Health-related quality of life across disease stages in patients with amyotrophic lateral sclerosis: results from a real-world survey

BACKGROUND

Amyotrophic lateral sclerosis (ALS) is characterized by a rapid disease course, with disease severity being associated with declining health-related quality of life (HRQoL) in persons living with ALS (pALS). The main objective of this study was to assess the impact of disease progression on HRQoL across King's, Milano-Torino Staging (MiToS), and physician-judgement clinical staging. Additionally, we evaluated the impact of the disease on the HRQoL of care partners (cALS).

METHODS

Data were sourced from the Adelphi ALS Disease Specific Programme (DSP)™, a cross-sectional survey of neurologists, pALS and cALS presenting in a real-world clinical setting between July 2020 and March 2021 in Europe and the United States.

RESULTS

Neurologists (n = 142) provided data for 880 pALS. There were significant negative correlations between all three clinical staging systems and EuroQol (European Quality of Life) Five Dimension Five Level Scale (EQ-5D-5L) utility scores and visual analogue scale (VAS) ratings. Although not all differences were significant, 5-item Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-5) scores showed a stepwise increase in HRQoL impairment at each stage of the disease regardless of the staging system. At later stages, high levels of fatigue and substantial activity impairment were reported. As pALS disease states progressed, cALS also experienced a decline in HRQoL and increased burden.

CONCLUSIONS

Across outcomes, pALS and cALS generally reported worse outcomes at later stages of the disease, highlighting an unmet need in this population for strategies to maximise QoL despite disease progression. Recognition and treatment of symptoms such as pain and fatigue may lead to improved outcomes for pALS and cALS.

Factors associated with increased radiation exposure in the fixation of proximal femoral fractures

INTRODUCTION

When using radiation intraoperatively, a surgeon should aim to keep the radiation dose as low as is reasonably achievable to obtain the therapeutic goal. We aimed to investigate factors associated with increased radiation exposure in fixation of proximal femur fractures.

METHODS

We assessed 369 neck of femur fractures over a 1-year period in a district general hospital. All hip fracture subtypes that had undergone surgical fixation were included. We assessed the relationship between type of fracture, implants used and surgeon level of experience with the dose-area product (DAP; cGy/cm2) and screening time (dS). We also looked at the quality of reduction and fixation and its effect on the radiation exposure.

RESULTS

A total of 184 patients were included in our analysis; 185 patients who were treated with hip arthroplasty were excluded. There was a significant association between higher DAP and fracture subtype (p = 0.001), fracture complexity (p < 0.001), if an additional implant was used (p = 0.001), if fixation was satisfactory (p = 0.002) and operative time (p < 0.001). DAP was higher with a proximal femoral nail than with a dynamic hip screw, especially when a long nail was used. There was some evidence of an association between the surgeon's level of experience and DAP exposure, although this was not statistically significant (p = 0.069).

CONCLUSIONS

Increased radiation in proximal femur fractures is seen in the fixation of complex fractures, some subtypes, with certain types of implants used and if an additional implant was required. Surgeon seniority did not result in less radiation exposure, which is in contrast to other published studies.

In silico interrogation of the miRNAome of infected hematopoietic cells to predict processes important for human cytomegalovirus latent infection

Human cytomegalovirus (HCMV) latency in CD34+ progenitor cells is the outcome of a complex and continued interaction of virus and host that is initiated during very early stages of infection and reflects pro- and anti-viral activity. We hypothesized that a key event during early infection could involve changes to host miRNAs, allowing for rapid modulation of the host proteome. Here, we identify 72 significantly upregulated miRNAs and three that were downregulated by 6hpi of infection of CD34+ cells which were then subject to multiple in silico analyses to identify potential genes and pathways important for viral infection. The analyses focused on the upregulated miRNAs and were used to predict potential gene hubs or common mRNA targets of multiple miRNAs. Constitutive deletion of one target, the transcriptional regulator JDP2, resulted in a defect in latent infection of myeloid cells; interestingly, transient knockdown in differentiated dendritic cells resulted in increased viral lytic IE gene expression, arguing for subtle differences in the role of JDP2 during latency establishment and reactivation of HCMV. Finally, in silico predictions identified clusters of genes with related functions (such as calcium signaling, ubiquitination, and chromatin modification), suggesting potential importance in latency and reactivation. Consistent with this hypothesis, we demonstrate that viral IE gene expression is sensitive to calcium channel inhibition in reactivating dendritic cells. In conclusion, we demonstrate HCMV alters the miRNAome rapidly upon infection and that in silico interrogation of these changes reveals new insight into mechanisms controlling viral gene expression during HCMV latency and, intriguingly, reactivation.

Anomalous Glide Plane in Platinum Nano- and Microcrystals

At the nanoscale, the properties of materials depend critically on the presence of crystal defects. However, imaging and characterizing the structure of defects in three dimensions inside a crystal remain a challenge. Here, by using Bragg coherent diffraction imaging, we observe an unexpected anomalous {110} glide plane in two Pt submicrometer crystals grown by very different processes and having very different morphologies. The structure of the defects (type, associated glide plane, and lattice displacement) is imaged in these faceted Pt crystals. Using this noninvasive technique, both plasticity and unusual defect behavior can be probed at the nanoscale.

Kinematic scattering by nanocrystals

Various formulations are compared which describe diffraction from ultra-thin single-crystal films in the symmetric scattering configuration, showing that, for this thickness range, several implicit assumptions in these formulations are no longer satisfied. Consequently, the position, integrated intensity and integral breadth of a diffraction peak cannot be related to the lattice spacing of the material or the number of unit cells along the diffraction vector using traditional analysis methods. Some simple equations are proposed to obtain the correct values of these parameters for this specific sample/diffraction geometry combination. More generally, the development of rigorous formalisms for analyzing diffraction from nanocrystals is proposed.

Artificial intelligence software standardizes electrogram-based ablation outcome for persistent atrial fibrillation

INTRODUCTION

Multiple groups have reported on the usefulness of ablating in atrial regions exhibiting abnormal electrograms during atrial fibrillation (AF). Still, previous studies have suggested that ablation outcomes are highly operator- and center-dependent. This study sought to evaluate a novel machine learning software algorithm named VX1 (Volta Medical), trained to adjudicate multipolar electrogram dispersion.

METHODS

This study was a prospective, multicentric, nonrandomized study conducted to assess the feasibility of generating VX1 dispersion maps. In 85 patients, 8 centers, and 17 operators, we compared the acute and long-term outcomes after ablation in regions exhibiting dispersion between primary and satellite centers. We also compared outcomes to a control group in which dispersion-guided ablation was performed visually by trained operators.

RESULTS

The study population included 29% of long-standing persistent AF. AF termination occurred in 92% and 83% of the patients in primary and satellite centers, respectively, p = 0.31. The average rate of freedom from documented AF, with or without antiarrhythmic drugs (AADs), was 86% after a single procedure, and 89% after an average of 1.3 procedures per patient (p = 0.4). The rate of freedom from any documented atrial arrhythmia, with or without AADs, was 54% and 73% after a single or an average of 1.3 procedures per patient, respectively (p < 0.001). No statistically significant differences between outcomes of the primary versus satellite centers were observed for one (p = 0.8) or multiple procedures (p = 0.4), or between outcomes of the entire study population versus the control group (p > 0.2). Interestingly, intraprocedural AF termination and type of recurrent arrhythmia (i.e., AF vs. AT) appear to be predictors of the subsequent clinical course.

CONCLUSION

VX1, an expertise-based artificial intelligence software solution, allowed for robust center-to-center standardization of acute and long-term ablation outcomes after electrogram-based ablation.

In Situ Nano-Indentation of a Gold Sub-Micrometric Particle Imaged by Multi-Wavelength Bragg Coherent X-ray Diffraction

The microstructure of a sub-micrometric gold crystal during nanoindentation is visualized by in situ multi-wavelength Bragg coherent X-ray diffraction imaging. The gold crystal is indented using a custom-built atomic force microscope. A band of deformation attributed to a shear band oriented along the (221) lattice plane is nucleated at the lower left corner of the crystal and propagates towards the crystal center with increasing applied mechanical load. After complete unloading, an almost strain-free and defect-free crystal is left behind, demonstrating a pseudo-elastic behavior that can only be studied by in situ imaging while it is invisible to ex situ examinations. The recovery is probably associated with reversible dislocations nucleation/annihilation at the side surface of the particle and at the particle-substrate interface, a behavior that has been predicted by atomistic simulations. The full recovery of the particle upon unloading sheds new light on extraordinary mechanical properties of metal nanoparticles obtained by solid-state dewetting.

Three strategies when physicians provide complex information in interactions with patients: How to recognize and measure them

OBJECTIVE

To define and operationalize three taught strategies for providing information in interactions with patients using videos collected in a randomized controlled trial (RCT).

METHODS

This was a qualitative exploratory study embedded in a randomized controlled design, using microanalysis of face-to-face dialogue as an inductive video analysis method to operationalize physicians' use of three information-provision strategies. Data were 34 video-recorded simulated (but unscripted) interactions between 17 physicians and 34 multiple sclerosis patients collected before and after a brief course on information provision. We operationalized (1) mapping the patient's preferences and (2) checking the patient's understanding, and pauses indicative of (3) portioning information.

RESULTS

Results are detailed analytical definitions, criteria, and assessable, quantifiable outcomes for each of the three strategies. Patients responded to portioning pauses as expected: whereas 91% of these pauses elicited an immediate patient response, only 23% of non-portioning pauses did so.

CONCLUSION

Our methods revealed how to define and evaluate information sharing strategies physicians used within the contingencies of clinical interaction.

PRACTICE IMPLICATIONS

Findings provide applicable methods to teach, analyze, and evaluate information sharing strategies and indications for further training.

Imaging the facet surface strain state of supported multi-faceted Pt nanoparticles during reaction

Nanostructures with specific crystallographic planes display distinctive physico-chemical properties because of their unique atomic arrangements, resulting in widespread applications in catalysis, energy conversion or sensing. Understanding strain dynamics and their relationship with crystallographic facets have been largely unexplored. Here, we reveal in situ, in three-dimensions and at the nanoscale, the volume, surface and interface strain evolution of single supported platinum nanocrystals during reaction using coherent x-ray diffractive imaging. Interestingly, identical {hkl} facets show equivalent catalytic response during non-stoichiometric cycles. Periodic strain variations are rationalised in terms of O₂ adsorption or desorption during O₂ exposure or CO oxidation under reducing conditions, respectively. During stoichiometric CO oxidation, the strain evolution is, however, no longer facet dependent. Large strain variations are observed in localised areas, in particular in the vicinity of the substrate/particle interface, suggesting a significant influence of the substrate on the reactivity. These findings will improve the understanding of dynamic properties in catalysis and related fields.

Understanding strain dynamics and their relationship with crystallographic facets have been largely unexplored. Here the authors demonstrate how the 3D lattice displacement and strain evolution depend on the crystallographic facets of Pt nanoparticles during CO oxidation reaction, providing new insights in the relationship between facet-related surface strain and chemistry.

Bragg coherent diffraction imaging of single 20 nm Pt particles at the ID01-EBS beamline of ESRF

This work demonstrates three-dimensional Bragg coherent diffraction imaging of single 20 nm Pt particles at the ID01-EBS beamline of ESRF.

Electronic or catalytic properties can be modified at the nanoscale level. Engineering efficient and specific nanomaterials requires the ability to study their complex structure–property relationships. Here, Bragg coherent diffraction imaging was used to measure the three-dimensional shape and strain of platinum nanoparticles with a diameter smaller than 30 nm, i.e. significantly smaller than any previous study. This was made possible by the realization of the Extremely Brilliant Source of ESRF, The European Synchrotron. This work demonstrates the feasibility of imaging the complex structure of very small particles in three dimensions and paves the way towards the observation of realistic catalytic particles.

X-ray Diffraction Imaging of Deformations in Thin Films and Nano-Objects

The quantification and localization of elastic strains and defects in crystals are necessary to control and predict the functioning of materials. The X-ray imaging of strains has made very impressive progress in recent years. On the one hand, progress in optical elements for focusing X-rays now makes it possible to carry out X-ray diffraction mapping with a resolution in the 50–100 nm range, while lensless imaging techniques reach a typical resolution of 5–10 nm. This continuous evolution is also a consequence of the development of new two-dimensional detectors with hybrid pixels whose dynamics, reading speed and low noise level have revolutionized measurement strategies. In addition, a new accelerator ring concept (HMBA network: hybrid multi-bend achromat lattice) is allowing a very significant increase (a factor of 100) in the brilliance and coherent flux of synchrotron radiation facilities, thanks to the reduction in the horizontal size of the source. This review is intended as a progress report in a rapidly evolving field. The next ten years should allow the emergence of three-dimensional imaging methods of strains that are fast enough to follow, in situ, the evolution of a material under stress or during a transition. Handling massive amounts of data will not be the least of the challenges.

Crystallographic Anisotropy Dependence of Interfacial Sliding Phenomenon in a Cu(16)/Nb(16) ARB (Accumulated Rolling Bonding) Nanolaminate

Nanolaminates are extensively studied due to their unique properties, such as impact resistance, high fracture toughness, high strength, and resistance to radiation damage. Varieties of nanolaminates are being fabricated to achieve high strength and fracture toughness. In this study, one such nanolaminate fabricated through accumulative roll bonding (Cu(16)/Nb(16) ARB nanolaminate, where 16 nm is the layer thickness) was used as a test material. Cu(16)/Nb(16) ARB nanolaminate exhibits crystallographic anisotropy due to the existence of distinct interfaces along the rolling direction (RD) and the transverse direction (TD). Nanoindentation was executed using a Berkovich tip, with the main axis oriented either along TD or RD of the Cu(16)/Nb(16) ARB nanolaminate. Subsequently, height profiles were obtained along the main axis of the Berkovich indent for both TD and RD using scanning probe microscopy (SPM), which was later used to estimate the pile-up along the RD and TD. The TD exhibited more pile-up than the RD due to the anisotropy of the Cu(16)/Nb(16) ARB interface and the material plasticity along the TD and RD. An axisymmetric 2D finite element analysis (FEA) was also performed to compare/validate nanoindentation data, such as load vs. displacement curves and pile-up. The FEA simulated load vs. displacement curves matched relatively well with the experimentally generated load–displacement curves, while qualitative agreement was found between the simulated pile-up data and the experimentally obtained pile-up data. The authors believe that pile-up characterization during indentation is of great importance to documenting anisotropy in nanolaminates.

High lead level in the Alps in XIXth century, learning from the analysis of 138 historical hair stands

Analysis of hair is known to provide useful information about environmental and toxic exposures. Very little historical use has been made of this type of investigation. Here we study 138 human hair samples from 19th century in France. In order to examine the potential association between contamination and historical health impacts, we characterized contamination by 33 elements in a set of hair strands sampled during the last quarter of the 19th century in the Savoy region of France. After a selected washing step on 138 hair strands conserved at the Museum National d'Histoire Naturelle in Paris (France), we assessed the presence of inorganics by ICP/MS, and lead level was higher than values reported in literature. We then compared concentrations and distributions between women and men, sampling locations and crossing gender and geographical origin. Hair lead level was high throughout Savoy at the end of the 19th century: significantly higher for people living in towns or industrial valleys, and lower for those of countryside and mountains areas. Environmental and economic changes (industrialization and urbanization with water adduction and leaded paints), living habits (kitchenware, cosmetics, wine, and tobacco), and local features (mines exploitation, railroad development, and industrialized narrow valleys) could be envisaged for explaining the level of lead contamination. In the same period, the two main industrial valleys of Savoy (Maurienne and Tarentaise) had high rates of endemic goiter and cretinism and among the highest hair lead levels. Other lines of evidence will need to be explore to investigate a possible link between historical Pb exposure and goiter in the study area.

Effect of type 1 tympanoplasty on the quality of life of patients suffering from chronic otitis media (safe type)

Background

Chronic otitis media (COM) remains a major public health issue and is associated with relentless discharge from the ear, pain, significant functional limitation of hearing, leading to communication problems and frequent specialist visits.

Aims

To assess the improvement in quality of life of patients of COM (safe type) and surgical success in terms of graft uptake and improvement in hearing.

Patients and Methods

A prospective questionnaire-based outcome study was directed in 100 patients with COM who were treated with Type I Tympanoplasty at our institution between May 2018 and May 2020. All patients were asked to fill Modified Chronic Otitis Media 4 (COM-4) survey before operation and 3 months after operation. Preoperative and postoperative total ear scores, audiological results, postoperative graft uptake were assessed.

Results

The correlation between preoperative and postoperative assessment by questionnaire was statistically critical (P < 0.001). There was significant improvement in hearing postoperatively (P < 0.001). Effective graft uptake was seen in 80%.

Conclusion

The current study emphasizes that Type 1 Tympanoplasty fundamentally improves quality of life of patients in terms of physical suffering, hearing loss, emotional distress postoperatively.

1414 The Impact Of COVID-19 On Individuals with Neck of Femur Fracture in The United Kingdom: A Systematic Review and Meta-analysis

Aim

All Neck of Femur fracture patients have a significant 30 – day mortality despite efforts to improve their outcomes. Incidence of NOF cases remained high during the pandemic in the UK and as a result numerus cases were complicated with SARS-CoV-2 infection. We performed a systematic review and meta-analysis of all UK published studies related to NOF fractures and 30-day mortality outcomes during the COVID 19 pandemic.

Method

A systematic review and meta-analysis was performed and reported as per the PRISMA checklist. Two reviewers independently searched on Medline for UK studies that were published between 1stof March 2020 and 1stof November 2020. Outcomes compared were 30-day mortality, time to surgery and anaesthetic risk.

Results

A total of 5 articles were included in our study. These studies were all case series with evidence level 3 or 4. A total of 286 patients complicated with COVID infection with a range of 30-day mortality 30.5%-50%. OR 6.02(95CI: 4.10-8.85), Chi24.82, I2 58%. Increased time to surgery due to Coronavirus related delays was also noted for the majority of studies. Mortality scores (Charlson Comorbidity Index, Nottingham Hip fracture score) failed to accurately predict the mortality risk.

Conclusions

Concurrent infection of COVID -19 in patients with NOF fractures increases the 30-day mortality 6 times compared to the negative group. Efforts should be made to optimise time to surgery as well as postoperative care via higher dependency units. Updates in mortality predicting scores is deemed necessary to include the SARS-CoV-2 infection as a factor.

When More Is Less: Plastic Weakening of Single Crystalline Ag Nanoparticles by the Polycrystalline Au Shell

It is well-known that in the case of bulk polycrystalline metals, a reduction in the grain size leads to material hardening, since the grain boundaries represent efficient barriers for slip transfer between the adjacent crystalline grains. Here, we show that coating single crystalline Ag nanoparticles with a thin polycrystalline Au layer leads to a weakening of the particles. Moreover, while the single crystalline Ag nanoparticles yield in a single large displacement burst when loaded in compression, their Ag-Au core-shell counterparts demonstrate a more homogeneous deformation with signs of strain hardening. Our molecular dynamics simulations demonstrate that particle weakening at low strains is attributed to the plasticity confinement in the polycrystalline shell, in which the grain boundaries play a dual role of dislocations sources and sinks. At higher strains, the plasticity within the Ag core is initiated by the dislocations nucleating at the Ag-Au interphase boundary. The widespread of energy barriers for dislocations nucleation at the interphase boundaries and their lower value as compared to the barriers for surface nucleation ensure particle weakening and more homogeneous deformation. The results of this study show that adding imperfect material to superstrong single crystalline metal nanoparticles makes them weaker. At the same time, thin nanocrystalline coatings can be employed to improve the formability of metals at the nanoscale.

Twin boundary migration in an individual platinum nanocrystal during catalytic CO oxidation

At the nanoscale, elastic strain and crystal defects largely influence the properties and functionalities of materials. The ability to predict the structural evolution of catalytic nanocrystals during the reaction is of primary importance for catalyst design. However, to date, imaging and characterising the structure of defects inside a nanocrystal in three-dimensions and in situ during reaction has remained a challenge. We report here an unusual twin boundary migration process in a single platinum nanoparticle during CO oxidation using Bragg coherent diffraction imaging as the characterisation tool. Density functional theory calculations show that twin migration can be correlated with the relative change in the interfacial energies of the free surfaces exposed to CO. The x-ray technique also reveals particle reshaping during the reaction. In situ and non-invasive structural characterisation of defects during reaction opens new avenues for understanding defect behaviour in confined crystals and paves the way for strain and defect engineering.

Durability of Left Atrial Lesions After Ethanol Infusion in the Vein of Marshall

OBJECTIVES

The aim of this study was to assess the persistence of left atrial (LA) lesions created by ethanol infusion in the vein of Marshall (EIVM) by electroanatomical mapping on repeat catheter ablation for recurrent atrial tachyarrhythmia.

BACKGROUND

Little is known about the durability of LA lesions created by EIVM.

METHODS

The study included consecutive patients who underwent EIVM for persistent atrial fibrillation or perimitral LA flutter (index procedure) and repeat catheter ablation for recurrent atrial tachyarrhythmia or atrial fibrillation at a single center between January 2019 and April 2020. The acute effect of EIVM was assessed at the index procedure by comparing the area of bipolar voltage <0.05 mV in the vein of Marshall (VOM) region before and immediately after EIVM. The long-term effect of EIVM was assessed by comparing this area in the VOM region between the redo procedure and the index procedure.

RESULTS

Twenty-four consecutive patients (mean age 68.6 ± 6.1 years, 58% men) underwent redo procedures after previous EIVM for persistent atrial fibrillation (n = 21 [88%]) or perimitral LA flutter (n = 5 [21%]). In each patient, the EIVM-related lesion persisted, with a chronic scar in the VOM region (median 13.1 cm² [interquartile range: 8.1-15.9 cm²] vs 12.4 cm² [interquartile range: 7.6-15.7 cm²] acutely, respectively). One quarter of patients (9 of 20) had late mitral isthmus reconnection, which was located at the mitral annular edge or in the coronary sinus.

CONCLUSIONS

Atrial lesions created by EIVM are durable, which reinforces the efficacy profile of EIVM. Reconduction sites in the mitral isthmus are located at the edge of the scar and in the coronary sinus.

Facet-Dependent Strain Determination in Electrochemically Synthetized Platinum Model Catalytic Nanoparticles

Studying model nanoparticles is one approach to better understand the structural evolution of a catalyst during reactions. These nanoparticles feature well-defined faceting, offering the possibility to extract structural information as a function of facet orientation and compare it to theoretical simulations. Using Bragg Coherent X-ray Diffraction Imaging, the uniformity of electrochemically synthesized model catalysts is studied, here high-index faceted tetrahexahedral (THH) platinum nanoparticles at ambient conditions. 3D images of an individual nanoparticle are obtained, assessing not only its shape but also the specific components of the displacement and strain fields both at the surface of the nanocrystal and inside. The study reveals structural diversity of shapes and defects, and shows that the THH platinum nanoparticles present strain build-up close to facets and edges. A facet recognition algorithm is further applied to the imaged nanoparticles and provides facet-dependent structural information for all measured nanoparticles. In the context of strain engineering for model catalysts, this study provides insight into the shape-controlled synthesis of platinum nanoparticles with high-index facets.

Energy-dispersive X-ray micro Laue diffraction on a bent gold nanowire

This article reports on energy-dispersive micro Laue (µLaue) diffraction of an individual gold nanowire that was mechanically deformed in three-point bending geometry using an atomic force microscope. The nanowire deformation was investigated by scanning the focused polychromatic X-ray beam along the nanowire and recording µLaue diffraction patterns using an energy-sensitive pnCCD detector that permits measurement of the angular positions of the Laue spots and the energies of the diffracted X-rays simultaneously. The plastic deformation of the nanowire was shown by a bending of up to 3.0 ± 0.1°, a torsion of up to 0.3 ± 0.1° and a maximum deformation depth of 80 ± 5 nm close to the position where the mechanical load was applied. In addition, extended Laue spots in the vicinity of one of the clamping points indicated the storage of geometrically necessary dislocations with a density of 7.5 × 1013 m-2. While µLaue diffraction with a non-energy-sensitive detector only gives access to the deviatoric strain, the energy sensitivity of the employed pnCCD offers absolute strain measurements with a resolution of 1%. Here, the residual strain after complete unloading of the nanowire amounted to maximum tensile and compressive strains of the order of +1.2 and -3%, which is comparable to the actual resolution limit. The combination of white-beam µLaue diffraction using an energy-sensitive pixel detector with nano-mechanical testing opens up new possibilities for the study of mechanical behavior at the nanoscale.

Lipid Nanoparticles Vectorized with NFL-TBS.40-63 Peptide Target Oligodendrocytes and Promote Neurotrophin-3 Effects After Demyelination In Vitro

Promoting remyelination in multiple sclerosis is important to prevent axon degeneration, given the lack of curative treatment. Although some growth factors improve this repair, unspecific delivery to cells and potential side effects limit their therapeutic use. Thus, NFL-TBS.40-63 peptide (NFL)-known to enter specifically myelinating oligodendrocytes (OL)-was used to vectorize 100 nm diameter lipid nanoparticles (LNC), and the ability of NFL-LNC to specifically target OL from newborn rat brain was assessed in vitro. Specific uptake of DiD-labeled NFL-LNC by OL characterized by CNP and myelin basic protein was observed by confocal microscopy, as well as DiD colocalization with NFL and with Rab5-a marker of early endosomes. Unvectorized LNC did not significantly penetrate OL and there was no uptake of NFL-LNC by astrocytes. Canonical maturation of OL which extended compacted myelin-like membranes was observed by transmission electron microscopy in cells grown up to 9 days with NFL-LNC. Endocytosis of NFL-LNC appeared to depend on several pathways, as demonstrated by inhibitors. In addition, vectorized NFL-LNC adsorbed on neurotrophin-3 (NT-3) potentiated the proremyelinating effects of NT-3 after demyelination by lysophosphatidyl choline, allowing noticeably decreasing NT-3 concentration. Our results if they were confirmed in vivo suggest that NFL-vectorized LNC appear safe and could be considered as putative carriers for specific drug delivery to OL in order to increase remyelination.

Mapping Inversion Domain Boundaries along Single GaN Wires with Bragg Coherent X-ray Imaging

Gallium nitride (GaN) is of technological importance for a wide variety of optoelectronic applications. Defects in GaN, like inversion domain boundaries (IDBs), significantly affect the electrical and optical properties of the material. We report, here, on the structural configurations of planar inversion domain boundaries inside n-doped GaN wires measured by Bragg coherent X-ray diffraction imaging. Different complex domain configurations are revealed along the wires with a 9 nm in-plane spatial resolution. We demonstrate that the IDBs change their direction of propagation along the wires, promoting Ga-terminated domains and stabilizing into {11̅00}, that is, m-planes. The atomic phase shift between the Ga- and N-terminated domains was extracted using phase-retrieval algorithms, revealing an evolution of the out-of-plane displacement (∼5 pm, at maximum) between inversion domains along the wires. This work provides an accurate inner view of planar defects inside small crystals.

Continuous scanning for Bragg coherent X-ray imaging

We explore the use of continuous scanning during data acquisition for Bragg coherent diffraction imaging, i.e., where the sample is in continuous motion. The fidelity of continuous scanning Bragg coherent diffraction imaging is demonstrated on a single Pt nanoparticle in a flow reactor at \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$400\,^\circ \hbox {C}$$\end{document}400∘C in an Ar-based gas flowed at 50 ml/min. We show a reduction of 30% in total scan time compared to conventional step-by-step scanning. The reconstructed Bragg electron density, phase, displacement and strain fields are in excellent agreement with the results obtained from conventional step-by-step scanning. Continuous scanning will allow to minimise sample instability under the beam and will become increasingly important at diffraction-limited storage ring light sources.

Piezoelectric Properties of Pb1-xLax(Zr0.52Ti0.48)1-x/4O3 Thin Films Studied by In Situ X-ray Diffraction

The piezoelectric properties of lanthanum-modified lead zirconate titanate Pb_1-xLa_x(Zr_0.52Ti_0.48)_1-x/4O₃ thin films, with x = 0, 3 and 12 mol% La, were studied by in situ synchrotron X-ray diffraction under direct (DC) and alternating (AC) electric fields, with AC frequencies covering more than four orders of magnitude. The Bragg reflections for thin films with low lanthanum concentration exhibit a double-peak structure, indicating two contributions, whereas thin films with 12% La possess a well-defined Bragg peak with a single component. In addition, built-in electric fields are revealed for low La concentrations, while they are absent for thin films with 12% of La. For static and low frequency AC electric fields, all lanthanum-modified lead zirconate titanate thin films exhibit butterfly loops, whereas linear piezoelectric behavior is found for AC frequencies larger than 1 Hz.

Direct Observations of the Structural Properties of Semiconducting Polymer: Fullerene Blends under Tensile Stretching

We describe the impact of tensile strains on the structural properties of thin films composed of PffBT4T-2OD π-conjugated polymer and PC₇₁BM fullerenes coated on a stretchable substrate, based on a novel approach using in situ studies of flexible organic thin films. In situ grazing incidence X-ray diffraction (GIXD) measurements were carried out to probe the ordering of polymers and to measure the strain of the polymer chains under uniaxial tensile tests. A maximum 10% tensile stretching was applied (i.e., beyond the relaxation threshold). Interestingly we found different behaviors upon stretching the polymer: fullerene blends with the modified polymer; fullerene blends with the 1,8-Diiodooctane (DIO) additive. Overall, the strain in the system was almost twice as low in the presence of additive. The inclusion of additive was found to help in stabilizing the system and, in particular, the π-π packing of the donor polymer chains.

Initial multicenter experience with a new high-density coloring module: impact for complex atrial arrhythmias interpretation

BACKGROUND

High-density automated mapping of complex atrial tachycardias (ATs) requires accurate assessment of activation maps. A new local activation display module (HD coloring, Biosense Webster®) provides higher map resolution, a better delineation of potential block reducing color interpolation, and a new propagation display. We evaluated the accuracy of a dedicated local activation display compared with standard algorithm.

METHODS

High-density maps from 10 AT were collected with a multipolar catheter and were displayed with standard activation or HD coloring. Six expert operators retrospectively analyzed activation maps and were asked to define (1) the tachycardia mechanism, (2) ablation target, and (3) level of difficulty to interpret those maps.

RESULTS

Using HD coloring, operators were able to reach a correct diagnosis in 93% vs. 63%, p < 0.05 compared to standard activation maps. Time to diagnosis was shorter 1.9 ± 1.0 min vs. 3.9 ± 2.1 min, p < 0.05. Confidence level would have allowed ablation without necessity for entrainment maneuvers in 87% vs. 53%, p < 0.05. Operators would have needed to remap or proceed with multiple entrainments in 3% vs. 13% of cases, p < 0.05. Finally, ablation strategy was more accurately identified in 97% vs. 67%, p < 0.05.

CONCLUSION

Activation mapping with the new HD coloring module allowed a more accurate, reliable, and faster interpretation of complex ATs mechanisms compared to standard activation maps.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Stress Buildup Upon Crystallization of GeTe Thin Films: Curvature Measurements and Modelling

Phase change materials are attractive materials for non-volatile memories because of their ability to switch reversibly between an amorphous and a crystal phase. The volume change upon crystallization induces mechanical stress that needs to be understood and controlled. In this work, we monitor stress evolution during crystallization in thin GeTe films capped with SiOx, using optical curvature measurements. A 150 MPa tensile stress buildup is measured when the 100 nm thick film crystallizes. Stress evolution is a result of viscosity increase with time and a tentative model is proposed that renders qualitatively the observed features.

Variable-Wavelength Quick Scanning Nanofocused X-Ray Microscopy for In Situ Strain and Tilt Mapping

Compression of micropillars is followed in situ by a quick nanofocused X-ray scanning microscopy technique combined with 3D reciprocal space mapping. Compared to other attempts using X-ray nanobeams, it avoids any motion or vibration that would lead to a destruction of the sample. The technique consists of scanning both the energy of the incident nanofocused X-ray beam and the in-plane translations of the focusing optics along the X-ray beam. Here, the approach by imaging the strain and lattice orientation of Si micropillars and their pedestals during in situ compression is demonstrated. Varying the energy of the incident beam instead of rocking the sample and mapping the focusing optics instead of moving the sample supplies a vibration-free measurement of the reciprocal space maps without removal of the mechanical load. The maps of strain and lattice orientation are in good agreement with the ones recorded by ordinary rocking-curve scans. Variable-wavelength quick scanning X-ray microscopy opens the route for in situ strain and tilt mapping toward more diverse and complex materials environments, especially where sample manipulation is difficult.

Multi-wavelength Bragg coherent X-ray diffraction imaging of Au particles

Multi-wavelength (mw) Bragg coherent X-ray diffraction imaging (BCDI) is demonstrated on a single Au particle. The multi-wavelength Bragg diffraction patterns are inverted using conventional phase-retrieval algorithms where the dilation of the effective pixel size of a pixelated 2D detector caused by the variation of the X-ray beam energy is mitigated by interpolating the raw data. The reconstructed Bragg electron density and phase field are in excellent agreement with the results obtained from conventional rocking scans of the same particle. Voxel sizes of about 63 nm3 are obtained for reconstructions from both approaches. Phase shifts as small as 0.41 rad, which correspond to displacements of 14 pm and translate into strain resolution better than 10−4 in the Au particle, are resolved. The displacement field changes shape during the experiment, which is well reproduced by finite element method simulations considering an inhomogeneous strained carbon layer deposited on the Au particle over the course of the measurements. These experiments thus demonstrate the very high sensitivity of BCDI and mw-BCDI to strain induced by contaminations. Furthermore, mw-BCDI offers new opportunities for in situ and operando 3D strain imaging in complex sample environments.

Towards a quantitative determination of strain in Bragg Coherent X-ray Diffraction Imaging: artefacts and sign convention in reconstructions

Bragg coherent X-ray diffraction imaging (BCDI) has emerged as a powerful technique to image the local displacement field and strain in nanocrystals, in three dimensions with nanometric spatial resolution. However, BCDI relies on both dataset collection and phase retrieval algorithms that can induce artefacts in the reconstruction. Phase retrieval algorithms are based on the fast Fourier transform (FFT). We demonstrate how to calculate the displacement field inside a nanocrystal from its reconstructed phase depending on the mathematical convention used for the FFT. We use numerical simulations to quantify the influence of experimentally unavoidable detector deficiencies such as blind areas or limited dynamic range as well as post-processing filtering on the reconstruction. We also propose a criterion for the isosurface determination of the object, based on the histogram of the reconstructed modulus. Finally, we study the capability of the phasing algorithm to quantitatively retrieve the surface strain (i.e., the strain of the surface voxels). This work emphasizes many aspects that have been neglected so far in BCDI, which need to be understood for a quantitative analysis of displacement and strain based on this technique. It concludes with the optimization of experimental parameters to improve throughput and to establish BCDI as a reliable 3D nano-imaging technique.

A new washing procedure for inorganic element analysis of hair

Hair incorporates chemical compounds from the bloodstream and external sources as it grows. Different analytical procedures are proposed, but no consensus can be found for external contamination removal (washing stage). Thus, a major limitation of the use of hair analysis for human biomonitoring is the issue related to the washing efficiency, and the objective of this study was to propose a simple washing method for a better cleaning of external contamination. Based on a sequence of three steps of detergent or acid washing (Triton, nitric acid, and hydrochloric acid), the TNCl method was tested on raw and spiked samples and compared to other methods. Thirty-seven inorganic elements were analyzed by inductively Coupled Plasma Mass Spectrometry (ICP-MS) after washing and acid digestion of 10 hair samples (Li, Be, Na, Mg, Al, P, K, Ca, V, Cr, Fe, Mn, Co, N, Cu, Zn, As, Se, Sr, Mo, Ru, Ag, Cd, Sn, Sb, Cs, Ba, La, Ce, Nd, Gd, Lu, Tl, Pb, Bi, Th, and U). The inorganic element concentrations in the hair samples were compared to those reported in the literature. The TNCl method was shown to be more efficient than other methods based on the use of surfactants and organic solvents.

Observational study of the medical management of patients with peripheral artery disease

BACKGROUND

Previous research has suggested that patients with peripheral artery disease (PAD) are not offered adequate risk factor modification, despite their high cardiovascular risk. The aim of this study was to assess the cardiovascular profiles of patients with PAD and quantify the survival benefits of target-based risk factor modification.

METHODS

The Vascular and Endovascular Research Network (VERN) prospectively collected cardiovascular profiles of patients with PAD from ten UK vascular centres (April to June 2018) to assess practice against UK and European goal-directed best medical therapy guidelines. Risk and benefits of risk factor control were estimated using the SMART-REACH model, a validated cardiovascular prediction tool for patients with PAD.

RESULTS

Some 440 patients (mean(s.d.) age 70(11) years, 24·8 per cent women) were included in the study. Mean(s.d.) cholesterol (4·3(1·2) mmol/l) and LDL-cholesterol (2·7(1·1) mmol/l) levels were above recommended targets; 319 patients (72·5 per cent) were hypertensive and 343 (78·0 per cent) were active smokers. Only 11·1 per cent of patients were prescribed high-dose statin therapy and 39·1 per cent an antithrombotic agent. The median calculated risk of a major cardiovascular event over 10 years was 53 (i.q.r. 44-62) per cent. Controlling all modifiable cardiovascular risk factors based on UK and European guidance targets (LDL-cholesterol less than 2 mmol/l, systolic BP under 140 mmHg, smoking cessation, antiplatelet therapy) would lead to an absolute risk reduction of the median 10-year cardiovascular risk by 29 (20-38) per cent with 6·3 (4·0-9·3) cardiovascular disease-free years gained.

CONCLUSION

The medical management of patients with PAD in this secondary care cohort was suboptimal. Controlling modifiable risk factors to guideline-based targets would confer significant patient benefit.

Selective growth of ordered hexagonal InN nanorods

Well-ordered and vertically aligned InN nanorods with high aspect ratios are synthesized by hydride vapor phase epitaxy (HVPE) using the selective area growth (SAG) approach.

In situ structural evolution of single particle model catalysts under ambient pressure reaction conditions

The catalytic activity of metal nanoparticles can be altered by applying strain, which changes the crystalline lattice spacing and modifies the electronic properties of the metal. Understanding the role of elastic strain during catalytic reactions is thus crucial for catalyst design. Here, we show how single highly faceted Pt nanoparticles expand or contract upon interaction with different gas atmospheres using in situ nano-focused coherent X-ray diffraction imaging. We also demonstrate inter-particle heterogeneities, as they differ in development of strain under CO oxidation reaction conditions. The reported observations offer new insights into the design of catalysts exploiting strain effects.

Effects of internal resonances in the pitch glide of Chinese gongs

The framework of nonlinear normal modes gives a remarkable insight into the dynamics of nonlinear vibratory systems exhibiting distributed nonlinearities. In the case of Chinese opera gongs, geometrical nonlinearities lead to a pitch glide of several vibration modes in playing situation. This study investigates the relationship between the nonlinear normal modes formalism and the ascendant pitch glide of the fundamental mode of a xiaoluo gong. In particular, the limits of a single nonlinear mode modeling for describing the pitch glide in playing situation are examined. For this purpose, the amplitude-frequency relationship (backbone curve) and the frequency-time dependency (pitch glide) of the fundamental nonlinear mode is measured with two excitation types, in free vibration regime: first, only the fundamental nonlinear mode is excited by an experimental appropriation method resorting to a phase-locked loop; second, all the nonlinear modes of the instrument are excited with a mallet impact (playing situation). The results show that a single nonlinear mode modeling fails at describing the pitch glide of the instrument when played because of the presence of 1:2 internal resonances implying the nonlinear fundamental mode and other nonlinear modes. Simulations of two nonlinear modes in 1:2 internal resonance confirm qualitatively the experimental results.

Experimental realization of a Rydberg optical Feshbach resonance in a quantum many-body system

Feshbach resonances are a powerful tool to tune the interaction in an ultracold atomic gas. The commonly used magnetic Feshbach resonances are specific for each species and are restricted with respect to their temporal and spatial modulation. Optical Feshbach resonances are an alternative which can overcome this limitation. Here, we show that ultra-long-range Rydberg molecules can be used to implement an optical Feshbach resonance. Tuning the on-site interaction of a degenerate Bose gas in a 3D optical lattice, we demonstrate a similar performance compared to recent realizations of optical Feshbach resonances using intercombination transitions. Our results open up a class of optical Feshbach resonances with a plenitude of available lines for many atomic species and the possibility to further increase the performance by carefully selecting the underlying Rydberg state.

In situ Bragg coherent X-ray diffraction during tensile testing of an individual Au nanowire

Systematic tensile tests were performed on single defect-free 〈110〉 Au nanowires grown by physical vapor deposition while simultaneously recording three-dimensional Bragg peaks using coherent X-rays. The trajectory of three-dimensional Bragg peaks in reciprocal space during tensile testing allowed for measurements of the evolution of strains and rotations of the nanowire, thus sensitively uncovering the full deformation geometry of the nanowire. The transition from elastic to plastic deformation is accompanied by rotations of the nanowire as quantified by analysis of the motion of Bragg peaks, showing the importance of boundary conditions in interpreting nanoscale mechanical deformations.

Crystallographic orientation of facets and planar defects in functional nanostructures elucidated by nano-focused coherent diffractive X-ray imaging

The physical and chemical properties of nanostructures depend on their surface facets. Here, we exploit a pole figure approach to determine the three-dimensional orientation matrix of a nanostructure from a single Bragg reflection measured with a coherent nano-focused X-ray beam. The signature of any truncated (faceted) crystal produces a crystal truncation rod, which corresponds to a streak of intensity in reciprocal space normal to the surface. When two or more non-parallel facets are present, both the crystal orientation and the crystal facets can be identified. This enables facets to be rapidly indexed and uncommon facets, and planar defects, that have been difficult to study before to be identified. We demonstrate the technique with (i) epitaxial core-shell InGaN/GaN multiple quantum-wells grown on GaN nanowires, where surface facets and planar defects are determined, and (ii) single randomly oriented highly faceted tetrahedrahexal Pt nanoparticles. The methodology is applicable to a broad range of nanocrystals and provides a unique insight into the connection between structure and properties of nanomaterials.

Combination of the best pacing configuration and atrioventricular and interventricular delays optimization in cardiac resynchronization therapy

BACKGROUND

Cardiac resynchronization therapy optimization can be pursued by left ventricular pacing vector selection and atrioventricular (AV) and interventricular (VV) delays optimization. The combination of these methods and its comparison with multipoint pacing (MPP) is scarcely studied.

METHODS

Using noninvasive cardiac output (CO) measurement, the best of five left ventricular pacing vectors was determined, then AV and VV delays optimization was applied on top of the best vector. Response to the optimization protocol was defined as a >5% CO increase compared to the standard biventricular configuration.

RESULTS

Twenty-two patients (18 men, age 71 ± 9 years) were included. Standard biventricular configuration increased CO compared to baseline (4.65 ± 1.55 L/min vs 4.27 ± 1.53 L/min, respectively, P = 0.02). The best quadripolar configuration increased CO to 4.85 ± 1.67 L/min (P = 0.03 compared to the standard biventricular configuration). AV then VV delay optimization both provided additional benefit (final CO 5.56 ± 2.03 L/min, P = 0.001 compared to the best quadripolar configuration). Fifteen (68%) patients responded to the optimization protocol. Anatomical MPP (based on maximal anatomical separation between electrodes) and electrical MPP (based on maximal electrical activation difference between electrodes) were evaluated in 16 patients and yielded a CO similar to that of the optimization procedure.

CONCLUSIONS

The combination of choosing the best quadripolar pacing configuration and optimizing atrioventricular and interventricular delays resulted in an improvement of cardiac output compared to standard biventricular stimulation in 68% of patients. The final cardiac output was comparable to multipoint pacing.