Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections

Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.^1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.^4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.⁸ However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.

Observation and Measurement of Forward Proton Scattering in Association with Lepton Pairs Produced via the Photon Fusion Mechanism at ATLAS

The observation of forward proton scattering in association with lepton pairs (e^{+}e^{-}+p or μ^{+}μ^{-}+p) produced via photon fusion is presented. The scattered proton is detected by the ATLAS Forward Proton spectrometer, while the leptons are reconstructed by the central ATLAS detector. Proton-proton collision data recorded in 2017 at a center-of-mass energy of sqrt[s]=13  TeV are analyzed, corresponding to an integrated luminosity of 14.6  fb^{-1}. A total of 57 (123) candidates in the ee+p (μμ+p) final state are selected, allowing the background-only hypothesis to be rejected with a significance exceeding 5 standard deviations in each channel. Proton-tagging techniques are introduced for cross-section measurements in the fiducial detector acceptance, corresponding to σ_{ee+p}=11.0±2.6(stat)±1.2(syst)±0.3(lumi) and σ_{μμ+p}=7.2±1.6(stat)±0.9(syst)±0.2(lumi)  fb in the dielectron and dimuon channel, respectively.

Search for Heavy Resonances Decaying into a Photon and a Hadronically Decaying Higgs Boson in pp Collisions at sqrt[s]=13 TeV with the ATLAS Detector

This Letter presents a search for the production of new heavy resonances decaying into a Higgs boson and a photon using proton-proton collision data at sqrt[s]=13  TeV collected by the ATLAS detector at the LHC. The data correspond to an integrated luminosity of 139  fb^{-1}. The analysis is performed by reconstructing hadronically decaying Higgs boson (H→bb[over ¯]) candidates as single large-radius jets. A novel algorithm using information about the jet constituents in the center-of-mass frame of the jet is implemented to identify the two b quarks in the single jet. No significant excess of events is observed above the expected background. Upper limits are set on the production cross-section times branching fraction for narrow spin-1 resonances decaying into a Higgs boson and a photon in the resonance mass range from 0.7 to 4 TeV, cross-section times branching fractions are excluded between 11.6 fb and 0.11 fb at a 95% confidence level.

International validation of a risk prediction algorithm for patients with malignant colorectal polyps

AIM

The optimal management strategy for patients with endoscopically resected malignant colorectal polyps (MCP) has yet to be defined. The aim of this study was to validate a published decision-making tool, termed the Scottish Polyp Cancer Study (SPOCS) algorithm, on a large international population.

METHODS

The SPOCS algorithm allocates patients to risk groups based on just two variables: the polyp resection margin and the presence of lymphovascular invasion (LVI). The risk groups are termed low (clear margin, LVI absent), medium (clear margin, LVI present) or high (involved/non-assessable margin). The International Polyp Cancer Collaborative was formed to validate the algorithm on data from Australia, Denmark, UK and New Zealand.

RESULTS

In total, 1423 patients were included in the final dataset. 680/1423 (47.8%) underwent surgical resection and 108/680 (15.9%) had residual disease (luminal disease 8.8%, lymph node metastases 8.8%). The SPOCS algorithm classified 602 patients as low risk (in which 1.5% had residual disease), 198 patients as medium risk (in which 7.1% had residual disease) and 484 as high risk (in which 14.5% had residual disease) (P < 0.001, χ² test). Receiver operating characteristic curve analysis demonstrated good accuracy of the algorithm in predicting residual disease (area under the curve 0.732, 95% CI 0.687-0.778, P < 0.001). When patients were designated as low risk, the negative predictive value was 98.5%.

CONCLUSION

The SPOCS algorithm can be used to predict the risk of residual disease in patients with endoscopically resected MCPs. Surgery can be safely avoided in patients who have a clear margin of excision and no evidence of LVI.

Search for Higgs Boson Decays into a Z Boson and a Light Hadronically Decaying Resonance Using 13 TeV pp Collision Data from the ATLAS Detector

A search for Higgs boson decays into a Z boson and a light resonance in two-lepton plus jet events is performed, using a pp collision dataset with an integrated luminosity of 139  fb^{-1} collected at sqrt[s]=13  TeV by the ATLAS experiment at the CERN LHC. The resonance considered is a light boson with a mass below 4 GeV from a possible extended scalar sector or a charmonium state. Multivariate discriminants are used for the event selection and for evaluating the mass of the light resonance. No excess of events above the expected background is found. Observed (expected) 95% confidence-level upper limits are set on the Higgs boson production cross section times branching fraction to a Z boson and the signal resonance, with values in the range 17-340 pb (16_{-5}^{+6}-320_{-90}^{+130}  pb) for the different light spin-0 boson mass and branching fraction hypotheses, and with values of 110 and 100 pb (100_{-30}^{+40} and 100_{-30}^{+40}  pb) for the η_{c} and J/ψ hypotheses, respectively.

Prevalence of temporomandibular disorder in children and adolescents with juvenile idiopathic arthritis - a Norwegian cross- sectional multicentre study

Background

Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer pain from temporomandibular disorder (TMD). Still, routines for the assessment of temporomandibular joint (TMJ) pain in health and dental care are lacking. The aims of this study were to examine the prevalence of TMD in children and adolescents with JIA compared to their healthy peers and to investigate potential associations between JIA and TMD.

Methods

This comparative cross-sectional study is part of a longitudinal multicentre study performed during 2015–2020, including 228 children and adolescents aged 4–16 years with a diagnosis of JIA according to the ILAR criteria. This particular substudy draws on a subset of data from the first study visit, including assessments of TMD as part of a broader oral health examination. Children and adolescents with JIA were matched with healthy controls according to gender, age, and centre site. Five calibrated examiners performed the clinical oral examinations according to a standardised protocol, including shortened versions of the diagnostic criteria for TMD (DC/TMD) and the TMJaw Recommendations for Clinical TMJ Assessment in Patients Diagnosed with JIA. Symptoms were recorded and followed by a clinical examination assessing the masticatory muscles and TMJs.

Results

In our cohort of 221 participants with JIA and 221 healthy controls, 88 (39.8%) participants with JIA and 25 (11.3%) healthy controls presented with TMD based on symptoms and clinical signs. Painful TMD during the last 30 days was reported in 59 (26.7%) participants with JIA vs. 10 (5.0%) of the healthy controls (p <  0.001). Vertical unassisted jaw movement was lower in participants with JIA than in controls, with means of 46.2 mm vs. 49.0 mm, respectively (p <  0.001). Among participants with JIA, a higher proportion of those using synthetic disease-modifying antirheumatic-drugs and biologic disease-modifying antirheumatic-drugs presented with painful masticatory muscles and TMJs at palpation.

Conclusion

Symptoms and clinical signs of TMD were seen in approximately half of the JIA patients compared to about one fourth of their healthy peers. Painful palpation to masticatory muscles and decreased vertical unassisted jaw movement were more frequent in participants with JIA than among healthy controls and should be part of both medical and dental routine examinations in patients with JIA.

Dijet Resonance Search with Weak Supervision Using sqrt[s]=13 TeV pp Collisions in the ATLAS Detector

This Letter describes a search for narrowly resonant new physics using a machine-learning anomaly detection procedure that does not rely on signal simulations for developing the analysis selection. Weakly supervised learning is used to train classifiers directly on data to enhance potential signals. The targeted topology is dijet events and the features used for machine learning are the masses of the two jets. The resulting analysis is essentially a three-dimensional search A→BC, for m_{A}∼O(TeV), m_{B},m_{C}∼O(100  GeV) and B, C are reconstructed as large-radius jets, without paying a penalty associated with a large trials factor in the scan of the masses of the two jets. The full run 2 sqrt[s]=13  TeV pp collision dataset of 139  fb^{-1} recorded by the ATLAS detector at the Large Hadron Collider is used for the search. There is no significant evidence of a localized excess in the dijet invariant mass spectrum between 1.8 and 8.2 TeV. Cross-section limits for narrow-width A, B, and C particles vary with m_{A}, m_{B}, and m_{C}. For example, when m_{A}=3  TeV and m_{B}≳200  GeV, a production cross section between 1 and 5 fb is excluded at 95% confidence level, depending on m_{C}. For certain masses, these limits are up to 10 times more sensitive than those obtained by the inclusive dijet search. These results are complementary to the dedicated searches for the case that B and C are standard model bosons.

CP Properties of Higgs Boson Interactions with Top Quarks in the tt[over ¯]H and tH Processes Using H→γγ with the ATLAS Detector

A study of the charge conjugation and parity (CP) properties of the interaction between the Higgs boson and top quarks is presented. Higgs bosons are identified via the diphoton decay channel (H→γγ), and their production in association with a top quark pair (tt[over ¯]H) or single top quark (tH) is studied. The analysis uses 139  fb^{-1} of proton-proton collision data recorded at a center-of-mass energy of sqrt[s]=13  TeV with the ATLAS detector at the Large Hadron Collider. Assuming a CP-even coupling, the tt[over ¯]H process is observed with a significance of 5.2 standard deviations. The measured cross section times H→γγ branching ratio is 1.64_{-0.36}^{+0.38}(stat)_{-0.14}^{+0.17}(sys)  fb, and the measured rate for tt[over ¯]H is 1.43_{-0.31}^{+0.33}(stat)_{-0.15}^{+0.21}(sys) times the Standard Model expectation. The tH production process is not observed and an upper limit on its rate of 12 times the Standard Model expectation is set. A CP-mixing angle greater (less) than 43 (-43)° is excluded at 95% confidence level.

Biodegradable, lignin-based encapsulation enables delivery of Trichoderma reesei with programmed enzymatic release against grapevine trunk diseases

Antagonistic fungi such as Trichoderma reesei are promising alternatives to conventional fungicides in agriculture. This is especially true for worldwide occurring grapevine trunk diseases, causing losses of US$1.5 billion every year, at which conventional fungicides are mostly ineffective or prohibited by law. Yet, applications of Trichoderma against grapevine trunk diseases are limited to preventive measures, suffer from poor shelf life, or uncontrolled germination. Therefore, we developed a mild and spore-compatible layer-by-layer assembly to encapsulate spores of a new mycoparasitic strain of T. reesei IBWF 034-05 in a bio-based and biodegradable lignin shell. The encapsulation inhibits undesired premature germination and enables the application as an aqueous dispersion via trunk injection. First injected into a plant, the spores remain in a resting state. Second, when lignin-degrading fungi infect the plant, enzymatic degradation of the shell occurs and germination is selectively triggered by the pathogenic fungi itself, which was proven in vitro. Germinated Trichoderma antagonizes the fungal pathogens and finally supplants them from the plant. This concept enables Trichoderma spores for curative treatment of esca, one of the most infective grapevine trunk diseases worldwide.

Knowledge of objects' physical properties implicitly guides attention during visual search

Our interactions with the world are guided by our understanding of objects' physical properties. When packing groceries, we place fragile items on top of more durable ones and position sharp corners so they will not puncture the bags. However, physical properties are not always readily observable, and we often must rely on our knowledge of attributes such as weight, hardness, and slipperiness to guide our actions on familiar objects. Here, we asked whether our knowledge of physical properties not only shapes our actions but also guides our attention to the visual world. In a series of four visual search experiments, participants viewed arrays of everyday objects and were tasked with locating a specified object. The target was sometimes differentiated from the distractors based on its hardness, while a host of other visual and semantic attributes were controlled. We found that observers implicitly used the hardness distinction to locate the target more quickly, even though none reported being aware that hardness was relevant. This benefit arose from fixating fewer distractors overall and spending less time interrogating each distractor when the target was distinguished by hardness. Progressively more stringent stimulus controls showed that surface properties and curvature cues to hardness were not necessary for the benefit. Our findings show that observers implicitly recruit their knowledge of objects' physical properties to guide how they attend to and engage with visual scenes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Antiferromagnetic textures in BiFeO3 controlled by strain and electric field

Antiferromagnetic thin films are currently generating considerable excitement for low dissipation magnonics and spintronics. However, while tuneable antiferromagnetic textures form the backbone of functional devices, they are virtually unknown at the submicron scale. Here we image a wide variety of antiferromagnetic spin textures in multiferroic BiFeO₃ thin films that can be tuned by strain and manipulated by electric fields through room-temperature magnetoelectric coupling. Using piezoresponse force microscopy and scanning NV magnetometry in self-organized ferroelectric patterns of BiFeO₃, we reveal how strain stabilizes different types of non-collinear antiferromagnetic states (bulk-like and exotic spin cycloids) as well as collinear antiferromagnetic textures. Beyond these local-scale observations, resonant elastic X-ray scattering confirms the existence of both types of spin cycloids. Finally, we show that electric-field control of the ferroelectric landscape induces transitions either between collinear and non-collinear states or between different cycloids, offering perspectives for the design of reconfigurable antiferromagnetic spin textures on demand.

Tailoring antiferromagnetic domains is critical for the development of low-dissipative spintronic and magnonic devices. Here the authors demonstrate the control of antiferromagnetic spin textures in multiferroic bismuth ferrite thin films using strain and electric fields.

Influence of Material and Surface Roughness of Resin Composite Cements on Fibroblast Behavior

Clinical Relevance

A well-polished cement surface increases the viability and spreading of gingival fibroblasts. The tested resin composite cements did not reveal any cytotoxic effects.

SUMMARY

Objective: This in vitro study aimed to investigate the effect of cement type and roughness on the viability and cell morphology of human gingival fibroblasts (HGF-1).

Methods and Materials: Discs of three adhesive (Panavia V5 [PV5], Multilink Automix [MLA], RelyX Ultimate [RUL] and three self-adhesive (Panavia SA plus [PSA], SpeedCem plus [SCP], RelyX Unicem [RUN]) resin composite cements were prepared with three different roughnesses using silica paper grit P180, P400, or P2500. The cement specimens were characterized by surface roughness and energy-dispersive X-ray spectroscopic mapping. A viability assay was performed after 24 hours of incubation of HGF-1 cells on cement specimens. Cell morphology was examined with scanning electron microscopy.

Results: The roughness of the specimens did not differ significantly among the different resin composite cements. Mean Ra values for the three surface treatments were 1.62 ± 0.34 μm for P180, 0.79 ± 0.20 μm for P400, and 0.17 ± 0.08 μm for P2500. HGF-1 viability was significantly influenced by the cement material and the specimens’ roughness, with the highest viability for PSA ≥ RUN = MLA ≥ SCP = PV5 &gt; RUL (p&lt;0.05) and for P2500 = P400 &gt; P180 (p&lt;0.001). Cell morphology did not vary among the materials but was affected by the surface roughness.

Conclusion: The composition of resin composite cements significantly affects the cell viability of HGF-1. Smooth resin composite cement surfaces with an Ra of 0.2–0.8 μm accelerate flat cell spreading and formation of filopodia.

Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society

BACKGROUND

Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short- and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias.

METHODS

The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done on 1 May 2018, and updated on 1 February 2019.

RESULTS

Literature reporting specifically on umbilical and epigastric hernias was limited in quantity and quality, resulting in a majority of the recommendations being graded as weak, based on low-quality evidence. The main recommendation was to use mesh for repair of umbilical and epigastric hernias to reduce the recurrence rate. Most umbilical and epigastric hernias may be repaired by an open approach with a preperitoneal flat mesh. A laparoscopic approach may be considered if the hernia defect is large, or if the patient has an increased risk of wound morbidity.

CONCLUSION

This is the first European and American guideline on the treatment of umbilical and epigastric hernias. It is recommended that symptomatic umbilical and epigastric hernias are repaired by an open approach with a preperitoneal flat mesh.

EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances

Background

Rare locations of hernias, as well as primary ventral hernias under certain circumstances (cirrhosis, dialysis, rectus diastasis, subsequent pregnancy), might be technically challenging. The aim was to identify situations where the treatment strategy might deviate from routine management.

Methods

The guideline group consisted of surgeons from the European and Americas Hernia Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used in formulating the recommendations. The Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists were used to evaluate the quality of full‐text papers. A systematic literature search was performed on 1 May 2018 and updated 1 February 2019. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was followed.

Results

Literature was limited in quantity and quality. A majority of the recommendations were graded as weak, based on low quality of evidence. In patients with cirrhosis or on dialysis, a preperitoneal mesh repair is suggested. Subsequent pregnancy is a risk factor for recurrence. Repair should be postponed until after the last pregnancy. For patients with a concomitant rectus diastasis or those with a Spigelian or lumbar hernia, no recommendation could be made for treatment strategy owing to lack of evidence.

Conclusion

This is the first European and American guideline on the treatment of umbilical and epigastric hernias in patients with special conditions, including Spigelian and lumbar hernias. All recommendations were weak owing to a lack of evidence. Further studies are needed on patients with rectus diastasis, Spigelian and lumbar hernias.

Heterogeneous Clusters of Phthalocyanine and Water Prepared and Probed in Superfluid Helium Nanodroplets

Superfluid helium nanodroplets comprised of thousands to millions of helium atoms can serve as a reactor for the synthesis of heterogeneous molecular clusters at cryogenic conditions. The cluster synthesis occurs via consecutive pick-up of the cluster building blocks by the helium droplet and their subsequent coalescence within the droplet. The effective collision cross section of the building blocks is determined by the helium droplet size and thus exceeds by orders of magnitude that of a reactive collision in the gas phase. Moreover, the cryogenic helium environment (at 0.38 K) as a host promotes the formation of metastable cluster configurations. The question arises as to the extent of the actual involvement of the helium environment in the cluster formation. The present study deals with clusters of single phthalocyanine (Pc) molecules with single water molecules. A large fluorophore such as Pc offers several sites where the water molecule can attach. The resulting isomeric variants of the Pc-H₂O complex can be selectively identified by electronic spectroscopy. We compare the experimental electronic spectra of the Pc-H₂O complex generated in superfluid helium nanodroplets with the results of quantum-chemical calculations on the same cluster but under gas-phase conditions. The number of isomeric variants observed in the helium droplet experiment comes out the same as that obtained from our gas-phase calculations.

Promoting Intern Resilience: Individual Chief Wellness Check-ins

INTRODUCTION

Promoting resilience is key during intern year as residents transition to becoming clinical providers. Residents consistently demonstrate a decline in empathy and an increase in burnout throughout training. Interventions involving mindfulness, stress management, and small-group discussions can reduce burnout. We created a curriculum to normalize the intern experience and provide debriefing opportunities to further improve resilience and decrease burnout.

METHODS

Thirty-two interns met monthly, one-on-one, with a pediatric chief resident to discuss personal, professional, and emotional well-being and complete just-in-time resilience exercises. After 6 and 12 months, we conducted follow-up surveys containing 5-point Likert questions and open-ended questions to determine interns' perceptions of the initiative.

RESULTS

We obtained response rates of 44% (14 interns) and 38% (12 interns) for the 6- and 12-month surveys, respectively. Interns found the sessions helpful for normalizing the intern experience (6 months: 4.6 ± 0.7, 12 months: 4.8 ± 0.5), stress management (6 months: 4.0 ± 1.0, 12 months: 4.3 ± 0.7), and feeling connected to program leadership (6 months: 4.6 ± 0.9, 12 months: 5.0 ± 0.0). Thematic analysis identified normalizing the intern experience, ability to express concerns, and mentorship as benefits.

DISCUSSION

Normalization of the intern experience and targeted wellness and resilience exercises can have a positive impact on interns' satisfaction with program support for their well-being. Through a time-limited intervention, chief residents can be utilized in a mentorship role that is well received by interns and rewarding for the chief residents.

[Career Prospects for Young Physicians in Infectious Diseases]

Infectious Diseases are a cross-sectional area connected to various medical disciplines and offer interested physicians multiple working opportunities. The spectrum of infectious diseases covers both out- and inpatient care as well as basic, clinical and epidemiological research. The need for infectious diseases specialists is increasing, thus career prospects are promising. Working conditions in infectious diseases are comparatively family-friendly. With this article we intend to arouse interest for working in the fascinating fields of infectious diseases and provide information on career opportunities. Data from a recently conducted survey among members of the German Society of Infectious Diseases deliver insight, how infectious disease specialists work today.

[Influence of culture and religion on the treatment of cancer patients]

Religion, which is one of the most important sources of human identity, has so far hardly been taken into account in the clinic. In the largely secularized society of Germany, this has played a highly subordinate role. Currently, however, the development towards a multireligious society is emerging, which will also be reflected in everyday medical care. Disease and mortality in patients can affect different cultural-religious spheres. Although distinction between cultural and religious aspects is possible, it is not necessary for clinical practice. In the situation of oncological therapy, questions may arise which must be answered differently in the religions Christianity, Judaism and Islam and which should be taken into account when selecting therapy. The consideration of cultural-religious rules can intensify the patient's acceptance, but it can also impair it in case of disregard. Such peculiarities can be the separation into male and female spheres or the restriction of certain auxiliary substances or drugs (blood products, narcotics). Kübler-Ross's phase model is suitable for determining where cultural-religious sensitivities should be taken into account in the phases of disease and how cultural-religious offerings can benefit the course of therapy. Due to large individual, regional, cultural and confessional differences, no systematic catalogue of procedures can be provided here. However, knowledge of such differences, more sensitive interaction with patients and their families and cooperation with hospital pastors can strengthen the relationship of trust between doctor and patient and thus improve the conditions for successful oncological therapy. These aspects should not be underestimated when treating people of other faiths in Germany's secular society.

Plasmids carrying antimicrobial resistance genes in Enterobacteriaceae

Bacterial antimicrobial resistance (AMR) is constantly evolving and horizontal gene transfer through plasmids plays a major role. The identification of plasmid characteristics and their association with different bacterial hosts provides crucial knowledge that is essential to understand the contribution of plasmids to the transmission of AMR determinants. Molecular identification of plasmid and strain genotypes elicits a distinction between spread of AMR genes by plasmids and dissemination of these genes by spread of bacterial clones. For this reason several methods are used to type the plasmids, e.g. PCR-based replicon typing (PBRT) or relaxase typing. Currently, there are 28 known plasmid types in Enterobacteriaceae distinguished by PBRT. Frequently reported plasmids [IncF, IncI, IncA/C, IncL (previously designated IncL/M), IncN and IncH] are the ones that bear the greatest variety of resistance genes. The purpose of this review is to provide an overview of all known AMR-related plasmid families in Enterobacteriaceae, the resistance genes they carry and their geographical distribution.

Abstract P3-01-12: Clinical safety of diagnostic leukapheresis as a liquid biopsy to collect circulating tumor cells in primary and metastatic breast cancer patients

Introduction: The enumeration of circulating tumor cells (CTCs) has been shown to be of prognostic relevance for neoadjuvant, adjuvant and metastatic setting of breast cancer in multiple clinical trials. Moreover, the serial determination of CTCs enables therapy monitoring in the metastatic setting. One major caveat is the low number of CTCs detected by established methods which limits the possibility for further evaluation including phenotyping and genotyping. Therefore, the clinical use of CTCs as liquid biopsy for making therapy decisions is still under discussion. Diagnostic leukapheresis (DLA) has been previously established by our research group and implemented in the workflow for isolation and detection of CTCs enabling a reliable detection of CTCs at high frequency. The aim of this clinical study was to assess the safety of leukapheresis in 39 patients with primary and metastatic breast cancer.

Methods: DLA was performed at least 1d before surgery or chemotherapy. A median blood volume of 2.7 L (range, 1.0 L–5.3 L) was processed. Citrate dextrose solution A was used for anticoagulation with ratios ranging from 11:1 to 24:1. Complete blood count as well as measuring blood pressure and heart rate was performed before start of DLA and immediately after DLA. CTCs were enumerated using the CellSearch system. DLA products containing a median number of 1,8x108 MNCs were processed.

Results: 41 patients were eligible for DLA. Only in two patients DLA could not be performed due to technical problems. Thirty-nine patients underwent leukapheresis. Twenty-six patients had non metastatic breast cancer. Thirteen patients were diagnosed with metastatic breast cancer. Severe adverse events including hypotension, nauseas, tingling e.g. resulting in interruption of apheresis were not observed. The DLA did not interfere with the start of chemotherapy or surgery. Complete blood count before and after DLA showed statistic significant but clinically irrelevant decrease in numbers of leukocytes, thrombocytes, hemoglobin and the percentage of hematocrit. In 11/21 DLA samples (52%) of patients with primary breast cancer CTCs were detected. Number of CTCs ranged from 1 to 51. In 11/13 DLA samples (85%) of patients with MBC CTCs were detected. Number of CTCs ranged from 1 to 2913.

Conclusion: Establishing a routine DLA protocol we demonstrated that this procedure is clinically safe and can be implemented into the clinical workflow of breast cancer patient care.

Citation Format: Fehm T, Meier-Stiegen F, Jaeger B, Reinhardt F, Naskou J, Franken A, Neubauer H, Driemel C, Ruckhaeberle E, Niederacher D, Fischer J, Stoecklein N. Clinical safety of diagnostic leukapheresis as a liquid biopsy to collect circulating tumor cells in primary and metastatic breast cancer patients [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 P3-01-12.

Pachyonychia congenita und Steatocystoma multiplex durch Mutation im Keratin-17-Gen

Die Pachyonychia congenita (PC) wird durch heterozygote Mutationen in den Keratin-Genen KRT6A, KRT6B, KRT6C, KRT16 oder KRT17 verursacht. Die Einteilung in PC Typ 1 und PC Typ 2 nach klinischen Kriterien wurde zugunsten einer molekulargenetischen Klassifikation auf Basis der 5 betroffenen Gene (PC-K6a, PC-K6b, PC-K6c, PC-K16, PC-K17) verlassen. Die Erkrankung wird autosomal-dominant vererbt, Spontanmutationen kommen in etwa 30 % der Fälle vor. Über 97 % der PC-Patienten weisen die 3 Hauptsymptome Verdickung der Fußnägel, Plantarkeratosen und Fußsohlenschmerzen auf.

Lokalisierte Steatozystome, Vellushaarzysten oder das diffuse Steatocystoma multiplex zeichnen die PC durch Keratin-17-Mutationen aus. Konnatale oder perinatale Zähne und follikuläre Hyperkeratosen an Ellenbogen, Knien und Rumpf sind ebenfalls häufig mit einer Mutation in KRT17 vergesellschaftet. Wir berichten über eine 40-jährige Patientin mit Steatocystoma multiplex, Verdickung und distaler Dystrophie aller Nägel, schmerzhaften Plantarkeratosen und palmoplantarer Hyperhidrose. Molekulargenetisch konnte mittels Next-Generation-Sequencing eine Mutation im Exon 1 des KRT17-Gens als ursächlich nachgewiesen werden.

A sea change in our view of overturning in the subpolar North Atlantic

To provide an observational basis for the Intergovernmental Panel on Climate Change projections of a slowing Atlantic meridional overturning circulation (MOC) in the 21st century, the Overturning in the Subpolar North Atlantic Program (OSNAP) observing system was launched in the summer of 2014. The first 21-month record reveals a highly variable overturning circulation responsible for the majority of the heat and freshwater transport across the OSNAP line. In a departure from the prevailing view that changes in deep water formation in the Labrador Sea dominate MOC variability, these results suggest that the conversion of warm, salty, shallow Atlantic waters into colder, fresher, deep waters that move southward in the Irminger and Iceland basins is largely responsible for overturning and its variability in the subpolar basin.

Denis RD, Stabile A, Stamen R, Stamm S, Stanecka E, Stanek RW, Stanescu C, Stanescu-Bellu M, Stanitzki MM, Stapnes S, Starchenko EA, Stark GH, Stark J, Staroba P, Starovoitov P, Stärz S, Staszewski R, Steinberg P, Stelzer B, Stelzer HJ, Stelzer-Chilton O, Stenzel H, Stewart GA, Stillings JA, Stockton MC, Stoebe M, Stoicea G, Stolte P, Stonjek S, Stradling AR, Straessner A, Stramaglia ME, Strandberg J, Strandberg S, Strandlie A, Strauss M, Strizenec P, Ströhmer R, Strom DM, Stroynowski R, Strubig A, Stucci SA, Stugu B, Styles NA, Su D, Su J, Suchek S, Sugaya Y, Suk M, Sulin VV, Sultansoy S, Sumida T, Sun S, Sun X, Sundermann JE, Suruliz K, Suster CJE, Sutton MR, Suzuki S, Svatos M, Swiatlowski M, Swift SP, Sykora I, Sykora T, Ta D, Tackmann K, Taenzer J, Taffard A, Tafirout R, Taiblum N, Takai H, Takashima R, Takeshita T, Takubo Y, Talby M, Talyshev AA, Tanaka J, Tanaka M, Tanaka R, Tanaka S, Tanioka R, Tannenwald BB, Tapia Araya S, Tapprogge S, Tarem S, Tartarelli GF, Tas P, Tasevsky M, Tashiro T, Tassi E, Tavares Delgado A, Tayalati Y, Taylor AC, Taylor GN, Taylor PTE, Taylor W, Teischinger FA, Teixeira-Dias P, Temming KK, Temple D, Ten Kate H, Teng PK, Teoh JJ, Tepel F, Terada S, Terashi K, Terron J, Terzo S, Testa M, Teuscher RJ, Theveneaux-Pelzer T, Thomas JP, Thomas-Wilsker J, Thompson PD, Thompson AS, Thomsen LA, Thomson E, Tibbetts MJ, Ticse Torres RE, Tikhomirov VO, Tikhonov YA, Timoshenko S, Tipton P, Tisserant S, Todome K, Todorov T, Todorova-Nova S, Tojo J, Tokár S, Tokushuku K, Tolley E, Tomlinson L, Tomoto M, Tompkins L, Toms K, Tong B, Tornambe P, Torrence E, Torres H, Torró Pastor E, Toth J, Touchard F, Tovey DR, Trefzger T, Tricoli A, Trigger IM, Trincaz-Duvoid S, Tripiana MF, Trischuk W, Trocmé B, Trofymov A, Troncon C, Trottier-McDonald M, Trovatelli M, Truong L, Trzebinski M, Trzupek A, Tseng JCL, Tsiareshka PV, Tsipolitis G, Tsirintanis N, Tsiskaridze S, Tsiskaridze V, Tskhadadze EG, Tsui KM, Tsukerman II, Tsulaia V, Tsuno S, Tsybychev D, Tu Y, Tudorache A, Tudorache V, Tulbure TT, Tuna AN, Tupputi SA, Turchikhin S, Turgeman D, Turk Cakir I, Turra R, Tuts PM, Ucchielli G, Ueda I, Ughetto M, Ukegawa F, Unal G, Undrus A, Unel G, Ungaro FC, Unno Y, Unverdorben C, Urban J, Urquijo P, Urrejola P, Usai G, Usui J, Vacavant L, Vacek V, Vachon B, Valderanis C, Valdes Santurio E, Valencic N, Valentinetti S, Valero A, Valery L, Valkar S, Valls Ferrer JA, Van Den Wollenberg W, Van Der Deijl PC, van der Graaf H, van Eldik N, van Gemmeren P, Van Nieuwkoop J, van Vulpen I, van Woerden MC, Vanadia M, Vandelli W, Vanguri R, Vaniachine A, Vankov P, Vardanyan G, Vari R, Varnes EW, Varol T, Varouchas D, Vartapetian A, Varvell KE, Vasquez JG, Vasquez GA, Vazeille F, Vazquez Schroeder T, Veatch J, Veeraraghavan V, Veloce LM, Veloso F, Veneziano S, Ventura A, Venturi M, Venturi N, Venturini A, Vercesi V, Verducci M, Verkerke W, Vermeulen JC, Vest A, Vetterli MC, Viazlo O, Vichou I, Vickey T, Vickey Boeriu OE, Viehhauser GHA, Viel S, Vigani L, Villa M, Villaplana Perez M, Vilucchi E, Vincter MG, Vinogradov VB, Vishwakarma A, Vittori C, Vivarelli I, Vlachos S, Vlasak M, Vogel M, Vokac P, Volpi G, Volpi M, von der Schmitt H, von Toerne E, Vorobel V, Vorobev K, Vos M, Voss R, Vossebeld JH, Vranjes N, Vranjes Milosavljevic M, Vrba V, Vreeswijk M, Vuillermet R, Vukotic I, Wagner P, Wagner W, Wahlberg H, Wahrmund S, Wakabayashi J, Walder J, Walker R, Walkowiak W, Wallangen V, Wang C, Wang C, Wang F, Wang H, Wang H, Wang J, Wang J, Wang K, Wang Q, Wang R, Wang SM, Wang T, Wang W, Wanotayaroj C, Warburton A, Ward CP, Wardrope DR, Washbrook A, Watkins PM, Watson AT, Watson MF, Watts G, Watts S, Waugh BM, Webb S, Weber MS, Weber SW, Weber SA, Webster JS, Weidberg AR, Weinert B, Weingarten J, Weiser C, Weits H, Wells PS, Wenaus T, Wengler T, Wenig S, Wermes N, Werner MD, Werner P, Wessels M, Wetter J, Whalen K, Whallon NL, Wharton AM, White A, White MJ, White R, Whiteson D, Wickens FJ, Wiedenmann W, Wielers M, Wiglesworth C, Wiik-Fuchs LAM, Wildauer A, Wilk F, Wilkens HG, Williams HH, Williams S, Willis C, Willocq S, Wilson JA, Wingerter-Seez I, Winklmeier F, Winston OJ, Winter BT, Wittgen M, Wobisch M, Wolf TMH, Wolff R, Wolter MW, Wolters H, Worm SD, Wosiek BK, Wotschack J, Woudstra MJ, Wozniak KW, Wu M, Wu M, Wu SL, Wu X, Wu Y, Wyatt TR, Wynne BM, Xella S, Xi Z, Xu D, Xu L, Yabsley B, Yacoob S, Yamaguchi D, Yamaguchi Y, Yamamoto A, Yamamoto S, Yamanaka T, Yamauchi K, Yamazaki Y, Yan Z, Yang H, Yang H, Yang Y, Yang Z, Yao WM, Yap YC, Yasu Y, Yatsenko E, Yau Wong KH, Ye J, Ye S, Yeletskikh I, Yildirim E, Yorita K, Yoshida R, Yoshihara K, Young C, Young CJS, Youssef S, Yu DR, Yu J, Yu JM, Yu J, Yuan L, Yuen SPY, Yusuff I, Zabinski B, Zaidan R, Zaitsev AM, Zakharchuk N, Zalieckas J, Zaman A, Zambito S, Zanzi D, Zeitnitz C, Zeman M, Zemla A, Zeng JC, Zeng Q, Zenin O, Ženiš T, Zerwas D, Zhang D, Zhang F, Zhang G, Zhang H, Zhang J, Zhang L, Zhang L, Zhang M, Zhang R, Zhang R, Zhang X, Zhang Z, Zhao X, Zhao Y, Zhao Z, Zhemchugov A, Zhong J, Zhou B, Zhou C, Zhou L, Zhou L, Zhou M, Zhou M, Zhou N, Zhu CG, Zhu H, Zhu J, Zhu Y, Zhuang X, Zhukov K, Zibell A, Zieminska D, Zimine NI, Zimmermann C, Zimmermann S, Zinonos Z, Zinser M, Ziolkowski M, Živković L, Zobernig G, Zoccoli A, zur Nedden M, Zwalinski L. Erratum to: Measurement of the W boson polarisation in t t ¯ events from pp collisions at s = 8 TeV in the lepton + jets channel with ATLAS

[This corrects the article DOI: 10.1140/epjc/s10052-017-4819-4.].

Microsolvation of porphine molecules in superfluid helium nanodroplets as revealed by optical line shape at the electronic origin

We investigate the line shape at the electronic origin of single porphine molecules doped into superfluid helium droplets as a function of the droplet size. Helium droplets comprised of less than 10⁵ atoms are generated from an expansion of gaseous helium, while droplets with more than 10⁵ atoms originate from liquid helium. In contrast to our recent study on phthalocyanine, porphine is found to exhibit a solvent shift to the blue with respect to the gas-phase resonance frequency as well as a multiplet splitting. A comparison of the helium-induced features of phthalocyanine and porphine with those obtained in similar studies on tetracene and pentacene reveals that these occur chiefly as two kinds of excitations distinguished by their linewidths and their dependence on the droplet size. Moreover, at quasi-bulk conditions achieved with droplets in excess of 10⁶ helium atoms, none of these four dopant species yields an optical spectrum that can be assigned to a plausible rotational band structure.

[Nagashima-type palmoplantar keratoderma: A little-known palmoplantar keratoderma in Europe]

BACKGROUND

Herein we present a case of palmoplantar keratoderma (PPK) in a young adopted girl of Chinese origin living in France.

OBSERVATION

The patient, aged six years, had presented transgressive PPK since birth, as well as erythema progressing in congestive inflammatory episodes, palmoplantar hyperhidrosis and progressive characteristics (moderate hyperkeratosis in areas of rubbing other than the palms and soles, namely the elbows and knees). Histopathological examination of a skin biopsy revealed a thick epidermis with lengthening and thickening of crests. The epithelium displayed a thick granular layer. Electron microscopy showed hyperorthokeratosis with hypergranulosis and loss of lamellar structure of the keratinosomes, as well as cleavage between corneocytes. Molecular studies showed the presence of two composite heterozygous mutations of the SERPINB7 gene, enabling a diagnosis of Nagashima-type PPK (NPPK) to be made.

DISCUSSION

NPPK is an autosomal recessive disease caused by a mutation in the SERPINB7, a member of the superfamily of serine protease inhibitors. It was described by Nagashima in 1977 with molecular characterisation by Kubo following in 2013. It is the most widespread form of PPK in Asia (with a prevalence of 1.2/10,000 in Japan and 3.1/10,000 in China). It is distinguished from the other PPKs in terms of transgressive soft hyperkeratosis, inflammatory episodes and hyperhidrosis, as well as by its non-progressive nature. In the present case, while the clinical presentation was characteristic, diagnosis was only made thanks to sequencing of a panel of over 50 genes responsible for PPK. The disease is effectively little-known in Europe. This study highlights the increasing importance of diagnostic investigation methods involving the use of gene panels.

Search for electroweak production of supersymmetric particles in final states with two or three leptons at s = 13 TeV with the ATLAS detector

A search for the electroweak production of charginos, neutralinos and sleptons decaying into final states involving two or three electrons or muons is presented. The analysis is based on 36.1 fb- 1 ofs = 13  TeV proton-proton collisions recorded by the ATLAS detector at the Large Hadron Collider. Several scenarios based on simplified models are considered. These include the associated production of the next-to-lightest neutralino and the lightest chargino, followed by their decays into final states with leptons and the lightest neutralino via either sleptons or Standard Model gauge bosons; direct production of chargino pairs, which in turn decay into leptons and the lightest neutralino via intermediate sleptons; and slepton pair production, where each slepton decays directly into the lightest neutralino and a lepton. No significant deviations from the Standard Model expectation are observed and stringent limits at 95% confidence level are placed on the masses of relevant supersymmetric particles in each of these scenarios. For a massless lightest neutralino, masses up to 580 GeV are excluded for the associated production of the next-to-lightest neutralino and the lightest chargino, assuming gauge-boson mediated decays, whereas for slepton-pair production masses up to 500 GeV are excluded assuming three generations of mass-degenerate sleptons.

Management of congenital ichthyoses: European guidelines of care, part one

These guidelines for the management of congenital ichthyoses have been developed by a multidisciplinary group of European experts following a systematic review of the current literature, an expert conference held in Toulouse in 2016 and a consensus on the discussions. They summarize evidence and expert-based recommendations and are intended to help clinicians with the management of these rare and often complex diseases. These guidelines comprise two sections. This is part one, covering topical therapies, systemic therapies, psychosocial management, communicating the diagnosis and genetic counselling.

Management of congenital ichthyoses: European guidelines of care, part two

These guidelines for the management of congenital ichthyoses have been developed by a multidisciplinary group of European experts following a systematic review of the current literature, an expert conference held in Toulouse in 2016, and a consensus on the discussions. These guidelines summarize evidence and expert-based recommendations and intend to help clinicians with the management of these rare and often complex diseases. These guidelines comprise two sections. This is part two, covering the management of complications and the particularities of some forms of congenital ichthyosis.