Isostructural metal-insulator transition in VO2

The metal-insulator transition in correlated materials is usually coupled to a symmetry-lowering structural phase transition. This coupling not only complicates the understanding of the basic mechanism of this phenomenon but also limits the speed and endurance of prospective electronic devices. We demonstrate an isostructural, purely electronically driven metal-insulator transition in epitaxial heterostructures of an archetypal correlated material, vanadium dioxide. A combination of thin-film synthesis, structural and electrical characterizations, and theoretical modeling reveals that an interface interaction suppresses the electronic correlations without changing the crystal structure in this otherwise correlated insulator. This interaction stabilizes a nonequilibrium metallic phase and leads to an isostructural metal-insulator transition. This discovery will provide insights into phase transitions of correlated materials and may aid the design of device functionalities.

An in vivo demonstration of efficacy and acute safety of burst wave lithotripsy using a porcine model

Burst wave lithotripsy (BWL) is a new non-invasive method for stone comminution using bursts of sub-megahertz ultrasound. A porcine model of urolithiasis and techniques to implement BWL treatment has been developed to evaluate its effectiveness and acute safety. Six human calcium oxalate monohydrate stones (6-7 mm) were hydrated, weighed, and surgically implanted into the kidneys of three pigs. Transcutaneous stone treatments were performed with a BWL transducer coupled to the skin via an external water bath. Stone targeting and treatment monitoring were performed with a co-aligned ultrasound imaging probe. Treatment exposures were applied in three 10-minute intervals for each stone. If sustained cavitation in the parenchyma was observed by ultrasound imaging feedback, treatment was paused and the pressure amplitude was decreased for the remaining time. Peak negative focal pressures between 6.5 and 7 MPa were applied for all treatments. After treatment, stone fragments were removed from the kidneys. At least 50% of each stone was reduced to <2 mm fragments. 100% of four stones were reduced to <4 mm fragments. Magnetic resonance imaging showed minimal injury to the functional renal volume. This study demonstrated that BWL could be used to effectively fragment kidney stones with minimal injury.

A new software scheme for scatter correction based on a simple radiographic scattering model

In common radiography, image contrast is often limited due mainly to scattered x-rays and noise, decreasing the quantitative usefulness of x-ray images. Several scatter reduction methods based on software correction schemes have been extensively investigated in an attempt to overcome these difficulties, most of which are based on measurement, mathematical-physical modeling, or a combination of both. However, those methods require special equipment, system geometry, and extra manual work to measure scatter characteristics. In this study, we investigated a new software scheme for scatter correction based on a simple radiographic scattering model where the intensity of the scattered x-rays was directly estimated from a single x-ray image using a weighted l¹-norm contextual regularization framework. We implemented the proposed algorithm and performed a systematic simulation and experiment to demonstrate its viability. We also conducted some clinical image studies using patient's image data of breast and L-spine to verify the clinical effectiveness of the proposed scheme. Our results indicate that the degradation of image characteristics by scattered x-rays and noise was effectively recovered by using the proposed software scheme, thus improving radiographic visibility considerably. Graphical abstract The schematic illustrations of scatter suppression methods by using a an antiscatter grid and b a scatter estimation algorithm.

Clastic cells are absent around the root surface in pulp-exposed periapical periodontitis lesions in mice

INTRODUCTION

Clastic cells, originating from the monocyte-macrophage lineage, resorb mineralized tissues. In periapical periodontitis, alveolar bone around the tooth apex becomes resorbed; however, the roots of the teeth are often left intact by yet unknown mechanisms. Here, we examined the status of clastic cells in a periapical periodontitis model in mice.

METHODS

Periapical periodontitis was induced by performing pulp exposure on the maxillary first molar. The contralateral maxillary first molar was used as a control. The maxillae were harvested, fixed, and subjected to μCT scanning and three-dimensional volumetric analysis. TRAP staining was performed, and osteoclasts were quantified. Immunohistochemical staining was performed for RANKL, OPG, and F4/80, a marker for macrophages.

RESULTS

At the apex of the tooth, pulp exposure resulted in periapical radiolucency with mineralized tissues at the surrounding bone surfaces but not on the root surfaces. Histologically, clastic cells were present on the bone surfaces but absent around the root surfaces. Expression of F4/80 and RANKL was not found at close proximity to the root surfaces, but OPG was globally expressed.

CONCLUSION

The absence of clastic cells around the root surface of pulp-exposed teeth, in part, is associated with the lack of macrophages and RANKL expression.

Randomized controlled trials define shape of dose response for Pollinex Quattro Birch allergoid immunotherapy

BACKGROUND

The Birch Allergoid, Tyrosine Adsorbate, Monophosphoryl Lipid A (POLLINEX^® Quattro Plus 1.0 ml Birch 100%) is an effective, well-tolerated short course subcutaneous immunotherapy. We performed 2 phase II studies to determine its optimal cumulative dose.

METHODS

The studies were conducted in Germany, Austria and Poland (EudraCT numbers: 2012-004336-28 PQBirch203 and 2015-000984-15 PQBirch204) using a wide range of cumulative doses. In both studies, subjects were administered 6 therapy injections weekly outside the pollen season. Conjunctival Provocation Tests were performed at screening, baseline and 3-4 weeks after completing treatment, to quantify the reduction in Total Symptom Scores (as the primary endpoint) with each cumulative dose. Multiple Comparison Procedure and Modeling analysis was used to test for the dose response, shape of the curve and estimation of the median effective dose (ED₅₀ ), a measure of potency.

RESULTS

Statistically significant dose responses (P < .01 & .001) were seen, respectively. The highest cumulative dose in PQBirch204 (27 300 standardized units [SU]) approached a plateau. Potency of the PQBirch was demonstrated by an ED₅₀ 2723 SU, just over half the current dose. Prevalence of treatment-emergent adverse events was similar for active doses, most being short-lived and mild. Compliance was over 85% in all groups.

CONCLUSION

Increasing the cumulative dose of PQBirch 5.5-fold from 5100 to 27 300 SU achieved an absolute point difference from placebo of 1.91, a relative difference 32.3% and an increase in efficacy of 50%, without compromising safety. The cumulative dose response was confirmed to be curvilinear in shape.

Infusion of Phospholipid Vesicles Amplifies the Local Thrombotic Response to TNF and Anti-Protein C into a Consumptive Response

Inflammation often is considered a contributing factor to both thrombosis and disseminated intravascular coagulation. The molecular mechanisms that dictate which of these clinical manifestations will result from the inflammatory stimulus remain obscure. Bacterial infection and certain tumors are common initiators of the disseminated intravascular coagulant response. Complement activation resulting from bacterial infection shares with selected tumors the capacity to generate or release membrane particles that lack functional adhesion receptors and hence could circulate to amplify a disseminated intravascular coagulant response. We developed a model of venous thrombosis that resulted in localized thrombus formation without disseminated intravascular coagulation. The model involves infusion of tumor necrosis factor, blockade of protein C and a partial decrease in venous flow caused by ligation of the superficial femoral vein without obstruction of the deep femoral vein. Infusion of phospholipid vesicles into this model resulted in amplification of a localized thrombotic response into a consumptive response.

Seven different groups of animals were studied. The first three groups established the conditions necessary to produce deep vein thrombosis. The second four groups established the conditions necessary to produce disseminated intravascular coagulation. The infusion of phospholipid vesicles plus tumor necrosis factor and anti-protein C antibody resulted in consumption of fibrinogen, the production of thrombin/antithrombin complexes, a fall in platelet count, and venous thrombosis. Without ligation and catheterization phospholipid vesicles failed to produce the consumptive response. We conclude, therefore, that phospholipid vesicles can amplify a local thrombotic response into a consumptive response, and that vesiculation accompanying inflammation is one means by which localized coagulant activity may be amplified to produce disseminated intravascular coagulation.

Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study

Background

Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.

Methods and Results

A random subcohort of 349 participants was selected from the DCCT / EDIC (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from DCCT baseline, year 1, and closeout of DCCT , and 1 to 2 years post‐ DCCT ( EDIC years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F 2α isoprostanes, and its metabolite, 2,3 dinor‐8 iso prostaglandin F 2α . Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8 iso prostaglandin F 2α , an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase, P <0.003; −5.3% risk for 10% higher 2,3 dinor‐8 iso prostaglandin F 2α , P =0.0092). In contrast, the oxidative markers myeloperoxidase and F 2α isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between DCCT intensive and conventional treatment groups in the change in all biomarkers across time segments.

Conclusions

Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.

Clinical Trial Registration

URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 00360815 and NCT 00360893.

A two-stage approach to estimate spatial and spatio-temporal disease risks in the presence of local discontinuities and clusters

Disease risk maps for areal unit data are often estimated from Poisson mixed models with local spatial smoothing, for example by incorporating random effects with a conditional autoregressive prior distribution. However, one of the limitations is that local discontinuities in the spatial pattern are not usually modelled, leading to over-smoothing of the risk maps and a masking of clusters of hot/coldspot areas. In this paper, we propose a novel two-stage approach to estimate and map disease risk in the presence of such local discontinuities and clusters. We propose approaches in both spatial and spatio-temporal domains, where for the latter the clusters can either be fixed or allowed to vary over time. In the first stage, we apply an agglomerative hierarchical clustering algorithm to training data to provide sets of potential clusters, and in the second stage, a two-level spatial or spatio-temporal model is applied to each potential cluster configuration. The superiority of the proposed approach with regard to a previous proposal is shown by simulation, and the methodology is applied to two important public health problems in Spain, namely stomach cancer mortality across Spain and brain cancer incidence in the Navarre and Basque Country regions of Spain.

Hydro-nanofibrous mesh deep cell penetration: a strategy based on peeling of electrospun coaxial nanofibers

A two-step strategy for coaxial electrospinning and postelectrospinning is an effective method for fabricating superfine nanofibers composed of highly swellable hydrogels. Alginate and poly(ε-caprolactone) [PCL] were coelectrospun via fibrous meshes with a coaxial nozzle; alginate at the core was subsequently cross-linked in calcium chloride solution. The PCL sheath was removed from the meshes by repeated organic-phase washing. The peeling process was monitored by scanning electron microscopy, transmission electron microscopy, and differential scanning calorimetry, and the complete removal of the PCL outer layers was confirmed by the thinning of the fiber volume. The obtained alginate hydronanofiber showed extreme water-swellability and mass erosion depending on the degree of cross-linking. We also measured the nanoscale and macroscale mechanical properties of a single nanofiber and of the whole mesh by atomic force microscopy and rheometry. Quantitative analysis of nanomechanical properties indicated that the hydronanofiber with higher cross-linking density had higher stiffness and Derjaguin-Müller-Toporov modulus. Cells laid on the mesh and the vertical infiltration distance were visualized and quantified by confocal laser scanning microscopy. Cells on the mesh with higher cross-linking density infiltrated deeply to the bottom of the mesh. Thus, hydrogel-like nanofibrous meshes are versatile matrices allowing for deep infiltration of cells throughout the mesh via manipulation of the mechanical properties of the nanofiber.

Obesity increases the risk of small intestinal bacterial overgrowth (SIBO)

BACKGROUND

Small intestinal bacterial overgrowth (SIBO) has been associated with anatomical and motility-related abnormalities. Specifically, obesity has been postulated to alter small bowel motility, leading to SIBO.

AIMS

(i) Assess the prevalence of SIBO in obesity; (ii) determine the relationship of obesity and SIBO, using small bowel transit time (SBTT) and pH; (iii) profile the gut microbiome in obese and non-obese patients with SIBO.

METHODS

Thirty consecutive participants referred for SIBO underwent lactulose breath tests (LBTs) and wireless motility capsule (WMC) studies. Composition of the intestinal microbiome was assessed by analyzing samples from three different gastrointestinal sites via 16S rRNA gene-sequencing.

KEY RESULTS

SIBO was more frequent among obese patients vs non-obese patients (88.9% vs 42.9%, P < .05). Obesity did not correlate with small bowel transit time (SBTT), gastric pH, and small bowel pH. In patients with normal SBTT, obesity was associated with an 11-fold increase (P = .05) in the risk of SIBO. Whereas in those with prolonged SBTT, there was no correlation between obesity and SIBO. Obese vs non-obese patients exhibited significant differences in microbiome diversity in rectal samples. Obesity was associated with increased odds of developing SIBO (P = .04) in multivariate regression analyses.

CONCLUSIONS AND INFERENCES

While obesity was significantly associated with SIBO, our findings suggest that alterations in gut pH, SBTT, and decline in species richness do not account for the obesity-SIBO relationship.

Abstract PD3-04: Complete pathologic response rate to neoadjuvant chemotherapy increases with increasing HER2 ratio in HER2 over-expressing breast cancer: Analysis of the National cancer database (NCDB)

Background: HER2-positive (HER2+) breast cancer is an aggressive subtype that overexpresses human epidermal growth factor receptor 2 promoting cancer cell growth. Monoclonal antibodies targeting the HER2 receptor have improved survival for this patient population, and current NCCN guidelines recommend consideration of neoadjuvant anti-HER2 therapy (NAC) in Stage 2 & 3 HER2+ breast cancer. Pathologic complete response (pCR) to NAC has correlated with longer disease free survival in multiple trials.

Per ASCO-CAP guidelines tumors are considered HER2+ if HER2 copy number≥ 6/cell, HER2/CEP17 ratio≥ 2, or ratio&lt;2 & HER2 copy number ≥6/cell. We hypothesize that patients with higher HER2 ratios will have higher rates of pCR after NAC.

Methods: The National Cancer Database is supported by the American College of Surgeons and the American Cancer Society containing de-identified patient treatment data from over 1,500 US facilities. We performed a retrospective review comparing pCR rates after NAC based on HER2 ratio. Patients were excluded if they were HER2 negative, did not undergo NAC, or if the HER2 ratio was not recorded. Chi-squared and Fisher's exact test were used to compare pCR versus partial response between deciles of HER2 ratios.

Results: The NCDB included 237,118 patients with HER2 equivocal or HER2+ breast tumors. 29,291 of these patients underwent NAC, and HER2 ratios were recorded in 14,597 of the NAC cases. The majority (98%) of included cases were from 2010-2014. A pCR was noted in 9,752 patients and 11,402 patients had a partial response. No response was observed in 1,735 patients and 6,402 patients had a response but the degree was not recorded.

HER2 ratios were significantly different between pCR vs. partial response groups, p &lt;0.001. We identified a direct relationship between increasing HER2 ratio and response to NAC. For ratios 2-2.9, 23.6% achieved pCR and 44.7% had a partial response. For ratio of 5-5.9, 40.7% achieved pCR and even higher rates of pCR were noted for ratios 8-8.9; 49.5% achieved pCR. While both estrogen receptor (ER) positive and ER negative tumors demonstrated this trend, ER negative tumors had higher rates of pCR (ER negative pCR range 37.6% to 59.4% vs ER positive pCR range 16.9% to 42.3%, p&lt;0.01).

Conclusion: Contrary to current dogma, not all HER2+ tumors respond similarly to NAC. We demonstrate a linear relationship between HER2 ratio and pCR in over 14,000 patients. Those with HER2 ratios ≥5.0 were more likely to achieve pCR compared to patients with ratio ≤4.9. The NCDB reflects current clinical practice across the country not restricted to confines of clinical trials, and in this population higher HER2 ratios are predictive of pCR after NAC.

Response to NAC by Her2 Ratio- Complete vs Partial Response  Response to NAC   p ValueHER2 Ratio Complete Response- pCR (N) Partial Response (N)   1.00- 1.99141819.5%343047.2%&lt;0.01 2.00- 2.9951423.6%97444.7%&lt;0.01 3.00- 3.9928328.7%41942.4%&lt;0.01 4.00- 4.9926533.2%30638.2%&lt;0.01 5.00- 5.9929940.7%24333.1%&lt;0.01 6.00- 6.9929241.0%25435.5%&lt;0.01 7.00- 7.9924746.2%17432.5%&lt;0.01 8.00- 8.9918749.5%12132.0%&lt;0.01 9.00- 9.87 and greater44143.9%31431.3%&lt;0.01TOTAL 394627.0%623542.7%&lt;0.01

Citation Format: Greenwell K, Hussain L, Ho C, Dunki-Jacobs E, Lee D, Bramlage M, Bills G, Mehta A, Jones J, Jackson A, Wexelman B. Complete pathologic response rate to neoadjuvant chemotherapy increases with increasing HER2 ratio in HER2 over-expressing breast cancer: Analysis of the National cancer database (NCDB) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD3-04.

Strain control of oxygen kinetics in the Ruddlesden-Popper oxide La1.85Sr0.15CuO4

Oxygen defect control has long been considered an important route to functionalizing complex oxide films. However, the nature of oxygen defects in thin films is often not investigated beyond basic redox chemistry. One of the model examples for oxygen-defect studies is the layered Ruddlesden-Popper phase La2-xSr x CuO4-δ (LSCO), in which the superconducting transition temperature is highly sensitive to epitaxial strain. However, previous observations of strain-superconductivity coupling in LSCO thin films were mainly understood in terms of elastic contributions to mechanical buckling, with minimal consideration of kinetic or thermodynamic factors. Here, we report that the oxygen nonstoichiometry commonly reported for strained cuprates is mediated by the strain-modified surface exchange kinetics, rather than reduced thermodynamic oxygen formation energies. Remarkably, tensile-strained LSCO shows nearly an order of magnitude faster oxygen exchange rate than a compressively strained film, providing a strategy for developing high-performance energy materials.