Search for supersymmetry in events with three leptons and missing transverse momentum in √[s]=7 TeV pp collisions with the ATLAS detector

A search for the weak production of charginos and neutralinos decaying to a final state with three leptons (electrons or muons) and missing transverse momentum is presented. The analysis uses 2.06 fb(-1) of √[s]=7 TeV proton-proton collision data delivered by the Large Hadron Collider and recorded with the ATLAS detector. Observations are consistent with standard model expectations in two signal regions that are either depleted or enriched in Z-boson decays. Upper limits at 95% confidence level are set in R-parity conserving phenomenological minimal supersymmetric and simplified models. For the simplified models, degenerate lightest chargino and next-to-lightest neutralino masses up to 300 GeV are excluded for mass differences from the lightest neutralino up to 300 GeV.

Age-related aspects of addiction

Research has shown that substance use, abuse and addiction are not limited to a specific age group. Problems related to substance addiction are an important cause of morbidity in the population aged 65 years and above, especially the abuse of prescription drugs and legal substances. A lack of evidence-based studies and tailored treatment options for the aging population is evident. Appropriate and effective health care is an important goal to improve the health-related quality of life of elderly people. Research in the increasingly aging population needs to include an age- and gender-sensitive approach.

Denis RD, Stahl T, Stahlman J, Stamen R, Stanecka E, Stanek RW, Stanescu C, Stapnes S, Starchenko EA, Stark J, Staroba P, Starovoitov P, Staude A, Stavina P, Stavropoulos G, Steele G, Steinbach P, Steinberg P, Stekl I, Stelzer B, Stelzer HJ, Stelzer-Chilton O, Stenzel H, Stevenson K, Stewart GA, Stillings JA, Stockmanns T, Stockton MC, Stoerig K, Stoicea G, Stonjek S, Strachota P, Stradling AR, Straessner A, Strandberg J, Strandberg S, Strandlie A, Strang M, Strauss E, Strauss M, Strizenec P, Ströhmer R, Strom DM, Strong JA, Stroynowski R, Strube J, Stugu B, Stumer I, Stupak J, Sturm P, Soh DA, Su D, Subramania HS, Sugaya Y, Sugimoto T, Suhr C, Suita K, Suk M, Sulin VV, Sultansoy S, Sumida T, Sun X, Sundermann JE, Suruliz K, Susinno G, Sutton MR, Suzuki Y, Swedish S, Sykora I, Sykora T, Sánchez J, Ta D, Tackmann K, Taffard A, Tafirout R, Taga A, Taiblum N, Takahashi Y, Takai H, Takashima R, Takeda H, Takeshita T, Talby M, Talyshev A, Tamsett MC, Tanaka J, Tanaka R, Tanaka S, Tanaka S, Tani K, Tannoury N, Tapprogge S, Tardif D, Tarem S, Tarrade F, Tartarelli GF, Tas P, Tasevsky M, Tassi E, Tatarkhanov M, Tayalati Y, Taylor C, Taylor FE, Taylor GN, Taylor W, Teixeira Dias Castanheira M, Teixeira-Dias P, Temming KK, Ten Kate H, Teng PK, Terada S, Terashi K, Terron J, Terwort M, Testa M, Teuscher RJ, Tevlin CM, Therhaag J, Theveneaux-Pelzer T, Thioye M, Thoma S, Thomas JP, Thompson EN, Thompson PD, Thompson PD, Thompson RJ, Thompson AS, Thomson E, Thomson M, Thun RP, Tic T, Tikhomirov VO, Tikhonov YA, Timmermans CJWP, Tipton P, Tique Aires Viegas FJ, Tisserant S, Todorov T, Todorova-Nova S, Toggerson B, Tojo J, Tokár S, Tokunaga K, Tokushuku K, Tollefson K, Tomoto M, Tompkins L, Toms K, Tonazzo A, Tonoyan A, Topfel C, Topilin ND, Torchiani I, Torrence E, Torró Pastor E, Toth J, Touchard F, Tovey DR, Traynor D, Trefzger T, Treis J, Tremblet L, Tricoli A, Trigger IM, Trincaz-Duvoid S, Trinh TN, Tripiana MF, Trischuk W, Trivedi A, Trocmé B, Troncon C, Trottier-McDonald M, Trzupek A, Tsarouchas C, Tseng JCL, Tsiakiris M, Tsiareshka PV, Tsionou D, Tsipolitis G, Tsiskaridze V, Tskhadadze EG, Tsukerman II, Tsulaia V, Tsung JW, Tsuno S, Tsybychev D, Tua A, Tuggle JM, Turala M, Turecek D, Turk Cakir I, Turlay E, Turra R, Tuts PM, Twomey MS, Tykhonov A, Tylmad M, Tyndel M, Typaldos D, Tyrvainen H, Tzanakos G, Uchida K, Ueda I, Ueno R, Ugland M, Uhlenbrock M, Uhrmacher M, Ukegawa F, Unal G, Undrus A, Unel G, Unno Y, Urbaniec D, Urkovsky E, Urrejola P, Usai G, Uslenghi M, Vacavant L, Vacek V, Vachon B, Vahsen S, Valderanis C, Valenta J, Valente P, Valentinetti S, Valkar S, Valladolid Gallego E, Vallecorsa S, Valls Ferrer JA, van der Graaf H, van der Kraaij E, Van Der Leeuw R, van der Poel E, van der Ster D, Van Eijk B, van Eldik N, van Gemmeren P, van Vulpen I, Vandelli W, Vaniachine A, Vankov P, Vannucci F, Vari R, Varnes EW, Varouchas D, Vartapetian A, Varvell KE, Vassilakopoulos VI, Vazeille F, Vegni G, Veillet JJ, Veloso F, Veness R, Veneziano S, Ventura A, Ventura D, Venturi M, Venturi N, Vercesi V, Verducci M, Verkerke W, Vermeulen JC, Vest A, Vetterli MC, Vichou I, Vickey T, Viehhauser GHA, Viel S, Villa M, Villani EG, Villaplana Perez M, Vilucchi E, Vincter MG, Vinek E, Vinogradov VB, Virchaux M, Viret S, Virzi J, Vitale A, Vitells O, Viti M, Vivarelli I, Vives Vaque F, Vlachos S, Vlasak M, Vlasov N, Vogel A, Vokac P, Volpi G, Volpi M, Volpini G, von der Schmitt H, von Loeben J, von Radziewski H, von Toerne E, Vorobel V, Vorwerk V, Vos M, Voss R, Voss TT, Vossebeld JH, Vovenko AS, Vranjes N, Vranjes Milosavljevic M, Vrba V, Vreeswijk M, Vu Anh T, Vuillermet R, Vukotic I, Wagner W, Wagner P, Wahlen H, Wakabayashi J, Walbersloh J, Walch S, Walder J, Walker R, Walkowiak W, Wall R, Waller P, Wang C, Wang H, Wang J, Wang J, Wang R, Wang SM, Warburton A, Ward CP, Warsinsky M, Wastie R, Watkins PM, Watson AT, Watson MF, Watts G, Watts S, Waugh AT, Waugh BM, Weber J, Weber M, Weber MS, Weber P, Weidberg AR, Weigell P, Weingarten J, Weiser C, Wellenstein H, Wells PS, Wen M, Wenaus T, Wendler S, Weng Z, Wengler T, Wenig S, Wermes N, Werner M, Werner P, Werth M, Werthenbach U, Wessels M, Whalen K, Wheeler-Ellis SJ, White A, White MJ, White S, Whitehead SR, Whiteson D, Whittington D, Wicek F, Wicke D, Wickens FJ, Wiedenmann W, Wielers M, Wienemann P, Wiik-Fuchs LAM, Wijeratne PA, Wildauer A, Wildt MA, Wilhelm I, Wilkens HG, Will JZ, Williams E, Williams HH, Willis W, Willocq S, Wilson JA, Wilson MG, Wilson A, Wingerter-Seez I, Winkelmann S, Winklmeier F, Wittgen M, Wolter MW, Wolters H, Wooden G, Wosiek BK, Wotschack J, Woudstra MJ, Wraight K, Wright C, Wright D, Wrona B, Wu SL, Wu X, Wu Y, Wulf E, Wynne BM, Xaplanteris L, Xella S, Xie S, Xu C, Xu D, Yabsley B, Yamada M, Yamamoto A, Yamamoto K, Yamamoto S, Yamamura T, Yamaoka J, Yamazaki T, Yamazaki Y, Yan Z, Yang H, Yang UK, Yang Y, Yang Z, Yanush S, Yao WM, Yao Y, Yasu Y, Ybeles Smit GV, Ye J, Ye S, Yilmaz M, Yoosoofmiya R, Yorita K, Yoshida R, Young C, Youssef S, Yu D, Yu J, Yu J, Yuan L, Yurkewicz A, Zaidan R, Zaitsev AM, Zajacova Z, Zalite YK, Zanello L, Zarzhitsky P, Zaytsev A, Zeitnitz C, Zeller M, Zema PF, Zemla A, Zendler C, Zenin AV, Zenin O, Ženiš T, Zinonos Z, Zenz S, Zerwas D, Zevi della Porta G, Zhan Z, Zhang D, Zhang H, Zhang J, Zhang Q, Zhang X, Zhang Z, Zhao L, Zhao T, Zhao Z, Zhemchugov A, Zhong J, Zhou B, Zhou N, Zhou Y, Zhu CG, Zhu H, Zhu Y, Zhuang X, Zhuravlov V, Zieminska D, Zilka B, Zimmermann R, Zimmermann S, Zimmermann S, Ziolkowski M, Zitoun R, Živković L, Zmouchko VV, Zobernig G, Zoccoli A, Zolnierowski Y, Zsenei A, zur Nedden M, Zutshi V, Zwalinski L. Search for lepton flavour violation in the eμ continuum with the ATLAS detector in [Formula: see text]pp collisions at the LHC

This paper presents a search for the t-channel exchange of an R-parity violating scalar top quark ([Formula: see text]) in the e±μ∓ continuum using 2.1 fb-1 of data collected by the ATLAS detector in [Formula: see text]pp collisions at the Large Hadron Collider. Data are found to be consistent with the expectation from the Standard Model backgrounds. Limits on R-parity-violating couplings at 95 % C.L. are calculated as a function of the scalar top mass ([Formula: see text]). The upper limits on the production cross section for pp→eμX, through the t-channel exchange of a scalar top quark, ranges from 170 fb for [Formula: see text] to 30 fb for [Formula: see text].

Propolis: a natural product as an alternative for disinfection of embryonated eggs for incubation

During the cooling process of embryonated eggs, there is a natural air flux from the surface to the inner part of the eggs, carrying contaminants such as bacteria and fungi through the shell's pores, infecting embryos and resulting in the inability to hatch or poor chick quality. Formaldehyde, a toxic product, is still the most used disinfectant for embryonated eggs in the aviculture industry. In order to evaluate the antimicrobial activity of the green propolis ethanolic extract as an alternative to formaldehyde, 140 hatching eggs from laying hens were collected and submitted to disinfection with five different treatments: T1 - without disinfection; T2 - formaldehyde fumigated eggs; T3, T4 and T5 disinfection by immersion in propolis solution in the concentrations of 2,400 µg, 240 µg and 24 µg, respectively. The contamination levels by total mesophiles and fungi of the egg shells (Aspergillus sp. and other moulds) after disinfection with propolis were lower than when compared to the control without disinfection. In comparison with formaldehyde, the 240 µg and 24 µg propolis concentrations did not differ regarding antibacterial activity, but for antifungal activity the 2,400 µg and 240 µg concentrations were more efficient. The 2,400 µg and 240 µg propolis treatments presented a hatching rate of 94.1%, compared to only 84.6% for the formaldehyde treatment. The green propolis ethanolic extract presented antibacterial and antifungal activities in embryonated eggs showing that it can be a new natural disinfectant product substituting formaldehyde.

Achieving elongated lesions employing cardiac cryoablation: a preclinical evaluation study

Cardiac cryoablation applied for treating cardiac arrhythmias has shown promising results after intervention, particularly for the creation of elongated lesions. A model for simulating and assessing cryoablation interventions was developed, evaluated and validated with animal experiments. We employed two simulations of different freezing outlet settings for a loop shaped cryocatheter, applying Pennes heat equation for cardiac tissue. Our experiments demonstrated that an equidistantly spaced freezing outlet distribution of 5mm led to an improved formation of lesions, i.e., elongated lesions were observed throughout the transmural cardiac volume and on the epicardial structure. A complete transmural frozen lesion was not achieved with a freezing outlet distance of 10mm. These simulation results could be experimentally verified by morphological and histological examinations. Using our simulation model we were able to optimize the intervention procedure by predicting and assessing the freezing process. This should further increase the success rate of cardiac cryoablation in clinical interventions.

Carrier-bound nonallergenic Der p 2 peptides induce IgG antibodies blocking allergen-induced basophil activation in allergic patients

BACKGROUND

More than 90% of house dust mite-allergic patients are sensitized to the major Dermatophagoides pteronyssinus allergen, Der p 2. The aim of this study was to develop and characterize an allergy vaccine based on carrier-bound Der p 2 peptides, which should allow reducing IgE- and T-cell-mediated side-effects during specific immunotherapy (SIT).

METHODS

Five Der p 2 peptides (P1-P5) were synthesized and analyzed regarding IgE reactivity and allergenic activity. Lymphoproliferative and cytokine responses induced with Der p 2 and Der p 2 peptides were determined in peripheral blood mononuclear cells from mite-allergic patients. Der p 2-specific IgG antibodies induced with carrier-bound Der p 2 peptides in mice and rabbits were tested for their capacity to inhibit IgE binding and basophil activation in allergic patients.

RESULTS

Of five overlapping peptides (P1-P5) covering the Der p 2 sequence, two peptides (P2 and P4) were identified, which showed no relevant IgE reactivity, allergenic activity, and induced lower Der p 2-specific T-cell activation than Der p 2. However, when coupled to a carrier, P2 and P4 induced Der p 2-specific IgG antibodies in animals, which inhibited allergic patients' IgE binding to the allergen and allergen-induced basophil activation similar as antibodies induced with Der p 2.

CONCLUSIONS

Carrier-bound Der p 2 peptides should allow avoiding IgE-mediated side-effects, and because of their low potential to activate allergen-specific T cells, they may reduce late-phase side-effects during SIT. Further, these peptides may be also useful for prophylactic vaccination.

Strategies to work with HLA data in human populations for histocompatibility, clinical transplantation, epidemiology and population genetics: HLA-NET methodological recommendations

HLA-NET (a European COST Action) aims at networking researchers working in bone marrow transplantation, epidemiology and population genetics to improve the molecular characterization of the HLA genetic diversity of human populations, with an expected strong impact on both public health and fundamental research. Such improvements involve finding consensual strategies to characterize human populations and samples and report HLA molecular typings and ambiguities; proposing user-friendly access to databases and computer tools and defining minimal requirements related to ethical aspects. The overall outcome is the provision of population genetic characterizations and comparisons in a standard way by all interested laboratories. This article reports the recommendations of four working groups (WG1-4) of the HLA-NET network at the mid-term of its activities. WG1 (Population definitions and sampling strategies for population genetics’ analyses) recommends avoiding outdated racial classifications and population names (e.g. ‘Caucasian’) and using instead geographic and/or cultural (e.g. linguistic) criteria to describe human populations (e.g. ‘pan-European’). A standard ‘HLA-NET POPULATION DATA QUESTIONNAIRE’ has been finalized and is available for the whole HLA community. WG2 (HLA typing standards for population genetics analyses) recommends retaining maximal information when reporting HLA typing results. Rather than using the National Marrow Donor Program coding system, all ambiguities should be provided by listing all allele pairs required to explain each genotype, according to the formats proposed in ‘HLA-NET GUIDELINES FOR REPORTING HLA TYPINGS’. The group also suggests taking into account a preliminary list of alleles defined by polymorphisms outside the peptide-binding sites that may affect population genetic statistics because of significant frequencies. WG3 (Bioinformatic strategies for HLA population data storage and analysis) recommends the use of programs capable of dealing with ambiguous data, such as the ‘gene[rate]’ computer tools to estimate frequencies, test for Hardy–Weinberg equilibrium and selective neutrality on data containing any number and kind of ambiguities. WG4 (Ethical issues) proposes to adopt thorough general principles for any HLA population study to ensure that it conforms to (inter)national legislation or recommendations/guidelines. All HLA-NET guidelines and tools are available through its website http://hla-net.eu.

Should pregnant women with substance use disorders be managed differently?

Pregnant women with substance use disorders have multiple special needs, which might be best managed within a multiprofessional treatment setting involving medical, psychological and social care. Adequate treatment provision remains a challenge for healthcare professionals, who should undergo special training and education when working with this patient population. Careful assessment and screening is necessary to tailor interventions individually to the woman's needs in order to achieve beneficial clinical outcomes for mothers and newborns, whereas the choice of treatment options highly depends on the type of substance of abuse and evidence-based treatment interventions available. Economic considerations have shown that early multiprofessional treatment might yield better clinical outcomes and save healthcare costs over the lifespan.

Measurement of the ZZ production cross section and limits on anomalous neutral triple gauge couplings in proton-proton collisions at sqrt[s] = 7 TeV with the ATLAS detector

A measurement of the ZZ production cross section in proton-proton collisions at sqrt[s] = 7 TeV using data corresponding to an integrated luminosity of 1.02 fb(-1) recorded by the ATLAS experiment at the LHC is presented. Twelve events containing two Z boson candidates decaying to electrons and/or muons are observed, with an expected background of 0.3 ± 0.3(stat)(-0.3)(+0.4)(syst) events. The cross section measured in a phase-space region with good detector acceptance and for dilepton masses within the range 66 to 116 GeV is σ(ZZ → ℓ+ ℓ- ℓ+ ℓ-)(fid) = 19.4(-5.2)(+6.3)(stat)(-0.7)(+0.9)(syst) ± 0.7(lumi) fb. The resulting total cross section for on-shell ZZ production, σ(ZZ)(tot) = 8.5(-2.3)(+2.7)(stat)(-0.3)(+0.4)(syst) ± 0.3(lumi) pb, is consistent with the standard model expectation of 6.5(-0.2)(+0.3) pb calculated at the next-to-leading order in QCD. Limits on anomalous neutral triple gauge boson couplings are derived.

Polybrominated diphenyl ethers (PBDE) in blood of children in Baden-Württemberg between 2002/03 and 2008/09

Polybrominated diphenyl ethers (PBDE) are used in high amounts as flame retardants in plastic materials and textiles. Due to their persistence, their accumulation in the food chain and their toxic properties they have been integrated in the human biomonitoring program of the Baden-Württemberg State Health Office since 2002. In repeated cross-sectional studies in winter 2002/03 (n=162), 2004/05 (n=194), 2005/06 (n=411) and 2008/09 (n=770) blood samples of 9-11-year-old pupils were taken, pooled and analysed for PBDE after extraction and purification by silica gel using HRGC/HRMS. Samples were pooled according to region, gender, and breast feeding. PBDE in the pooled samples ranged from 1.9 to 12.5 ng/g blood fat (sum of all PBDE). Mean concentrations of PBDE, calculated for the four investigation periods, were 6.2 ng/g (2002/03), 5.4 ng/g (2004/05), 7.8 ng/g (2005/06) and 6.7 ng/g (2008/09). While the concentration of the decabrominated diphenyl ether (BDE-209) increased, the concentration of other congeners (BDE-47, BDE-99, BDE-100, BDE-153, BDE-154, BDE-183) decreased slightly or remained at the same level. Consistent differences with respect to gender and breast-feeding were not recognizable. Concentrations of PBDE in children range on the same level as in adults and do not seem to be critical from the toxicological point of view. Because of the slight increase of BDE 209, the internal concentrations of BDE should be monitored in the future. The strong variations in PBDE concentration between the different pooled samples indicate that, apart from ingestion, other routes of exposure (dermal, inhalation) and additional sources (textiles, building materials) must be taken into consideration.

P1-12-21: Adjuvant Trastuzumab Treatment without Adjuvant Chemotherapy in Early Breast Cancer

Background: Trastuzumab (T) is approved in most Western countries for the treatment of early, HER2+ breast cancer (BC) parallel or sequential to adjuvant chemotherapy (CT). Nevertheless, as in metastatic disease, the antibody seems to be used without chemotherapy in a selected group of HER2+ patients (pt). The purpose of this analysis is to characterize this subgroup as well as describe safety and efficacy outcome parameters in this German prospective observation trial.

Methods: At present, 2870 patients (pts) have been enrolled and documented in this ongoing non-interventional study from 270 German centers. At data base closure for this analysis, sufficient documentation was available from 2422 eligible pts.

Results: The proportion of pts receiving T without preceding or concomitant CT (noCT) was 180/2422 (7.4%). This subgroup was characterized by higher age (median 58 vs.56 in the CT group, p=0.0026; ≥70 years: 18%/10%), smaller primaries (pT1 49%/43%, p=0.11), more favorable grading (G3 45%/53%, p=0.045), a higher proportion of positive hormone receptor (67%/61%, p=0.096) and less radiotherapy (64%/79%, p<0.0001). The strong association to radiotherapy is probably due to the fact, that the choice of this additional modality reflects the overall risk assessment of the pt.

In contrast, there was no difference in nodal involvement (pN0: 52%/51%; positive nodes: mean 2.5/2.4). In multivariate analysis (logistic regression model, not incorporating radiotherapy), hormone receptor status is not predictive (p=0.41), while age ≥65 (p=0.0011), grade 1/2 (p=0.046) and pT1 (p=0.089) independently remain at least borderline significant. The mean number of T administrations was 18 and the median duration of T therapy was 12 months in the noCT group as well as the CT group. 57% of the noCT pts received adjuvant endocrine therapy. In the CT group, 81% received anthracyclines and 61% taxanes.

Based on a still low number of only 13 observed events in the noCT group, no differences in relapse-free survival could be detected (p=0.38). Pathological cardiac findings in the pt's history was not predictive of therapy selection (6%/7%) and were also similarly distributed at the end of T therapy (7%/8%). Cardiac function disorders of CTC grade 3/4 were reported in 1% of both groups, across all grades slightly less frequent in the noCT group (2.8%/4.0%).

Conclusions: A small, but distinct group of early BC pts without adjuvant chemotherapy receives T treatment for HER2+ disease. These patients are characterized by higher age and favorable primary tumor staging and grading, but not by cardiac comorbidities.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-12-21.

Are male neonates more vulnerable to neonatal abstinence syndrome than female neonates?

BACKGROUND

Prior studies have shown an increased vulnerability among males to adverse outcomes during the postnatal period. Most children exposed to opioids and other medications in utero develop neonatal abstinence syndrome (NAS), yet individual predisposition for NAS is poorly understood.

OBJECTIVE

This investigation examined the role of neonatal sex in the postnatal period for neonates exposed to standardized opioid maintenance treatment in utero with a focus on NAS regarding severity, medication requirements, and duration.

METHODS

This was a secondary analysis of data collected in a prospective randomized, double-blind, double-dummy, multicenter trial (MOTHER study) that examined the comparative safety and efficacy of methadone and buprenorphine during pregnancy. A total of 131 neonates born to opioid-dependent women randomized at 6 US sites (n = 74) and 1 European site (n = 37) were analyzed. Sex-based differences in birth weight, length, head circumference, NAS duration, NAS severity, and treatment parameters of full-term neonates were assessed.

RESULTS

Males had a significantly higher birth weight (P = 0.027) and head circumference (P = 0.017) compared with females, with no significant sex difference in rates of preterm delivery. No significant sex-related differences were found for NAS development, severity, or duration, or medication administered, and there were no significant differences in concomitant drug consumption during pregnancy (P = 0.959).

CONCLUSIONS

This unique prospective study shows similar postnatal vulnerability for both sexes, suggesting that factors other than sex are the major determinants of clinically significant NAS. ClinicalTrials.gov identifier: NCT 00271219.

Impact of treatment approach on maternal and neonatal outcome in pregnant opioid-maintained women

OBJECTIVE

The objective of this study is to compare maternal and neonatal outcome of opioid-dependent women maintained on buprenorphine or methadone throughout pregnancy in a randomized double-blind double-dummy clinical trial (CT) with a comparison group undergoing a structured standard protocol (SP) at the Medical University of Vienna, Austria.

METHODS

One hundred and fourteen subjects were included in the analysis, with 77 in SP (n = 51 methadone, n = 26 buprenorphine), and 37 in CT (n = 19 methadone, n = 18 buprenorphine), comparing maternal concomitant consumption during third trimester, demographic birth data, duration of treatment for neonatal abstinence syndrome (NAS), morphine dose for NAS treatment and length of hospital stay (LOS).

RESULTS

Both study groups yielded healthy neonates with no significant demographic differences and equivalently low rates of positive maternal urine toxicologies. However, NAS parameters were significantly better in CT regarding total medication dose administered to neonates (p = 0.014) and LOS (p = 0.015). Superior results were achieved in buprenorphine compared with methadone-exposed neonates regarding gestational age at birth (p = 0.003), birth weight (p = 0.011), total morphine dose administered (p = 0.008), NAS treatment duration (p = 0.008) and LOS (p = 0.001).

CONCLUSIONS

Comparably favorable outcome for mothers and infants and efficacy and safety of opioid medications were shown in both treatment approaches. Neonatal care could benefit from transferring successful CT procedures into clinical practice.

Trans-sinusal frontal approach for olfactory groove meningiomas

The authors report on their experience with the trans-sinusal frontal approach in removing olfactory groove meningiomas. Six tumors were operated on by the trans-sinusal frontal approach, using a bicoronal incision; two tumors developed on one side, and there were four bilateral olfactosellar tumors. Osteotomy of the anterior wall of the frontal sinus was performed with an oscillating saw without any burr hole. The posterior wall of the sinus was resected and the tumor was attacked through a real subfrontal route along the plane of the anterior skull base. Ethmoidal blood supply was controlled at the initial stages of the operation, allowing avascular tumor debulking. Olfactory nerves, invaded by the tumor, were removed along with the tumor. Tumor extensions toward the sella and the optic canals were removed without brain retraction, opening of the Sylvian fissure, or dissection of the carotid arteries. All patients made a good neurologic recovery; intellectual impairment disappeared within 1 month, and visual acuity normalized within 2 weeks. Olfactory nets were preserved on the contralateral side in unilateral tumors. The trans-sinusal frontal approach is technically easy and safe to achieve. Osteotomy and replacement of the anterior wall of the frontal sinus are rapidly performed. When the frontal sinus is small, imageguided surgery allows precise deliniation of its limits and the free bone flap, including the calvarial outer layer, tangentially cut from one supraorbital canal to the other. The cosmetic result is perfect, as the normal contour of the forehead is maintained without any scar or visible burr hole. The trans-sinusal frontal approach gives access to the orbital roofs and to the central anterior skull base from the crista galli to the tuberculum sellae and the anterior clinoid processes. The trans-sinusal frontal approach represents an alternative to conventional craniotomies for tumors developed in the central anterior skull base, especially for olfactory groove meningiomas, whatever their size.

Randomized controlled trials in pregnancy: scientific and ethical aspects. Exposure to different opioid medications during pregnancy in an intra-individual comparison

BACKGROUND

Chronic medical conditions such as opioid dependence require evidence-based treatment recommendations. However, pregnant women are under-represented in clinical trials. We describe the first within-subject comparison of maternal and neonatal outcomes for methadone- versus buprenorphine-exposed pregnancies. Although methadone is the established treatment of pregnant opioid-dependent women, recent investigations have shown a trend for a milder neonatal abstinence syndrome (NAS) under buprenorphine. However, it is not only the choice of maintenance medication that determines the occurrence of NAS; other factors such as maternal metabolism, illicit substance abuse and nicotine consumption also influence its severity and duration and represent confounding factors in the assessment of randomized clinical trials. CASE SERIES DESCRIPTION: Three women who were part of the European cohort of a randomized, double-blind multi-center trial with a contingency management tool [the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study], each had two consecutive pregnancies and were maintained on either methadone or buprenorphine for their first and then the respective opposite, still-blinded medication for their second pregnancy. Birth measurements, the total neonatal abstinence score, the total amounts of medication used to treat NAS and the days of NAS treatment duration were assessed.

RESULTS

Both medications were effective and safe in reducing illicit opioid relapse and avoiding preterm labor. Methadone maintenance yielded to a significantly higher neonatal birth weight. Data patterns suggest that buprenorphine exposure was associated with lower neonatal abstinence syndrome (NAS) scores. Findings from this unique case series are consistent with earlier reports using between-group analyses.

CONCLUSIONS

Buprenorphine has the potential to become an established treatment alternative to methadone for pregnant opioid-dependent women. Under special consideration of ethical boundaries, psychopharmacological treatment during pregnancy must be addressed as an integral part of clinical research projects in order to optimize treatment for women and neonates.

Shortening of treatment duration in patients with chronic hepatitis C genotype 2 and 3 - impact of ribavirin dose - a randomized multicentre trial

Background

Chronic hepatitis C (CHC) Patients, infected with genotype (GT) 2 or 3 are treated with Peg-IFN and ribavirin (RBV) (800 mg/day) for 24 weeks. Treatment duration can be shortened to 12-16 weeks if a higher dose of RBV (1.000/1.200 mg/day) was used without considerable loss of responsiveness or increased risk of relapse. Previously we have shown that in patients with CHC, GT 2/3 RBV can be reduced to 400 mg/day if administered for 24 weeks without an increase in relapse rates. Therefore we investigated the efficacy of a reduced RBV dosage of 400 mg/day with shorter treatment duration (16 weeks).

Methods

Treatment naïve patients with CHC, GT 2/3 were randomized to receive 180 μg peginterferonα2a/week in combination with either 800 (group C) or 400 mg/d (group D) for 16 weeks. The primary endpoint was SVR.

Results

12 months after the first patient was randomized a inferior outcome of group D as compared to group C was noted, therefore the study was terminated. At study termination 89 patients were enrolled (group C: 31, D: 51). The SVR rate was statistically different in the two study groups with 51.6% in group C and 28.4% in group D (p = 0.038). Patients with low viral load had higher SVR rates (C: 67%, D: 33%) than those with high viral load (C: 33%, D: 21%).

Conclusion

Both treatment duration and the dose of RBV play a major role to optimize outcome of patients with GT3. If one intends to shorten the treatment weight based RBV dose should be used, if lower RBV doses are used patients should be treated for at least 24 weeks as. A treatment regimen with a reduced RBV dosage and shortened treatment duration is associated with low SVR rates due to high relapse rates.

Trial registration

NCT01258101

Continuous spinal anesthesia versus continuous femoral nerve block for elective total knee replacement

BACKGROUND

Continuous spinal analgesia (CSA) and continuous femoral nerve blockade (CFNB) are well-established procedures for postoperative pain relief. This study compares the efficacy, adverse effects and complications associated with these two analgesic methods in patients undergoing total knee arthroplasty (TKA).

METHODS

Data were analyzed from consecutive patients undergoing TKA under either CSA or spinal anesthesia plus CFNB. Quality of analgesia was assessed based on opioid consumption and pain intensity (visual analogue scale [VAS] where 0=no pain and 10=utmost imaginable pain) until postoperative day 4. In addition, joint mobility was assessed, and any adverse reactions or side effects were noted.

RESULTS

Sixty-two patients had satisfactory postoperative pain relief, and maximum pain scores were reported between 12 and 24 hrs. Median pain scores in the CSA group were significantly lower than those in the CFNB group (1.0 [0.9-1.9] vs. 2.0 [1.5-3.6] for resting pain and 2.0 [1.7-3.1] vs. 5.0 [3.0-5.5] for dynamic pain, respectively; P<0.001 for days 0 and 1; P<0.05 for all other days). Piritramide consumption was significantly higher in the CFNB group (P<0.01). There were no significant differences between the groups for postoperative mobility of the joint or patient satisfaction.

CONCLUSION

Both methods demonstrated analgesic efficacy after total knee arthroplasty, although there was less pain severity and opioid consumption use reported with continuous spinal analgesia. However, the use of continuous spinal analgesia is limited by concerns about the risk profile and absence of approved devices for continuous intrathecal infusion.

Neonatal abstinence syndrome after methadone or buprenorphine exposure

BACKGROUND

Methadone, a full mu-opioid agonist, is the recommended treatment for opioid dependence during pregnancy. However, prenatal exposure to methadone is associated with a neonatal abstinence syndrome (NAS) characterized by central nervous system hyperirritability and autonomic nervous system dysfunction, which often requires medication and extended hospitalization. Buprenorphine, a partial mu-opioid agonist, is an alternative treatment for opioid dependence but has not been extensively studied in pregnancy.

METHODS

We conducted a double-blind, double-dummy, flexible-dosing, randomized, controlled study in which buprenorphine and methadone were compared for use in the comprehensive care of 175 pregnant women with opioid dependency at eight international sites. Primary outcomes were the number of neonates requiring treatment for NAS, the peak NAS score, the total amount of morphine needed to treat NAS, the length of the hospital stay for neonates, and neonatal head circumference.

RESULTS

Treatment was discontinued by 16 of the 89 women in the methadone group (18%) and 28 of the 86 women in the buprenorphine group (33%). A comparison of the 131 neonates whose mothers were followed to the end of pregnancy according to treatment group (with 58 exposed to buprenorphine and 73 exposed to methadone) showed that the former group required significantly less morphine (mean dose, 1.1 mg vs. 10.4 mg; P<0.0091), had a significantly shorter hospital stay (10.0 days vs. 17.5 days, P<0.0091), and had a significantly shorter duration of treatment for the neonatal abstinence syndrome (4.1 days vs. 9.9 days, P<0.003125) (P values calculated in accordance with prespecified thresholds for significance). There were no significant differences between groups in other primary or secondary outcomes or in the rates of maternal or neonatal adverse events.

CONCLUSIONS

These results are consistent with the use of buprenorphine as an acceptable treatment for opioid dependence in pregnant women. (Funded by the National Institute on Drug Abuse; ClinicalTrials.gov number, NCT00271219.).

Magnetic effects of defect pair formation in ZnO

In order to gain insight into the so-called d(0)-magnetic properties of defective ZnO we have carried out first principles calculations on various types of defects formed by intrinsic defects and doped atoms as well as pairs of them. The doped atoms include N and H. In agreement with previous works we find several possibilities to create magnetic defects especially by hole formation. Our results also show that two defects which are in the vicinity of each other and that are magnetic when isolated, in general become non-magnetic if one of them is acceptor-like and the other one donor-like. Furthermore, we have investigated the magnetic interaction of different defect pairs via total energy calculations, the results of which show in all cases the stability of ferromagnetic configurations. In order to reproduce the experimentally found localization of the magnetic hole states we have investigated the effect of applying correlation corrections on the p orbitals containing these holes.

Unintended pregnancy in opioid-abusing women

The aim of this study was to estimate the prevalence of unintended pregnancy and its three subtypes (mistimed, unwanted, and ambivalent) among opioid-abusing women. In the general population, 31%-47% of pregnancies are unintended; data on unintended pregnancy in opioid- and other drug-abusing women are lacking. Pregnant opioid-abusing women (N = 946) screened for possible enrollment in a multisite randomized controlled trial comparing opioid maintenance medications completed a standardized interview assessing sociodemographic characteristics, current and past drug use, and pregnancy intention. Almost 9 of every 10 pregnancies were unintended (86%), with comparable percentages mistimed (34%), unwanted (27%), and ambivalent (26%). Irrespective of pregnancy intention, more than 90% of the total sample had a history of drug abuse treatment, averaging more than three treatment episodes. Interventions are sorely needed to address the extremely high rate of unintended pregnancy among opioid-abusing women. Drug treatment programs are likely to be an important setting for such interventions.

Peritransplant immunoadsorption for positive crossmatch deceased donor kidney transplantation

Various desensitization protocols were shown to enable successful living donor kidney transplantation across a positive complement-dependent cytotoxicity crossmatch (CDCXM). Positive crossmatch transplantation, however, is less well established for deceased donor transplantation. We report a cohort of 68 deceased donor renal allograft recipients who, on the basis of broad sensitization (lymphocytotoxic panel reactivity ≥40%), were subjected to a protocol of peritransplant immunoadsorption (IA). Treatment consisted of a single session of immediate pretransplant IA (protein A) followed by posttransplant IA and antilymphocyte antibody therapy. Twenty-one patients had a positive CDCXM, which could be rendered negative by pretransplant apheresis. Solid phase HLA antibody detection revealed preformed donor-specific antibodies (DSA) in all 21 CDCXM-positive and in 30 CDCXM-negative recipients. At 5 years, overall graft survival, death-censored graft survival and patient survival were 63%, 76% and 87%, respectively, without any differences between CDCXM-positive, CDCXM-negative/DSA-positive and CDCXM-negative/DSA-negative recipients. Furthermore, groups did not differ regarding rates of antibody-mediated rejection (24% vs. 30% vs. 24%, p = 0.84), cellular rejection (14% vs. 23% vs. 18%, p = 0.7) or allograft function (median 5-year serum creatinine: 1.3 vs. 1.8 vs. 1.7 mg/dL, p = 0.62). Our results suggest that peritransplant IA is an effective strategy for rapid desensitization in deceased donor transplantation.

Co-occurring psychiatric symptoms are associated with increased psychological, social, and medical impairment in opioid dependent pregnant women

The interaction of psychiatric symptoms with drug dependence during pregnancy is not well understood. This study examines the relationship of psychiatric symptoms to severity of drug use and drug-related problems among participants in a clinical trial of pharmacologic treatment of opioid dependence during pregnancy (N = 174). A total of 64.6% reported additional psychiatric symptoms (48.6% mood symptoms, 40.0% anxiety symptoms, and 12.6% suicidal thinking). Women who endorsed co-occurring psychiatric symptoms showed more severe impairment on the Addiction Severity Index. Further investigation is warranted to understand the effect of psychiatric symptoms on long-term maternal and neonatal outcomes.

Gender issues in the pharmacotherapy of opioid-addicted women: buprenorphine

Gender, a biological determinant of mental health and illness, plays a critical role in determining patients' susceptibility, exposure to mental health risks, and related outcomes. Regarding sex differences in the epidemiology of opioid dependence, one third of the patients are women of childbearing age. Women have an earlier age of initiation of substance use and a more rapid progression to drug involvement and dependence than men. Generally few studies exist which focus on the special needs of women in opioid maintenance therapy. The aim of this paper is to provide an overview of treatment options for opioid-dependent women, with a special focus on buprenorphine, and to look at recent findings related to other factors that should be taken into consideration in optimizing the treatment of opioid-dependent women. Issues addressed include the role of gender in the choice of medication assisted treatment, sex differences in pharmacodynamics and pharmacokinetics of buprenorphine drug interactions, cardiac interactions, induction of buprenorphine in pregnant patients, the neonatal abstinence syndrome and breastfeeding. This paper aims to heighten the awareness for the need to take gender into consideration when making treatment decisions in an effort to optimize services and enhance the quality of life of women suffering from substance abuse.

First-trimester fetal heart rate in mothers with opioid addiction

AIM

To investigate the difference in fetal heart rate of opioid-dependent mothers compared to non-dependent mothers in the first trimester of pregnancy.

DESIGN

The data of 74 consecutive singleton pregnancies of mothers enrolled in a maintenance programme for opioid-dependent women was matched to 74 non-exposed singleton pregnancies by maternal age, crown-rump length, smoking status, ethnic background and mode of conception.

MEASUREMENT

Fetal heart rate measured as part of first-trimester screening by Doppler ultrasound between 11+0 and 13+6 gestational weeks was compared retrospectively.

FINDINGS

The mean fetal heart rate in opioid-dependent mothers was 156.0 beats per minute (standard deviation 7.3) compared to 159.6 (6.5) in controls. The difference in fetal heart rate was significant (P = 0.02). There was a significant difference in mean maternal body mass index (P = 0.01) but not in mean nuchal translucency (P = 0.3), gestational age (0.5), fetal gender (P = 0.3) and parity (P = 0.3) between both groups. Fifty-five per cent (41 of 74) of cases were taking methadone, 30% (22 of 74) buprenorphine and 15% (11 of 74) were taking slow-release morphines throughout the pregnancy.

CONCLUSIONS

In fetuses of opioid-dependent mothers a decreased fetal heart rate can already be observed between 11+0 and 13+6 gestational weeks. The effect of opioid intake needs to be taken into consideration when interpreting fetal heart rate in opioid-dependent mothers at first-trimester screening.

Smoking in pregnant women screened for an opioid agonist medication study compared to related pregnant and non-pregnant patient samples

BACKGROUND

Little is known about the prevalence and severity of smoking in pregnant opioid dependent patients.

OBJECTIVES

To first characterize the prevalence and severity of smoking in pregnant patients screened for a randomized controlled trial, Maternal Opioid Treatment: Human Experimental Research (MOTHER), comparing two agonist medications; and second, to compare the MOTHER screening sample to published samples of other pregnant and/or patients with substances use disorders.

METHODS

Pregnant women (N = 108) screened for entry into an agonist medication comparison study were retrospectively compared on smoking variables to samples of pregnant methadone-maintained patients (N = 50), pregnant opioid or cocaine dependent patients (N = 240), non-pregnant methadone-maintained women (N = 75), and pregnant non-drug-addicted patients (N = 1,516).

RESULTS

Of screened patients, 88% (n = 95) smoked for a mean of 140 months (SD = 79.0) starting at a mean age of 14 (SD = 3.5). This rate was similar to substance use disordered patients and significantly higher compared to general pregnant patients (88% vs. 22%, p < .001).

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

Aggressive efforts are needed to reduce/eliminate smoking in substance-abusing pregnant women.

Analysis of the HLA population data (AHPD) submitted to the 15th International Histocompatibility/Immunogenetics Workshop by using the Gene[rate] computer tools accommodating ambiguous data (AHPD project report)

During the 15th International Histocompatibility and Immunogenetics Workshop (IHIWS), 14 human leukocyte antigen (HLA) laboratories participated in the Analysis of HLA Population Data (AHPD) project where 18 new population samples were analyzed statistically and compared with data available from previous workshops. To that aim, an original methodology was developed and used (i) to estimate frequencies by taking into account ambiguous genotypic data, (ii) to test for Hardy-Weinberg equilibrium (HWE) by using a nested likelihood ratio test involving a parameter accounting for HWE deviations, (iii) to test for selective neutrality by using a resampling algorithm, and (iv) to provide explicit graphical representations including allele frequencies and basic statistics for each series of data. A total of 66 data series (1-7 loci per population) were analyzed with this standard approach. Frequency estimates were compliant with HWE in all but one population of mixed stem cell donors. Neutrality testing confirmed the observation of heterozygote excess at all HLA loci, although a significant deviation was established in only a few cases. Population comparisons showed that HLA genetic patterns were mostly shaped by geographic and/or linguistic differentiations in Africa and Europe, but not in America where both genetic drift in isolated populations and gene flow in admixed populations led to a more complex genetic structure. Overall, a fruitful collaboration between HLA typing laboratories and population geneticists allowed finding useful solutions to the problem of estimating gene frequencies and testing basic population diversity statistics on highly complex HLA data (high numbers of alleles and ambiguities), with promising applications in either anthropological, epidemiological, or transplantation studies.