Results of a Randomized Pilot Trial of SHARE: A Self-Management Intervention for Head and Neck Cancer Patients Undergoing Radiotherapy and their Spousal Caregivers

Head and neck cancer (HNC) patients experience significant physical and psychological morbidity during radiotherapy (XRT) which contributes to treatment interruptions and poor quality of life. Although spouses/partners can help by encouraging patient self-management (e.g., self-care) during XRT, they often experience high psychological distress rates, lack basic healthcare knowledge/skills, and report increased marital conflict regarding patient self-management. This pilot study examined the feasibility and acceptability of a six-session telephone-based intervention called SHARE (Spouses coping with the Head And neck Radiation Experience), which teaches self-management, communication, and coping skills to HNC patients and their spouses. Treatment effects of SHARE relative to usual medical care (UMC) in controlling patient physical symptoms and improving patient/spouse psychological and marital functioning were also examined. METHODS: Thirty patients initiating XRT and their spouses (N = 60 participants; 40% racial/ethnic minorities) were randomized to SHARE or UMC, and pre- and post-intervention assessments were completed. RESULTS: Solid recruitment (70%) and low attrition rates (7%) demonstrated feasibility. Strong program evaluations and homework completion rates (72%) supported acceptability. Significant treatment effects (medium in magnitude) were observed for SHARE relative to UMC with regard to HNC-specific physical symptom burden (Cohen's d = −0.89) and symptom interference (d = −0.86). Medium-to-large effects favoring SHARE were also found for patient and spouse depressive symptoms (d = −0.84) and cancer-specific distress (d = −1.05). CONCLUSION: Findings support the feasibility, acceptability, and preliminary efficacy of SHARE. They also suggest that programs that empower HNC couples with the necessary skills to coordinate care and manage the challenges of XRT together hold great promise for controlling patient physical symptoms and improving both partners' psychological functioning.

Granulocyte-macrophage colony-stimulating factor (GM-CSF) as a therapeutic target in psoriasis: randomized, controlled investigation using namilumab, a specific human anti-GM-CSF monoclonal antibody

BACKGROUND

The relevance of granulocyte-macrophage colony-stimulating factor (GM-CSF) in the management of psoriasis has not been studied previously. GM-CSF is important in the initiation and maintenance of chronic inflammatory processes.

OBJECTIVES

To investigate the clinical use of GM-CSF neutralization by evaluating the efficacy and safety of namilumab (AMG203), a monoclonal antibody GM-CSF inhibitor, in patients with moderate-to-severe plaque psoriasis.

METHODS

A phase II, multicentre, randomized, double-blind, placebo-controlled, parallel-group, dose-finding, proof-of-concept study (NEPTUNE) was conducted. Four doses of namilumab (20, 50, 80 and 150 mg, via subcutaneous injection) were compared with placebo. Assessment of the primary end point - the proportion of patients achieving ≥ 75% reduction in Psoriasis Area and Severity Index (PASI 75 treatment response) - was performed at week 12. Exploratory investigation at the tissue level was conducted in a subset of the overall study population. The trial was registered with the number NCT02129777.

RESULTS

In total, 122 patients were enrolled and 106 (86·9%) completed the double-blind treatment; 16 (13·1%) prematurely discontinued study medication. Serum concentration-time profiles were as expected for subcutaneous delivery of an IgG1 monoclonal antibody, and exposure increased proportionally with dose elevation. The number of patients showing PASI 75 treatment response at week 12 was low in all groups; no significant difference was recorded in this end point between placebo and any namilumab group. Similar outcomes were recorded for other clinical study end points. Moreover, no significant treatment-related changes from baseline were observed in laboratory investigations of cell types or subpopulations, or cytokines relevant to inflammatory pathways in psoriasis.

CONCLUSIONS

GM-CSF blockade is not critical for suppression of key inflammatory pathways underlying psoriasis.

Determination of the refractive indices of ionic liquids by ellipsometry, and their application as immersion liquids

In principle, ionic liquids (ILs) can serve as stable and less harmful high-refractive-index liquids (n>1.60). However, detailed information on their complex refractive indices and dispersions is rare. Therefore, we determined the optical constants of six commercially available low-index ILs (n ca. 1.4) and two high-index ILs (n max. 2.38) synthesized by us utilizing spectroscopic ellipsometry. Furthermore, we tested the ILs as immersion liquids for different photonic crystals. Analysis of the optical properties of these photonic crystals after infiltration demonstrates potential applications of ILs in optofluidics and as index-matching liquids.

Intermittent Regional Therapy with rt-PA is not Superior to Systemic Thrombolysis in Deep Vein Thrombosis (DVT) - a German Multicenter Trial

In a prospective and randomized multicenter trial the efficacy of intermittent regional and systemic thrombolytic therapy for DVT was evaluated. 137 patients with phlebographically confirmed acute DVT above the calf region were treated with 20 mg of rt-PA for 4 h each day. Thrombolysis was applied either locally via a dorsal pedal vein of the firmly bandaged affected leg or systemically using a cubital vein. Treatment lasted for 4-7 days, and during this time unfractionated heparin was applied continuously with the dosage adjusted according to aPTT (1.5-2.0 times the normal value). A second phlebography was performed within 24 h after the end of treatment. Results were evaluated by an independent radiologist who was unaware of the treatment given

Significant thrombolytic results (e.g. lysis of more than 50% of the original thrombus and complete recanalization of all affected veins) were reached in only 1/3 of all patients. Rates of recanalization did not differ in both groups and bleeding complications occurred in 26.5%. We conclude that intermittent local or systemic application of 20 mg rt-PA seems to be ineffective in the treatment of DVT

Molecular Reorientation during the Initial Growth of Perfluoropentacene on Ag(110)

Perfluoropentacene (PFP) is an organic material that has been widely studied over the last years and has already found applications in organic electronics. However, fundamental physical questions, such as the structural formation and the preferential orientation of the molecules during deposition on metal surfaces, are still not fully understood. In this work, we report on a unique in-plane molecular reorientation during the completion of the first monolayer of PFP on the Ag(110) surface. To characterize the molecular alignment, we have monitored the deposition process in real time using polarization-dependent differential reflectance spectroscopy and reflectance anisotropy spectroscopy. Abrupt changes in the optical signals reveal an intricate sequence of reorientation transitions of the PFP molecules upon monolayer completion and during the formation of the second monolayer, eventually leading to a full alignment of the long molecular axis along the [001] direction of the substrate and an enhanced structural ordering. Scanning tunneling microscopy and low-energy electron diffraction confirm the observed molecular reorientation upon monolayer compression and provide further details on the structural and orientational ordering of the PFP monolayer before and after compression.

Extracardiac 18F-florbetapir imaging in patients with systemic amyloidosis: more than hearts and minds

Purpose

¹⁸F-Florbetapir has been reported to show cardiac uptake in patients with systemic light-chain amyloidosis (AL). This study systematically assessed uptake of ¹⁸F-florbetapir in patients with proven systemic amyloidosis at sites outside the heart.

Methods

Seventeen patients with proven cardiac amyloidosis underwent ¹⁸F-florbetapir PET/CT imaging, 15 with AL and 2 with transthyretin amyloidosis (ATTR). Three patients had repeat scans. All patients had protocolized assessment at the UK National Amyloidosis Centre including imaging with ¹²³I-serum amyloid P component (SAP). ¹⁸F-Florbetapir images were assessed for areas of increased tracer accumulation and time–uptake curves in terms of standardized uptake values (SUV_mean) were produced.

Results

All 17 patients showed ¹⁸F-florbetapir uptake at one or more extracardiac sites. Uptake was seen in the spleen in 6 patients (35%; 6 of 9, 67%, with splenic involvement on ¹²³I-SAP scintigraphy), in the fat in 11 (65%), in the tongue in 8 (47%), in the parotids in 8 (47%), in the masticatory muscles in 7 (41%), in the lungs in 3 (18%), and in the kidney in 2 (12%) on the late half-body images. The ¹⁸F-florbetapir spleen retention index (SRI) was calculated. SRI >0.045 had 100% sensitivity/sensitivity (in relation to ¹²³I-SAP splenic uptake, the current standard) in detecting splenic amyloid on dynamic imaging and a sensitivity of 66.7% and a specificity of 100% on the late half-body images. Intense lung uptake was seen in three patients, one of whom had lung interstitial infiltration suggestive of amyloid deposition on previous high-resolution CT. Repeat imaging showed a stable appearance in all three patients suggesting no early impact of treatment response.

Conclusion

¹⁸F-Florbetapir PET/CT is a promising tool for the detection of extracardiac sites of amyloid deposition. The combination of uptake in the heart and uptake in the spleen on ¹⁸F-florbetapir PET/CT, a hallmark of AL, suggests that this tracer holds promise as a screening tool for AL.

Electronic supplementary material

The online version of this article (10.1007/s00259-018-3995-2) contains supplementary material, which is available to authorized users.

Tungsten Oxide Photonic Crystals as Optical Transducer for Gas Sensing

Some metal oxide semiconductors, such as tungsten trioxide or tin dioxide, are well-known as resistive transducers for gas sensing and offer high sensitivities down to the part per billion level. Electrical signal read-out, however, limits the information obtained on the electronic properties of metal oxides to a certain frequency range and its application because of the required electrical contacts. Therefore, a novel approach for building an optical transducer for gas reactions utilizing metal oxide photonic crystals is presented here. By the rational design of the structure and composition it is possible to synthesize a functional material which allows one to obtain insight into its electronic properties in the optical frequency range with simple experimental measures. The concept is demonstrated by tungsten trioxide inverse opal structure as optical transducer material for hydrogen sensing. The sensing behavior is analyzed in a temperature range from room temperature to 500 °C and in a wide hydrogen concentration range (3000 ppm to 10%). The sensing mechanism is mainly the refractive index change resulting from hydrogen intercalation in tungsten trioxide, but the back reaction has also impact on the optical properties of this system. Detailed chemical reaction studies provide suggestions for specific sensing conditions.

Sentinel lymph node diagnostic in prostate carcinoma: Part I: Technique and clinical evaluation

Aim: Evaluation of the significance of lymphoscintigraphy and intraoperative probe measurement for the identification of the sentinel lymph node (SLN) in prostate cancer. Patients and method: In 117 patients with prostate cancer scintigrams in various projections were acquired till approximately 6 hours p.i. after ultrasound guided transrectal intraprostatic injection of 99mTc-Nanocoll ®. On the following day the SLNs were identified in the operation theatre with a gamma probe and removed. Pelvic standard lymph node dissection followed SLNE. Results: In three of 117 patients with preoperative lymphoscintigraphy no SLN was scintigraphically detectable. These three patients had antecedent transurethral resection of the prostate. In 113 of the residual 114 patients SLN could be intraoperatively localized. In the mean four SLNs per patient were removed. 28 of 117 patients had pelvic lymph node metastases. In 25 cases SLN were right-positive, in one false-negative and in one intraoperatively not detectable. In one patient we found macrometastasis of up to 4 cm diameter (one SLN was tumour positive). In 15 cases only the SLN was bearing tumour. Conclusion: The SLNE with preoperative lymphoscintigraphy and intraoperative gamma probe measurement is suitable for detecting lymph node metastasis in prostate cancer. SLNE is superior to the surgical techniques commonly used in pelvic lymphadenectomy.

One-dimensional quantum matter: gold-induced nanowires on semiconductor surfaces

Interacting electrons confined to only one spatial dimension display a wide range of unusual many-body quantum phenomena, ranging from Peierls instabilities to the breakdown of the canonical Fermi liquid paradigm to even unusual spin phenomena. The underlying physics is not only of tremendous fundamental interest, but may also have bearing on device functionality in future micro- and nanoelectronics with lateral extensions reaching the atomic limit. Metallic adatoms deposited on semiconductor surfaces may form self-assembled atomic nanowires, thus representing highly interesting and well-controlled solid-state realizations of such 1D quantum systems. Here we review experimental and theoretical investigations on a few selected prototypical nanowire surface systems, specifically Ge(0 0 1)-Au and Si(hhk)-Au, and the search for 1D quantum states in them. We summarize the current state of research and identify open questions and issues.

[Assessment of ability to drive in patients with MCI and dementia]

People with mild cognitive impairment and dementia are a frequent and continuously increasing patient group in practically all fields of medicine. The associated challenges involve nearly all areas of life in addition to the direct medical treatment. Assessment of the ability to drive in patients with cognitive deficits is becoming increasingly more important. What are the options available to physicians in order to make a valid assessment? Which legal aspects must be taken into consideration? Which rights and obligations arise from the framework conditions? These questions nowadays give rise to great uncertainty for many medical personnel; however, the increasing importance of these problems necessitates a clear procedure, which allows difficult decisions to be made with utmost sovereignty and legal certainty and to be able to give patients and relatives a plausible explanation. Because age is a substantial risk factor for the development of cognitive disorders, the question of the ability to drive is affected not only by neuropsychiatric diseases, such as mild cognitive disorders or dementia but also the frequently occurring somatic comorbidities. Estimation of the ability to drive is therefore a complex approach, which should be standardized in order to appreciate all relevant aspects. It would be desirable to have a practice-oriented algorithm, the formulation of which is the aim of this article. Additionally, we would like to make a contribution to road safety and make medical personnel fully aware of this topic.

Phase 1b randomized, double-blind study of namilumab, an anti-granulocyte macrophage colony-stimulating factor monoclonal antibody, in mild-to-moderate rheumatoid arthritis

Background

Namilumab (AMG203) is an immunoglobulin G1 monoclonal antibody that binds with high affinity to the GM-CSF ligand. This was a phase 1b, randomized, double-blind study (PRIORA) to assess namilumab in active, mild-to-moderate rheumatoid arthritis (RA). The primary outcome was the safety and tolerability of repeated subcutaneous injections of namilumab in patients with mild-to-moderate RA.

Methods

Adults with mild-to-moderate RA on stable methotrexate doses for ≥12 weeks were eligible. Patients received three subcutaneous injections of namilumab 150 or 300 mg, or placebo on days 1, 15, and 29, with 12 weeks’ follow-up. Primary objective was safety/tolerability.

Results

Patients in cohort 1 were randomized to namilumab 150 mg (n = 8) or placebo (n = 5). In cohort 2, patients were randomized to namilumab 300 mg (n = 7) or placebo (n = 4). Incidence of treatment-emergent adverse events (TEAEs) was similar across the three groups (namilumab 150 mg: 63%; namilumab 300 mg: 57%; placebo: 56%). TEAEs in ≥10% of patients were nasopharyngitis (17%) and exacerbation/worsening of RA (13%). No anti-namilumab antibodies were detected. The pharmacokinetics of namilumab were linear and typical of a monoclonal antibody with subcutaneous administration. In a post hoc efficacy, per protocol analysis (n = 21), patients randomized to namilumab showed greater improvement in Disease Activity Score 28 (erythrocyte sedimentation rate and C-reactive protein [CRP]), swelling joint counts and tender joint counts compared with placebo. Difference in mean DAS28-CRP changes from baseline between namilumab and placebo favored namilumab at both doses and at all time points. In addition area under the curve for DAS28-CRP was analyzed as time-adjusted mean change from baseline. A significant improvement in DAS28-CRP was shown with namilumab (150 and 300 mg groups combined) compared with placebo at day 43 (p = 0.0117) and also 8 weeks after last dosing at day 99 (p = 0.0154).

Conclusions

Subcutaneous namilumab was generally well tolerated. Although namilumab demonstrated preliminary evidence of efficacy, patient numbers were small; phase 2 studies are ongoing.

Trial registration

ClinicalTrials.gov, NCT01317797. Registered 18 February 2011.

Electronic supplementary material

The online version of this article (doi:10.1186/s13075-017-1267-3) contains supplementary material, which is available to authorized users.

A millikelvin all-fiber cavity optomechanical apparatus for merging with ultra-cold atoms in a hybrid quantum system

We describe the construction of an apparatus designed to realize a hybrid quantum system comprised of a cryogenically cooled mechanical oscillator and ultra-cold ⁸⁷Rb atoms coupled via light. The outstanding feature of our instrument is an in situ adjustable asymmetric all-fiber membrane-in-the-middle cavity located inside an ultra-high vacuum dilution refrigerator based cryostat. We show that Bose-Einstein condensates of N=2×10⁶ atoms can be produced in less than 20 s and demonstrate a single photon optomechanical coupling strength of g₀=2π×9 kHz employing a high-stress Si₃N₄ membrane with a mechanical quality factor Q_m>10⁷ at a cavity setup temperature of T_MiM = 480 mK.

Classification and Segmentation of Nanoparticle Diffusion Trajectories in Cellular Micro Environments

Darkfield and confocal laser scanning microscopy both allow for a simultaneous observation of live cells and single nanoparticles. Accordingly, a characterization of nanoparticle uptake and intracellular mobility appears possible within living cells. Single particle tracking allows to measure the size of a diffusing particle close to a cell. However, within the more complex system of a cell’s cytoplasm normal, confined or anomalous diffusion together with directed motion may occur. In this work we present a method to automatically classify and segment single trajectories into their respective motion types. Single trajectories were found to contain more than one motion type. We have trained a random forest with 9 different features. The average error over all motion types for synthetic trajectories was 7.2%. The software was successfully applied to trajectories of positive controls for normal- and constrained diffusion. Trajectories captured by nanoparticle tracking analysis served as positive control for normal diffusion. Nanoparticles inserted into a diblock copolymer membrane was used to generate constrained diffusion. Finally we segmented trajectories of diffusing (nano-)particles in V79 cells captured with both darkfield- and confocal laser scanning microscopy. The software called “TraJClassifier” is freely available as ImageJ/Fiji plugin via https://git.io/v6uz2.

Kinetics of ozone decomposition in porous In2O3 monoliths

We determine ozone decomposition on indium oxide by utilizing the gas transducing properties of hierarchically porous monoliths.

Electrical switching of an antiferromagnet

Antiferromagnets are hard to control by external magnetic fields because of the alternating directions of magnetic moments on individual atoms and the resulting zero net magnetization. However, relativistic quantum mechanics allows for generating current-induced internal fields whose sign alternates with the periodicity of the antiferromagnetic lattice. Using these fields, which couple strongly to the antiferromagnetic order, we demonstrate room-temperature electrical switching between stable configurations in antiferromagnetic CuMnAs thin-film devices by applied current with magnitudes of order 10(6) ampere per square centimeter. Electrical writing is combined in our solid-state memory with electrical readout and the stored magnetic state is insensitive to and produces no external magnetic field perturbations, which illustrates the unique merits of antiferromagnets for spintronics.

Real-time measurement of protein adsorption on electrophoretically deposited hydroxyapatite coatings and magnetron sputtered metallic films using the surface acoustic wave technique

Surface acoustic wave (SAW) biosensors are highly sensitive for mass binding and are therefore used to detect protein-protein and protein-antibody interactions. Whilst the standard surface of the chips is a thin gold film, measurements on implant- or bone-like surfaces could significantly enhance the range of possible applications for this technique. The aim of this study was to establish methods to coat biosensor chips with Ti, TiN, and silver-doped TiN using physical vapor deposition as well as with hydroxyapatite by electrophoresis. To demonstrate that protein adsorption can be detected on these surfaces, binding experiments with fibronectin and fibronectin-specific antibodies have been performed with the coatings, which successfully proved the applicability of PVD and EPD for SAW biosensor functionalization.

Layer-Resolved Evolution of Organic Thin Films Monitored by Photoelectron Emission Microscopy and Optical Reflectance Spectroscopy

Photoelectron emission microscopy (PEEM) and differential (optical) reflectance spectroscopy (DRS) have proven independently to be versatile analytical tools for monitoring the evolution of organic thin films during growth. In this paper, we present the first experiment in which both techniques have been applied simultaneously and synchronously. We illustrate how the combined PEEM and DRS results can be correlated to obtain an extended perspective on the electronic and optical properties of a molecular film dependent on the film thickness and morphology. As an example, we studied the deposition of the organic molecule α-sexithiophene on Ag(111) in the thickness range from submonolayers up to several monolayers.