Glycaemic control of Type 1 diabetes in clinical practice early in the 21st century: an international comparison

AIMS

Improving glycaemic control in people with Type 1 diabetes is known to reduce complications. Our aim was to compare glycaemic control among people with Type 1 diabetes using data gathered in regional or national registries.

METHODS

Data were obtained for children and/or adults with Type 1 diabetes from the following countries (or regions): Western Australia, Austria, Denmark, England, Champagne-Ardenne (France), Germany, Epirus, Thessaly and Thessaloniki (Greece), Galway (Ireland), several Italian regions, Latvia, Rotterdam (The Netherlands), Otago (New Zealand), Norway, Northern Ireland, Scotland, Sweden, Volyn (Ukraine), USA and Wales) from population or clinic-based registries. The sample size with available data varied from 355 to 173 880. Proportions with HbA1c < 58 mmol/mol (< 7.5%) and ≥ 75 mmol/mol (≥ 9.0%) were compared by age and sex.

RESULTS

Data were available for 324 501 people. The proportions with HbA1c 58 mmol/mol (< 7.5%) varied from 15.7% to 46.4% among 44 058 people aged < 15 years, from 8.9% to 49.5% among 50 766 people aged 15-24 years and from 20.5% to 53.6% among 229 677 people aged ≥ 25 years. Sex differences in glycaemic control were small. Proportions of people using insulin pumps varied between the 12 sources with data available.

CONCLUSION

These results suggest that there are substantial variations in glycaemic control among people with Type 1 diabetes between the data sources and that there is room for improvement in all populations, especially in young adults.

Abstract P5-14-16: Hypofractionated breast irradiation in early-stage breast cancer patients following adjuvant chemotherapy: Evaluation of acute and late toxicities

Purpose

To evaluate the effect of adjuvant chemotherapy (CTX) on acute and late toxicity among women undergoing hypofractionated radiation therapy (HRT) following breast-conserving therapy and to assess the relative impact of breast size.

Materials and Methods

In this retrospective study, patients treated with HRT to the whole breast (42.4 Gy in 16 fractions) followed by a boost (9.6 Gy in 4 fractions) between 2005 and 2009 were evaluated for inclusion. Early-stage (I-II) patients who underwent post-lumpectomy CTX prior to HRT were included. Patients who underwent neoadjuvant CTX were excluded; node positive patients and larger-breasted women (chest wall separation of &gt;25 cm) were included. Toxicity evaluations during HRT and at 2-4 weeks, 3, 6, 9 months, and at yearly intervals were collected and graded using the RTOG Acute and Late Toxicity scales. Relevant data was available in 43 women. The median age was 60 years (35 – 71), and women were primarily of African American (55.8%) and Hispanic (27.9%) ethnicity. The majority of patients had high-grade lesions (69.8%), were Stage II (60.4%), and had T1 primaries (55.8%). Slightly more than half the patients (53.5%) were ER+; 20% were Her2 positive, and 37.2% were triple negative. Thirty-three (76.7%) were treated in the prone position. Lumpectomy cavity boosts were given via photons (58.2%) or electrons. Chemotherapy regimens included ACT (Adriamycin, Cytoxan, and Taxol) in 33/43 (76.7%) and CMF (Cytoxan, methotrexate, and 5FU) in the remainder. The median interval between completion of adjuvant CTX and the start of HRT was 41 days. The median BMI of the women was 31.8 (18.2 – 44.4; normal weight defined as BMI of 18.5 – 24.9); 11 women (25.6%) had a separation of more than 25 cm, and the median PTV volume was 1353cc (589-4213). STATA v 11 was used for all statistical analyses.

Results

The median cosmetic evaluation follow-up was 33.5 months. Forty women (93%) experienced an acute toxicity. The majority of these (31/40) were Grade 1 dermatitis with the remainder Grade 2 dermatitis (moist desquamation). There were no reported acute toxicities &gt; Grade 2. Thirteen women (30.2%) were reported to have a late toxicity: Grade 1 skin in 9, Grade 1 subcutaneous tissue in 5, and Grade 2 subcutaneous in 2 of the 9 women with Grade 1 skin. There were no late toxicities &gt; Grade 2. The acute and late toxicity rates of our main cohort and those with larger breasts were similar to those reported in the literature. On univariate analysis, there was no significant correlation (p&gt;0.05) between toxicity and age, race, BMI, separation, tumor size, grade, or hormone receptor status, CTX regimen, and treatment position and duration. There was, however, a trend toward increased toxicity with a shorter interval between CTX completion and HRT start (p = 0.052).

Conclusions

The addition of adjuvant chemotherapy to the treatment regimen of breast conservation using HRT does not appear to lead to worse cosmetic outcomes. In addition, larger-breasted women, excluded from prior reports on HRT, were at no increased risk of acute or late toxicity. We found a trend toward significance suggesting that shorter intervals between CTX and HRT may be associated with increased toxicity.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-14-16.

Structure and dynamics of colliding plasma jets

Monoenergetic-proton radiographs of laser-generated, high-Mach-number plasma jets colliding at various angles shed light on the structures and dynamics of these collisions. The observations compare favorably with results from 2D hydrodynamic simulations of multistream plasma jets, and also with results from an analytic treatment of electron flow and magnetic field advection. In collisions of two noncollinear jets, the observed flow structure is similar to the analytic model's prediction of a characteristic feature with a narrow structure pointing in one direction and a much thicker one pointing in the opposite direction. Spontaneous magnetic fields, largely azimuthal around the colliding jets and generated by the well-known ∇T(e)×∇n(e) Biermann battery effect near the periphery of the laser spots, are demonstrated to be "frozen in" the plasma (due to high magnetic Reynolds number Re(M)∼5×10(4)) and advected along the jet streamlines of the electron flow. These studies provide novel insight into the interactions and dynamics of colliding plasma jets.

Measurement of J/ψ polarization in pp collisions at [Formula: see text]

An angular analysis of the decay J/ψ→μ+μ- is performed to measure the polarization of prompt J/ψ mesons produced in pp collisions at [Formula: see text]. The dataset corresponds to an integrated luminosity of 0.37 fb-1 collected with the LHCb detector. The measurement is presented as a function of transverse momentum, pT, and rapidity, y, of the J/ψ meson, in the kinematic region 2 Collapse

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Measurement of form-factor-independent observables in the decay B0→K(*0)μ(+)μ(-)

We present a measurement of form-factor-independent angular observables in the decay B(0)→K*(892)(0)μ(+)μ(-). The analysis is based on a data sample corresponding to an integrated luminosity of 1.0 fb(-1), collected by the LHCb experiment in pp collisions at a center-of-mass energy of 7 TeV. Four observables are measured in six bins of the dimuon invariant mass squared q² in the range 0.1<q²<19.0 GeV²/c(4). Agreement with recent theoretical predictions of the standard model is found for 23 of the 24 measurements. A local discrepancy, corresponding to 3.7 Gaussian standard deviations is observed in one q² bin for one of the observables. Considering the 24 measurements as independent, the probability to observe such a discrepancy, or larger, in one is 0.5%.

Measurement of the CP asymmetry in B(+)→K(+)μ(+)μ(-) decays

A measurement of the CP asymmetry in B(+)→K(+)μ(+)μ(-) decays is presented using pp collision data, corresponding to an integrated luminosity of 1.0 fb(-1), recorded by the LHCb experiment during 2011 at a center-of-mass energy of 7 TeV. The measurement is performed in seven bins of μ(+)μ(-) invariant mass squared in the range 0.05<q2<22.00 GeV2/c4, excluding the J/ψ and ψ(2S) resonance regions. Production and detection asymmetries are corrected for using the B(+)→J/ψK(+) decay as a control mode. Averaged over all the bins, the CP asymmetry is found to be A(CP)=0.000±0.033 (stat)±0.005 (syst)±0.007 (J/ψK), where the third uncertainty is due to the CP asymmetry of the control mode. This is consistent with the standard model prediction.

Search for the lepton-flavor-violating decays B(s)0→e(±)μ(∓) and B0→e(±)μ(∓)

A search for the lepton-flavor-violating decays B(s)0→e(±)μ(∓) and B0→e(±)μ(∓) is performed with a data sample, corresponding to an integrated luminosity of 1.0 fb(-1) of pp collisions at √s=7 TeV, collected by the LHCb experiment. The observed number of B(s)0→e(±)μ(∓) and B0→e(±)μ(∓) candidates is consistent with background expectations. Upper limits on the branching fractions of both decays are determined to be B(B(s)0→e(±)μ(∓))<1.1(1.4)×10(-8) and B(B0→e(±)μ(∓))<2.8(3.7)×10(-9) at 90% (95%) confidence level (C.L.). These limits are a factor of 20 lower than those set by previous experiments. Lower bounds on the Pati-Salam leptoquark masses are also calculated, M(LQ)(B(s)0→e(±)μ(∓))>101 TeV/c(2) and M(LQ)(B0→e(±)μ(∓))>126 TeV/c(2) at 95% C.L., and are a factor of 2 higher than the previous bounds.

Observation of a resonance in B+ → K+ μ+ μ- decays at low recoil

A broad peaking structure is observed in the dimuon spectrum of B+ → K+ μ+ μ- decays in the kinematic region where the kaon has a low recoil against the dimuon system. The structure is consistent with interference between the B+ → K+ μ+ μ- decay and a resonance and has a statistical significance exceeding six standard deviations. The mean and width of the resonance are measured to be 4191(-8)(+9)  MeV/c2 and 65(-16)(+22)  MeV/c2, respectively, where the uncertainties include statistical and systematic contributions. These measurements are compatible with the properties of the ψ(4160) meson. First observations of both the decay B+ → ψ(4160)K+ and the subsequent decay ψ(4160) → μ+ μ- are reported. The resonant decay and the interference contribution make up 20% of the yield for dimuon masses above 3770  MeV/c2. This contribution is larger than theoretical estimates.

Precision measurement of the Λb(0) baryon lifetime

The ratio of the Λb(0) baryon lifetime to that of the B(0) meson is measured using 1.0  fb(-1) of integrated luminosity in 7 TeV center-of-mass energy pp collisions at the LHC. The Λb(0) baryon is observed for the first time in the decay mode Λb(0)→J/ψpK-, while the B(0) meson decay used is the well known B(0)→J/ψπ+ K- mode, where the π+ K- mass is consistent with that of the K(*0)(892) meson. The ratio of lifetimes is measured to be 0.976±0.012±0.006, in agreement with theoretical expectations based on the heavy quark expansion. Using previous determinations of the B(0) meson lifetime, the Λb(0) lifetime is found to be 1.482±0.018±0.012  ps. In both cases, the first uncertainty is statistical and the second systematic.

Measurement of CP violation in the phase space of B±→K± π+ π- and B±→K± K+ K- decays

The charmless decays B±→K± π+ π- and B±→K± K+ K- are reconstructed using data, corresponding to an integrated luminosity of 1.0  fb(-1), collected by LHCb in 2011. The inclusive charge asymmetries of these modes are measured as ACP(B±→K± π+ π-)=0.032±0.008 (stat)±0.004 (syst)±0.007(J/ψK±) and ACP(B±→K± K+ K-)=-0.043±0.009 (stat)±0.003 (syst)±0.007(J/ψK±), where the third uncertainty is due to the CP asymmetry of the B±→J/ψK± reference mode. The significance of ACP(B±→K± K+ K-) exceeds three standard deviations and is the first evidence of an inclusive CP asymmetry in charmless three-body B decays. In addition to the inclusive CP asymmetries, larger asymmetries are observed in localized regions of phase space.

First measurement of the CP-violating phase in Bs(0) → ϕϕ decays

A first flavor-tagged measurement of the time-dependent CP-violating asymmetry in B(s)(0) → ϕϕ decays is presented. In this decay channel, the CP-violating weak phase arises due to CP violation in the interference between B(s)(0)-B(s)(0) mixing and the b → sss gluonic penguin decay amplitude. Using a sample of pp collision data corresponding to an integrated luminosity of 1.0 fb(-1) and collected at a center-of-mass energy of 7 TeV with the LHCb detector, 880 B(s)(0) → ϕϕ signal decays are obtained. The CP-violating phase is measured to be in the interval [-2.46,-0.76] rad at a 68% confidence level. The p value of the standard model prediction is 16%.

Measurements of the branching fractions of [Formula: see text] decays

The branching fractions of the decay [Formula: see text] for different intermediate states are measured using data, corresponding to an integrated luminosity of 1.0 fb^-1, collected by the LHCb experiment. The total branching fraction, its charmless component [Formula: see text] and the branching fractions via the resonant [Formula: see text] states η_c (1S) and ψ(2S) relative to the decay via a J/ψ intermediate state are [Formula: see text] Upper limits on the B⁺ branching fractions into the η_c (2S) meson and into the charmonium-like states X(3872) and X(3915) are also obtained.

First observation of CP violation in the decays of B(s)0 mesons

Using pp collision data corresponding to an integrated luminosity of 1.0 fb(-1) and collected by LHCb in 2011 at a center-of-mass energy of 7 TeV, we report the measurement of direct CP violation in B(s)(0)→K(-)π(+) decays, A(CP)(B(s)(0)→K(-)π(+)=0.27±0.04 (stat)±0.01 (syst), with significance exceeding 5 standard deviations. This is the first observation of CP violation in the decays of B(s)(0) mesons. Furthermore, we provide an improved determination of direct CP violation in B(0)→K(+)π(-) decays, A(CP)(B(0)→K(+)π(-)=-0.080±0.007 (stat)±0.003 (syst), which is the most precise measurement of this quantity to date.

Determination of the X(3872) meson quantum numbers

The quantum numbers of the X(3872) meson are determined to be J(PC)=1(++) based on angular correlations in B(+)→X(3872)K(+) decays, where X(3872)→π(+)π(-)J/ψ and J/ψ→μ(+)μ(-). The data correspond to 1.0 fb(-1) of pp collisions collected by the LHCb detector. The only alternative assignment allowed by previous measurements J(PC)=2(-+) is rejected with a confidence level equivalent to more than 8 Gaussian standard deviations using a likelihood-ratio test in the full angular phase space. This result favors exotic explanations of the X(3872) state.

Search for rare B(0)((s))→μ(+)μ(-)μ(+)μ(-) decays

A search for the decays B(0)((s))→μ(+)μ(-)μ(+)μ(-) and B(0)→μ(+)μ(-)μ(+)μ(-) is performed using data, corresponding to an integrated luminosity of 1.0 fb(-1), collected with the LHCb detector in 2011. The number of candidates observed is consistent with the expected background and, assuming phase-space models of the decays, limits on the branching fractions are set: B(B(s)(0)→μ(+)μ(-)μ(+)μ(-))<1.6(1.2)×10(-8) and B(B(0)→μ(+)μ(-)μ(+)μ(-))<6.6(5.3)×10(-9) at 95% (90%) confidence level. In addition, limits are set in the context of a supersymmetric model which allows for the B((s))(0) meson to decay into a scalar (S) and pseudoscalar particle (P), where S and P have masses of 2.5 GeV/c and 214.3 MeV/c, respectively, both resonances decay into μ(+)μ(-). The branching fraction limits for these decays are B(B(s)(0)→SP)<1.6(1.2)×10(-8) and B(B(0)→SP)<6.3(5.1)×10(-9) at 95% (90%) confidence level.

Measurement of the forward energy flow in pp collisions at [Formula: see text]

The energy flow created in pp collisions at [Formula: see text] is studied within the pseudorapidity range 1.9<η<4.9 with data collected by the LHCb experiment. The measurements are performed for inclusive minimum-bias interactions, hard scattering processes and events with an enhanced or suppressed diffractive contribution. The results are compared to predictions given by Pythia-based and cosmic-ray event generators, which provide different models of soft hadronic interactions.

Performance of the LHCb RICH detector at the LHC

The LHCb experiment has been taking data at the Large Hadron Collider (LHC) at CERN since the end of 2009. One of its key detector components is the Ring-Imaging Cherenkov (RICH) system. This provides charged particle identification over a wide momentum range, from 2-100 GeV/c. The operation and control, software, and online monitoring of the RICH system are described. The particle identification performance is presented, as measured using data from the LHC. Excellent separation of hadronic particle types (π, K, p) is achieved.

Measurement of the Λ(b)(0), Ξ (b)(-), and Ω(b((-) Baryon masses

Bottom baryons decaying to a J/ψ meson and a hyperon are reconstructed using 1.0 fb(-1) of data collected in 2011 with the LHCb detector. Significant Λ(b)(0) → J/ψΛ, Ξ(b((-) → J/ψΞ(-) and Ω(b)(-) → J/ψΩ(-) signals are observed and the corresponding masses are measured to be M(Λ(b)(0))=5619.53 ± 0.13(stat.) ± 0.45(syst.) MeV/c(2), M(Ξ(b)(-)) = 5795.8 ± 0.9(stat.) ± 0.4(syst.) MeV/c(2), M(Ω(b)(-)) = 6046.0 ± 2.2(stat.) ± 0.5(syst.) MeV/c(2) , while the differences with respect to the Λ(b)(0) mass are M(Ξ(b)(-))-M(Λ(b)(0))=176.2 ± 0.9(stat.) ± 0.1(syst.) MeV/c(2), M(Ω(b)(-))-M(Λ(b)(0))=426.4 ± 2.2(stat.) ± 0.4(syst.) MeV/c(2). These are the most precise mass measurements of the Λ(b)(0), Ξ(b)(-) and Ω(b)(-) baryons to date. Averaging the above Λ(b)(0) mass measurement with that published by LHCb using 35 pb(-1) of data collected in 2010 yields M(Λ(b)(0)) = 5619.44 ± 0.13(stat.)± 0.38(syst.) MeV/c(2).

Microtopography of the eye surface of the crab Carcinus maenas: an atomic force microscope study suggesting a possible antifouling potential

Marine biofouling causes problems for technologies based on the sea, including ships, power plants and marine sensors. Several antifouling techniques have been applied to marine sensors, but most of these methodologies are environmentally unfriendly or ineffective. Bioinspiration, seeking guidance from natural solutions, is a promising approach to antifouling. Here, the eye of the green crab Carcinus maenas was regarded as a marine sensor model and its surface characterized by means of atomic force microscopy. Engineered surface micro- and nanotopography is a new mechanism found to limit biofouling, promising an effective solution with much reduced environmental impact. Besides giving a new insight into the morphology of C. maenas eye and its characterization, our study indicates that the eye surface probably has antifouling/fouling-release potential. Furthermore, the topographical features of the surface may influence the wettability properties of the structure and its interaction with organic molecules. Results indicate that the eye surface micro- and nanotopography may lead to bioinspired solutions to antifouling protection.

First observation of the decay Bs2*(5840)(0)→B*+ K- and studies of excited Bs(0) mesons

The properties of the orbitally excited (L=1) Bs(0) states are studied by using 1.0  fb(-1) of pp collisions at sqrt[s]=7  TeV collected with the LHCb detector. The first observation of the Bs2*(5840)(0) meson decaying to B*+ K- is reported, and the corresponding branching fraction measured relative to the B+ K- decay mode. The Bs1(5830)(0)→B*+ K- decay is observed as well. The width of the Bs2*(5840)(0) state is measured for the first time, and the masses of the two states are determined with the highest precision to date. The observation of the Bs2*(5840)(0)→B*+ K- decay favors the spin-parity assignment J(P)=2+ for the Bs2*(5840)(0) meson. In addition, the most precise measurement of the mass difference m(B*+)-m(B+)=45.01±0.30(stat)±0.23(syst)  MeV/c(2) is obtained.

Antagonisms between Surfactants: The Case of Laundry Detergents

Interaction between surfactants forms micelles that typically lead to a reduction of the irritation potential of the mixture. The objective of this study is to illustrate that such antagonism between surfactants is applicable to actual cases of consumer products e.g. laundry detergent products. The Zein test is an in vitro assay measuring corn protein denaturation by solutions of surfactant(s) and often used to predict their acute irritation potential. The Zein test data for the surfactant mixtures from nine representative laundry detergents demonstrate that the protein denaturation by the mixtures is, in all cases, lower than the cumulative score of protein denaturation by the different surfactants tested separately. The data clearly indicate that antagonism occurs between the actual surfactants present in their exact proportions as found in the consumer laundry detergent products. These data support the view that the hazard classification of detergent products as (irritant) by the dangerous preparation directive should not be based on a simple cumulative score of the irritation properties of the individual components of the products.

Observation of D0-D0 oscillations

We report a measurement of the time-dependent ratio of D(0) → K(+) π- to D(0) → K(-) π(+) decay rates in D(*+)-tagged events using 1.0 fb(-1) of integrated luminosity recorded by the LHCb experiment. We measure the mixing parameters x('2) = (-0.9 ± 1.3) × 10(-4), y' = (7.2 ± 2.4) × 10(-3), and the ratio of doubly-Cabibbo-suppressed to Cabibbo-favored decay rates R(D) = (3.52 ± 0.15) × 10^{-3}, where the uncertainties include statistical and systematic sources. The result excludes the no-mixing hypothesis with a probability corresponding to 9.1 standard deviations and represents the first observation of D0-D0 oscillations from a single measurement.

Measurement of the CP asymmetry in B(0)→K(*0)μ(+)μ(-) decays

A measurement of the CP asymmetry in B(0)→K(*0)μ(+)μ(-) decays is presented, based on 1.0 fb(-1) of pp collision data recorded by the LHCb experiment during 2011. The measurement is performed in six bins of invariant mass squared of the μ(+)μ(-) pair, excluding the J/ψ and ψ(2S) resonance regions. Production and detection asymmetries are removed using the B(0)→J/ψK(*0) decay as a control mode. The integrated CP asymmetry is found to be -0.072±0.040(stat)±0.005(syst), consistent with the standard model.

First evidence for the decay B(s)(0)→μ+ μ-

A search for the rare decays B(s)(0)→μ+ μ- and B(0)→μ+ μ- is performed with data collected in 2011 and 2012 with the LHCb experiment at the Large Hadron Collider. The data samples comprise 1.1  fb(-1) of proton-proton collisions at sqrt[s]=8  TeV and 1.0  fb(-1) at sqrt[s]=7  TeV. We observe an excess of B(s)(0)→μ+ μ- candidates with respect to the background expectation. The probability that the background could produce such an excess or larger is 5.3×10(-4) corresponding to a signal significance of 3.5 standard deviations. A maximum-likelihood fit gives a branching fraction of B(B(s)(0)→μ+ μ-)=(3.2(-1.2)(+1.5))×10(-9), where the statistical uncertainty is 95% of the total uncertainty. This result is in agreement with the standard model expectation. The observed number of B(0)→μ+ μ- candidates is consistent with the background expectation, giving an upper limit of B(B(0)→μ+ μ-)<9.4×10(-10) at 95% confidence level.

Measurements of B(c)+ production and mass with the B(c)+ → J/ψπ+ decay

Measurements of B(c)(+) production and mass are performed with the decay mode B(c)(+)→J/ψπ(+) using 0.37 fb(-1) of data collected in pp collisions at √[s]=7 TeV by the LHCb experiment. The ratio of the production cross section times branching fraction between the B(c)(+)→J/ψπ(+) and the B(+)→J/ψK(+) decays is measured to be (0.68±0.10(stat)±0.03(syst)±0.05(lifetime))% for B(c)(+) and B(+) mesons with transverse momenta p(T)>4 GeV/c and pseudorapidities 2.5<η<4.5. The B(c)(+) mass is directly measured to be 6273.7±1.3(stat)±1.6(syst) MeV/c(2), and the measured mass difference with respect to the B(+) meson is M(B(c)(+))-M(B(+))=994.6±1.3(stat)±0.6(syst) MeV/c(2).

Observation of excited Λ(b)(0) baryons

Using pp collision data corresponding to 1.0 fb(-1) integrated luminosity collected by the LHCb detector, two narrow states are observed in the Λ(b)(0)π(+)π(-) spectrum with masses 5911.97±0.12(stat)±0.02(syst)±0.66(Λ(b)(0) mass) MeV/c(2) and 5919.77±0.08(stat)±0.02(syst)±0.66(Λ(b)(0) mass) MeV/c(2). The significances of the observations are 5.2 and 10.2 standard deviations, respectively. These states are interpreted as the orbitally excited Λ(b)(0) baryons, Λ(b)(*0)(5912) and Λ(b)(*0)(5920).