Impact of the Covid-19 pandemic on melanoma and non-melanoma skin cancer inpatient treatment in Germany - a nationwide analysis

BACKGROUND

SARS-CoV-2 has massively changed the care situation in hospitals worldwide. Although tumour care should not be affected, initial reports from European countries were suggestive for a decrease in skin cancer during the first pandemic wave and only limited data are available thereafter.

OBJECTIVES

The aim of this study was to investigate skin cancer cases and surgeries in a nationwide inpatient dataset in Germany.

METHODS

Comparative analyses were performed in a prepandemic (18 March 2019 until 17 March 2020) and a pandemic cohort (18 March 2020 until 17 March 2021). Cases were identified and analysed using the WHO international classification of diseases codes (ICDs) and process key codes (OPSs).

RESULTS

Comparing the first year of the pandemic with the same period 1 year before, a persistent decrease of 14% in skin cancer cases (n = 19 063) was observed. The largest decrease of 24% was seen in non-invasive in situ tumours (n = 1665), followed by non-melanoma skin cancer (NMSC) with a decrease of 16% (n = 15 310) and malignant melanoma (MM) with a reduction of 7% (n = 2088). Subgroup analysis showed significant differences in the distribution of sex, age, hospital carrier type and hospital volume. There was a decrease of 17% in surgical procedures (n = 22 548), which was more pronounced in minor surgical procedures with a decrease of 24.6% compared to extended skin surgery including micrographic surgery with a decrease of 15.9%.

CONCLUSIONS

Hospital admissions and surgical procedures decreased persistently since the beginning of the pandemic in Germany for skin cancer patients. The higher decrease in NMSC cases compared to MM might reflect a prioritization effect. Further evidence from tumour registries is needed to investigate the consequences of the therapy delay and identify the upcoming challenges in skin cancer care.

Response durability after cessation of immune checkpoint inhibitors in patients with metastatic Merkel cell carcinoma: a retrospective multicenter DeCOG study

BACKGROUND

Immune checkpoint inhibitors (ICI) have led to a prolongation of progression-free and overall survival in patients with metastatic Merkel cell carcinoma (MCC). However, immune-mediated adverse events due to ICI therapy are common and often lead to treatment discontinuation. The response duration after cessation of ICI treatment is unknown. Hence, this study aimed to investigate the time to relapse after discontinuation of ICI in MCC patients.

METHODS

We analyzed 20 patients with metastatic MCC who have been retrospectively enrolled at eleven skin cancer centers in Germany. These patients have received ICI therapy and showed as best overall response (BOR) at least a stable disease (SD) upon ICI therapy. All patients have discontinued ICI therapy for other reasons than disease progression. Data on treatment duration, tumor response, treatment cessation, response durability, and tumor relapse were recorded.

RESULTS

Overall, 12 of 20 patients (60%) with MCC relapsed after discontinuation of ICI. The median response durability was 10.0 months. Complete response (CR) as BOR to ICI-treatment was observed in six patients, partial response (PR) in eleven, and SD in three patients. Disease progression was less frequent in patients with CR (2/6 patients relapsed) as compared to patients with PR (7/11) and SD (3/3), albeit the effect of initial BOR on the response durability was below statistical significance. The median duration of ICI therapy was 10.0 months. Our results did not show a correlation between treatment duration and the risk of relapse after treatment withdrawal. Major reasons for discontinuation of ICI therapy were CR (20%), adverse events (35%), fatigue (20%), or patient decision (25%). Discontinuation of ICI due to adverse events resulted in progressive disease (PD) in 71% of patients regardless of the initial response. A re-induction of ICI was initiated in 8 patients upon tumor progression. We observed a renewed tumor response in 4 of these 8 patients. Notably, all 4 patients showed an initial BOR of at least PR.

CONCLUSION

Our results from this contemporary cohort of patients with metastatic MCC indicate that MCC patients are at higher risk of relapse after discontinuation of ICI as compared to melanoma patients. Notably, the risk of disease progression after discontinuation of ICI treatment is lower in patients with initial CR (33%) as compared to patients with initial PR (66%) or SD (100%). Upon tumor progression, re-induction of ICI is a feasible option. Our data suggest that the BOR to initial ICI therapy might be a potential predictive clinical marker for a successful re-induction.

Apremilast effectively inhibits TNFα-induced vascular inflammation in human endothelial cells

BACKGROUND

Patients with chronic inflammatory diseases (e.g. psoriasis and rheumatoid arthritis) are at increased risk for the development of atherosclerosis and cardiovascular diseases (CVD). Previous studies have suggested that phosphodiesterase 4 (PDE4) inhibitors possess anti-inflammatory properties.

OBJECTIVES

Here we examined the effect of the PDE4 inhibitor apremilast, a well-established anti-psoriatic drug, on pro-inflammatory responses in TNFα-activated endothelial cells.

METHODS

Human umbilical vein endothelial cells (HUVEC) were treated with tumour necrosis factor-α (TNFα) in the presence or absence of apremilast. Expression levels of pro-inflammatory cytokines, chemokines and adhesion molecules were assessed by ELISA, western blot and RT-PCR. Effects of apremilast on adhesion and transendothelial migration (TEM) of THP-1 monocytic cells were analysed in transwell assays.

RESULTS

Apremilast suppressed TNFα-induced expression and secretion of important endothelial and monocytic pro-inflammatory factors, including granulocyte-macrophage colony-stimulating factor (GM-CSF), C-X-C motif chemokine ligand 10 (CXCL10), chemokine (C-C motif) ligand 2 (CCL2), vascular cell adhesion molecule 1 (VCAM-1), E-selectin and matrix metalloproteinase-9 (MMP9). Functionally, apremilast reduced adhesion of THP-1 cells to activated HUVECs and TEM in response to TNFα. Mechanistically, apremilast suppressed activation of nuclear factor κB (NFκB) and mitogen-activated protein kinases (MAPK) signalling in activated HUVECs. Furthermore, inhibition of p38, C-Jun-N-terminale Kinase (JNK) and NFκB in activated HUVECs decreased expression of GM-CSF, VCAM-1 and E-selectin. Additionally, apremilast decreased IL-17A-induced secretion of IL-6 and CCL2.

CONCLUSIONS

We demonstrate that apremilast has distinct anti-inflammatory effects in activated HUVECs, indicating that apremilast could have the therapeutic potential to prevent higher risk for CVD in patients with chronic inflammatory diseases.

G protein-coupled receptor 40 expression in human melanoma - correlation with tumour thickness, AJCC stage and survival

BACKGROUND

In melanoma, preclinical data suggest a possible role of polyunsaturated fatty acids inhibiting cell growth. A new target molecule for free fatty acids, the G protein-coupled receptor GPR40, was identified in melanoma cells.

OBJECTIVES

The aim of this study was to investigate GPR40 expression in human melanocytic tissues and to evaluate its potential as a prognostic marker.

METHODS AND RESULTS

A total of 114 tissue sections of naevi, primary melanoma and melanoma metastasis were immunohistochemically stained with anti-GPR40. The staining was evaluated, using the immunoreactivity scoring system. Compared to naevi, primary melanoma and melanoma metastasis showed significantly higher levels of GPR40 (P < 0.05). In primary melanoma, GPR40 expression positively correlated with tumour thickness (P = 0.044) and AJCC level (P = 0.017) and in melanoma metastasis with AJCC level (P = 0.035). Primary melanoma patients with high levels of GPR40 had a significantly poorer overall survival (P = 0.004) and shorter disease-free survival (0.040).

CONCLUSION

The present study identified GPR40 as a novel target molecule in melanoma. First evidence for a potential role of the receptor in tumour progression and metastases was found, and it could be demonstrated that GPR40 expression is negatively correlated with patient's survival.

Sandbox-Dermatitis als unterdiagnostizierte Differenzialdiagnose bei juckenden Papeln an den Streckseiten der Extremitäten bei Kindern

Die Sandbox-Dermatitis ist eine weitestgehend unbekannte Erkrankung im Kindesalter, deren Prävalenz wahrscheinlich häufiger ist als angenommen. Wir berichten über den Fall eines 6-jährigen Jungen, der sich mit juckenden, stecknadelkopfgroßen, hypopigmentierten Papeln an den Streckseiten der Extremitäten, die seit den Sommermonaten bestünden, vorstellte. Da der Juckreiz für den Jungen sehr quälend war und die Eltern sich sehr besorgt zeigten, erfolgte die Vorstellung durch den Kinderarzt. Zur Diagnosefindung wurden Differenzialdiagnosen nach ihrer Lokalisation, Morphologie und nach saisonalem Auftreten bewertet. Anhand der typischen Klinik konnte die Diagnose der Sandbox-Dermatitis gestellt werden und dem kleinen Patienten weitere schmerzhafte Diagnostik erspart bleiben. Aufgrund der Einordnung war es nun möglich, eine adäquate Therapie einzuleiten und den Eltern die Sorge zu nehmen, da nun über die Harmlosigkeit, die Triggerfaktoren und den variablen Verlauf der Erkrankung aufgeklärt werden konnte.

Directing adipose-derived stem cells into keratinocyte-like cells: impact of medium composition and culture condition

BACKGROUND

Adipose-derived stem cells (ASC) are known to transdifferentiate into a wide range of different cell species in vitro including along the epidermal lineage. This property makes them a promising tool for regenerative medicine to restore the epidermal barrier.

OBJECTIVE

This study is dedicated to identify in vitro conditions enabling transdifferentiation to a keratinocyte-like phenotype. In particular, the impact of different culture conditions (media compositions, 2D, 3D cultures) and extracellular matrix (ECM) molecules was evaluated.

METHODS

Adipose-derived stem cells derived from subcutaneous abdominal fat were characterized by stemness-associated markers and subjected to different media. Epithelial differentiation in 2D cultures was monitored by pan-cytokeratin expression using flow cytometry and immunocytochemistry. To evaluate the impact of different ECM molecules on epidermal stratification, 3D cultures were produced, lifted to the air-liquid interface (ALI) and examined by histological analysis and quantitative real-time RT-PCR.

RESULTS

We identified a medium composition containing retinoic acid, hydrocortisone, ascorbic acid and BMP-4 enabling maximum pan-cytokeratin expression in 2D cultures. Moreover, adhesion to type IV collagen further promotes the pan-cytokeratin expression. When cultures were lifted to the ALI, significant stratification was observed, particularly in supports coated with type IV collagen or fibronectin. Moreover, epidermal differentiation markers (involucrin, cytokeratin 1 and 14) become induced.

CONCLUSION

Conditions with hampered wound healing such as non-healing ulcers demand new treatment regimes. The here introduced optimized protocols for transdifferentiation of ASC into keratinocyte-like cells may help to establish more effective treatment procedures.

Endoscopic and histopathologic reflux-associated mucosal damage in the remnant esophagus following transthoracic esophagectomy for cancer-5-year long-term follow-up

Gastroesophageal reflux is a common problem following esophagectomy and reconstruction with gastric interposition. Despite a routine prescription of proton pump inhibitors, reflux-associated mucosal damage in the remnant esophagus is frequently observed. Purpose of this study is to evaluate mucosal damage in the esophageal remnant during long-term follow-up and to compare the prevalence of this damage between the subgroups of esophageal squamous cell and adenocarcinoma. All patients undergoing transthoracic Ivor-Lewis esophagectomy were prospectively entered in our IRB approved database. All patients underwent a routine check-up program with yearly surveillance endoscopies following esophagectomy. Only patients with a complete follow-up were included into this study. Endoscopic and histopathologic mucosal changes of the remnant esophagus were analyzed in close intervals. A total of 50 patients met the inclusion criteria, consisting of 31 adenocarcinomas (AC) and 19 squamous cell carcinomas (SCC). Mucosal damage was already seen 1 year after surgery in 20 patients macroscopically (43%) and in 21 patients microscopically (45%). At 5-year follow-up the prevalence for macroscopic and microscopic damage was 55% and 60%, respectively. The prevalence of mucosal damage was higher in AC patients than in SCC patients (1y-FU: 51% [AC] vs. 28% [SCC]; 5y-FU: 68% [AC] vs. 35% [SCC], P < 0.05). Newly acquired Barrett's esophagus was seen in 10 patients (20%) with two of those patients (20%) showing histopathologic proof of neoplasia. This study shows a high prevalence of reflux-associated mucosal damage in the remnant esophagus one year out of surgery and only a moderate increase in prevalence in the following years. Mucosal damage was more frequently seen in AC patients and the occurrence of de-novo Barrett's esophagus and de-novo neoplasia was high. Endoscopic surveillance with targeted biopsies seems to be an indispensable tool to follow patients after esophagectomy appropriately.

Updated search for long-lived particles decaying to jet pairs

A search is presented for long-lived particles with a mass between 25 and 50 GeV / c 2 and a lifetime between 2 and 500 ps, using proton-proton collision data corresponding to an integrated luminosity of 2.0 fb - 1 , collected by the LHCb detector at centre-of-mass energies of 7 and 8 TeV. The particles are assumed to be pair-produced in the decay of a 125 GeV / c 2 Standard-Model-like Higgs boson. The experimental signature is a single long-lived particle, identified by a displaced vertex with two associated jets. No excess above background is observed and limits are set on the production cross-section as a function of the mass and lifetime of the long-lived particle.

Measurement of the CP Violation Parameter A_{Γ} in D^{0}→K^{+}K^{-} and D^{0}→π^{+}π^{-} Decays

Asymmetries in the time-dependent rates of D^{0}→K^{+}K^{-} and D^{0}→π^{+}π^{-} decays are measured in a pp collision data sample collected with the LHCb detector during LHC Run 1, corresponding to an integrated luminosity of 3  fb^{-1}. The asymmetries in effective decay widths between D^{0} and D[over ¯]^{0} decays, sensitive to indirect CP violation, are measured to be A_{Γ}(K^{+}K^{-})=(-0.30±0.32±0.10)×10^{-3} and A_{Γ}(π^{+}π^{-})=(0.46±0.58±0.12)×10^{-3}, where the first uncertainty is statistical and the second systematic. These measurements show no evidence for CP violation and improve on the precision of the previous best measurements by nearly a factor of two.

Study of J/ψ Production in Jets

The production of J/ψ mesons in jets is studied in the forward region of proton-proton collisions using data collected with the LHCb detector at a center-of-mass energy of 13 TeV. The fraction of the jet transverse momentum carried by the J/ψ meson, z(J/ψ)≡p_{T}(J/ψ)/p_{T}(jet), is measured using jets with p_{T}(jet)>20  GeV in the pseudorapidity range 2.5<η(jet)<4.0. The observed z(J/ψ) distribution for J/ψ mesons produced in b-hadron decays is consistent with expectations. However, the results for prompt J/ψ production do not agree with predictions based on fixed-order nonrelativistic QCD. This is the first measurement of the p_{T} fraction carried by prompt J/ψ mesons in jets at any experiment.

Search for massive long-lived particles decaying semileptonically in the LHCb detector

A search is presented for massive long-lived particles decaying into a muon and two quarks. The dataset consists of proton-proton interactions at centre-of-mass energies of 7 and 8 TeV, corresponding to integrated luminosities of 1 and 2[Formula: see text], respectively. The analysis is performed assuming a set of production mechanisms with simple topologies, including the production of a Higgs-like particle decaying into two long-lived particles. The mass range from 20 to 80 [Formula: see text] and lifetimes from 5 to 100[Formula: see text] are explored. Results are also interpreted in terms of neutralino production in different R-Parity violating supersymmetric models, with masses in the 23-198 GeV/[Formula: see text] range. No excess above the background expectation is observed and upper limits are set on the production cross-section for various points in the parameter space of theoretical models.

Observation of B_{c}^{+}→D^{0}K^{+} Decays

Using proton-proton collision data corresponding to an integrated luminosity of 3.0  fb^{-1}, recorded by the LHCb detector at center-of-mass energies of 7 and 8 TeV, the B_{c}^{+}→D^{0}K^{+} decay is observed with a statistical significance of 5.1 standard deviations. By normalizing to B^{+}→D[over ¯]^{0}π^{+} decays, a measurement of the branching fraction multiplied by the production rates for B_{c}^{+} relative to B^{+} mesons in the LHCb acceptance is obtained, R_{D^{0}K}=(f_{c}/f_{u})×B(B_{c}^{+}→D^{0}K^{+})=(9.3_{-2.5}^{+2.8}±0.6)×10^{-7}, where the first uncertainty is statistical and the second is systematic. This decay is expected to proceed predominantly through weak annihilation and penguin amplitudes, and is the first B_{c}^{+} decay of this nature to be observed.

Measurement of the phase difference between short- and long-distance amplitudes in the [Formula: see text] decay

A measurement of the phase difference between the short- and long-distance contributions to the [Formula: see text] decay is performed by analysing the dimuon mass distribution. The analysis is based on pp collision data corresponding to an integrated luminosity of 3[Formula: see text] collected by the LHCb experiment in 2011 and 2012. The long-distance contribution to the [Formula: see text] decay is modelled as a sum of relativistic Breit-Wigner amplitudes representing different vector meson resonances decaying to muon pairs, each with their own magnitude and phase. The measured phases of the [Formula: see text] and [Formula: see text] resonances are such that the interference with the short-distance component in dimuon mass regions far from their pole masses is small. In addition, constraints are placed on the Wilson coefficients, [Formula: see text] and [Formula: see text], and the branching fraction of the short-distance component is measured.

Observation of the Annihilation Decay Mode B^{0}→K^{+}K^{-}

A search for the B^{0}→K^{+}K^{-} decay is performed using pp-collision data collected by LHCb. The data set corresponds to integrated luminosities of 1.0 and 2.0  fb^{-1} at center-of-mass energies of 7 and 8 TeV, respectively. This decay is observed for the first time, with a significance of more than 5 standard deviations. The analysis also results in an improved measurement of the branching fraction for the B_{s}^{0}→π^{+}π^{-} decay. The measured branching fractions are B(B^{0}→K^{+}K^{-})=(7.80±1.27±0.81±0.21)×10^{-8} and B(B_{s}^{0}→π^{+}π^{-})=(6.91±0.54±0.63±0.19±0.40)×10^{-7}. The first uncertainty is statistical, the second is systematic, the third is due to the uncertainty on the B^{0}→K^{+}π^{-} branching fraction used as a normalization. For the B_{s}^{0} mode, the fourth accounts for the uncertainty on the ratio of the probabilities for b quarks to hadronize into B_{s}^{0} and B^{0} mesons.

Observation of the Decay Ξ_{b}^{-}→pK^{-}K^{-}

Decays of the Ξ_{b}^{-} and Ω_{b}^{-} baryons to the charmless final states ph^{-}h^{'-}, where h^{(')} denotes a kaon or pion, are searched for with the LHCb detector. The analysis is based on a sample of proton-proton collision data collected at center-of-mass energies sqrt[s]=7 and 8 TeV, corresponding to an integrated luminosity of 3  fb^{-1}. The decay Ξ_{b}^{-}→pK^{-}K^{-} is observed with a significance of 8.7 standard deviations, and evidence at the level of 3.4 standard deviations is found for the Ξ_{b}^{-}→pK^{-}π^{-} decay. Results are reported, relative to the B^{-}→K^{+}K^{-}K^{-} normalization channel, for the products of branching fractions and b-hadron production fractions. The branching fractions of Ξ_{b}^{-}→pK^{-}π^{-} and Ξ_{b}^{-}→pπ^{-}π^{-} relative to Ξ_{b}^{-}→pK^{-}K^{-} decays are also measured.

Observation of [Formula: see text] and [Formula: see text] decays

The decays [Formula: see text] and [Formula: see text] are observed for the first time using a data sample corresponding to an integrated luminosity of 3.0 fb[Formula: see text], collected by the LHCb experiment in proton-proton collisions at the centre-of-mass energies of 7 and 8[Formula: see text]. The branching fractions relative to that of [Formula: see text] are measured to be [Formula: see text]where the first uncertainties are statistical and the second are systematic.

Measurement of the b-Quark Production Cross Section in 7 and 13 TeV pp Collisions

Measurements of the cross section for producing b quarks in the reaction pp→bb[over ¯]X are reported in 7 and 13 TeV collisions at the LHC as a function of the pseudorapidity η in the range 2<η<5 covered by the acceptance of the LHCb experiment. The measurements are done using semileptonic decays of b-flavored hadrons decaying into a ground-state charmed hadron in association with a muon. The cross sections in the covered η range are 72.0±0.3±6.8 and 154.3±1.5±14.3  μb for 7 and 13 TeV. The ratio is 2.14±0.02±0.13, where the quoted uncertainties are statistical and systematic, respectively. The agreement with theoretical expectation is good at 7 TeV, but differs somewhat at 13 TeV. The measured ratio of cross sections is larger at lower η than the model prediction.

Observation of J/ψϕ Structures Consistent with Exotic States from Amplitude Analysis of B^{+}→J/ψϕK^{+} Decays

The first full amplitude analysis of B^{+}→J/ψϕK^{+} with J/ψ→μ^{+}μ^{-}, ϕ→K^{+}K^{-} decays is performed with a data sample of 3  fb^{-1} of pp collision data collected at sqrt[s]=7 and 8 TeV with the LHCb detector. The data cannot be described by a model that contains only excited kaon states decaying into ϕK^{+}, and four J/ψϕ structures are observed, each with significance over 5 standard deviations. The quantum numbers of these structures are determined with significance of at least 4 standard deviations. The lightest has mass consistent with, but width much larger than, previous measurements of the claimed X(4140) state.

First Experimental Study of Photon Polarization in Radiative B_{s}^{0} Decays

The polarization of photons produced in radiative B_{s}^{0} decays is studied for the first time. The data are recorded by the LHCb experiment in pp collisions corresponding to an integrated luminosity of 3  fb^{-1} at center-of-mass energies of 7 and 8 TeV. A time-dependent analysis of the B_{s}^{0}→ϕγ decay rate is conducted to determine the parameter A^{Δ}, which is related to the ratio of right- over left-handed photon polarization amplitudes in b→sγ transitions. A value of A^{Δ}=-0.98_{-0.52}^{+0.46}_{-0.20}^{+0.23} is measured. This result is consistent with the standard model prediction within 2 standard deviations.

Measurement of CP Violation in B^{0}→D^{+}D^{-} Decays

The CP violation observables S and C in the decay channel B^{0}→D^{+}D^{-} are determined from a sample of proton-proton collisions at center-of-mass energies of 7 and 8 TeV, collected by the LHCb experiment and corresponding to an integrated luminosity of 3  fb^{-1}. The observable S describes CP violation in the interference between mixing and the decay amplitude, and C parametrizes direct CP violation in the decay. The following values are obtained from a flavor-tagged, decay-time-dependent analysis: S=-0.54_{-0.16}^{+0.17}(stat)±0.05(syst), C=0.26_{-0.17}^{+0.18}(stat)±0.02(syst). These values provide evidence for CP violation at a significance level of 4.0 standard deviations. The phase shift due to higher-order standard model corrections is constrained to a small value of Δϕ=-0.16_{-0.21}^{+0.19}  rad.

Search for Higgs-like bosons decaying into long-lived exotic particles

A search is presented for massive long-lived particles, in the 20-60 [Formula: see text] mass range with lifetimes between 5 and 100 [Formula: see text]. The dataset used corresponds to 0.62[Formula: see text] of proton-proton collision data collected by the LHCb detector at [Formula: see text]. The particles are assumed to be pair-produced by the decay of a Higgs-like boson with mass between 80 and 140 [Formula: see text]. No excess above the background expectation is observed and limits are set on the production cross-section as a function of the long-lived particle mass and lifetime and of the Higgs-like boson mass.

Search for Structure in the B_{s}^{0}π^{±} Invariant Mass Spectrum

The B_{s}^{0}π^{±} invariant mass distribution is investigated in order to search for possible exotic meson states. The analysis is based on a data sample recorded with the LHCb detector corresponding to 3  fb^{-1} of pp collision data at sqrt[s]=7 and 8 TeV. No significant excess is found, and upper limits are set on the production rate of the claimed X(5568) state within the LHCb acceptance. Upper limits are also set as a function of the mass and width of a possible exotic meson decaying to the B_{s}^{0}π^{±} final state. The same limits also apply to a possible exotic meson decaying through the chain B_{s}^{*0}π^{±}, B_{s}^{*0}→B_{s}^{0}γ where the photon is excluded from the reconstructed decays.

Evidence for Exotic Hadron Contributions to Λ_{b}^{0}→J/ψpπ^{-} Decays

A full amplitude analysis of Λ_{b}^{0}→J/ψpπ^{-} decays is performed with a data sample acquired with the LHCb detector from 7 and 8 TeV pp collisions, corresponding to an integrated luminosity of 3  fb^{-1}. A significantly better description of the data is achieved when, in addition to the previously observed nucleon excitations N→pπ^{-}, either the P_{c}(4380)^{+} and P_{c}(4450)^{+}→J/ψp states, previously observed in Λ_{b}^{0}→J/ψpK^{-} decays, or the Z_{c}(4200)^{-}→J/ψπ^{-} state, previously reported in B^{0}→J/ψK^{+}π^{-} decays, or all three, are included in the amplitude models. The data support a model containing all three exotic states, with a significance of more than three standard deviations. Within uncertainties, the data are consistent with the P_{c}(4380)^{+} and P_{c}(4450)^{+} production rates expected from their previous observation taking account of Cabibbo suppression.

Model-Independent Evidence for J/ψp Contributions to Λ_{b}^{0}→J/ψpK^{-} Decays

The data sample of Λ_{b}^{0}→J/ψpK^{-} decays acquired with the LHCb detector from 7 and 8 TeV pp collisions, corresponding to an integrated luminosity of 3  fb^{-1}, is inspected for the presence of J/ψp or J/ψK^{-} contributions with minimal assumptions about K^{-}p contributions. It is demonstrated at more than nine standard deviations that Λ_{b}^{0}→J/ψpK^{-} decays cannot be described with K^{-}p contributions alone, and that J/ψp contributions play a dominant role in this incompatibility. These model-independent results support the previously obtained model-dependent evidence for P_{c}^{+}→J/ψp charmonium-pentaquark states in the same data sample.

Measurement of the CP Asymmetry in B_{s}^{0}-B[over ¯]_{s}^{0} Mixing

The CP asymmetry in the mixing of B_{s}^{0} and B[over ¯]_{s}^{0} mesons is measured in proton-proton collision data corresponding to an integrated luminosity of 3.0  fb^{-1}, recorded by the LHCb experiment at center-of-mass energies of 7 and 8 TeV. Semileptonic B_{s}^{0} and B[over ¯]_{s}^{0} decays are studied in the inclusive mode D_{s}^{∓}μ^{±}ν[over (-)]_{μ}X with the D_{s}^{∓} mesons reconstructed in the K^{+}K^{-}π^{∓} final state. Correcting the observed charge asymmetry for detection and background effects, the CP asymmetry is found to be a_{sl}^{s}=(0.39±0.26±0.20)%, where the first uncertainty is statistical and the second systematic. This is the most precise measurement of a_{sl}^{s} to date. It is consistent with the prediction from the standard model and will constrain new models of particle physics.

A precise measurement of the [Formula: see text] meson oscillation frequency

The oscillation frequency, [Formula: see text], of [Formula: see text] mesons is measured using semileptonic decays with a [Formula: see text] or [Formula: see text] meson in the final state. The data sample corresponds to 3.0[Formula: see text] of pp collisions, collected by the LHCb experiment at centre-of-mass energies [Formula: see text] = 7 and 8[Formula: see text]. A combination of the two decay modes gives [Formula: see text], where the first uncertainty is statistical and the second is systematic. This is the most precise single measurement of this parameter. It is consistent with the current world average and has similar precision.

First Observation of D^{0}-D[over ¯]^{0} Oscillations in D^{0}→K^{+}π^{-}π^{+}π^{-} Decays and Measurement of the Associated Coherence Parameters

Charm meson oscillations are observed in a time-dependent analysis of the ratio of D^{0}→K^{+}π^{-}π^{+}π^{-} to D^{0}→K^{-}π^{+}π^{-}π^{+} decay rates, using data corresponding to an integrated luminosity of 3.0  fb^{-1} recorded by the LHCb experiment. The measurements presented are sensitive to the phase-space averaged ratio of doubly Cabibbo-suppressed to Cabibbo-favored amplitudes r_{D}^{K3π} and the product of the coherence factor R_{D}^{K3π} and a charm mixing parameter y_{K3π}^{'}. The constraints measured are r_{D}^{K3π}=(5.67±0.12)×10^{-2}, which is the most precise determination to date, and R_{D}^{K3π}y_{K3π}^{'}=(0.3±1.8)×10^{-3}, which provides useful input for determinations of the CP-violating phase γ in B^{±}→DK^{±}, D→K^{∓}π^{±}π^{∓}π^{±} decays. The analysis also gives the most precise measurement of the D^{0}→K^{+}π^{-}π^{+}π^{-} branching fraction, and the first observation of D^{0}-D[over ¯]^{0} oscillations in this decay mode, with a significance of 8.2 standard deviations.

Search for Violations of Lorentz Invariance and CPT Symmetry in B_{(s)}^{0} Mixing

Violations of CPT symmetry and Lorentz invariance are searched for by studying interference effects in B^{0} mixing and in B_{s}^{0} mixing. Samples of B^{0}→J/ψK_{S}^{0} and B_{s}^{0}→J/ψK^{+}K^{-} decays are recorded by the LHCb detector in proton-proton collisions at center-of-mass energies of 7 and 8 TeV, corresponding to an integrated luminosity of 3  fb^{-1}. No periodic variations of the particle-antiparticle mass differences are found, consistent with Lorentz invariance and CPT symmetry. Results are expressed in terms of the standard model extension parameter Δa_{μ} with precisions of O(10^{-15}) and O(10^{-14})  GeV for the B^{0} and B_{s}^{0} systems, respectively. With no assumption on Lorentz (non)invariance, the CPT-violating parameter z in the B_{s}^{0} system is measured for the first time and found to be Re(z)=-0.022±0.033±0.005 and Im(z)=0.004±0.011±0.002, where the first uncertainties are statistical and the second systematic.

Measurement of the Difference of Time-Integrated CP Asymmetries in D^{0}→K^{-}K^{+} and D^{0}→π^{-}π^{+} Decays

A search for CP violation in D^{0}→K^{-}K^{+} and D^{0}→π^{-}π^{+} decays is performed using pp collision data, corresponding to an integrated luminosity of 3  fb^{-1}, collected using the LHCb detector at center-of-mass energies of 7 and 8 TeV. The flavor of the charm meson is inferred from the charge of the pion in D^{*+}→D^{0}π^{+} and D^{*-}→D[over ¯]^{0}π^{-} decays. The difference between the CP asymmetries in D^{0}→K^{-}K^{+} and D^{0}→π^{-}π^{+} decays, ΔA_{CP}≡A_{CP}(K^{-}K^{+})-A_{CP}(π^{-}π^{+}), is measured to be [-0.10±0.08(stat)±0.03(syst)]%. This is the most precise measurement of a time-integrated CP asymmetry in the charm sector from a single experiment.

Observation of B_{s}^{0}→D[over ¯]^{0}K_{S}^{0} and Evidence for B_{s}^{0}→D[over ¯]^{*}^{0}K_{S}^{0} Decays

The first observation of the B_{s}^{0}→D[over ¯]^{0}K_{S}^{0} decay mode and evidence for the B_{s}^{0}→D[over ¯]^{*0}K_{S}^{0} decay mode are reported. The data sample corresponds to an integrated luminosity of 3.0  fb^{-1} collected in pp collisions by LHCb at center-of-mass energies of 7 and 8 TeV. The branching fractions are measured to be B(B_{s}^{0}→D[over ¯]^{0}K[over ¯]^{0})=[4.3±0.5(stat)±0.3(syst)±0.3(frag)±0.6(norm)]×10^{-4},B(B_{s}^{0}→D[over ¯]^{*0}K[over ¯]^{0})=[2.8±1.0(stat)±0.3(syst)±0.2(frag)±0.4(norm)]×10^{-4},where the uncertainties are due to contributions coming from statistical precision, systematic effects, and the precision of two external inputs, the ratio f_{s}/f_{d} and the branching fraction of B^{0}→D[over ¯]^{0}K_{S}^{0}, which is used as a calibration channel.

[Dermatosurgery in the elderly]

In recent decades, the portion of elderly has increased substantially due to demographic changes in developed countries. Dermatological surgery is particularly affected by this development, because a large proportion of the elderly suffer from skin tumors, which are primarily treated surgically. Physiological changes of age and multimorbidity, often associated with polypharmacy, present the treating physician with enormous challenges. What aspects of care are important? What must be considered? What are possible complications and how can they be prevented? These important questions are answered. Finally, selected surgical approaches for the care of very old patients are also described.

The Mercedes flap and its new variants: a 'workhorse' flap for the dermatological surgeon?

BACKGROUND

The plastic reconstruction of defects in problem regions, such as, e.g. the heel, temple, malleolar region, sternum and capillitium, is usually a challenge.

OBJECTIVE

We describe the use of the Mercedes flap, a combination of the purse string and advancement flap, and new modifications for use in various body locations. These examples extend the scope of application in tumour surgery of the skin.

METHODS

We demonstrate the different techniques and practical application of the repair and evaluate the benefits and limitations.

RESULTS

The Mercedes flap and its modifications are an excellent method for repairing various defects in problem locations after tumour surgery of the skin.

CONCLUSION

The Mercedes flap and its modifications prove to be a good alternative to other closure types, especially in problem regions such as the shoulder, malleolar region, heel, etc. The procedure is fast and simple, with few side-effects, and proves to be a 'workhorse' flap for the dermatological surgeon.

Search for long-lived heavy charged particles using a ring imaging Cherenkov technique at LHCb

A search is performed for heavy long-lived charged particles using 3.0 [Formula: see text] of proton-proton collisions collected at [Formula: see text][Formula: see text] 7 and 8  TeV with the LHCb detector. The search is mainly based on the response of the ring imaging Cherenkov detectors to distinguish the heavy, slow-moving particles from muons. No evidence is found for the production of such long-lived states. The results are expressed as limits on the Drell-Yan production of pairs of long-lived particles, with both particles in the LHCb pseudorapidity acceptance, [Formula: see text]. The mass-dependent cross-section upper limits are in the range 2-4 fb (at 95 % CL) for masses between 14 and 309 [Formula: see text].

Evidence for the Strangeness-Changing Weak Decay Ξ_{b}^{-}→Λ_{b}^{0}π^{-}

Using a pp collision data sample corresponding to an integrated luminosity of 3.0  fb^{-1}, collected by the LHCb detector, we present the first search for the strangeness-changing weak decay Ξ_{b}^{-}→Λ_{b}^{0}π^{-}. No b hadron decay of this type has been seen before. A signal for this decay, corresponding to a significance of 3.2 standard deviations, is reported. The relative rate is measured to be f_{Ξ_{b}^{-}}/f_{Λ_{b}^{0}}B(Ξ_{b}^{-}→Λ_{b}^{0}π^{-})=(5.7±1.8_{-0.9}^{+0.8})×10^{-4},where f_{Ξ_{b}^{-}} and f_{Λ_{b}^{0}} are the b→Ξ_{b}^{-} and b→Λ_{b}^{0} fragmentation fractions, and B(Ξ_{b}^{-}→Λ_{b}^{0}π^{-}) is the branching fraction. Assuming f_{Ξ_{b}^{-}}/f_{Λ_{b}^{0}} is bounded between 0.1 and 0.3, the branching fraction B(Ξ_{b}^{-}→Λ_{b}^{0}π^{-}) would lie in the range from (0.57±0.21)% to (0.19±0.07)%.

Search for Hidden-Sector Bosons in B(0)→K(*0)μ(+)μ(-) Decays

A search is presented for hidden-sector bosons, χ, produced in the decay B(0)→K*(892)(0)χ, with K*(892)(0)→K(+)π(-) and χ→μ(+)μ(-). The search is performed using pp-collision data corresponding to 3.0  fb(-1) collected with the LHCb detector. No significant signal is observed in the accessible mass range 214≤m(χ)≤4350  MeV, and upper limits are placed on the branching fraction product B(B(0)→K*(892)(0)χ)×B(χ→μ(+)μ(-)) as a function of the mass and lifetime of the χ boson. These limits are of the order of 10(-9) for χ lifetimes less than 100 ps over most of the m(χ) range, and place the most stringent constraints to date on many theories that predict the existence of additional low-mass bosons.

First observation of top quark production in the forward region

Top quark production in the forward region in proton-proton collisions is observed for the first time. The W+b final state with W→μν is reconstructed using muons with a transverse momentum, p_{T}, larger than 25 GeV in the pseudorapidity range 2.0<η<4.5. The b jets are required to have 50<p_{T}<100  GeV and 2.2<η<4.2, while the transverse component of the sum of the muon and b-jet momenta must satisfy p_{T}>20  GeV. The results are based on data corresponding to integrated luminosities of 1.0 and 2.0  fb^{-1} collected at center-of-mass energies of 7 and 8 TeV by LHCb. The inclusive top quark production cross sections in the fiducial region are σ(top)[7  TeV]=239±53(stat)±33(syst)±24(theory)  fb,σ(top)[8  TeV]=289±43(stat)±40(syst)±29(theory)  fb.These results, along with the observed differential yields and charge asymmetries, are in agreement with next-to-leading order standard model predictions.

Measurement of the ratio of branching fractions B(B[over ¯]^{0}→D^{*+}τ^{-}ν[over ¯]_{τ})/B(B[over ¯]^{0}→D^{*+}μ^{-}ν[over ¯]_{μ})

The branching fraction ratio R(D^{*})≡B(B[over ¯]^{0}→D^{*+}τ^{-}ν[over ¯]_{τ})/B(B[over ¯]^{0}→D^{*+}μ^{-}ν[over ¯]_{μ}) is measured using a sample of proton-proton collision data corresponding to 3.0  fb^{-1} of integrated luminosity recorded by the LHCb experiment during 2011 and 2012. The tau lepton is identified in the decay mode τ^{-}→μ^{-}ν[over ¯]_{μ}ν_{τ}. The semitauonic decay is sensitive to contributions from non-standard-model particles that preferentially couple to the third generation of fermions, in particular, Higgs-like charged scalars. A multidimensional fit to kinematic distributions of the candidate B[over ¯]^{0} decays gives R(D^{*})=0.336±0.027(stat)±0.030(syst). This result, which is the first measurement of this quantity at a hadron collider, is 2.1 standard deviations larger than the value expected from lepton universality in the standard model.

Observation of J/ψp Resonances Consistent with Pentaquark States in Λ_{b}^{0}→J/ψK^{-}p Decays

Observations of exotic structures in the J/ψp channel, which we refer to as charmonium-pentaquark states, in Λ_{b}^{0}→J/ψK^{-}p decays are presented. The data sample corresponds to an integrated luminosity of 3 fb^{-1} acquired with the LHCb detector from 7 and 8 TeV pp collisions. An amplitude analysis of the three-body final state reproduces the two-body mass and angular distributions. To obtain a satisfactory fit of the structures seen in the J/ψp mass spectrum, it is necessary to include two Breit-Wigner amplitudes that each describe a resonant state. The significance of each of these resonances is more than 9 standard deviations. One has a mass of 4380±8±29 MeV and a width of 205±18±86 MeV, while the second is narrower, with a mass of 4449.8±1.7±2.5 MeV and a width of 39±5±19 MeV. The preferred J^{P} assignments are of opposite parity, with one state having spin 3/2 and the other 5/2.