Setup for the measurement of the 235U(n, f) cross section relative to n-p scattering up to 1 GeV

The neutron induced fission of 235U is extensively used as a reference for neutron fluence measurements in various applications, ranging from the investigation of the biological effectiveness of high energy neutrons, to the measurement of high energy neutron cross sections of relevance for accelerator driven nuclear systems. Despite its widespread use, no data exist on neutron induced fission of 235U above 200 MeV. The neutron facility n_TOF offers the possibility to improve the situation. The measurement of 235U(n,f) relative to the differential n-p scattering cross-section, was carried out in September 2018 with the aim of providing accurate and precise cross section data in the energy range from 10 MeV up to 1 GeV. In such measurements, Recoil Proton Telescopes (RPTs) are used to measure the neutron flux while the fission events are detected and counted with dedicated detectors. In this paper the measurement campaign and the experimental set-up are illustrated.

Monte Carlo simulations and n-p differential scattering data measured with Proton Recoil Telescopes

The neutron-induced fission cross section of 235U, a standard at thermal energy and between 0.15 MeV and 200 MeV, plays a crucial role in nuclear technology applications. The long-standing need of improving cross section data above 20 MeV and the lack of experimental data above 200 MeV motivated a new experimental campaign at the n_TOF facility at CERN. The measurement has been performed in 2018 at the experimental area 1 (EAR1), located at 185 m from the neutron-producing target (the experiment is presented by A. Manna et al. in a contribution to this conference). The 235U(n,f) cross section from 20 MeV up to about 1 GeV has been measured relative to the 1H(n,n)1H reaction, which is considered the primary reference in this energy region. The neutron flux impinging on the 235U sample (a key quantity for determining the fission events) has been obtained by detecting recoil protons originating from n-p scattering in a C2H4 sample. Two Proton Recoil Telescopes (PRT), consisting of several layers of solid-state detectors and fast plastic scintillators, have been located at proton scattering angles of 25.07° and 20.32°, out of the neutron beam. The PRTs exploit the ΔE-E technique for particle identification, a basic requirement for the rejection of charged particles from neutron-induced reactions in carbon. Extensive Monte Carlo simulations were performed to characterize proton transport through the different slabs of silicon and scintillation detectors, to optimize the experimental set-up and to deduce the efficiency of the whole PRT detector. In this work we compare measured data collected with the PRTs with a full Monte Carlo simulation based on the Geant-4 toolkit.

Continuing Medical Education as a Translational Science Opportunity for Health Communication Researchers: The BCERP Model

Health communication researchers often work across health issues to engage in research that bridges distance between bench scientists and practitioners. This translational activity is essential to increase the likelihood that emerging science from the laboratory makes it into the hands of health professionals who can integrate it into their everyday practice with patients. An underutilized translational approach by communication researchers is the development of continuing medical education (CME) opportunities that incorporate a communication science approach to the uptake of recommended practices based on emerging science. This manuscript explains the nature of translational science, highlights the role of CME as an integral strategy for engaging in it, and then provides the exemplar of a training and evaluation project funded by the National Institute for Environmental Health Sciences for the Breast Cancer and the Environment Research Program (BCERP). Lessons learned are discussed as they relate to developing a translational opportunity for the BCERP.

Macropolycytes: Severe stress time for neutrophils

Macropolycytes are giant neutrophils found in a variety of benign and neoplastic conditions. Since megaloblastic anaemia is one of the recognised causes of macropolycytes, other blood film features of megaloblastic anaemia should be sought when they harbor hypersegmented nuclei. When they are hypolobulated and hypogranular, the occurrence of a myelodysplastic syndrome must be investigated. Finding macropolycytes in the context of a nonspecific reactive granulopoiesis is more questionable but is often associated with stressed myelopoiesis and/or granulocyte colony-stimulating factor therapy.

Measurement of the energy-differential cross-section of the 12C(n,p)12B and 12C(n,d)11B reactions at the n_TOF facility at CERN

Although the 12C(n,p)12B and 12C(n,d)11B reactions are of interest in several fields of basic and applied Nuclear Physics the present knowledge of these two cross-sections is far from being accurate and reliable, with both evaluations and data showing sizable discrepancies. As part of the challenging n_TOF program on (n,cp) nuclear reactions study, the energy differential cross-sections of the 12C(n,p)12B and 12C(n,d)11 B reactions have been measured at CERN from the reaction thresholds up to 30 MeV neutron energy. Both measurements have been recently performed at the long flight-path (185 m) experimental area of the n_TOF facility at CERN using a pure (99.95%) rigid graphite target and two silicon telescopes. In this paper an overview of the experiment is presented together with a few preliminary results.

Status and perspectives of the neutron time-of-flight facility n_TOF at CERN

Since the start of its operation in 2001, based on an idea of Prof. Carlo Rubbia [1], the neutron time of-flight facility of CERN, n_TOF, has become one of the most forefront neutron facilities in the world for wide-energy spectrum neutron cross section measurements. Thanks to the combination of excellent neutron energy resolution and high instantaneous neutron flux available in the two experimental areas, the second of which has been constructed in 2014, n_TOF is providing a wealth of new data on neutron-induced reactions of interest for nuclear astrophysics, advanced nuclear technologies and medical applications. The unique features of the facility will continue to be exploited in the future, to perform challenging new measurements addressing the still open issues and long-standing quests in the field of neutron physics. In this document the main characteristics of the n_TOF facility and their relevance for neutron studies in the different areas of research will be outlined, addressing the possible future contribution of n_TOF in the fields of nuclear astrophysics, nuclear technologies and medical applications. In addition, the future perspectives of the facility will be described including the upgrade of the spallation target, the setup of an imaging installation and the construction of a new irradiation area.

First results of the 230Th(n,f) cross section measurements at the CERN n_TOF facility

The study of neutron-induced reactions on actinides is of considerable importance for the design of advanced nuclear systems and alternative fuel cycles. Specifically, 230Th is produced from the α-decay of 234U as a byproduct of the 232Th/233U fuel cycle, thus the accurate knowledge of its fission cross section is strongly required. However, few experimental datasets exist in literature with large deviations among them, covering the energy range between 0.2 to 25 MeV. In addition, the study of the 230Th(n,f) cross-section is of great interest in the research on the fission process related to the structure of the fission barriers. Previous measurements have revealed a large resonance at En=715 keV and additional fine structures, but with high discrepancies among the cross-section values of these measurements. This contribution presents preliminary results of the 230Th(n,f) cross-section measurements at the CERN n_TOF facility. The high purity targets of the natural, but very rare isotope 230Th, were produced at JRC-Geel in Belgium. The measurements were performed at both experimental areas (EAR-1 and EAR-2) of the n_TOF facility, covering a very broad energy range from thermal up to at least 100 MeV. The experimental setup was based on Micromegas detectors with the 235U(n,f) and 238U(n,f) reaction cross-sections used as reference.

New reaction rates for the destruction of7Be during big bang nucleosynthesis measured at CERN/n_TOF and their implications on the cosmological lithium problem

New measurements of the7Be(n,α)4He and7Be(n,p)7Li reaction cross sections from thermal to keV neutron energies have been recently performed at CERN/n_TOF. Based on the new experimental results, astrophysical reaction rates have been derived for both reactions, including a proper evaluation of their uncertainties in the thermal energy range of interest for big bang nucleosynthesis studies. The new estimate of the7Be destruction rate, based on these new results, yields a decrease of the predicted cosmological7Li abundance insufficient to provide a viable solution to the cosmological lithium problem.

The 154Gd neutron capture cross section measured at the n_TOF facility and its astrophysical implications

The (n, γ) cross sections of the gadolinium isotopes play an important role in the study of the stellar nucleosynthesis. In particular, among the isotopes heavier than Fe, 154Gd together with 152Gd have the peculiarity to be mainly produced by the slow capture process, the so-called s-process, since they are shielded against the β-decay chains from the r-process region by their stable samarium isobars. Such a quasi pure s-process origin makes them crucial for testing the robustness of stellar models in galactic chemical evolution (GCE). According to recent models, the 154Gd and 152Gd abundances are expected to be 15-20% lower than the reference un-branched s-process 150Sm isotope. The close correlation between stellar abundances and neutron capture cross sections prompted for an accurate measurement of 154Gd cross section in order to reduce the uncertainty attributable to nuclear physics input and eventually rule out one of the possible causes of present discrepancies between observation and model predictions. To this end, the neutron capture cross section of 154Gd was measured in a wide neutron energy range (from thermal up to some keV) with high resolution in the first experimental area of the neutron time-of-flight facility n_TOF (EAR1) at CERN. In this contribution, after a brief description of the motivation and of the experimental setup used in the measurement, the preliminary results of the 154Gd neutron capture reaction as well as their astrophysical implications are presented.

First results of the 241Am(n,f) cross section measurement at the Experimental Area 2 of the n_TOF facility at CERN

Feasibility, design and sensitivity studies on innovative nuclear reactors that could address the issue of nuclear waste transmutation using fuels enriched in minor actinides, require high accuracy cross section data for a variety of neutron-induced reactions from thermal energies to several tens of MeV. The isotope 241Am (T1/2= 433 years) is present in high-level nuclear waste (HLW), representing about 1.8 % of the actinide mass in spent PWR UOx fuel. Its importance increases with cooling time due to additional production from the β-decay of 241Pu with a half-life of 14.3 years. The production rate of 241 Am in conventional reactors, including its further accumulation through the decay of 241Pu and its destruction through transmutation/incineration are very important parameters for the design of any recycling solution. In the present work, the 241 Am(n,f) reaction cross-section was measured using Micromegas detectors at the Experimental Area 2 of the n_TOF facility at CERN. For the measurement, the 235U(n,f) and 238U(n,f) reference reactions were used for the determination of the neutron flux. In the present work an overview of the experimental setup and the adopted data analysis techniques is given along with preliminary results.

Biological and behavioral markers of pain following nerve injury in humans

The evolution of peripheral and central changes following a peripheral nerve injury imply the onset of afferent signals that affect the brain. Changes to inflammatory processes may contribute to peripheral and central alterations such as altered psychological state and are not well characterized in humans. We focused on four elements that change peripheral and central nervous systems following ankle injury in 24 adolescent patients and 12 age-sex matched controls. Findings include (a) Changes in tibial, fibular, and sciatic nerve divisions consistent with neurodegeneration; (b) Changes within the primary motor and somatosensory areas as well as higher order brain regions implicated in pain processing; (c) Increased expression of fear of pain and pain reporting; and (d) Significant changes in cytokine profiles relating to neuroinflammatory signaling pathways. Findings address how changes resulting from peripheral nerve injury may develop into chronic neuropathic pain through changes in the peripheral and central nervous system.

Regional Cerebral Blood Flow in the Posterior Cingulate and Precuneus and the Entorhinal Cortical Atrophy Score Differentiate Mild Cognitive Impairment and Dementia Due to Alzheimer Disease

BACKGROUND AND PURPOSE

Alzheimer disease is the most common degenerative dementia affecting humans and mild cognitive impairment is considered the forerunner of this devastating illness with variable progression. Differentiating between them has become all the more essential with the advent of disease-modifying medications. The aim of this study was to test the utility of the entorhinal cortical atrophy score in combination with quantitative CBF in the posterior cingulate and precuneus using arterial spin-labeling to differentiate mild cognitive impairment and early Alzheimer disease.

MATERIALS AND METHODS

We analyzed MR imaging from a prospective data base of 3 age-matched groups: 21 cognitively healthy controls, 20 patients with mild cognitive impairment, and 19 patients with early Alzheimer disease. The highest entorhinal cortical atrophy score and an atlas-based measurement of CBF in the posterior cingulate and precuneus were estimated in these groups. Statistical comparison was performed among the groups for disease-prediction probability with these parameters independently and in combination using a binary logistic regression model.

RESULTS

The entorhinal cortical atrophy score performed well in distinguishing AD from HC, with a predicted probability of .887 (area under the curve, P < .001). The mean CBF of the posterior cingulate and precuneus was also found to be a useful discriminator (area under the curve, 0.810, P = < .001). Combining the entorhinal cortical atrophy score and CBF was the best predictor (area under the curve, 0.957, P < .001). In distinguishing mild cognitive impairment and Alzheimer disease, entorhinal cortical atrophy also did well with an area under the curve of 0.838 (P < .001). However regional CBF was not useful in differentiating them (area under the curve = 0.589, P = .339). Entorhinal cortical atrophy scored poorly in distinguishing mild cognitive impairment from healthy controls (AUC = 0.571, P = .493), but CBF fared well, with an area under the curve of 0.776 (P = .002).

CONCLUSIONS

Combining entorhinal cortical atrophy and regional CBF could be a potential imaging biomarker in distinguishing mild cognitive impairment and Alzheimer disease.

Comparative Analysis of Volumetric High-Resolution Heavily T2-Weighted MRI and Time-Resolved Contrast-Enhanced MRA in the Evaluation of Spinal Vascular Malformations

BACKGROUND AND PURPOSE

Volumetric high-resolution heavily T2-weighted imaging or time-resolved contrast-enhanced MRA is used in the detection and characterization of spinal vascular malformations, though inherent trade-offs can affect their overall sensitivity and accuracy. We compared the efficacy of volumetric high-resolution heavily T2-weighted and time-resolved contrast-enhanced images in spinal vascular malformation diagnosis and feeder characterization and assessed whether a combined evaluation improved the overall accuracy of diagnosis.

MATERIALS AND METHODS

Twenty-eight patients with spinal vascular malformations (spinal dural arteriovenous fistula, spinal cord arteriovenous malformation, and perimedullary arteriovenous fistula) were prospectively enrolled. MR images were separately analyzed by 2 neuroradiologists blinded to the final diagnosis.

RESULTS

Both sequences demonstrated 100% sensitivity and 93.5% accuracy for the detection of spinal vascular malformations. Volumetric high-resolution heavily T2-weighted imaging was superior to time-resolved contrast-enhanced MR imaging for identification of spinal cord arteriovenous malformations (100% versus 90% sensitivity and 96.7% versus 93.5% accuracy), however, for the diagnosis of perimedullary arteriovenous fistula, time resolved contrast enhanced MRI was found to perform better than the volumetric T2 sequence (80% versus 60% sensitivity and 96.7% versus 93.5% accuracy). Both sequences showed equal sensitivity (100%) and accuracy (87%) for spinal dural arteriovenous fistulas. Combined evaluation improved the overall accuracy across all types of spinal vascular malformation. Volumetric high-resolution heavily T2-weighted imaging was superior or equal to time-resolved contrast-enhanced MR imaging for feeder identification of spinal dural arteriovenous fistulas for both observers (90.9% and 72.7% versus 72.7%), which improved to 90.9% when the sequences were combined. Time-resolved contrast-enhanced MR imaging performed better for major and total feeder identification of spinal cord arteriovenous malformation (80% versus 60%) and perimedullary arteriovenous fistula (80% versus 60%-80%).

CONCLUSIONS

Combined volumetric high-resolution heavily T2-weighted imaging and time-resolved contrast-enhanced MR imaging can improve the sensitivity and accuracy of spinal vascular malformation diagnosis, classification, and feeder characterization.

Corrosion threshold data of metallic materials in various operating environment of offshore wind turbine parts (tower, foundation, and nacelle/gearbox)

This paper outlines corrosion thresholds for different environmental conditions of metallic materials commonly used in the tower, foundation, and nacelle/gearbox of an offshore wind turbine. These threshold values were derived from laboratory corrosion testing employing electrochemical analysis techniques, using the media/solvents that are representative to the operating environment of those wind turbine parts, such as seawater, grease, oils/lubricants, or their combination, at room temperature and at 328K. These values can provide an indication when general/local corrosion or protective film/surface damages have occurred. They can thus be utilised for detecting and monitoring corrosion at certain locations in the wind turbine structure. The presented data have been verified and validated to ensure their repeatability and reliability by means of numerous laboratory tests in accordance to the relevant engineering test standards and an extensive literature/published data review.

Diabetes and pre-diabetes among household contacts of tuberculosis patients in India: is it time to screen them all?

SETTING

Pre-diabetes mellitus (pre-DM) and DM increase the risk of developing tuberculosis (TB). Screening contacts of TB patients for pre-DM/DM and linking them to care may mitigate the risk of developing TB and improve DM management.

OBJECTIVE

To measure the prevalence of pre-DM/DM and associated factors among the adult household contacts (HHCs) of pulmonary TB patients.

METHODS

Between August 2014 and May 2017, adult HHCs of newly diagnosed adult PTB patients in Pune and Chennai, India, had single blood samples tested for glycosylated haemoglobin (HbA1c) at enrolment. DM was defined as previously diagnosed, self-reported DM or HbA1c 6.5%, and pre-DM as HbA1c between 5.7% and 6.4%. Latent tuberculous infection (LTBI) was defined as a positive tuberculin skin test (5 mm induration) or QuantiFERON® Gold In-Tube (0.35 international units/ml).

RESULTS

Of 652 adult HHCs, 175 (27%) had pre-DM and 64 (10%) had DM. Forty (64%) HHCs were newly diagnosed with DM and 48 (75%) had poor glycaemic control (HbA1c 7.0%). Sixty-eight (22%) pre-DM cases were aged 18-34 years. Age 35 years, body mass index 25 kg/m2, chronic disease and current tobacco smoking were significantly associated with DM among HHCs.

CONCLUSIONS

Adult HHCs of TB patients in India have a high prevalence of undiagnosed DM, pre-DM and LTBI, putting them at high risk for developing TB. Routine DM screening should be considered among all adult HHCs of TB.

Systematic review and meta-analysis of adjunctive corticosteroids in the treatment of tuberculous pericarditis

SETTING

Tuberculosis (TB) is the most common cause of pericarditis worldwide and carries a high mortality, even with effective anti-tuberculosis treatment. In the light of a randomized control trial in 2014, the American Thoracic Society and the Centers for Disease Control and Prevention/Infectious Diseases Society of America recently revised their recommendations against the routine use of adjunctive corticosteroids.

OBJECTIVE

To evaluate the strength of evidence that resulted in this reversal of the guideline recommendations on the use of adjunctive corticosteroids in TB pericarditis by a meta-analysis, followed by a sensitivity analysis.

DESIGN

Systematic review and meta-analysis of published randomized control trials.

RESULTS

We identified five randomized control trials that met the eligibility criteria. Combining the results of the included trials, there was no overall mortality benefit from adjunctive corticosteroids (a random-effects model yielded a non-significant relative risk of 0.66 and 95%CI of 0.35-1.27). A sensitivity analysis further confirmed that the results of the meta-analysis were robust.

CONCLUSION

Routine addition of oral corticosteroids to standard anti-tuberculosis treatment does not reduce mortality among patients with TB pericarditis.

The oral nitrate-reducing capacity correlates with peak power output and peak oxygen uptake in healthy humans

Interest in inorganic nitrate and nitrite has grown substantially over the past decade as research has revealed the role of these anions in enhancing nitric oxide (NO) availability through an oral pathway. Nitrite synthesis in the mouth seems to be an important mechanism to feed the circulatory system with this anion. This is interesting since greater plasma nitrite concentration has been associated with better fitness levels in humans, but this question has not been investigated in relation to salivary nitrite concentration. Additionally, no previous study has investigated the oral nitrate-reducing capacity in regards to peak oxygen uptake (VO_2peak) or peak power output (W_peak) in humans. Thus, the main goal of this study was to investigate whether salivary nitrite and nitrate concentration and the oral nitrate-reducing capacity were associated with VO2_peak and W_peak in healthy humans. Fifty individuals (22 females and 28 males; 38.8 ± 14.3 years/old; BMI = 22.8 ± 3.9) performed a graded exercise test on a cycle ergometer to assess their VO_2peak and W_peak. Unstimulated salivary samples were taken before and 20 min after exercise to measure nitrate/nitrite, pH and lactate. The oral nitrate-reducing capacity was also assessed in 25 subjects before and after exercise. Oral nitrate-reducing capacity was positively associated with W_peak (r_s = 0.64; P = 0.001) and the VO_2peak (r_s = 0.54; P = 0.005). Similar correlations were found when these variables were analysed after exercise. In addition, a significant decrease in salivary pH (pre: 7.28 ± 0.361; post-exercise: 7.16 ± 0.33; P = 0.003) accompanied by an increase of salivary lactate (pre: 0.17 ± 0.14 mmol/L; post-exercise: 0.48 ± 0.38; P < 0.001) was found after exercise. However, these changes did not have any impact on salivary nitrate/nitrite concentration and the oral nitrate-reducing capacity after exercise. In conclusion, this is the first evidence showing a link between the oral nitrate-reducing capacity and markers of aerobic fitness levels in healthy humans.

The molecular chaperone sigma 1 receptor mediates rescue of retinal cone photoreceptor cells via modulation of NRF2

Sigma 1 receptor (Sig1R), a putative molecular chaperone, has emerged as a novel therapeutic target for retinal degenerative disease. Earlier studies showed that activation of Sig1R via the high-affinity ligand (+)-pentazocine ((+)-PTZ) induced profound rescue of cone photoreceptor cells in the rd10 mouse model of retinitis pigmentosa; however the mechanism of rescue is unknown. Improved cone function in (+)-PTZ-treated mice was accompanied by reduced oxidative stress and normalization of levels of NRF2, a transcription factor that activates antioxidant response elements (AREs) of hundreds of cytoprotective genes. Here, we tested the hypothesis that modulation of NRF2 is central to Sig1R-mediated cone rescue. Activation of Sig1R in 661W cone cells using (+)-PTZ induced dose-dependent increases in NRF2-ARE binding activity and NRF2 gene/protein expression, whereas silencing Sig1R significantly decreased NRF2 protein levels and increased oxidative stress, although (+)-PTZ did not disrupt NRF2-KEAP1 binding. In vivo studies were conducted to investigate whether, in the absence of NRF2, activation of Sig1R rescues cones. (+)-PTZ was administered systemically for several weeks to rd10/nrf2+/+ and rd10/nrf2-/- mice. Through post-natal day 42, cone function was significant in rd10/nrf2+/+, but minimal in rd10/nrf2-/- mice as indicated by electroretinographic recordings using natural noise stimuli, optical coherence tomography and retinal histological analyses. Immunodetection of cones was limited in (+)-PTZ-treated rd10/nrf2-/-, though considerable in (+)-PTZ-treated rd10/nrf2+/+mice. The data suggest that Sig1R-mediated cone rescue requires NRF2 and provide evidence for a previously-unrecognized relationship between these proteins.

Approaching the Gamow Window with Stored Ions: Direct Measurement of ^{124}Xe(p,γ) in the ESR Storage Ring

We report the first measurement of low-energy proton-capture cross sections of ^{124}Xe in a heavy-ion storage ring. ^{124}Xe^{54+} ions of five different beam energies between 5.5 and 8 AMeV were stored to collide with a windowless hydrogen target. The ^{125}Cs reaction products were directly detected. The interaction energies are located on the high energy tail of the Gamow window for hot, explosive scenarios such as supernovae and x-ray binaries. The results serve as an important test of predicted astrophysical reaction rates in this mass range. Good agreement in the prediction of the astrophysically important proton width at low energy is found, with only a 30% difference between measurement and theory. Larger deviations are found above the neutron emission threshold, where also neutron and γ widths significantly impact the cross sections. The newly established experimental method is a very powerful tool to investigate nuclear reactions on rare ion beams at low center-of-mass energies.

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

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

Citation Format: Tang W, Deng X, Ou Z, Gan J, Dong Q, Tan B, Lu L, Chen B, Bao C, Li S, Thomas B, Yu J-C. BAT8001, a potent anti-HER2 antibody-drug conjugate with a novel stable linker for the treatment of HER2-positive breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-39.

Abstract PD9-03: The genomic landscape of de novo metastatic breast cancer (MBC)

Background: Approximately 5-10% of newly diagnosed breast cancers (BC) are de novo MBC, which means that metastatic disease was identified at the time of initial diagnosis. Patients with de novo MBC are underrepresented in currently available genomic studies. In The Cancer Genome Atlas (TCGA) dataset, only 15 out of ˜980 BC patients can be classified as having de novo MBC. The objective of this study is to analyze the genomic landscape of de novo MBC and to study the genomic differences of this cohort with early stage BC. To enhance our ability to study de novo MBC, we utilized data from the Metastatic Breast Cancer Project (MBCproject), a patient-partnered research project that aims to generate a large public database of clinical, genomic, and patient reported data (PRD) from patients with MBC.

Methods: We defined de novo MBC as patients diagnosed with metastatic disease less than 4 months after their initial diagnosis with BC.Out of 127 patients in the MBCproject with publicly released whole exome sequencing (WES) data, we identified 33 patients with de novo MBC. We combined this data with 15 de novo MBC patients in TCGA. For patients with de novo MBC with multiple tumor biopsies available, we used WES from breast biopsies to enable appropriate comparison to the early stage biopsies. Somatic mutations were evaluated and significantly recurring genes were identified using MutSig2CV. We compared the mutations found in the de novo cohort with early stage tumors. 10 patients in the de novo MBC cohort had paired simultaneous primary and metastatic biopsies; genomic alterations in these samples were compared. Finally, we used RNA sequencing data to compare cytolytic signatures among the de novo and early stage biopsies.

Results: Among the 48 patients analyzed the receptor subtype distribution was: HR+/HER2-(23), HR+/HER2+(13), HR-/HER2+(2), HR-/HER2-(3), HR+/HER2 unknown(5), and HR-/HER2 unknown(2). Histology subtype distribution was as follows: IDC(39), MDLC(6), ILC(2) and Other (1). Significantly recurrent genes in the de novo MBC cohort (q&lt;0.1) included TP53(27%), PIK3CA(30%), CDH1(8%) and MAP3K1(11%). Mutations in PTEN, EGFR, and MDM4 were significantly enriched (p &lt;0.05) in the de novo cohort when compared to early stage BC Evolutionary analysis of paired primary and metastatic biopsies for de novo MBC patients demonstrated the presence of shared clonal mutations, indicating that these were highly evolutionarily related. RNA-seq immune cytolytic signature was downregulated in de novo MBC as compared to early stage BC (p &lt;0.2).

Gene% Mutation Rate in De Novo MBC (N=48)% Mutation rate in Early Stage BC (N= 997)p-valuePTEN10.403.510.0324EGFR6.250.500.00435MDM44.170.300.0189

Conclusions: Our initial results highlight genomic differences between de novo MBC and early stage BC, including increased frequency of PTEN, EGFR, and MDM4 mutations. Enrichment of PTEN mutations (implicated in tumor immune surveillance), and downregulation of cytolytic signature potentially suggests that de novo MBC may have immunosuppressive tumor microenvironment. To date, ˜1200 patients with self-reported de novo MBC have registered for the MBCproject. We anticipate that additional study of genomic and clinical data from these patients will greatly improve our understanding of de novo MBC.

Citation Format: Jain E, Kim D, Buendia JB, Cohen O, Sousa RB, Anastasio E, Dunphy M, McGillicuddy M, Stoddard R, Balch S, Thomas B, Di Lascio S, Tomson BN, Nguyen C, Painter C, Wagle N. The genomic landscape of de novo metastatic breast cancer (MBC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD9-03.

Fission program at n_TOF

Since its start in 2001 the n_TOF collaboration developed a measurement program on fission, in view of advanced fuels in new generation reactors. A special effort was made on measurement of cross sections of actinides, exploiting the peculiarity of the n_TOF neutron beam which spans a huge energy domain, from the thermal region up to GeV. Moreover fission fragment angular distributions have also been measured. An overview of the cross section results achieved with different detectors is presented, including a discussion of the 237Np case where discrepancies showed up between different detector systems. The results on the anisotropy of the fission fragments and its implication on the mechanism of neutron absorption, and in applications, are also shown.

DXA Measured Distal Femur Bone Mineral Density in Patients After Total Knee Arthroplasty: Method Development and Reproducibility

INTRODUCTION

Total knee arthroplasty (TKA) is increasingly being performed. Distal femur periprosthetic fracture is a potentially catastrophic complication following TKA and existing data document substantial distal femur bone mineral density (BMD) loss following TKA. However, distal femur BMD is virtually never measured clinically as no consensus approach exists. This pilot study's purpose was to define regional BMD variation throughout the femur, suggest standard dual-energy X-ray absorptiometry (DXA) regions of interest (ROIs) and evaluate BMD reproducibility at these ROIs.

METHODS

Thirty volunteers 2-5 yr post TKA had both entire femurs imaged twice using a Lunar iDXA with subject repositioning between scans; the atypical femur fracture feature of enCORE software was utilized. To define femoral BMD distribution, custom 1 cm ROIs were stacked one atop the other starting at the intercondylar notch and continuing to the base of the lesser trochanter. Femur length was measured with the ruler tool to calculate distance at 5% increments. ROIs encompassing each 5% increment were utilized to measure BMD at each location. Descriptive statistics were used to determine mean BMD at each ROI and reproducibility at the 15%, 25%, 45%, 60%, and 80% ROIs.

RESULTS

The 5 and 10% ROIs included prosthetic and/or patella, causing high BMD values. Distal femur BMD was lowest at the 15% ROI and was higher (p < 0.05) at each more proximal ROI to 45%, then plateaued from 45% to 75%. BMD reproducibility at these regions was excellent; coefficient of variation (CV) from ∼1% to 3.5%. As periprosthetic fractures generally occur in the distal femur, we propose measuring femur BMD using ROIs placed at 15% and 25%. A 60% region could also be used as a highly cortical site.

CONCLUSION

Existing DXA capabilities allow distal femur BMD measurement with good reproducibility. Further research using standardized ROIs to assess distal femur BMD loss after TKA, and interventions to mitigate this loss, is indicated.

Pigment carbon and nitrogen isotopic signatures in euxinic basins

The carbon and nitrogen isotopic signatures of chloropigments and porphyrins from the sediments of redox-stratified lakes and marine basins reveal details of past biogeochemical nutrient cycling. Such interpretations are strengthened by modern calibration studies, and here, we report on the C and N isotopic composition of pigments and nutrients in the water column and surface sediment of redox-stratified Fayetteville Green Lake (FGL; New York). We also report δ¹³ C and δ¹⁵ N values for pyropheophytin a (Pphe a) and bacteriochlorophyll e (Bchl e) deposited in the Black Sea during its transition to a redox-stratified basin ca. 7.8 ka. We propose a model for evolving nutrient cycling in the Black Sea from 7.8 to 6.4 ka, informed by the new pigment data from FGL. The seasonal study of water column nutrients and pigments at FGL revealed population dynamics in surface and deep waters that were also captured in the sediments. Biomass was greatest near the chemocline, where cyanobacteria, purple sulfur bacteria (PSB), and green sulfur bacteria (GSB) had seasonally variable populations. Bulk organic matter in the surface sediment, however, was derived mainly from the oxygenated surface waters. Surface sediment pigment δ¹³ C and δ¹⁵ N values indicate intact chlorophyll a (Chl a) was derived from near the chemocline, but its degradation product pheophytin a (Phe a) was derived primarily from surface waters. Bacteriopheophytin a (Bphe a) and Bchl e in the sediments came from chemocline populations of PSB and GSB, respectively. The distinctive δ¹³ C and δ¹⁵ N values for Chl a, Phe a, and Bphe a in the surface sediment are inputs to an isotopic mixing model that shows their decomposition to a common porphyrin derivative can produce non-specific sedimentary isotope signatures. This model serves as a caveat for paleobiogeochemical interpretations in basins that had diverse populations near a shallow chemocline.

'Non-standard' panoramic programmes and the unusual artefacts they produce

Dental panoramic radiographs (DPTs) are commonly taken in dental practice in the UK with the number estimated to be 2.7 million per annum. They are used to diagnose caries, periodontal disease, trauma, pathology in the jaws, supernumerary teeth and for orthodontic assessment. Panoramic radiographs are not simple projections but involve a moving X-ray source and detector plate. Ideally only the objects in the focal trough are displayed. This is achieved with a tomographic movement and one or more centre(s) of rotation. One advantage of digital radiography is hardware and software changes to optimise the image. This has led to increasingly complex manufacturer specific digital panoramic programmes. Panoramic radiographs suffer from ghost artefacts which can limit the effectiveness and make interpretation difficult. Conversely 'conventional dental imaging' such as intraoral bitewings do not suffer the same problems. There are also now several 'non-standard' panoramic programmes which aim to optimise the image for different clinical scenarios. These include 'improved interproximality', 'improved orthogonality' and 'panoramic bitewing mode'.This technical report shows that these 'non-standard' panoramic programmes can produce potentially confusing ghost artefacts, of which the practitioner may not be aware.

Alcohol intervention strategy among tuberculosis patients: a pilot study from South India

BACKGROUND

Alcohol dependence has been a major cause of treatment non-adherence in tuberculosis (TB) management. There is an urgent need to develop a feasible, acceptable alcohol intervention programme to ensure treatment completion.

METHODOLOGY

Four of the 10 Chennai Corporation zones in Chennai, South India, were randomly selected: two each for the experimental and control arms of the study. TB patients registered from August 2013 to January 2014 with the Revised National Tuberculosis Control Programme were assessed using the Alcohol Use Disorder Identification Test (AUDIT) scale. The intervention consisted of four individual counselling sessions at months 0, 2, 4 and 6 conducted by highly trained interventionists.

RESULTS

Of 872 TB patients, 298 (31%) were found to have alcohol use disorders. The numbers of TB patients in the experimental and control arms were respectively 113 (38%) and 185 (62%). The proportion of patients with favourable treatment outcomes was higher in the intervention than in the control group (87% vs. 62%, P = 0.04). Overall adherence to anti-tuberculosis treatment was significantly higher in the intervention group (P = 0.02).

CONCLUSION

Study findings suggest that alcohol interventions could be effective in ensuring favourable TB treatment outcomes and adherence. This calls for a large cluster randomised trial for greater generalisability. Tested alcohol-intervention strategies should be recommended to promote treatment adherence among TB patients who consume alcohol.

Calibration of the low-energy channel Thomson parabola of the LMJ-PETAL diagnostic SEPAGE with protons and carbon ions

The SEPAGE diagnostic will detect charged particles (electrons, protons, and ions) accelerated in the interaction of the PETAL (PETawatt Aquitaine Laser) laser with its targets on the LMJ (Laser MegaJoule)-PETAL laser facility. SEPAGE will be equipped with a proton-radiography front detector and two Thomson parabolas (TP), corresponding to different ranges of the particle energy spectra: Above 0.1 MeV for electrons and protons in the low-energy channel, with a separation capability between protons and ¹²C⁶⁺ up to 20 MeV proton energy and above 8 MeV for the high-energy channel, with a separation capability between protons and ¹²C⁶⁺ up to 200 MeV proton kinetic energy. This paper presents the calibration of the SEPAGE's low-energy channel TP at the Tandem facility of Orsay (France) with proton beams between 3 and 22 MeV and carbon-ion beams from 5.8 to 84 MeV. The magnetic and electric fields' integrals were determined with an accuracy of 10^-3 by combining the deflections measured at different energies with different target thicknesses and materials, providing different in-target energy losses of the beam particles and hence different detected energies for given beam energies.

Group intervention for carers of geriatric patients: experiences from a clinic in India

Sixty per cent of the global elderly population live in low-and middle-income countries, and this proportion was expected to rise to 70% by 2010 (International Institute of Ageing, 2001; Ferri et al, 2005). The 2001 Indian census found over 70 million people aged 60 years or more (considered senior citizens according to the Indian National Policy on Older Persons). Most of those senior citizens live with younger family members and are dependent on them for financial and social support. Hence, any physiological and psychological changes in the older family members affect the younger supportive members as well.

Second-harmonic generation imaging of collagen in ancient bone

Second-harmonic generation imaging (SHG) captures triple helical collagen molecules near tissue surfaces. Biomedical research routinely utilizes various imaging software packages to quantify SHG signals for collagen content and distribution estimates in modern tissue samples including bone. For the first time using SHG, samples of modern, medieval, and ice age bones were imaged to test the applicability of SHG to ancient bone from a variety of ages, settings, and taxa. Four independent techniques including Raman spectroscopy, FTIR spectroscopy, radiocarbon dating protocols, and mass spectrometry-based protein sequencing, confirm the presence of protein, consistent with the hypothesis that SHG imaging detects ancient bone collagen. These results suggest that future studies have the potential to use SHG imaging to provide new insights into the composition of ancient bone, to characterize ancient bone disorders, to investigate collagen preservation within and between various taxa, and to monitor collagen decay regimes in different depositional environments.

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Second-Harmonic Generation (SHG) confocal laser scanning microscopy is used to investigate collagen remnants in ancient bone.

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Four independent techniques confirm the presence of collagen remnants in ancient bone samples with SHG-detected collagen.

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SHG imaging can visualise collagen remnants in ancient bone of various taxa, ages, and settings.

Significant decline in lymphatic filariasis associated with nationwide scale-up of insecticide-treated nets in Zambia

Lymphatic filariasis (LF) is a mosquito-borne disease, broadly endemic in Zambia, and is targeted for elimination by mass drug administration (MDA) of albendazole and diethylcarbamazine citrate (DEC) to at-risk populations. Anopheline mosquitoes are primary vectors of LF in Africa, and it is possible that the significant scale-up of malaria vector control over the past decade may have also impacted LF transmission, and contributed to a decrease in prevalence in Zambia. We therefore aimed to examine the putative association between decreasing LF prevalence and increasing coverage of insecticide-treated mosquito nets (ITNs) for malaria vector control, by comparing LF mapping data collected between 2003-2005 and 2009-2011 to LF sentinel site prevalence data collected between 2012 and 2014, before any anti-LF MDA was started. The coverage of ITNs for malaria was quantified and compared for each site in relation to the dynamics of LF. We found a significant decrease in LF prevalence from the years 2003-2005 (11.5% CI95 6.6; 16.4) to 2012-2014 (0.6% CI95 0.03; 1.1); at the same time, there was a significant scale-up of ITNs across the country from 0.2% (CI95 0.0; 0.3) to 76.1% (CI95 71.4; 80.7) respectively. The creation and comparison of two linear models demonstrated that the geographical and temporal variation in ITN coverage was a better predictor of LF prevalence than year alone. Whilst a causal relationship between LF prevalence and ITN coverage cannot be proved, we propose that the scale-up of ITNs has helped to control Anopheles mosquito populations, which have in turn impacted on LF transmission significantly before the scale-up of MDA. This putative synergy with vector control has helped to put Zambia on track to meet national and global goals of LF elimination by 2020.

Calibration of imaging plate detectors to mono-energetic protons in the range 1-200 MeV

Responses of Fuji Imaging Plates (IPs) to proton have been measured in the range 1-200 MeV. Mono-energetic protons were produced with the 15 MV ALTO-Tandem accelerator of the Institute of Nuclear Physics (Orsay, France) and, at higher energies, with the 200-MeV isochronous cyclotron of the Institut Curie-Centre de Protonthérapie d'Orsay (Orsay, France). The experimental setups are described and the measured photo-stimulated luminescence responses for MS, SR, and TR IPs are presented and compared to existing data. For the interpretation of the results, a sensitivity model based on the Monte Carlo GEANT4 code has been developed. It enables the calculation of the response functions in a large energy range, from 0.1 to 200 MeV. Finally, we show that our model reproduces accurately the response of more complex detectors, i.e., stack of high-Z filters and IPs, which could be of great interest for diagnostics of Petawatt laser accelerated particles.

'If it's a medical issue I would have covered it by now': learning about fibromyalgia through the hidden curriculum: a qualitative study

BACKGROUND

Fibromyalgia syndrome (FMS) is a long-term condition that affects between 1 and 5% of the general population and lies within the spectrum of medically unexplained symptoms (MUS). FMS can be difficult to diagnose and is usually done so as a diagnosis of exclusion. There is continuing debate regarding its legitimacy excluding other causes of symptoms. It is known that the diagnosis and management of MUS, including FMS, receives little attention in medical curricula and attitudes towards patients with FMS amongst medical professionals and trainees can be negative. The purpose of this study was to investigate how attitudes and perspectives of undergraduate medical students towards FMS are acquired during their training.

METHODS

Qualitative interviews with 21 medical students were conducted to explore their views on FMS, encounters with patients with FMS, and where learning about FMS occurs. Participants were recruited from two English medical schools and the study was approved by two University Ethics committees. Interviews were digitally recorded with consent and data analysed thematically, using principles of constant comparison.

RESULTS

The data were organised within three themes: i) FMS is a complex, poorly understood condition; ii) multiple sources for learning about FMS; and iii) consequences of negative attitudes for patients with FMS.

CONCLUSION

Undergraduate medical students have limited understanding of, and are sceptical over the existence of FMS. These attitudes are influenced by the 'hidden curriculum' and witnessing attitudes and actions of their clinical teachers. Students interpret a lack of formal curriculum teaching around FMS to mean that it is not serious and hence a low priority. Encountering a patient, friend or family member with FMS can increase knowledge and lead to altered perceptions of the condition. Teaching and learning about FMS needs to be consistent to improve knowledge and attitudes of clinicians. Undergraduate students should be exposed to patients with FMS so that they better understand patients with FMS.

Assessment of Iron Deposition in the Brain in Frontotemporal Dementia and Its Correlation with Behavioral Traits

BACKGROUND AND PURPOSE

Brain iron deposition has been implicated as a major culprit in the pathophysiology of neurodegeneration. However, the quantitative assessment of iron in behavioral variant frontotemporal dementia and primary progressive aphasia brains has not been performed, to our knowledge. The aim of our study was to investigate the characteristic iron levels in the frontotemporal dementia subtypes using susceptibility-weighted imaging and report its association with behavioral profiles.

MATERIALS AND METHODS

This prospective study included 46 patients with frontotemporal dementia (34 with behavioral variant frontotemporal dementia and 12 with primary progressive aphasia) and 34 age-matched healthy controls. We performed behavioral and neuropsychological assessment in all the subjects. The quantitative iron load was determined on SWI in the superior frontal gyrus and temporal pole, precentral gyrus, basal ganglia, anterior cingulate, frontal white matter, head and body of the hippocampus, red nucleus, substantia nigra, insula, and dentate nucleus. A linear regression analysis was performed to correlate iron content and behavioral scores in patients.

RESULTS

The iron content of the bilateral superior frontal and temporal gyri, anterior cingulate, putamen, right hemispheric precentral gyrus, insula, hippocampus, and red nucleus was higher in patients with behavioral variant frontotemporal dementia than in controls. Patients with primary progressive aphasia had increased iron levels in the left superior temporal gyrus. In addition, right superior frontal gyrus iron deposition discriminated behavioral variant frontotemporal dementia from primary progressive aphasia. A strong positive association was found between apathy and iron content in the superior frontal gyrus and disinhibition and iron content in the putamen.

CONCLUSIONS

Quantitative assessment of iron deposition with SWI may serve as a new biomarker in the diagnostic work-up of frontotemporal dementia and help distinguish frontotemporal dementia subtypes.

Histological Evolution of BK Virus-Associated Nephropathy: Importance of Integrating Clinical and Pathological Findings

Long-term clinicopathological studies of BK-associated nephropathy (PyVAN) are not available. We studied 206 biopsies (71 patients), followed 3.09 ± 1.46 years after immunosuppression reduction. The biopsy features (% immunostain for PyV large T ag + staining and inflammation ± acute rejection) were correlated with viral load dynamics and serum creatinine to define the clinicopathological status (PyVCPS). Incidence of acute rejection was 28% in the second biopsy and 50% subsequently (25% mixed T cell-mediated allograft rejection (TCMR) + antibody-mediated allograft rejection (AMR); rejection overall affected 38% of patients (>50% AMR). Graft loss was 15.4% (0.8-5.3 years after PyVAN); 76% had complete viral clearance (mean 28 weeks). The only predictors of graft loss were acute rejection (TCMR p = 0.008, any type p = 0.07), and increased "t" and "ci" in the second biopsy (p = 0.006 and 0.048). Higher peak viremia correlated with poorer viral clearance (p = 0.002). Presumptive and proven PyVAN had similar presentation, evolution, and outcome. Late PyVAN (>2 years, 9.8%) justifies BK viremia evaluation at any point with graft dysfunction and/or biopsy evaluation. This study describes the histological evolution of PyVAN and corresponding clinicopathological correlations. Although the pathological features overall reflect the viral and immunological interactions, the PyVAN course remains difficult to predict based on any single feature. Appropriate clinical management requires repeat biopsies and determination of the PyVCPS at relevant time points, for corresponding personalized immunosuppression adjustment.

Is pyridoxine effective and safe for post-partum lactation inhibition? A systematic review

WHAT IS KNOWN AND OBJECTIVE

It has been suggested that pyridoxine has an antilactogenic effect. Studies of the efficacy of pyridoxine in suppressing lactation have reported conflicting results. The aim of this review was to evaluate the effectiveness and safety of high-dose pyridoxine in post-partum lactation inhibition.

METHODS

This systematic review included published trials that compared the efficacy and/or safety of pyridoxine to placebo or to other pharmacological agents for the inhibition of post-partum lactation. We searched PubMed, Embase, ScienceDirect, CINAHL, AMED, the Cochrane library and the clinical trials registry to identify relevant literature. No limit was imposed on the year of publication of the studies, and the review included studies published until 15 January 2016. Two reviewers independently extracted data and assessed the risk of bias.

RESULTS AND DISCUSSION

Seven studies were included, with a total of 1155 women, of which 471 women received pyridoxine. Three studies were randomized controlled trials, whereas the remaining four studies were non-randomized controlled trials. All of the included studies were relatively small (n=18-482). The studies compared pyridoxine with placebo, bromocriptine and/or stilboestrol. Pyridoxine was given orally, with a total daily dose of 450-600 mg for 5-7 days. Two trials (n=349 participants) indicated that pyridoxine was effective in inhibiting lactation in approximately 95% of the enrolled patients. All other studies failed to demonstrate pyridoxine efficacy through either clinical assessment or prolactin level measurements. Pyridoxine safety was assessed by two trials in which no serious untoward side effects were reported. Overall, the risk of bias for most of the studies was low to moderate.

WHAT IS NEW AND CONCLUSION

Current evidence supporting the effectiveness of high-dose pyridoxine in the inhibition of post-partum lactation is inconsistent and insufficient. Larger randomized trials are needed to confirm the efficacy of pyridoxine in post-partum lactation inhibition.