Inhibited Inelastic Scattering of Incoherent Excitons for Near-Band Edge Excitations

A multiple pump-terahertz probe experiment enables the clear distinction between elastic and inelastic scattering of excitons with a free electron-hole plasma in (Ga,In)As multiquantum wells. Low plasma energies dictate the prevalence of elastic scattering by inhibiting inelastic processes due to the absence of final states for quasiparticles. Yet, an increased plasma energy results in a progressive destruction of excitons. Notably, despite plasma energy variations, the interaction strength between excitons and the electron-hole plasma remains unaltered.

The Changing Profile of Academic Radiation Oncology Leaders: Updates over the Past Decade

PURPOSE/OBJECTIVE(S)

To report objective characteristics of program directors (PDs) and chairpersons and examine contemporary trends of their demographic and academic profiles from 2013 to 2023. We hypothesize that there are significant changes in the profiles of our radiation oncology leaders over the past decade.

MATERIALS/METHODS

A total of 89 PDs and 85 chairpersons in the Accreditation Council for Graduate Medical Education (ACGME)-approved residency programs in the U.S were queried for analysis. Demographic data on race, ethnicity, post graduate training, years in practice were obtained from publicly available online resources (e.g., institutional websites and online networking services for physicians). Variables on academic productivity and professional accolades included Hirsh-index, National Institute of Health (NIH) research grant (R), the ASTRO fellowship designation, and leadership positions in professional society meetings. Descriptive analyses, including Fisher's exact tests, were performed to compare findings from the published article in 2013 on this topic (Wilson LD et al. IJROBP 2013).

RESULTS

A total of 36 out of 89 PDs (40.4%) and 11 out of 85 chairpersons (12.8%) were females, revealing higher proportion of females from the initial analysis: 40.4 vs. 24.1% for PDs (p = 0.025) and 12.8 vs. 9.2% for chairpersons (p = 0.618). 29 out of 89 (32.6%) PDs and 30 out of 85 (35.3%) chairpersons were non-White. The median length of practice for PDs and chairpersons were 11 and 29 years, respectively. 38 out of 89 PDs (42.7%) and 11 out of 85 (12.9%) chairpersons were employed at the institution of their training. 7 out of 89 (7.9%) for PDs and 51 out of 85 (60.0%) for chairpersons were awarded FASTRO designation. Median H-index showed increasing trends for PDs (14.5 vs 9) and chairpersons (40 vs 29) from the initial analysis.

CONCLUSION

While most PDs and chairpersons are males, female representation has increased in radiation oncology leadership in the last 10 years, most notably among PDs. Academic productivity among our leaders has also increased. These trends highlight the changes in the landscape of our leadership characteristics.

Construction of an active humidity regulation setup for NMR/MRI-Observation and simulation of the controlled evaporation of sessile water droplets

Controlling and improving processes like for example the production of organic semiconductors via printing depends on understanding the interplay of wetting and evaporation of complex fluids. Therefore, examination of the time dependent composition of complex fluid droplets during wetting or evaporation is of interest. The evaporation rate of sessile droplets containing largely water depends on the vapor pressures of the individual components and on the humidity (or partial pressure) of the surrounding gas phase. Hence, for a complete picture of an evaporation process and the comparability of the results of different measurements, it is essential to measure and control the humidity and temperature in the measurement compartment. Accordingly, climate chambers are available in different scales to fit a variety of techniques like contact angle goniometry to obtain results in a controlled atmosphere. We recently reported the application of MRI (Magnetic Resonance Imaging) and spatially resolved NMR (Nuclear Magnetic Resonance) spectroscopy for the examination of the evaporation of sessile droplets on surfaces in 10 mm NMR tubes. These are considered to be closed compartments. Here, we present an apparatus to a) measure and b) control the relative humidity within the sample compartment of the NMR setup by introducing preconditioned gas into the NMR tube. We monitored the evaporation of water droplets using RARE images and compared the volume decay with a) a simple diffusive evaporation model and b) with detailed FEM (finite element numerical model) simulations using COMSOL for validation. We find three evaporation regimes depending on the flow rate as well as on the distance of the gas outlet and the evaporating droplet. In one of the sample configurations tested the evaporation takes place in such a way that it can be described with the help of the simple diffusive model without convection. Thus, the presented approach opens comparative measurements with other methods as well as the observation of droplet evaporation in very dry or very humid environments with and without the influence of convection. Finally, using PRESS spectra, it is shown that the evaporation rate of water from a water/DMSO droplet can be controlled. This shows how the setup presented here can be used to study the evaporation of droplets of more complex mixtures.

Stent length and -diameter and long-term clinical outcomes following percutaneous coronary intervention with drug-eluting stent implantation

Background

Long total stent length and small stent diameter have been associated with adverse events following percutaneous coronary intervention (PCI).

Purpose

To assess whether stent length and -diameter influence long-term target-lesion failure (TLF) following implantation of contemporary drug-eluting stents (DES) in an all-comers population undergoing PCI.

Methods

Patients included in the ReCre8 trial were stratified for troponin status and diabetes and randomized to implantation of a permanent polymer (PP-ZES) or polymer-free stent (PF-AES). Troponin negative patients were treated with dual antiplatelet therapy for one month, and troponin positive patients for twelve months. For the analysis on stent length, patients were divided in the quartiles of total stent length implanted per patient. Group 1a had a stent length of ≤18mm, Group 2a had a total stent length between 18 and 30mm, Group 3a had a total stent length of ≥30mm and lower than 49mm, and Group 4a had a total stent length of 49mm or more. For the analysis on stent diameter, patients were divided in the quartiles of the smallest stent diameter implanted per patient. Group 1b had a minimal stent diameter of ≤2.5mm, Group 2b had a minimal stent diameter between 2.5 and 3mm, Group 3b had a minimal stent diameter of ≥3mm and lower than 3.5mm, and Group 4b had a minimal stent diameter of 3.5mm or higher. The primary endpoint of TLF and its components – cardiac death, target-vessel myocardial infarction and target-lesion revascularization (TLR) – were assessed after three years.

Results

After division of patients in subgroups based on stent length, Group 1a included 409 patients (27.6%), Group 2a included 322 patients (20.7%), Group 3a included 376 patients (25.3%) and Group 4a included 377 patients (25.4%). After three years, TLF occurred more frequently in Group 4a with 6.6% in Group 1a, 8.4% in Group 2a, 7.7% in Group 3a and 18.0% in Group 4a (p<0.001) as shown in Figure 1. This was driven by a higher rate of TLR (p<0.001) and target-vessel myocardial infarction (p<0.001) in Group 4a. After division of patients in subgroups based on stent diameter, Group 1b included 408 patients (27.5%), Group 2b included 214 patients (14.4%), Group 3b included 477 patients (32.1%) and Group 4b included 386 patients (26.0%). After three years, TLF occurred more frequently in Group 1b with 14.0% vs. 7.9% in Group 2b, 8.6% in Group 3b and 9.3% in Group 4b (p=0.0241) as shown in Figure 2. The difference in TLF was driven by a higher rate of TLR in Group 1b (8.6% vs. 3.7% vs. 4.4% vs. 4.9%; p=0.016).

Conclusion

In an all-comers population undergoing PCI with implantation of contemporary DES, a stent length ≥49mm and a stent diameter ≤2.5mm were associated with a higher rate of TLF after three years.

Funding Acknowledgement

Type of funding sources: None.

Scalable high-repetition-rate sub-half-cycle terahertz pulses from spatially indirect interband transitions

Intense phase-locked terahertz (THz) pulses are the bedrock of THz lightwave electronics, where the carrier field creates a transient bias to control electrons on sub-cycle time scales. Key applications such as THz scanning tunnelling microscopy or electronic devices operating at optical clock rates call for ultimately short, almost unipolar waveforms, at megahertz (MHz) repetition rates. Here, we present a flexible and scalable scheme for the generation of strong phase-locked THz pulses based on shift currents in type-II-aligned epitaxial semiconductor heterostructures. The measured THz waveforms exhibit only 0.45 optical cycles at their centre frequency within the full width at half maximum of the intensity envelope, peak fields above 1.1 kV cm^-1 and spectral components up to the mid-infrared, at a repetition rate of 4 MHz. The only positive half-cycle of this waveform exceeds all negative half-cycles by almost four times, which is unexpected from shift currents alone. Our detailed analysis reveals that local charging dynamics induces the pronounced positive THz-emission peak as electrons and holes approach charge neutrality after separation by the optical pump pulse, also enabling ultrabroadband operation. Our unipolar emitters mark a milestone for flexibly scalable, next-generation high-repetition-rate sources of intense and strongly asymmetric electric field transients.

Comparison of carbon ion and photon reirradiation for recurrent glioblastoma

PURPOSE

Purpose of this study was to investigate overall survival in recurrent glioblastoma treated with either carbon ion reirradiation or photon reirradiation.

MATERIALS AND METHODS

In this retrospective study we evaluated 78 consecutive patients with recurrent IDH (Isocitrate dehydrogenase)-wildtype glioblastoma (38 patients carbon ion re-radiotherapy, 40 patients photon re-radiotherapy) treated with either carbon ion reirradiation or stereotactic photon reirradiation. 45 Gy (RBE; 15 fractions) carbon ion reirradiation (CIRT) or 39 Gy (13 fractions) photon reirradiation (FSRT) was administered, respectively. Overall survival was investigated with respect to histological, clinical, and epidemiological features. Kaplan-Meier and multivariate Cox statistics were calculated. A propensity score-matched analysis of the FSRT and CIRT groups using variables from a validated prognosis score was carried out.

RESULTS

The type of reirradiation (CIRT vs. FSRT) significantly influenced overall survival-8.0 months vs. 6.5 months (univariate: p = 0.046)-and remained an independent prognostic factor in multivariate analysis (p = 0.017). Propensity score-adjusted analysis with CIRT versus FSRT as the dependent variable yielded a significant overall survival advantage for the CIRT group (median OS 8.9 versus 7.2 months, p = 0.041, 1‑year survival 29 versus 10%). Adverse events (AE) were evaluated for both subgroups. For the FSRT group no toxicity ≥ grade 4 occurred. For the CIRT subgroup no grade 5 AE occurred, but 1 patient developed a grade 4 radionecrosis. We encountered 4 grade 3 toxicities. One patient developed a zoster at the trunk, 2 progressed in their paresis, and 1 featured progressive dysesthesia.

CONCLUSION

In conclusion, carbon ion treatment is a safe and feasible treatment option for recurrent glioblastoma. Due to the retrospective nature of the study and two different dose levels for CIRT or FSRT, the improved outcome in CIRT reirradiation might be an effect of higher biological impact from carbon ions or a simple dose-escalation effect. This hypothesis needs prospective testing in larger patient cohorts. A prospective phase III randomized trial is in preparation at our center.

A210 HEPATOLITHIASIS IS A FREQUENT AND PROGNOSTIC FINDING IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS

Aims

Intrahepatic biliary stones (hepatolithiasis) are not well characterised in patients with primary sclerosing cholangitis (PSC).

Methods

Chart reviews were conducted on 302 patients with a histologic or radiographic diagnosis of PSC followed at the Toronto Centre for Liver Disease. Radiographic data were collected for patients between the years 2008–2018. Depending on frequency of testing, magnetic resonance imaging (MRI) and ultrasound (US) data was reviewed every 3–5 years. We assessed factors associated with hepatolithiasis based on sex, race, age and phenotype of PSC and inflammatory bowel disease (IBD). Qualitative radiographic findings on image report review, episodes of cholangitis, endoscopic retrograde cholangiopancreatography (ERCP) and occurrence of cholangiocarcinoma (CCA), death and transplant were documented. Data are reported with median and IQR and analysed using χ ² and Mann-Whitney U tests.

Results

302 patients were reviewed. The median time to follow-up, defined as from date of diagnosis to last clinic visit or to transplantation date, was 98 months (IQR = 87). The mean age at diagnosis was 38 (SD = 15.1) years; 54% of patients were male. A total of 224 patients had IBD (74%). Of the 302 patients, 80 patients (26%) had evidence of hepatolithiasis on US or MRI. Patients with hepatolithiasis were more likely to be younger (37.4 vs 39.1, p = 0.025), male (65% vs. 50%, p = 0.021), and have large duct disease (99% vs. 88%, p = 0.004). Imaging report review revealed patients with hepatolithiasis were more likely to have intrahepatic biliary thickening (76% vs. 45%, p < 0.001), extrahepatic biliary thickening (69% vs. 50%, p = 0.003), focal biliary dilation (96% vs. 78%, p < 0.001) and disease characterised by more reported strictures on qualitative imaging report review (89% vs 69%, p < 0.001). Concomitant presence of cholelithiasis was greater in the hepatolithiasis vs. the non-hepatolithiasis group (45% vs. 19%, p < 0.001). There was no significant difference in the prevalence of hepatic or portal venous thrombosis in both groups. Patients with hepatolithiasis more likely have experienced acute ascending cholangitis (50% vs. 20%, p < 0.001) and need for ERCP (50% vs. 35%, p = 0.020). CCA was numerically higher in the hepatolithiasis group (8.75% vs. 4%, p = 0.1). Patients with hepatolithiasis received transplant more frequently (26.3% vs 12.2%, p < 0.001) with no significant difference in mortality.

Conclusions

Hepatolithiasis is common in PSC and associated with an increased clinical and radiologic disease burden.

Funding Agencies

None

A systematic literature review on the use of health care resources during pandemic response

Background

The COVID-19 pandemic demonstrated the need for better pandemic preparedness and response, and more international collaboration. The H2020 EU-funded PANDEM-2 project aims to prepare Europe for future pandemics. As part of the project, an European dashboard consisting of epidemiological data and insights on available pandemic health care capacity is developed. To model and map the availability of pandemic resources, data on the use of these resources and interdependencies between resources are needed to parametrize the resource model of the PANDEM-2 dashboard.

Methods

We conduct a systematic literature review. The database Embase.com was searched on articles that include a model, scenario, or simulation of pandemic resources and/or describe resource parameters, for example PPE usage, length of stay on the ICU, or vaccine efficacy. Our search included data from all continents and focuses on infectious diseases that have been declared a pandemic by the WHO in the last twenty years, which are the H1N1 influenza (2009-2010) and COVID-19 (ongoing).

Preliminary results

The search query and additional sources resulted in 1215 articles, of which 187 are included for the full text eligibility assessment. We identified several pandemic resources in the field of vaccination (vaccine efficacy), contact tracing (apps), general practitioners, the hospital (staff, PPE, ventilators), and national and regional public health institutes. Furthermore, interdependencies between resources and possible resource gaps were found, for example in hospital staff and PPE.

Conclusions

To be better prepared and to be able to respond fast to a pandemic outbreak, it is important to have insight in the availability of pandemic resources on a national and regional level, their use and mutual dependencies. This makes it possible to anticipate on fast changes and possible shortages by reallocating resources within and between regions.

Importance of confirming the underlying diagnosis in patients with myocardial infarction and non-obstructive coronary arteries (MINOCA): a single-centre retrospective cohort study

BACKGROUND

Many patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) are discharged without a known aetiology for their clinical presentation. This study sought to assess the effect of this 'indeterminate MINOCA' diagnosis on the prevalence of recurrent cardiovascular events and presentations to the Cardiac Emergency Department (CED).

METHODS

We retrospectively analysed all patients meeting the diagnostic MINOCA criteria presenting at a large secondary hospital between January 2017 and April 2019.

PARTICIPANTS

Patients were divided into the (1) 'indeterminate MINOCA', or (2) 'MINOCA with diagnosis' group. The primary outcome was the occurrence of major adverse cardiac events (MACE) defined as the composite of all-cause mortality, non-fatal myocardial infarction, stroke and any revascularisation procedure. Secondary outcomes were all recurrent visits at the CED, and MACE including unplanned cardiac hospitalisation.

RESULTS

In 62/198 (31.3%) MINOCA patients, a conclusive diagnosis was found (myocardial infarction, (peri)myocarditis, cardiomyopathy, or miscellaneous). MINOCA patients with a confirmed diagnosis were younger compared to those with an indeterminate diagnosis (56.7 vs. 62.3 years, p = 0.007), had higher maximum troponin-T [238 ng/L vs. 69 ng/L, p < 0.001] and creatine kinase (CK) levels [212U/L vs. 152U/L, p = 0.007], and presented more frequently with electrocardiographic signs of ischaemia (71.0% vs. 47.1%, p = 0.002). Indeterminate MINOCA patients more often showed recurrent CED presentations (36.8% vs. 22.6%, p = 0.048), however the occurrence of cardiovascular events was equal (8.8 vs. 8.1%, p = 0.86). Multivariable analysis showed that elevated levels of troponin-T and CK, ST-segment deviation on electrocardiography, reduced left ventricular ejection fraction, regional wall motion abnormalities, and performance of additional examination methods were independent predictors for finding the underlying MINOCA cause.

CONCLUSIONS

Only in one-third of MINOCA patients a conclusive diagnosis for the acute presentation was identified. Recurrent CED visits were more often observed in the indeterminate MINOCA group, while the occurrence of cardiovascular events was similar across groups.

TRIAL REGISTRATION

Retrospectively registered.

The effect of myxomatous mitral valve disease severity on packed cell volume in dogs

OBJECTIVES

The aim of this study was to examine whether associations between disease severity and packed cell volume exist in dogs with myxomatous mitral valve disease.

MATERIALS AND METHODS

Data were selected from 289 dogs that had been examined at a research clinic (2004-2017) on multiple occasions (n=1465). American College of Veterinary Internal Medicine stage and echocardiographic measurements were entered in separate multivariable linear mixed effects models with packed cell volume as the dependent variable. Age, breed, sex, weight and blood urea nitrogen concentrations were additionally tested in these analyses to control for patient characteristics.

RESULTS

Packed cell volume (% whole blood) in stages B1 and B2 (B1: 42.62 ±0.27, P=0.001; B2: 41.77± 0.42, P < 0.001) was lower than stage A (44.57 ±0.53). In stage C, packed cell volume was greater than both preclinical stages (C: 43.84 ±0.46). When the administration of loop diuretics was included in statistical models, packed cell volume was inversely related to normalised left ventricular internal diameters (β: -2.37; 95% confidence intervals: -3.49, -1.25; P < 0.001).

CLINICAL SIGNIFICANCE

Dogs with myxomatous mitral valve disease may develop reductions in packed cell volume as their disease progresses. Although this finding was statistically significant at a population level, it should be noted that the differences described are relatively small. This, along with other causes of variation in packed cell volume, means that changes would be challenging to appreciate within individual patients. Plasma volume depletion following diuretic administration may explain why findings differed in stage C.

Sharing primary percutaneous coronary intervention care: first experiences with South Limburg ST-elevation myocardial infarction network

Background

In the region of South Limburg, the Netherlands, a shared ST-elevation myocardial infarction (STEMI) networking system (SLIM network) was implemented. During out-of-office hours, two percutaneous coronary intervention (PCI) centres—Maastricht University Medical Centre and Zuyderland Medical Centre—are supported by the same interventional cardiologist. The aim of this study was to analyse performance indicators within this network and to compare them with contemporary European Society of Cardiology guidelines.

Methods

Key time indicators for an all-comer STEMI population were registered by the emergency medical service and the PCI centres. The time measurements showed a non-Gaussian distribution; they are presented as median with 25th and 75th percentiles.

Results

Between 1 February 2018 and 31 March 2019, a total of 570 STEMI patients were admitted to the participating centres. The total system delay (from emergency call to needle time) was 65 min (53–77), with a prehospital system delay of 40 min (34–47) and a door-to-needle time of 22 min (15–34). Compared with in-office hours, out-of-office hours significantly lengthened system delays (55 (47–66) vs 70 min (62–81), p < 0.001), emergency medical service transport times (29 (24–34) vs 35 min (29–40), p < 0.001) and door-to-needle times (17 (14–26) vs 26 min (18–37), p < 0.001).

Conclusions

With its effective patient pathway management, the SLIM network was able to meet the quality criteria set by contemporary European revascularisation guidelines.

Sphingosine‑1‑phosphate analogue FTY720 exhibits a potent anti‑proliferative effect on glioblastoma cells

Sphingosine‑1‑phosphate (S1P) plays a key role in cell survival, growth, migration, and in angiogenesis. In glioma, it triggers the activity of the S1P‑receptor 1 and of the sphingosine kinase 1; thus influencing the survival rate of patients. The aim of the present study was to investigate the anti‑proliferative effect of the S1P analogue FTY720 (fingolimod) in glioblastoma (GBM) cells. A172, G28, and U87 cells were incubated with micromolar concentrations of FTY720 or temozolomide (TMZ) for 24 to 72 h. Proliferation and half maximal inhibitory concentration (IC50) were determined by using the xCELLigence system. FACS analysis was performed to check the cell cycle distribution of the cells after a 72‑h incubation with FTY720. This was then compared to TMZ‑incubated and to untreated cells. Gene expression was detected by RT‑qPCR in A172, G28, U87 and three primary GBM‑derived cell lines. FTY720 was able to reduce the number of viable cells. The IC50 value was 4.6 µM in A172 cells, 17.3 µM in G28 cells, and 25.2 µM in U87 cells. FTY720 caused a significant arrest of the cell cycle in all cells and stabilized or over‑expressed the level of AKT1, MAPK1, PKCE, RAC1, and ROCK1 transcripts. The TP53 transcript level remained stable or was downregulated after treatment with FTY720. FTY720 may be a promising target drug for the treatment of GBM, as it has a strong anti‑proliferative effect on GBM cells.

Direct comparison of predictive performance of PRECISE-DAPT versus PARIS versus CREDO-Kyoto: a subanalysis of the ReCre8 trial

Background

Multiple scores have been proposed to guide risk stratification after percutaneous coronary intervention. This study assessed the performance of the PRECISE-DAPT, PARIS and CREDO-Kyoto risk scores to predict post-discharge ischaemic or bleeding events.

Methods

A total of 1491 patients treated with latest-generation drug-eluting stent implantation were evaluated. Risk scores for post-discharge ischaemic or bleeding events were calculated and directly compared. Prognostic performance of both risk scores was assessed with calibration, Harrell’s c‑statistics net reclassification index and decision curve analyses.

Results

Post-discharge ischaemic events occurred in 56 patients (3.8%) and post-discharge bleeding events in 34 patients (2.3%) within the first year after the invasive procedure. C‑statistics for the PARIS ischaemic risk score was marginal (0.59, 95% confidence interval (CI) 0.51–0.68), whereas the CREDO-Kyoto ischaemic risk score was moderate (0.68, 95% CI 0.60–0.75). With regard to post-discharge bleeding events, CREDO-Kyoto displayed moderate discrimination (c-statistic 0.67, 95% CI 0.56–0.77), whereas PRECISE-DAPT (0.59, 95% CI 0.48–0.69) and PARIS (0.55, 95% CI 0.44–0.65) had a marginal discriminative capacity. Net reclassification index and decision curve analysis favoured CREDO-Kyoto-derived bleeding risk assessment.

Conclusion

In this contemporary all-comer population, PARIS and PRECISE-DAPT risk scores were not resilient to independent testing for post-discharge bleeding events. CREDO-Kyoto-derived risk stratification was associated with a moderate predictive capability for post-discharge ischaemic or bleeding events. Future studies are warranted to improve risk stratification with more focus on robustness and rigorous testing.

Electronic supplementary material

The online version of this article (10.1007/s12471-020-01486-y) contains supplementary material, which is available to authorized users.

0925 Associations Between Co-sleeping And Sleep Quality Of Urban Preschool Children

Introduction

Perspectives on co-sleeping vary by family cultural background and socio-demographic characteristics; furthermore, families may choose to co-sleep based on family values or out of necessity. To better understand the role of co-sleeping in young children from ethnic minority backgrounds, the current study sought to test the relationship between co-sleeping and sleep outcomes in an urban early childhood setting.

Methods

141 Parent-child dyads with children aged 1-5 years old (N=141,50.4% female, M=4.01 [SD=1.05]; 41% African American; 41% Latinx; median income $20-30,000) were recruited through an urban preschool. Parents completed demographic information and the Brief Child Sleep Questionnaire, which yielded insomnia and sleep hygiene indices. Step-wise regressions were used to examine the relationship between sleeping location and sleep outcomes (insomnia, sleep health, and child sleep quality), controlling for child age.

Results

Approximately half of the sample (n=71) reported that their child sleeps in a space shared by caregivers or siblings. Co-sleeping did not differ by race/ethnicity [χ 2(3)=1.45, p=.694], child age [F(1, 140)=2.15, p=.145], or income [χ 2(5)=7.05, p=.217]. Controlling for age, insomnia was higher in co-sleeping children [F(2,140)=4.10, p=.019], although sleep location was not a significant independent predictor. Sleep hygiene [F(2,140)=2.39, p=.095] and sleep quality [F(2,139)=0.94, p=.394] did not differ by sleeping location, when controlling for age.

Conclusion

Co-sleeping was common but was not related to sociodemographic factors as described in prior research. Controlling for age, co-sleeping predicted higher insomnia scores suggesting that co-sleeping may be related to symptoms of behavioral insomnia. Sleep hygiene practices and sleep quality did not differ by sleeping location, suggesting that in children without behavioral insomnia symptoms, co-sleeping may not affect sleep. Future studies that seek to better understand caregiver preference and intentions regarding co-sleeping may be important to intervention development seeking to improve behavioral insomnia in ethnic/minority samples.

Support

 

Nonlinear refraction in CH3NH3PbBr3 single crystals

We measure both nonlinear absorption and nonlinear refraction in a ${{\rm CH}_3}{{\rm NH}_3}{{\rm PbBr}_3}$CH₃NH₃PbBr₃ single crystal using the Z-scan technique with femtosecond laser pulses. At 1000 nm, we obtain values of 5.2 cm/GW and ${+}{9.5} \cdot {{10}^{ - 14}}\;{{\rm cm}^2}/{\rm W}$+9.5⋅10^-14cm²/W for nonlinear absorption and nonlinear refraction, respectively. The sign and magnitude of the observed refractive nonlinearity are reproduced well by the two-band model. Our results suggest that the large nonlinear refractive index measured in perovskite nanostructures cannot be explained by an intrinsically high bound-electronic nonlinear refractive index in this emerging material class but is possibly caused by free carriers or quantum confinement effects.

P14.110 Primary leptomeningeal melanocytic tumors - clinical course and molecular pathological aspects of an underestimated entity

BACKGROUND

Primary leptomeningeal melanocytic tumors (PLMT) of the central nervous system are extremely rare, usually benign pigmented tumors. The aim of our study is to present two complex cases of PLMT with discussion of clinical and molecular aspects.

MATERIAL AND METHODS

Medical charts of two patients from our institution with PLMT were reviewed. Oncogenic common gene mutations in GNAQ (Q209, exon 5), GNA11 (Q209, exon 5), TERT promoter and BRAF (exon 11, 15) were analyzed and a genome-wide DNA methylation array (Infinium Human-MethylationEPIC BeadChip) was performed. Brain tumors were categorized according to their DNA methylation profile using the brain tumor classifier algorithm (https://www.molecularneuropathology.org/mnp).

RESULTS

Case1: A 15 year-old boy presented with a large tumor in the in the cerebellopontine angle with extension to the cavernous sinus and the middle fossa in June 2013. Consequently, partial resection of the PLMT was performed followed by photon radiation therapy. First recurrence developed after 12 months. Despite reradiation with proton therapy, reresection, and several chemotherapies the patient died 4 years and 3 month after initial diagnosis. Histopathological examination of the resected tumor sample revealed a pigmented neoplasm with epithelioid cells with strong expression of melanocytic markers Melan A and HMB 45. In the recurrent biopsy samples, an increase in the Ki-67/MIB index from 2 to 10 % was observed. Molecular analysis showed a characteristic GNA11 Q209L mutation that supports the diagnosis of PLMT.

Case2: In April 2016 the resection of a PLMT in a 42 year-old female in the pinealis region was performed. First recurrence developed after 21 months and reresection followed by proton therapy was performed. A distant tumor developed 7 month later and after resection the patient received local proton therapy. Only 1 month later a new tentorial tumor was detected and treated by proton therapy. Tumor tissue of the local recurrence showed focal epitheloid cell morphology with brain invasion, tumor necrosis and increased mitotic activity. KI-67/MIB1 index was approximately 3% in the first and above 10 % in the second and third operation. The hotspot mutation in GNAQ Q209L was found in all tumor samples. In addition to histological signs of malignancy, an increase in chromosomal aberrations was seen at recurrence as a sign of malignant progression. To-date the patient is alive but new cranial metastases were detected.

CONCLUSION

Though PLMT is defined as benign lesion, the treatment is complicated by early local recurrence as well as intracranial and spinal metastases. For the first time malignant transformation during the clinical course of PLMT was confirmed by histology and DNA methylation array.

P14.07 Complete response under treatment with proton therapy followed by chemotherapy together with Tumor Treating Fields in a biopsied IDH wildtype glioblastoma patient

BACKGROUND

Proton therapy is able to apply high radiation doses to the tumor while sparing healthy tissues by reducing integral dose. Tumor Treating Fields (TTFields) are low intensity (1–3 V/cm) and intermediate frequency (100–300 kHz) alternating electric fields that demonstrated significantly increased survival rates in combination with adjuvant temozolomide (TMZ) in patients with newly diagnosed glioblastoma (ndGBM). Especially in ndGBM IDH wildtype with unmethylated MGMT promotor therapeutic options are restricted. Here, we report on a patient with biopsied ndGBM IDH wildtype with complete radiological response.

MATERIAL AND METHODS

Brain MRI demonstrated an occlusive hydrocephalus and a ring enhancing lesion in the right posterior thalamus in a 42 year old male. Endoscopic third ventriculostomy and stereotactic biopsy of the lesion were performed. Histopathological examination resulted in the diagnosis of a glioblastoma (WHO grade IV), IDH 1 wildtype (R132), IDH 2 wildtype (R172), HIST1H3B/C wildtype, TERT wildtype (C228 and C250), BRAF wildtype, and unmethylated MGMT promotor. In view of the tumor site, resection was not feasible. Consequently, the patient received definitive chemoradiation with TMZ to a total dose of 60Gy incl. proton boost of 5x2 GyRBE. TTFields therapy in combination with TMZ was initiated 4 weeks after completion of chemoradiation, TMZ maintenance was completed per protocol after 6 cycles. TTFields therapy was continued for more than 13 month and to-date the patient is still on therapy.

RESULTS

Current follow up time is 20 months after initial diagnosis with the patient showing a radiological complete response. The first MRI following chemoradiation with TMZ and protons (showed pseudoprogression. After 3 months, the MRI again showed slightly increasing contrast enhancement. However, no clinical symptoms of tumor progression were present. The TTFields usage (compliance) rate, i.e. the rate per time the patient is applying the therapy, of the patient was 86 %. This was well above the independent prognostic threshold of 75 % and supports the feasibility of this approach. A further MRI after 8 weeks showed a stable disease. In a MRI 4 months later, partial response with decreased contrast enhancement plus perfusion restriction in the tumor area was observed. Another MRI after 3 months showed a complete response without perfusion signal in the tumor area. In the clinical examination the patient had no neurological deficits and to-date the patient is still stable

CONCLUSION

Complete response was observed following combination treatment of chemoradiation with TMZ including proton boost, TMZ maintenance and TTFields in a patient with pathologically confirmed GBM IDH wildtype. To our knowledge, this is the first report on a ndGBM patient receiving proton therapy followed by TTFields therapy.

Room-Temperature Stimulated Emission and Lasing in Recrystallized Cesium Lead Bromide Perovskite Thin Films

Cesium lead halide perovskites are of interest for light-emitting diodes and lasers. So far, thin-films of CsPbX₃ have typically afforded very low photoluminescence quantum yields (PL-QY < 20%) and amplified spontaneous emission (ASE) only at cryogenic temperatures, as defect related nonradiative recombination dominated at room temperature (RT). There is a current belief that, for efficient light emission from lead halide perovskites at RT, the charge carriers/excitons need to be confined on the nanometer scale, like in CsPbX₃ nanoparticles (NPs). Here, thin films of cesium lead bromide, which show a high PL-QY of 68% and low-threshold ASE at RT, are presented. As-deposited layers are recrystallized by thermal imprint, which results in continuous films (100% coverage of the substrate), composed of large crystals with micrometer lateral extension. Using these layers, the first cesium lead bromide thin-film distributed feedback and vertical cavity surface emitting lasers with ultralow threshold at RT that do not rely on the use of NPs are demonstrated. It is foreseen that these results will have a broader impact beyond perovskite lasers and will advise a revision of the paradigm that efficient light emission from CsPbX₃ perovskites can only be achieved with NPs.

Serum Cortisol as an Early Biomarker of Cardiopulmonary Parameters Within the First 24 Hours After Aneurysmal Subarachnoid Hemorrhage in Intensive Care Unit Patients

OBJECTIVE

Cardiopulmonary complications/stress are well-known phenomena in patients after aneurysmal subarachnoid hemorrhage (aSAH) and might be associated with an elevated serum troponin I (TNI) level. Since the glucocorticoid hormone cortisol is released during stress situations, the present study was conducted to investigate the influence of serum cortisol (SC) on cardiac and pulmonary parameters in patients after aSAH within the first 24 hours of intensive care unit (ICU) treatment.

PATIENTS AND METHODS

We retrospectively analyzed a cohort of 104 patients with aSAH admitted to our emergency department between January 2008 and April 2017. Blood samples were taken to determine SC and TNI. Demographics, initial Glasgow Coma Scale (GCS) score, World Federation of Neurosurgical Societies (WFNS) score, and Fisher grade were evaluated retrospectively. Mean norepinephrine application rate (NAR) in µg/kg/min and mean inspiratory oxygen fraction (OF) within the first 24 hours were defined as cardiopulmonary parameters.

RESULTS

An elevated SC value was found in 44 (42%) patients, and 27 (26%) patients showed an increased TNI value. In patients with initially increased SC value, a significant higher NAR (P = .04) was needed. Furthermore, patients with initially elevated TNI value had a lower GCS score (P = .0013) and a higher WFNS score (P = .003) on admission and required a higher NAR (P = .02) as well as OF (P = .0008) within the first 24 hours of ICU treatment.

CONCLUSIONS

In the current study, initially elevated SC values were associated with a higher need of NAR within the first 24 hours of ICU treatment after aSAH. Moreover, patients with initially elevated TNI values required an increased NAR and a higher OF so that these biomarkers could be useful to improve ICU treatment.

Erratum: First Dark Matter Constraints from a SuperCDMS Single-Charge Sensitive Detector [Phys. Rev. Lett. 121, 051301 (2018)]

This corrects the article DOI: 10.1103/PhysRevLett.121.051301.

Inhibition of polarity-regulating kinase PAR1b contributes to Helicobacter pylori inflicted DNA Double Strand Breaks in gastric cells

The serine/threonine kinase Par1 is a core component of the machinery that sets up polarity in the embryo and regulates cell fate decisions but its role in the homeostasis of adult tissues is poorly understood. Inhibition of Par1 by the bacterium Helicobacter pylori (H. pylori) represents the only established pathology that affects Par1 function in an adult epithelium. Thus, during chronic H. pylori infection of the gastric mucosa Par1 is one of the targets of the non-obligate H.pylori cytotoxic protein and oncogene CagA, which stimulates inflammation and triggers morphological changes, both believed to contribute to the gastric cancer risk imposed by H. pylori infection. Based on Par1's role in cell polarity, it has been speculated that Par1 inhibition affects epithelial polarity. Here we report the unexpected finding that CagA-mediated Par1-inhibition promotes the generation of DNA Double Strand Breaks in primary gastric epithelial cells, which likely contributes to the reported accumulation of mutations in chronically infected mucosal cells. Abbreviations: AGS: human gastric adenocarcinoma cell line; CM: CagA Multimerization (and Par1 binding) domain; H. pylori: Helicobacter pylori; DSB: Double Strand Break; HGECs: human (primary) gastric epithelial cells; IB: immunoblot; IF: immunofluorescence; MOI: Multiplicity of Infection; ROS: reactive oxygen species; Par1: Partitioning Defective 1 kinase; WT: wild type.

Correlation of optical properties and interface morphology in type-II semiconductor heterostructures

(Ga,In)As/GaAs/Ga(As,Sb) and (Ga,In)As/GaAs/Ga(N,As) type-II double quantum well heterostructures have been grown by metal-organic vapor phase epitaxy. A growth interruption procedure was used to intentionally modify the morphology of the internal interfaces. The heterostructures were investigated using continuous wave and time-resolved photoluminescence as well as optical pump-optical probe spectroscopy. We find a correlation between the interface morphology and optical and kinetic properties. A growth interruption of about 120 s yielded substantially smoother interfaces both on vertical as well as lateral length scales. On the other hand a considerably enhanced type-II recombination time as well as a longer electron tunneling time are observed. We attribute this to a reduced interface localization in case of smoother interfaces.

Tolerability of inhaled N-chlorotaurine in humans: a double-blind randomized phase I clinical study

BACKGROUND

N-chlorotaurine (NCT), a long-lived oxidant produced by human leukocytes, can be synthesized chemically and used topically as a well-tolerated antiseptic to different body regions including sensitive ones. The aim of this study was to test the tolerability of inhaled 1% NCT in aqueous solution upon repeated application.

METHODS

The study was performed double-blind and randomized with a parallel test group (1% NCT) and control group (0.9% NaCl as placebo). There were two Austrian centres involved, the hospitals, Natters and Vöcklabruck. Healthy, full age volunteers were included, 12 in each centre. A total of 12 patients were treated with NCT, and 12 with placebo, exactly half of each group from each centre. The single dose was 1.2 ml inhaled over a period of 10 min using an AKITA JET nebulizer. One inhalation was done every day for five consecutive days. The primary criterion of evaluation was the forced expiratory volume in 1 second (FEV₁). Secondary criteria were subjective sensations, further lung function parameters such as airway resistance, physical examination, and blood analyses (gases, electrolytes, organ function values, pharmacokinetic parameters taurine and methionine, immune parameters).

RESULTS

All included 15 females and 9 males completed the treatment and the control examinations according to the study protocol. FEV₁ (100.83% ± 8.04% for NCT and 92.92% ± 11.35% for controls) remained unchanged and constant during the treatment and in control examinations 1 week and 3 months after the treatment (98.75% ± 7.37% for NCT and 91.17% ± 9.46% for controls, p > 0.082 between time points within each group). The same was true for all other objective parameters. Subjective mild sensations with a higher frequency in the test group were chlorine taste ( p < 0.01) and occasional tickle in the throat ( p = 0.057). Taurine and methionine plasma concentrations did not change within 60 min after inhalation or later on.

CONCLUSIONS

Inhaled NCT is well tolerated as in other applications of different body regions. Side effects are mild, topical and transitory. The study was registered prospectively in the European Clinical Trials Database of the European Medicines Agency. The EudraCT number is 2012-003700-12.

First Dark Matter Constraints from a SuperCDMS Single-Charge Sensitive Detector

We present the first limits on inelastic electron-scattering dark matter and dark photon absorption using a prototype SuperCDMS detector having a charge resolution of 0.1 electron-hole pairs (CDMS HVeV, a 0.93 g CDMS high-voltage device). These electron-recoil limits significantly improve experimental constraints on dark matter particles with masses as low as 1  MeV/c^{2}. We demonstrate a sensitivity to dark photons competitive with other leading approaches but using substantially less exposure (0.49 g d). These results demonstrate the scientific potential of phonon-mediated semiconductor detectors that are sensitive to single electronic excitations.

Enhanced Absorption by Linewidth Narrowing in Optically Excited Type-II Semiconductor Heterostructures

We experimentally report a surprising linewidth narrowing of the direct exitonic 1  s heavy-hole transition in a type-II quantum well system. This narrowing, which builds up on a pico- to nanosecond timescale, causes a transient enhanced absorption at the spectral peak position of the excitonic resonance. We discuss how this effect depends on experimental parameters such as excitation density, temperature, and barrier width. We cannot attribute this effect to known physical mechanisms.

Evaluation of three MALDI-TOF mass spectrometry libraries for the identification of filamentous fungi in three clinical microbiology laboratories in Manitoba, Canada

Matrix-assisted laser desorption ionisation-time of flight mass spectrometry (MALDI-TOF MS) is commonly used by clinical microbiology laboratories to identify bacterial pathogens and yeasts, but not for the identification of moulds. Recent progress in extraction protocols and the composition of comparative libraries support potential application of MALDI-TOF MS for mould identification in clinical microbiology laboratories. We evaluated the performance of the Bruker Microflex™ MALDI-TOF MS instrument (Billerica, MA, USA) to identify clinical isolates and reference strains of moulds using 3 libraries, the Bruker mould library, the National Institutes of Health (NIH) library and the Mass Spectrometry Identification (MSI) online library, and compared those results to conventional (morphological) and molecular (18S/ITS; gold standard) identification methods. All 3 libraries demonstrated greater accuracy in genus identification (≥94.9%) than conventional methods (86.4%). MALDI-TOF MS identified 73.3% of isolates to species level compared to only 31.7% by conventional methods. The MSI library demonstrated the highest rate of species-level identification (72.0%) compared to NIH (19.5%) and Bruker (13.6%) libraries. Greater than 20% of moulds remained unidentified to species level by all 3 MALDI-TOF MS libraries primarily because of library limitations or imperfect spectra. The overall identification rate of each MALDI-TOF MS library depended on the number of species and the number of spectra representing each species in the library.

Disseminated Mycobacterium bovis infection post-kidney transplant following remote intravesical BCG therapy for bladder cancer

Intravesical Bacillus Camlette-Guérin (BCG) is the treatment of choice for non-muscle invasive bladder cancer, and has been used successfully for over 40 years. A rare and potentially fatal complication of intravesical BCG therapy is BCG-induced sepsis. We report a rare case in which a patient with end-stage renal disease secondary to chronic granulomatous interstitial nephritis underwent remote, pre-transplant intravesical BCG treatment for high-grade non-invasive papillary bladder carcinoma. The patient subsequently received a deceased donor kidney transplant 5 years after BCG therapy, with thymoglobulin induction therapy and standard triple maintenance immunosuppression. Two years post-transplant, he developed BCG-induced sepsis confirmed by cultures from urine, blood, and left native kidney biopsy. He died from disseminated BCG-induced sepsis and failure of his renal allograft. This case highlights the potential adverse reactions associated with intravesical BCG therapy that may occur years after bladder cancer therapy is completed, and should heighten physician awareness for BCG-related infections during pre-transplant assessment and post-transplant care of solid organ transplants recipients.

Pathological Stage I Endometrial Carcinoma: The Role for Adjuvant Radiotherapy

Background

In order to assess the efficacy of adjuvant radiotherapy in the treatment of pathological stage I endometrial carcinoma, we performed a retrospective analysis of 158 patients with this diagnosis who after surgery were either treated with radiation therapy or only followed from January 1980 through December 1987.

Methods

Patients were divided into two prognostic categories, high and low risk, on the basis of three known predictors of survival: histology, differentiation, and depth of myometrial invasion. All patients underwent total abdominal hysterectomy and bilateral salpingooophorectomy but only the high risk group received radiotherapy as well.

Results

After a median follow up time of 59 months the survival rates of the two groups were similar. The 5-year disease-free survival of the surgery alone group was 92 % compared to 89 % for the postoperative radiotherapy group. Side effects of treatment were minimal.

Conclusions

Postoperative radiation therapy for high risk pathological stage I endometrial carcinoma is an effective adjuvant therapy and confers an excellent prognosis.

Composition of Anopheline (Diptera: Culicidae) Community and Its Seasonal Variation in Three Environments of the City of Puerto Iguazú, Misiones, Argentina

In order to extend the knowledge of the composition of the anopheline community and the seasonal variation related to anthropogenic modifications in the city of Puerto Iguazú, adult females were captured between 2009 and 2012. Samples were collected in three environments with different degrees of anthropogenic modification: urban, periurban, and wild. Alpha diversity was evaluated as the 'true' diversity of the species in each environment. Among environments, range-abundance curves were used to compare the composition, abundance, and uniformity of species and cluster analysis was used to analyze the similarities and differences. The temporal distribution was analyzed and the relative abundance of the species captured was correlated with meteorological variables. A total of 4,565 females, belonging to seven species: Anopheles albitarsis s.s. (Lynch-Arribálzaga), Anopheles argyritarsis (Robineau-Desvoidy), Anopheles deaneorum (Rosa-Freitas), Anopheles fluminensis (Root), Anopheles mediopunctatus (Theobald), Anopheles strodei s.l. (Root), and Anopheles triannulatus s.l. (Neiva and Pinto) were captured. The wild environment showed higher abundance, diversity, and greater uniformity reflected on the less sharp area of the range-abundance curve. Species richness was the same in the wild and periurban environments. Higher abundances were observed in summer during the months with higher temperatures. Although the wild environment showed greater Anopheles abundances and diversity, specific richness and species complementarity were similar among the three environments studied. Thus, the periurban environment would turn into a transition zone of great epidemiological importance due to the introduction of people in this environment, which represents a potential risk of malaria transmission in the area.