric field-tunable properties. Here we report the experimental observation of field-tunable dichotomic electronic structure of tMBG by nanospot angle-resolved photoemission spectroscopy (NanoARPES) with operando gating. Interestingly, selective enhancement of the relative spectral weight contributions from monolayer and bilayer graphene is observed when switching the polarity of the bias voltage. Combining experimental results with theoretical calculations, the origin of such field-tunable electronic structure, resembling either tBLG or twisted double-bilayer graphene (tDBG), is attributed to the selectively enhanced contribution from different stacking graphene layers with a strong electron-hole asymmetry. Our work provides electronic structure insights for understanding the rich field-tunable physics of tMBG.

Evolution of the flat band and the role of lattice relaxations in twisted bilayer graphene

Magic-angle twisted bilayer graphene exhibits correlated phenomena such as superconductivity and Mott insulating states related to the weakly dispersing flat band near the Fermi energy. Such a flat band is expected to be sensitive to both the moiré period and lattice relaxations. Thus, clarifying the evolution of the electronic structure with the twist angle is critical for understanding the physics of magic-angle twisted bilayer graphene. Here we combine nano-spot angle-resolved photoemission spectroscopy and atomic force microscopy to resolve the fine electronic structure of the flat band and remote bands, as well as their evolution with twist angle from 1.07° to 2.60°. Near the magic angle, the dispersion is characterized by a flat band near the Fermi energy with a strongly reduced band width. Moreover, we observe a spectral weight transfer between remote bands at higher binding energy, which allows to extract the modulated interlayer spacing near the magic angle. Our work provides direct spectroscopic information on flat band physics and highlights the important role of lattice relaxations.

Selective Control of Phases and Electronic Structures of Monolayer TaTe2

Transition metal dichalcogenide (TMDC) films exhibit rich phases and superstructures, which can be controlled by the growth conditions as well as post-growth annealing treatment. Here, the selective growth of monolayer TaTe2 films with different phases as well as superstructures using molecular beam epitaxy (MBE) is reported. Monolayer 1H-TaTe2 and 1T-TaTe2 films can be selectively controlled by varying the growth temperature, and their different electronic structures are revealed through the combination of angle-resolved photoemission spectroscopy measurements (ARPES) and first-principles calculations. Moreover, post-growth annealing of the 1H-TaTe2 film further leads to a transition from a19 × 19 $\sqrt {19}{\times }\sqrt {19}$ superstructure to a new 2 × 2 superstructure, where two gaps are observed in the electronic structure and persist up to room temperature. First-principles calculations reveal the role of the phonon instability in the formation of superstructures and the effect of local atomic distortions on the modified electronic structures. This work demonstrates the manipulation of the rich phases and superstructures of monolayer TaTe2 films by controlling the growth kinetics and post-growth annealing.

The expression of GADA, ZnT8A and IA-2A in patients with type 1 diabetes mellitus with thyroid disease and their correlation with thyroid autoantibodies

OBJECTIVE

The aim of this research was to study the expression of anti-glutamate decarboxylase antibody (GADA), zinc transporter-8 autoantibody (ZnT8A), and insulinoma-associated protein-2 antibody (IA-2A) in patients with type 1 diabetes (T1DM) with thyroid disease (TD) and its correlation with thyroid autoantibodies.

PATIENTS AND METHODS

380 patients with T1DM were included in the study, of which 313 patients with T1DM alone were included in the control group. In the TD group, 41 patients with T1DM and Hashimoto's thyroiditis (HT) were included, and 26 cases of T1DM patients with Graves' disease were included in the Graves group. The clinical features of the control group, the HT group, and the Graves group were compared. The positive rates of insulin autoantibodies in the control group and the TD group were analyzed. The clinical characteristics of patients with and without insulin autoantibody positivity were compared. The positive rates of thyroid autoantibodies in T1DM patients with positive GADA, ZnT8A, IA-2A, and different numbers of positive insulin autoantibodies were analyzed.

RESULTS

The levels of total cholesterol (TC) and thyroid stimulating hormone (TSH) in the HT group were significantly higher than those in the control and Graves groups, and the levels of free thyroid hormone (FT4) and low-density lipoprotein cholesterol (LDL-C) were significantly lower than those in the control and Graves groups (p<0.001). The levels of TC and TSH in the Graves group were significantly lower than those in the control group, the levels of HbA1c, LDL-C, and FT4 were significantly higher than those in the control group, and the levels of FT3 were significantly higher than those in the control and HT groups (p<0.001). The levels of C peptide, triglyceride (TG), and LDL-C of insulin autoantibodies positive patients were significantly lower than those of negative patients (p<0.05). The positive rates of GADA, ZnT8A, and IA-2A in the TD group, as well as the positive rates of double antibodies and triple antibodies, were significantly higher than those of the control group (p<0.05). In T1DM patients, the positive rates of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) in GADA and IA-2A-positive patients were significantly higher than those in GADA and IA-2A-negative patients (p<0.05). The positive rate of TPOAb in ZnT8A-positive patients was significantly higher than that in ZnT8A-negative patients (p<0.05). The positive rates of TRAb, TPOAb, and TGAb in T1DM patients positive for two of the three insulin autoantibodies and three insulin autoantibodies were significantly higher than those positive for one of the three insulin autoantibodies (p<0.001).

CONCLUSIONS

TD can exacerbate the disorder of glucose and lipid metabolism in patients with T1DM, and multiple insulin autoantibodies positive T1DM patients it is more likely to have thyroid autoantibody positivity. It is suggested that patients with aggravated glucose and lipid metabolism and multiple insulin autoantibody positivity should be routinely screened for thyroid antibodies to help early diagnosis of TD.

Floquet Engineering of Black Phosphorus upon Below-Gap Pumping

Time-periodic light field can dress the electronic states and lead to light-induced emergent properties in quantum materials. While below-gap pumping is regarded favorable for Floquet engineering, so far direct experimental evidence of momentum-resolved band renormalization still remains missing. Here, we report experimental evidence of light-induced band renormalization in black phosphorus by pumping at photon energy of 160 meV, which is far below the band gap, and the distinction between below-gap pumping and near-resonance pumping is revealed. Our Letter demonstrates light-induced band engineering upon below-gap pumping, and provides insights for extending Floquet engineering to more quantum materials.

Ionic liquid gating induced self-intercalation of transition metal chalcogenides

Ionic liquids provide versatile pathways for controlling the structures and properties of quantum materials. Previous studies have reported electrostatic gating of nanometer-thick flakes leading to emergent superconductivity, insertion or extraction of protons and oxygen ions in perovskite oxide films enabling the control of different phases and material properties, and intercalation of large-sized organic cations into layered crystals giving access to tailored superconductivity. Here, we report an ionic-liquid gating method to form three-dimensional transition metal monochalcogenides (TMMCs) by driving the metals dissolved from layered transition metal dichalcogenides (TMDCs) into the van der Waals gap. We demonstrate the successful self-intercalation of PdTe2 and NiTe2, turning them into high-quality PdTe and NiTe single crystals, respectively. Moreover, the monochalcogenides exhibit distinctive properties from dichalcogenides. For instance, the self-intercalation of PdTe2 leads to the emergence of superconductivity in PdTe. Our work provides a synthesis pathway for TMMCs by means of ionic liquid gating driven self-intercalation.

Machine-learning models for prediction of sepsis patients mortality

OBJECTIVES

Sepsis is an infection-caused syndrome, that leads to life-threatening organ damage. We aim to develop machine learning models with large-scale data to predict sepsis patients' mortality.

DESIGN

we extracted sepsis patients from two databases, Medical Information Mart for Intensive Care IV (MIMIC-IV) as a train set and Philips eICU Collaborative Research Database as a test set.

SETTING

ICUs in multicenter hospitals in the USA during 2012-2019.

PATIENTS OR PARTICIPANTS

A total of 21,680 sepsis-3 patients are included in the study, in which, 3771 patients were dead and 17,909 survived during hospitalization, respectively.

INTERVENTIONS

No interventions.

MAIN VARIABLES OF INTEREST

Basic information, examination items during hospitalization and some medication and treatment information are incorporated into analyzed. Seven different models were built with a Support vector machine, Decision Tree Classifier, Random Forest, Gradients Boosting, Multiple Layer Perception, Xgboost, light Gradients Boosting to predict dead or live during hospitalization.

RESULTS

Algorithms with an AUC value in the test set of the top three: light GBM, GBM, Xgboost. Considering the performance of the training set and the test set, the light GBM model performs best, and then the parameters of the model were adjusted, after that the AUC value was 0.99 in the train set, 0.96 in the test set, respectively.

CONCLUSIONS

Models built with light GBM algorithm from real-world sepsis patients from electronic health records accurately predict whether sepsis patients are dead and can be incorporated into clinical decision tools to enhance the prognosis of the patient and prevent adverse outcomes.

B-Cell-Derived TGF-β1 Inhibits Osteogenesis and Contributes to Bone Loss in Periodontitis

B cells play a vital role in the elimination of periodontal pathogens, the regulation of the immune response, and the induction of tissue destruction. However, the role of B cells in the dysfunction of mesenchymal stem cell (MSC) differentiation to osteoblasts in periodontitis (PD) has been poorly studied. Here we show that the frequency of CD45^-CD105⁺CD73⁺ MSCs in inflamed periodontal tissues is significantly decreased in patients with PD compared with that of healthy controls. CD19⁺ B cells dominate the infiltrated immune cells in periodontal tissues of patients with PD. Besides, B-cell depletion therapy reduces the alveolar bone loss in a ligature-induced murine PD model. B cells from PD mice express a high level of TGF-β1 and inhibit osteoblast differentiation by upregulating p-Smad2/3 expression and downregulating Runx2 expression. The inhibitory effect of PD B cells on osteoblast differentiation is reduced by TGF-β1 neutralization or Smad2/3 inhibitor. Importantly, B-cell-specific knockout of TGF-β1 in PD mice significantly increases the number of CD45^-CD105⁺Sca1⁺ MSCs, ALP-positive osteoblast activity, and alveolar bone volume but decreases TRAP-positive osteoclast activity compared with that from control littermates. Lastly, CD19⁺CD27⁺CD38^- memory B cells dominate the B-cell infiltrates in periodontal tissues from both patients with PD and patients with PD after initial periodontal therapy. Memory B cells in periodontal tissues of patients with PD express a high level of TGF-β1 and inhibit MSC differentiation to osteoblasts. Thus, TGF-β1 produced by B cells may contribute to alveolar bone loss in periodontitis, in part, by suppressing osteoblast activity.

A newly designed femtosecond KBe2BO3F2 device with pulse duration down to 55 fs for time- and angle-resolved photoemission spectroscopy

Developing a widely tunable vacuum ultraviolet (VUV) source with a sub-100 fs pulse duration is critical for ultrafast pump-probe techniques such as time- and angle-resolved photoemission spectroscopy (TrARPES). While a tunable probe source with a photon energy of 5.3-7.0 eV has been recently implemented for TrARPES by using a KBe₂BO₃F₂ (KBBF) device, the time resolution of 280-320 fs is still not ideal, which is mainly limited by the duration of the VUV probe pulse generated by the KBBF device. Here, by designing a new KBBF device, which is specially optimized for fs applications, an optimum pulse duration of 55 fs is obtained after systematic diagnostics and optimization. More importantly, a high time resolution of 81-95 fs is achieved for TrARPES measurements covering the probe photon energy range of 5.3-7.0 eV, making it particularly useful for investigating the ultrafast dynamics of quantum materials. Our work extends the application of the KBBF device to ultrafast pump-probe techniques with the advantages of both a widely tunable VUV source and ultimate time resolution.

Population Inversion and Dirac Fermion Cooling in 3D Dirac Semimetal Cd3As2

Revealing the ultrafast dynamics of three-dimensional (3D) Dirac fermions is critical for both fundamental science and device applications. So far, how the cooling of 3D Dirac fermions differs from that of two-dimensional (2D) and whether there is population inversion are fundamental questions to be answered. Here we reveal the ultrafast dynamics of Dirac fermions in a model 3D Dirac semimetal Cd₃As₂ by time- and angle-resolved photoemission spectroscopy with a tunable probe photon energy. The energy- and momentum-resolved relaxation rate shows a linear dependence on the energy, suggesting Dirac fermion cooling through intraband relaxation. Moreover, a population inversion is reported based on the observation of accumulated photoexcited carriers in the conduction band with a lifetime of 3.0 ps. Our work provides direct experimental evidence for a long-lived population inversion in a 3D Dirac semimetal, which is in contrast to 2D graphene with a much shorter lifetime.

Ultrafast time- and angle-resolved photoemission spectroscopy with widely tunable probe photon energy of 5.3-7.0 eV for investigating dynamics of three-dimensional materials

Time- and angle-resolved photoemission spectroscopy (TrARPES) is a powerful technique for capturing the ultrafast dynamics of charge carriers and revealing photo-induced phase transitions in quantum materials. However, the lack of widely tunable probe photon energy, which is critical for accessing the dispersions at different out-of-plane momentum k_z in TrARPES measurements, has hindered the ultrafast dynamics investigation of 3D quantum materials, such as Dirac or Weyl semimetals. Here, we report the development of a TrARPES system with a highly tunable probe photon energy from 5.3 to 7.0 eV. The tunable probe photon energy is generated by the fourth harmonic generation of a tunable wavelength femtosecond laser source by combining a β-BaB₂O₄ crystal and a KBe₂BO₃F₂ crystal. A high energy resolution of 29-48 meV and time resolution of 280-320 fs are demonstrated on 3D topological materials ZrTe₅ and Sb₂Te₃. Our work opens up new opportunities for exploring ultrafast dynamics in 3D quantum materials.

Robust charge-density wave strengthened by electron correlations in monolayer 1T-TaSe2 and 1T-NbSe2

Combination of low-dimensionality and electron correlation is vital for exotic quantum phenomena such as the Mott-insulating phase and high-temperature superconductivity. Transition-metal dichalcogenide (TMD) 1T-TaS2 has evoked great interest owing to its unique nonmagnetic Mott-insulator nature coupled with a charge-density-wave (CDW). To functionalize such a complex phase, it is essential to enhance the CDW-Mott transition temperature TCDW-Mott, whereas this was difficult for bulk TMDs with TCDW-Mott < 200 K. Here we report a strong-coupling 2D CDW-Mott phase with a transition temperature onset of ~530 K in monolayer 1T-TaSe2. Furthermore, the electron correlation derived lower Hubbard band survives under external perturbations such as carrier doping and photoexcitation, in contrast to the bulk counterpart. The enhanced Mott-Hubbard and CDW gaps for monolayer TaSe2 compared to NbSe2, originating in the lattice distortion assisted by strengthened correlations and disappearance of interlayer hopping, suggest stabilization of a likely nonmagnetic CDW-Mott insulator phase well above the room temperature. The present result lays the foundation for realizing monolayer CDW-Mott insulator based devices operating at room temperature.

Self-energy dynamics and mode-specific phonon threshold effect in a Kekulé-ordered graphene

Electron-phonon interaction and related self-energy are fundamental to both the equilibrium properties and non-equilibrium relaxation dynamics of solids. Although electron-phonon interaction has been suggested by various time-resolved measurements to be important for the relaxation dynamics of graphene, the lack of energy- and momentum-resolved self-energy dynamics prohibits direct identification of the role of specific phonon modes in the relaxation dynamics. Here by performing time- and angle-resolved photoemission spectroscopy measurements on a Kekulé-ordered graphene with folded Dirac cones at the Γ point, we have succeeded in resolving the self-energy effect induced by coupling of electrons to two phonons at Ω1 = 177 meV and Ω2 = 54 meV and revealing its dynamical change in the time domain. Moreover, these strongly coupled phonons define energy thresholds, which separate the hierarchical relaxation dynamics from ultrafast, fast to slow, thereby providing direct experimental evidence for the dominant role of mode-specific phonons in the relaxation dynamics.

Light-Tunable Surface State and Hybridization Gap in Magnetic Topological Insulator MnBi8Te13

MnBi₈Te₁₃ is an intrinsic ferromagnetic (FM) topological insulator with different complex surface terminations. Resolving the electronic structures of different termination surfaces and manipulation of the electronic state are important. Here, by using micrometer spot time- and angle-resolved photoemission spectroscopy (μ-TrARPES), we resolve the electronic structures and reveal the ultrafast dynamics upon photoexcitation. Photoinduced filling of the surface state hybridization gap is observed for the Bi₂Te₃ quintuple layer directly above MnBi₂Te₄ accompanied by a nontrivial shift of the surface state, suggesting light-tunable interlayer interaction. Relaxation of photoexcited electrons and holes is observed within 1-2 ps. Our work reveals photoexcitation as a potential control knob for tailoring the interlayer interaction and surface state of MnBi₈Te₁₃.

AB0463 IMPROVEMENTS IN PATIENT-REPORTED OUTCOMES IN ANKYLOSING SPONDYLITIS PATIENTS TREATED WITH GOLIMUMAB: SUB-ANALYSIS OF ASIAN PATIENTS ENROLLED IN PHASE-3 CLINICAL TRIALS

Background:

Clinical efficacy and safety of golimumab (GLM) for patients with ankylosing spondylitis (AS) who have not received prior biologic therapy were studied in two phase-3 clinical trials (NCT00265083 - GO RAISE and NCT01248793). In both studies, a greater proportion of patients treated with GLM 50 mg every 4 weeks achieved improvement in clinical signs and symptoms measured by ASAS20 and in patient-reported outcomes, such as Health Related Quality of Life (HRQoL) and sleep disturbance when compared with placebo (PBO) at Weeks 14 and 24.

Objectives:

To assess the effect of GLM on HRQoL, back pain, and sleep disturbances in phase-3 studies in Asian patients with AS.

Methods:

Post-hoc sub-analysis to examine HRQoL, measured with the Short Form 36 (SF-36) Physical and Mental Component Summary (PCS and MCS), total back pain (VAS) and sleep disturbance, assessed with the Jenkins Sleep Evaluation Questionnaire (JSEQ) in active AS patients enrolled from Asian countries (China, including Taiwan region and South Korea). Improvement from baseline to Week 24 was expressed as mean and standard deviation (SD) for SF-36 PCS and MCS and total back pain. Reduction of sleep disturbance was expressed as the proportion of patients with improvement from baseline ≥2 points in the JSEQ, defined as baseline value minus post-baseline value with lower scores indicating the better sleep evaluation.

Results:

At Week 24, active AS patients treated with GLM 50 mg had greater mean improvements in SF-36 and total back pain than PBO. The pooled results were comparable with patients enrolled from other regions (Table 1). A higher proportion of Asian patients who received GLM had reduced sleep disturbance (JSEQ ≥2) after 24 weeks than PBO (59.7% [83/139] vs 38.5% [47/122]; Δ21.2) and the results were similar with AS patients on GLM (67.4% [64/95] vs 45.6% [26/57]; Δ21.8) pooled from other regions.

Conclusion:

Asian patients with AS treated with GLM demonstrated improved HRQoL, total back pain, and reduced sleep disturbance. The pooled results were comparable with other regions.

Table 1.

Mean Improvement from Baseline in HRQoL and total back pain at Week 24: Randomized Patients in AS Studies Pooled for Asia and all other regions

Pooled AS in APACPooled AS in All Other RegionsParameterPlaceboGLM 50 mgPlaceboGLM 50 mgNMean (SD)NMean (SD)NMean (SD)NMean (SD)SF-36 PCS1222.51 (6.372)1397.10 (8.434)581.91 (8.268)9910.12 (11.096)SF-36 MCS1220.22 (9.609)1393.32 (9.280)581.20 (9.705)991.98 (8.032)Total Back Pain1201.86 (2.469)1352.73 (2.607)580.79 (2.688)993.39 (3.210)

APAC, Asia-Pacific; AS, ankylosing spondylitis; GLM, golimumab; HRQoL, Health Related Quality of Life; MCS, mental component summary; PCS, physical component summary; SD, standard deviation; SF-36, Short Form 36

Disclosure of Interests:

Wen-Chan Tsai Consultant of: Pfizer, AbbVie, Roche, and Eli Lilly, Chunde Bao: None declared., Daniel Furtner Shareholder of: Johnson & Johnson, Employee of: Johnson & Johnson Pte. Ltd., Singapore, Kim Hung Lo Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Yiying Zhou Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Elizabeth C Hsia Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC.

POS0664 A MULTICENTER RANDOMIZED STUDY IN RHEUMATOID ARTHRITIS TO COMPARE IGURATIMOD, METHOTREXATE, OR COMBINATION: 52 WEEK EFFICACY AND SAFETY RESULTS OF THE SMILE TRIAL

Background:

Iguratimod (IGU) has demonstrated efficacy and safety for active rheumatoid arthritis (RA) patients in double-blind clinical trials in China and Japan as a new disease-modifying anti-rheumatic drug (DMARD). There are no studies evaluating the radiographic progression of structural joint damage of IGU for the treatment of RA using the mTSS as the primary endpoint.

Objectives:

Our study was to evaluate the efficacy and safety of IGU monotherapy and IGU combined methotrexate (MTX) compared with MTX monotherapy, including the inhibitory effects of joint destruction.

Methods:

This randomized, double-blind, parallel-controlled, multicenter study in patients with active RA who have not previously used MTX and biological DMARDs (bDMARDs) (ClinicalTrials.gov Identifier NCT01548001) was carried out in China. Patients were randomized 1:1:1 to receive IGU 25 mg twice a day (bid), MTX 10mg once a week(qw) for the first 4 weeks and 15 mg once a week(qw) for week 5 to 52, or IGU combined MTX (IGU+MTX) for 52 weeks. The primary endpoints were to assess and compare American College of Rheumatology 20% (ACR20) response and the change of modified total Sharp scoring (mTSS) score over 52 weeks (Intention-to-treat, ITT analysis). The non-inferiority test was used to analyze the difference of ACR20 response at 52 weeks between the IGU monotherapy and the MTX monotherapy arms, and the non-inferiority limit value was 10%. The difference test was used for the comparison between the IGU+MTX and MTX monotherapy arms. Two-way ANOVA was used to analyze the difference of the changes of mTSS score of each arm compared with baseline value (0 week).

Results:

A total of 895 patients were randomized to IGU 25mg bid (n =297), MTX 10-15mg qw(n=293), and IGU+MTX (n=305). Baseline characteristics were comparable between the arms (Table 1).

Table 1.

Demographic and Other Baseline Characteristics (SAS)

IGUMTXIGU+MTXNumber of Subjects297293305Age, mean (SD) years46.87(10.67)47.63(10.70)48.37(10.69)Female/male, %77.44/22.5679.18/20.8278.03/21.97Duration of RA, mean(SD) years11.67±7.1611.60±7.9811.67±7.27CRP, mean(SD) mg/L222.32±35.4720.67±26.6119.74±31.38Tender joint count, mean (SD)14.59±9.1614.83±9.3014.93±9.88Swollen joint count, mean (SD)9.81±6.639.73±7.209.51±6.22DAS28-CRP, mean (SD)5.084±0.9945.102±0.9795.103±0.956HAQ score, mean (SD)15.82±11.2515.24±10.9316.06±10.92

SAS: Safety Analysis Set; CRP: C-reactive protein;

DAS28: disease activity score; HAQ: Health Assessment Questionnaire

The study met its primary endpoints. More concretely, IGU monotherapy and IGU+MTX were found to be superior to MTX at week 52 with a higher ACR20 response of 77.44%(230/297, P=0.0019) and 77.05%(235/305, P=0.0028) versus 65.87%(193/293) (fig 1). As shown in fig 1, the structural remission (ΔmTSS≤0.5) was statistically significant for IGU monotherapy (57.4%, P=0.0308) but not for IGU+MTX arm (55%) versus MTX monotherapy (47.8%).

Overall incidence of the adverse events (AEs) leading to study discontinuation were reported in 13.8% (41/297) in IGU monotherapy arm, 11.26% (33/293) in MTX monotherapy arm and 11.51% (35/305) patients in IGU+MTX arm. The incidence of adverse drug reactions (ADR) leading to study discontinuation were 11.45% (34/297), 8.53% (25/293) and 9.21% (28/305), respectively. There was no one death and no significant difference in all the safety indicators among the three arms.

Conclusion:

Iguratimod alone or in combination with MTX demonstrated superior efficacy with acceptable safety compared to MTX for patients with active RA who have not previously used MTX bDMARDs.

Disclosure of Interests:

None declared

Experimental Evidence of Chiral Symmetry Breaking in Kekulé-Ordered Graphene

The low-energy excitations of graphene are relativistic massless Dirac fermions with opposite chiralities at valleys K and K^{'}. Breaking the chiral symmetry could lead to gap opening in analogy to dynamical mass generation in particle physics. Here we report direct experimental evidences of chiral symmetry breaking (CSB) from both microscopic and spectroscopic measurements in a Li-intercalated graphene. The CSB is evidenced by gap opening at the Dirac point, Kekulé-O type modulation, and chirality mixing near the gap edge. Our work opens up opportunities for investigating CSB related physics in a Kekulé-ordered graphene.

Full diagnostics and optimization of time resolution for time- and angle-resolved photoemission spectroscopy

Achieving a high time resolution is highly desirable for revealing the electron dynamics and light-induced phenomena in time- and angle-resolved photoemission spectroscopy (TrARPES). Here, we identify key factors for achieving the optimum time resolution, including laser bandwidth and optical component induced chirp. A full diagnostic scheme is constructed to characterize the pulse duration and chirp of the fundamental beam, second harmonic, and fourth harmonic, and prism pairs are used to compensate for the chirp. Moreover, by using a Sb₂Te₃ film as a test sample, we can achieve a high test efficiency for the time resolution during the optimization process. An optimized time resolution of 81 fs is achieved in our TrARPES system with a high repetition rate tunable from 76 to 4.75/n MHz.

Hydrogen gas (XEN) inhalation ameliorates airway inflammation in asthma and COPD patients

BACKGROUND

Hydrogen was proven to have anti-oxidative and anti-inflammation effects to various diseases.

AIM

We wish to investigate the acute effects of inhaled hydrogen on airway inflammation in patients with asthma and chronic obstructive pulmonary disease (COPD).

DESIGN

Prospective study.

METHODS

In total, 2.4% hydrogen containing steam mixed gas (XEN) was inhaled once for 45 min in 10 patients with asthma and 10 patients with COPD. The levels of granulocyte-macrophage colony stimulating factor, interferon-γ, interleukin-1β (IL-1β), IL-2, IL-4, IL-6 and so on in peripheral blood and exhaled breath condensate (EBC) before and after 'XEN' inhalation were measured.

RESULTS

45 minutes 'XEN' inhalation once decreased monocyte chemotactic protein 1 level in both COPD (564.70-451.51 pg/mL, P = 0.019) and asthma (386.39-332.76 pg/mL, P = 0.033) group, while decreased IL-8 level only in asthma group (5.25-4.49 pg/mL, P = 0.023). The level of EBC soluble cluster of differentiation-40 ligand in COPD group increased after inhalation (1.07-1.16 pg/mL, P = 0.031), while IL-4 and IL-6 levels in EBC were significantly lower after inhalation in the COPD (0.80-0.64 pg/mL, P = 0.025) and asthma (0.06-0.05 pg/mL, P = 0.007) group, respectively.

CONCLUSIONS

A single inhalation of hydrogen for 45 min attenuated inflammatory status in airways in patients with asthma and COPD.

THU0270 ONLINE INTERACTION AND FREQUENT SELF-ASSESSMENTS PROMOTED TREAT-TO-TARGET FOR SLE VIA EMPOWERING PATIENTS: A COHORT STUDY FROM CHINA BY SMART SYSTEM OF DISEASE MANAGEMENT (SSDM)

Background:

Treating to target (T2T) is routine in RA, but no comparable standard has been defined for SLE. In 2015, the definition of Lupus Low Disease Activity State (LLDAS) was generated by Asia-Pacific Lupus Collaboration, and the preliminary validation demonstrated its attainment to be associated with improved outcomes in SLE. A SLEDAI-2K score lower than 4 is the main criteria for LLDAS. SSDM is an interactive mobile disease management application, including application systems for both the doctors and patients.

Objectives:

To evaluate the patterns of T2T and related influential factors among SLE patients after applying SSDM in real world.

Methods:

Patients were trained to master SSDM by healthcare professionals in clinics. The first assessment for SLEDAI-2K was performed as the baseline. Patients were required to perform repeated self-assessments after leaving the clinics. The data is synchronized to the SSDM of authorized rheumatologists. Based on the patients’ data, rheumatologists will provide medical advices to the patients.

Results:

From July 2015 to Jan 2020, 32,559 SLE patients enrolled in SSDM. The mean age is 36.35 years old and median disease duration is 3.85 years. Among them 1,937 SLE patients from 134 hospitals across China were followed up for more than 12 months, and the demographics were summarized in table 1.

Table 1.Baseline\Final follow-upn%x <= 4%5 <= x <= 9%10 <= x <= 14%15 <= x%x <= 4104053.69%82078.85%13512.98%504.81%353.37%5 <= x <= 935718.43%23064.43%6016.81%328.96%359.80%10 <= x <= 1422211.46%12054.05%3817.12%4018.02%2410.81%15 <= x31816.42%15649.06%4915.41%4714.78%6620.75%Total1937100%132668.46%28214.56%1698.72%1608.26%

The ratio of T2T achievers was 53.69% (1,040/1,937) at the baseline and improved significantly to 68.46% (1,326/1,937) after a 12-month follow-up, p<0.01. Among T2T achievers at the baseline, 78.85% (820/1,040) maintained T2T, and 21.15% (220/1,040) relapsed. Of patients who didn’t achieve T2T at baseline, 56.41% (506/897) of the patients achieve T2T after 12-month follow-up.

The impact of the online interaction and the frequency of self-assessment for SLEDAI-2K on T2T has been analyzed. Compared with 1,475 patients who didn’t interact online with their physicians through SSDM, 462 patients with online interaction achieved higher rate of T2T improvement (19.48% vs 13.29%, p<0.05). The more frequent of the self-assessments being performed by patients, the higher improvement of T2T rate will be. The improvement rates of T2T in the subgroups which self-assessed with SSDM by quarterly, bimonthly and monthly were 8.56%, 16.14% and 23.24% respectively. The improvement rate (y) of T2T was positively correlated with the frequency of self-assessment for SLEDAI-2K(x) independently, r = 0.9998. (Figure 1)

Conclusion:

After proactive disease management via SSDM for more than 12 months, the rate of T2T in SLE patients increased significantly. Online interaction between patients and physicians contributed in promoting T2T improvement rate. The patients who performed more self-assessments through SSDM had higher probability of T2T achievement. SSDM is a valuable tool for long term SLE follow-up through empowering patients.

References:

Acknowledgments:

SSDM was developed by Shanghai Gothic Internet Technology Co., Ltd.

Disclosure of Interests:

None declared

Interlayer quantum transport in Dirac semimetal BaGa2

The quantum limit is quite easy to achieve once the band crossing exists exactly at the Fermi level (EF) in topological semimetals. In multilayered Dirac fermion systems, the density of Dirac fermions on the zeroth Landau levels (LLs) increases in proportion to the magnetic field, resulting in intriguing angle- and field-dependent interlayer tunneling conductivity near the quantum limit. BaGa2 is an example of a multilayered Dirac semimetal with its quasi-2D Dirac cone located at EF, providing a good platform to study its interlayer transport properties. In this paper, we report the negative interlayer magnetoresistance induced by the tunneling of Dirac fermions between the zeroth LLs of neighboring Ga layers in BaGa2. When the field deviates from the c-axis, the interlayer resistivity ρzz(θ) increases and finally results in a peak with the applied field perpendicular to the c-axis. These unusual interlayer transport properties are observed together in the Dirac semimetal under ambient pressure and are well explained by the model of tunneling between Dirac fermions in the quantum limit.

WNT3A accelerates delayed alveolar bone repair in ovariectomized mice

Our goal was to evaluate alveolar bone healing in OVX mice, and to assess the functional utility of a WNT-based treatment to accelerate healing in mice with an osteoporotic-like bony phenotype.

INTRODUCTION

Is osteoporosis a risk factor for dental procedures? This relatively simple question is exceedingly difficult to answer in a clinical setting, for two reasons. First, as an age-related disease, osteoporosis is frequently accompanied by age-related co-morbidities that can contribute to slower tissue repair. Second, the intervals at which alveolar bone repair are assessed in a clinical study are often measured in months to years. This study aimed to evaluate alveolar bone repair in ovariectomized (OVX) mice and provide preclinical evidence to support a WNT-based treatment to accelerate alveolar bone formation.

METHODS

OVX was performed in young mice to produce an osteoporotic-like bone phenotype. Thereafter, the rate of extraction socket healing and osteotomy repair was assessed. A liposomal WNT3A treatment was tested for its ability to promote alveolar bone formation in this OVX-induced model of bone loss.

RESULTS

Bone loss was observed throughout the murine skeleton, including the maxilla, and mirrored the pattern of bone loss observed in aged mice. Injuries to the alveolar bone, including tooth extraction and osteotomy site preparation, both healed significantly slower than the same injuries produced in young controls. Given sufficient time, however, all injuries eventually healed. In OVX mice, osteotomies healed significantly faster if they were treated with L-WNT3A.

CONCLUSIONS

Alveolar bone injuries heal slower in OVX mice that exhibit an osteoporotic-like phenotype. The rate of alveolar bone repair in OVX mice can be significantly promoted with local delivery of L-WNT3A.

Abstract P6-17-39: BAT8001, a potent anti-HER2 antibody-drug conjugate with a novel stable linker for the treatment of HER2-positive breast cancer

Overexpression of HER2 occurs in approximately 20% of breast cancers and is associated with shortened survival. Trastuzumab emtansine (T-DM1), an anti-HER2 ADC, has shown efficacy in HER2-positive breast cancer patients and was approved by the FDA and EMA for advanced HER2-positive breast cancer. However T-DM1 causes grade 3 and 4 thrombocytopenia in up to 14.5% of patients as its major toxicity. The thrombocytopenia is likely caused by one of T-DM1's catabolites and payload, DM1, indicating T-DM1's linker can be cleaved. Here we adopted a novel noncleavable linker and created an anti-HER2 ADC, BAT8001, which is expected be efficacious in HER2-positive breast cancer and have a better side effect profile relative to T-DM1 due to the stability of BAT8001's noncleavable linker. BAT8001 is internalized in HER2-positive cancer cells. It inhibits proliferation of HER2-positive tumor cells with IC50s of ˜0.1 nM, similar to the potency of T-DM1. BAT8001 also induces apoptosis in HER2-positive cancer cells. In both cell-line and patient-derived mouse xenograft (PDX) models, BAT8001 demonstrates strong inhibition activity on tumor growth. For example, in a cell-line model of breast cancer (BT474), BAT8001 demonstrates potent activity with complete responses in all animals tested at the 15mg/kg dose level. Pharmacokinetics studies in monkey reveals BAT8001 has similar Cmax, AUC, and t1/2 as T-DM1. The major catabolite of BAT8001 is the Cys-linker-payload containing product. No free payload is observed. This compares favorably with T-DM1 where free DM1, T-DM1's payload, is one of the major catabolites. In a multiple dose toxicity study, BAT8001 had a NOAEL of 15 mg/kg versus 10 mg/kg for T-DM1. BAT8001 exhibits similar potency to T-DM1 on inhibiting HER2-positive cell proliferation and tumor growth, yet demonstrates better multiple dose toxicity than T-DM1. The improved toxicity profile of BAT8001 suggests that the novel noncleavable linker utilized in BAT8001 is more stable than the linker utilized in T-DM1. BAT8001 is very efficacious in cell-line xenograft models of breast cancer. The preclinical profile of BAT8001 warrants further development for the treatment of breast cancer and other HER2-positive cancers.

Citation Format: Tang W, Deng X, Ou Z, Gan J, Dong Q, Tan B, Lu L, Chen B, Bao C, Li S, Thomas B, Yu J-C. BAT8001, a potent anti-HER2 antibody-drug conjugate with a novel stable linker for the treatment of HER2-positive breast cancer [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 P6-17-39.

Resolving Deep Quantum-Well States in Atomically Thin 2H-MoTe2 Flakes by Nanospot Angle-Resolved Photoemission Spectroscopy

Transition-metal dichalcogenides exhibit strong quantum confinement effects, and their electronic structure is strongly dependent on the number of layers. Resolving the thickness-dependent electronic structure is important. While the electronic structure of atomically thin 2H-MoSe₂ or 2H-MoS₂ have been explored, information on the experimental electronic structure of 2H-MoTe₂ is still missing. Here, by using nanospot angle-resolved photoemission spectroscopy (nanoARPES), we reveal the experimental electronic structure of exfoliated 2H-MoTe₂ thin flakes with different thickness (three, five, and seven monolayers). Well-separated quantum-well states are clearly observed in thin 2H-MoTe₂ flakes at deep valence bands at energies between -3 to -5 eV, while those at the top of the valence band between -1 and -2 eV are much more closely spaced compared with those from 2H-MoSe₂ and 2H-MoS₂. First-principles calculation shows that the main difference is attributed to the weaker hybridization and smaller energy difference between Mo 4d _z² and Te 5p _z orbitals as compared with Se 4p _z and S 3p _z orbitals. Our work demonstrates the power of nanoARPES in resolving the electronic structure of atomically thin exfoliated flakes.

Quasicrystalline 30° twisted bilayer graphene as an incommensurate superlattice with strong interlayer coupling

The interlayer coupling can be used to engineer the electronic structure of van der Waals heterostructures (superlattices) to obtain properties that are not possible in a single material. So far research in heterostructures has been focused on commensurate superlattices with a long-ranged Moiré period. Incommensurate heterostructures with rotational symmetry but not translational symmetry (in analogy to quasicrystals) are not only rare in nature, but also the interlayer interaction has often been assumed to be negligible due to the lack of phase coherence. Here we report the successful growth of quasicrystalline 30° twisted bilayer graphene (30°-tBLG), which is stabilized by the Pt(111) substrate, and reveal its electronic structure. The 30°-tBLG is confirmed by low energy electron diffraction and the intervalley double-resonance Raman mode at 1383 cm-1 Moreover, the emergence of mirrored Dirac cones inside the Brillouin zone of each graphene layer and a gap opening at the zone boundary suggest that these two graphene layers are coupled via a generalized Umklapp scattering mechanism-that is, scattering of a Dirac cone in one graphene layer by the reciprocal lattice vector of the other graphene layer. Our work highlights the important role of interlayer coupling in incommensurate quasicrystalline superlattices, thereby extending band structure engineering to incommensurate superstructures.

[Clinical manifestations analysis of patients diagnosed with primary pulmonary mucosa-associated lymphoid tissue lymphoma]

Objective: To analyze the clinical features of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma. Methods: A total of 14 cases diagnosed with primary pulmonary MALT lymphoma were collected from May 2007 to May 2017 in Zhongshan Hospital, Fudan University. The clinical features, pathological characteristics, diagnosis, treatment and prognosis were retrospectively analyzed. Results: All 14 cases were pathologically diagnosed with primary pulmonary MALT lymphoma. The biopsy tissues were obtained through the Video-assisted Thoracoscopic Surgery (VATS) (4 cases), percutaneous puncture (2 cases), and bronchoscopy (8 cases). Cell types of these tumors were centrocyte-like cells (10 cases), lymphocytoid cells (2 cases), and monocytoid B cells (2 cases). The B cell clonality was detected by IgH cloning test in 4 cases and 3 of them were demonstrated with monoclonal strips. MALT1 breakup gene was positive in 3 out of 6 examined cases using fluorescence in situ hybridization (FISH). As for the treatment, 8 patients underwent chemotherapy, 5 patients underwent surgical resection and 1 patient abandoned treatment. Twelve patients were followed up to 9 years. The tumor recurrence occurred in 2 patients and resulted their death. Conclusions: The clinical manifestations of primary pulmonary MALT lymphoma are lack of specificity. The pathology, immunohistochemistry, IgH cloning test and MALT1 breakup gene tested by FISH are the criteria for diagnosis.

Stacking-Dependent Electronic Structure of Trilayer Graphene Resolved by Nanospot Angle-Resolved Photoemission Spectroscopy

The crystallographic stacking order in multilayer graphene plays an important role in determining its electronic structure. In trilayer graphene, rhombohedral stacking (ABC) is particularly intriguing, exhibiting a flat band with an electric-field tunable band gap. Such electronic structure is distinct from simple hexagonal stacking (AAA) or typical Bernal stacking (ABA) and is promising for nanoscale electronics and optoelectronics applications. So far clean experimental electronic spectra on the first two stackings are missing because the samples are usually too small in size (μm or nm scale) to be resolved by conventional angle-resolved photoemission spectroscopy (ARPES). Here, by using ARPES with a nanospot beam size (NanoARPES), we provide direct experimental evidence for the coexistence of three different stackings of trilayer graphene and reveal their distinctive electronic structures directly. By fitting the experimental data, we provide important experimental band parameters for describing the electronic structure of trilayer graphene with different stackings.

Effects of Condensation on Peri-implant Bone Density and Remodeling

Bone condensation is thought to densify interfacial bone and thus improve implant primary stability, but scant data substantiate either claim. We developed a murine oral implant model to test these hypotheses. Osteotomies were created in healed maxillary extraction sites 1) by drilling or 2) by drilling followed by stepwise condensation with tapered osteotomes. Condensation increased interfacial bone density, as measured by a significant change in bone volume/total volume and trabecular spacing, but it simultaneously damaged the bone. On postimplant day 1, the condensed bone interface exhibited microfractures and osteoclast activity. Finite element modeling, mechanical testing, and immunohistochemical analyses at multiple time points throughout the osseointegration period demonstrated that condensation caused very high interfacial strains, marginal bone resorption, and no improvement in implant stability. Collectively, these multiscale analyses demonstrate that condensation does not positively contribute to implant stability.

Raman signatures of inversion symmetry breaking and structural phase transition in type-II Weyl semimetal MoTe2

Transition metal dichalcogenide MoTe₂ is an important candidate for realizing the newly predicted type-II Weyl fermions, for which the breaking of the inversion symmetry is a prerequisite. Here we present direct spectroscopic evidence for the inversion symmetry breaking in the low-temperature phase of MoTe₂ by systematic Raman experiments and first-principles calculations. We identify five lattice vibrational modes that are Raman-active only in the low-temperature noncentrosymmetric structure. A hysteresis is also observed in the peak intensity of inversion symmetry-activated Raman modes, confirming a temperature-induced structural phase transition with a concomitant change in the inversion symmetry. Our results provide definitive evidence for the low-temperature noncentrosymmetric T_d phase from vibrational spectroscopy, and suggest MoTe₂ as an ideal candidate for investigating the temperature-induced topological phase transition.

To experimentally confirm the predicted type-II Weyl fermions in transition metal dichalcogenide, the evidence of inversion symmetry breaking is required. Here, Zhang et al. report Raman spectroscopic evidence for the inversion symmetry breaking in MoTe₂.

Pre- and undiagnosed-hypertension in urban Chinese adults: a population-based cross-sectional study

Hypertension is common in adults and often undiagnosed, and the prevalence of pre- and undiagnosed-hypertension remains unclear. We aimed to investigate the prevalence of pre- and undiagnosed-hypertension and their correlates among urban Chinese adults. A total of 7435 participants aged 20-79 were included in this study. Data on demographics, lifestyle and medical history were collected through a structured interview. Pre- and undiagnosed-hypertension was defined as systolic blood pressure/ diastolic blood pressure (SBP/DBP) of 120-139/80-89 mm Hg and SBP⩾140 mm Hg and/or DBP⩾90 mm Hg, respectively, in participants without a history of hypertension and use of antihypertensive medication. Prevalence rates were calculated and standardized using local age- and gender-specific census data. Data were analysed using multinomial logistic regression with adjustment for potential confounders. Of all the participants, 2726 (36.7%) were diagnosed with pre-hypertension and 919 (12.3%) with undiagnosed-hypertension. Undiagnosed-hypertension accounted for 37.3% of all participants with hypertension. The prevalence of pre-hypertension gradually decreased with age, while undiagnosed-hypertension increased, although presenting different changing patterns among men and women. In a fully adjusted multinomial logistic regression, age, male sex, low socio-economic status (SES), abdominal obesity, alcohol drinking, physical inactivity and type 2 diabetes mellitus (T2DM) were significantly associated with increased odds of pre- and undiagnosed-hypertension. In conclusions, the prevalence of pre- and undiagnosed-hypertension was ~50% among urban Chinese adults. Abdominal obesity, low SES, alcohol drinking, physical inactivity and T2DM may be indicators for pre- and undiagnosed-hypertension.

Molecular detection and extraction of pyrene in plasma and tissues of Sprague-Dawley rats

In this paper, an efficient method for determination of total pyrene concentration in the biological samples including plasma, liver, spleen, lung and kidney of Sprague-Dawley rats were investigated and established using steady-state fluorescence method. Equilibrium dialysis method was applied to determine plasma protein binding rate of pyrene. The results illustrated that the protein binding rate depends on the concentration of pyrene in plasma. Extraction of pyrene in plasma was studied by using biomedical nanopartical which was prepared from synthesized associating polymer poly(ethylene glycol) end-capped by hexadecane. The Critical Micelle Concentration (CMC) of the polymeric micelle in aqueous solution was determined to equal 0.0063 mg/mL using 1-pyrenemethanol as a fluorescent probe. The distribution of free pyrene and pyrene loaded nanoparticals in blood were determined. The results showed that over 95% of the free pyrene was distributed into the erythrocyte, and the pyrene-loaded nanoparticles were less distributed in to the erythrocyte than free pyrene, but it was higher than 60%. This study provides an efficient method to detect pyrene in different tissues as well as an extraction method at the molecular level, which might contribute to the development of modern molecular diagnosis and identification in vivo.

Emergence of a new GII.17 norovirus variant in patients with acute gastroenteritis in Jiangsu, China, September 2014 to March 2015

From September 2014 to March 2015, 23 outbreaks of norovirus (NoV) acute gastroenteritis occurred in Jiangsu, China. Partial sequencing of the NoV capsid gene suggested that 16 of the 23 outbreaks were related to a new GII.17 variant. This variant was first detected in sporadic specimens in October 2014, and became predominant in February 2015. Analysis of the RNA-dependent RNA polymerase (RdRp), and complete capsid including the protruding domain P2 sequences confirmed this GII.17 variant as distinct from previously identified GII variants.

Spatial and temporal analysis of human infection with avian influenza A(H7N9) virus in China, 2013

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Case-control study of risk factors for human infection with influenza A(H7N9) virus in Jiangsu Province, China, 2013

We describe a case-control study performed in Jiangsu, China, to evaluate risk factors for human infection with novel avian influenza A(H7N9) virus. Twenty-five cases and 93 controls matched by age, sex, and location were included in the study. Direct contact with poultry or birds in the two weeks before illness onset, chronic medical conditions (hypertension excluded), and environment-related exposures were significantly associated with A(H7N9) infection.