Safety and Virologic Impact of Haploidentical NK Cells Plus Interleukin 2 or N-803 in HIV Infection

BACKGROUND

Natural killer (NK) cells are dysfunctional in chronic human immunodeficiency virus (HIV) infection as they are not able to clear virus. We hypothesized that an infusion of NK cells, supported by interleukin 2 (IL-2) or IL-15, could decrease virus-producing cells in the lymphatic tissues.

METHODS

We conducted a phase 1 pilot study in 6 persons with HIV (PWH), where a single infusion of haploidentical related donor NK cells was given plus either IL-2 or N-803 (an IL-15 superagonist).

RESULTS

The approach was well tolerated with no unexpected adverse events. We did not pretreat recipients with cyclophosphamide or fludarabine to "make immunologic space," reasoning that PWH on stable antiretroviral treatment remain T-cell depleted in lymphatic tissues. We found donor cells remained detectable in blood for up to 8 days (similar to what is seen in cancer pretreatment with lymphodepleting chemotherapy) and in the lymph nodes and rectum up to 28 days. There was a moderate decrease in the frequency of viral RNA-positive cells in lymph nodes.

CONCLUSIONS

There was a moderate decrease in HIV-producing cells in lymph nodes. Further studies are warranted to determine the impact of healthy NK cells on HIV reservoirs and if restoring NK-cell function could be part of an HIV cure strategy. Clinical Trials Registration. NCT03346499 and NCT03899480.

Measuring High-Order Phonon Correlations in an Optomechanical Resonator

We use single photon detectors to probe the motional state of a superfluid ^{4}He resonator of mass ∼1  ng. The arrival times of Stokes and anti-Stokes photons (scattered by the resonator's acoustic mode) are used to measure the resonator's phonon coherences up to the fourth order. By postselecting on photon detection events, we also measure coherences in the resonator when ≤3 phonons have been added or subtracted. These measurements are found to be consistent with predictions that assume the acoustic mode to be in thermal equilibrium with a bath through a Markovian coupling.

Quantum Optomechanics in a Liquid

We measure the quantum fluctuations of a single acoustic mode in a volume of superfluid He that is coupled to an optical cavity. Specifically, we monitor the Stokes and anti-Stokes light scattered by a standing acoustic wave that is confined by the cavity mirrors. The intensity of these signals (and their cross-correlation) exhibits the characteristic features of the acoustic wave's zero-point motion and the quantum backaction of the intracavity light. While these features are also observed in the vibrations of solid objects and ultracold atomic gases, their observation in superfluid He opens the possibility of exploiting the remarkable properties of this material to access new regimes of quantum optomechanics.

Widely Tunable Single-Photon Source from a Carbon Nanotube in the Purcell Regime

The narrow emission of a single carbon nanotube at low temperature is coupled to the optical mode of a fiber microcavity using the built-in spatial and spectral matching brought by this flexible geometry. A thorough cw and time-resolved investigation of the very same emitter both in free space and in cavity shows an efficient funneling of the emission into the cavity mode together with a strong emission enhancement corresponding to a Purcell factor of up to 5. At the same time, the emitted photons retain a strong sub-Poissonian statistics. By exploiting the cavity feeding effect on the phonon wings, we locked the emission of the nanotube at the cavity resonance frequency, which allowed us to tune the frequency over a 4 THz band while keeping an almost perfect antibunching. By choosing the nanotube diameter appropriately, this study paves the way to the development of carbon-based tunable single-photon sources in the telecom bands.

Direct photonic coupling of a semiconductor quantum dot and a trapped ion

Coupling individual quantum systems lies at the heart of building scalable quantum networks. Here, we report the first direct photonic coupling between a semiconductor quantum dot and a trapped ion and we demonstrate that single photons generated by a quantum dot controllably change the internal state of a Yb^{+} ion. We ameliorate the effect of the 60-fold mismatch of the radiative linewidths with coherent photon generation and a high-finesse fiber-based optical cavity enhancing the coupling between the single photon and the ion. The transfer of information presented here via the classical correlations between the σ_{z} projection of the quantum-dot spin and the internal state of the ion provides a promising step towards quantum-state transfer in a hybrid photonic network.

Photon emission and absorption of a single ion coupled to an optical-fiber cavity

We present a light-matter interface which consists of a single 174Yb+ ion coupled to an optical fiber cavity. We observe that photons at 935 nm are mainly emitted into the cavity mode and that correlations between the polarization of the photon and the spin state of the ion are preserved despite the intrinsic coupling into a single-mode fiber. Complementary, when a faint coherent light field is injected into the cavity mode, we find enhanced and polarization dependent absorption by the ion.

Optically mediated hybridization between two mechanical modes

In this Letter we study a system consisting of two nearly degenerate mechanical modes that couple to a single mode of an optical cavity. We show that this coupling leads to nearly complete (99.5%) hybridization of the two mechanical modes into a bright mode that experiences strong optomechanical interactions and a dark mode that experiences almost no optomechanical interactions. We use this hybridization to transfer energy between the mechanical modes with 40% efficiency.

Integrated fiber-mirror ion trap for strong ion-cavity coupling

We present and characterize fiber mirrors and a miniaturized ion-trap design developed to integrate a fiber-based Fabry-Perot cavity (FFPC) with a linear Paul trap for use in cavity-QED experiments with trapped ions. Our fiber-mirror fabrication process not only enables the construction of FFPCs with small mode volumes, but also allows us to minimize the influence of the dielectric fiber mirrors on the trapped-ion pseudopotential. We discuss the effect of clipping losses for long FFPCs and the effect of angular and lateral displacements on the coupling efficiencies between cavity and fiber. Optical profilometry allows us to determine the radii of curvature and ellipticities of the fiber mirrors. From finesse measurements, we infer a single-atom cooperativity of up to 12 for FFPCs longer than 200 μm in length; comparison to cavities constructed with reference substrate mirrors produced in the same coating run indicates that our FFPCs have similar scattering losses. We characterize the birefringence of our fiber mirrors, finding that careful fiber-mirror selection enables us to construct FFPCs with degenerate polarization modes. As FFPCs are novel devices, we describe procedures developed for handling, aligning, and cleaning them. We discuss experiments to anneal fiber mirrors and explore the influence of the atmosphere under which annealing occurs on coating losses, finding that annealing under vacuum increases the losses for our reference substrate mirrors. X-ray photoelectron spectroscopy measurements indicate that these losses may be attributable to oxygen depletion in the mirror coating. Special design considerations enable us to introduce a FFPC into a trapped ion setup. Our unique linear Paul trap design provides clearance for such a cavity and is miniaturized to shield trapped ions from the dielectric fiber mirrors. We numerically calculate the trap potential in the absence of fibers. In the experiment additional electrodes can be used to compensate distortions of the potential due to the fibers. Home-built fiber feedthroughs connect the FFPC to external optics, and an integrated nanopositioning system affords the possibility of retracting or realigning the cavity without breaking vacuum.

Interferometry with Bose-Einstein condensates in microgravity

Atom interferometers covering macroscopic domains of space-time are a spectacular manifestation of the wave nature of matter. Because of their unique coherence properties, Bose-Einstein condensates are ideal sources for an atom interferometer in extended free fall. In this Letter we report on the realization of an asymmetric Mach-Zehnder interferometer operated with a Bose-Einstein condensate in microgravity. The resulting interference pattern is similar to the one in the far field of a double slit and shows a linear scaling with the time the wave packets expand. We employ delta-kick cooling in order to enhance the signal and extend our atom interferometer. Our experiments demonstrate the high potential of interferometers operated with quantum gases for probing the fundamental concepts of quantum mechanics and general relativity.

Spin self-rephasing and very long coherence times in a trapped atomic ensemble

We perform Ramsey spectroscopy on the ground state of ultracold 87Rb atoms magnetically trapped on a chip in the Knudsen regime. Field inhomogeneities over the sample should limit the 1/e contrast decay time to about 3 s, while decay times of 58 ± 12 s are actually observed. We explain this surprising result by a spin self-rephasing mechanism induced by the identical spin rotation effect originating from particle indistinguishability. We propose a theory of this synchronization mechanism and obtain good agreement with the experimental observations. The effect is general and may appear in other physical systems.

Bose-Einstein condensation on a microelectronic chip

Although Bose-Einstein condensates of ultracold atoms have been experimentally realizable for several years, their formation and manipulation still impose considerable technical challenges. An all-optical technique that enables faster production of Bose-Einstein condensates was recently reported. Here we demonstrate that the formation of a condensate can be greatly simplified using a microscopic magnetic trap on a chip. We achieve Bose-Einstein condensation inside the single vapour cell of a magneto-optical trap in as little as 700 ms-more than a factor of ten faster than typical experiments, and a factor of three faster than the all-optical technique. A coherent matter wave is emitted normal to the chip surface when the trapped atoms are released into free fall; alternatively, we couple the condensate into an 'atomic conveyor belt', which is used to transport the condensed cloud non-destructively over a macroscopic distance parallel to the chip surface. The possibility of manipulating laser-like coherent matter waves with such an integrated atom-optical system holds promise for applications in interferometry, holography, microscopy, atom lithography and quantum information processing.

Magnetic conveyor belt for transporting and merging trapped atom clouds

We demonstrate an integrated magnetic device which transports cold atoms near a surface with very high positioning accuracy. Time-dependent currents in a lithographic conductor pattern create a moving chain of potential wells; atoms are transported in these wells while remaining confined in all three dimensions. We achieve mean fluxes up to 10(6) s(-1) with a negligible heating rate. An extension of this device allows merging of atom clouds by unification of two Ioffe-Pritchard potentials. The unification, which we demonstrate experimentally, can be performed without loss of phase space density. This novel, all-magnetic atom manipulation offers exciting perspectives, such as trapped-atom interferometry.

Integer wavelet transform for embedded lossy to lossless image compression

The use of the discrete wavelet transform (DWT) for embedded lossy image compression is now well established. One of the possible implementations of the DWT is the lifting scheme (LS). Because perfect reconstruction is granted by the structure of the LS, nonlinear transforms can be used, allowing efficient lossless compression as well. The integer wavelet transform (IWT) is one of them. This is an interesting alternative to the DWT because its rate-distortion performance is similar and the differences can be predicted. This topic is investigated in a theoretical framework. A model of the degradations caused by the use of the IWT instead of the DWT for lossy compression is presented. The rounding operations are modeled as additive noise. The noise are then propagated through the LS structure to measure their impact on the reconstructed pixels. This methodology is verified using simulations with random noise as input. It predicts accurately the results obtained using images compressed by the well-known EZW algorithm. Experiment are also performed to measure the difference in terms of bit rate and visual quality. This allows to a better understanding of the impact of the IWT when applied to lossy image compression.

Treatment of venous thromboembolism

Venous thromboembolism (VTE) is a disease entity composed of pulmonary embolism (PE) and deep vein thrombosis (DVT). Anticoagulation, initiated as soon as the diagnosis is suspected, is the treatment of choice. Traditionally, anticoagulation is started with intravenous heparin, and changed to warfarin for long-term treatment. The introduction of unmonitored, subcutaneously administered, low molecular weight heparin has resulted in shorter hospitalizations, reduced the incidence of major bleeding as a complication, and shifted the treatment of VTE for selected patients to the outpatient setting. Thrombolytic therapy has been recommended for patients with life-threatening PE. Technologic advances in catheter embolectomy and fragmentation permit clot resolution in patients in whom thrombolytic therapy is contraindicated. Inferior cava filters can be placed percutaneously in patients at high risk for VTE or those in whom anticoagulation is contraindicated. Because VTE is often clinically silent, prevention of VTE is therefore the most effective means to reduce associated morbidity and mortality. Strategies to prevent VTE have been studied and validated for specific clinical circumstances.

Primary pulmonary hypertension

Primary pulmonary hypertension (PPH) is a condition characterized by sustained elevation of pulmonary artery pressure (PAP) without demonstrable cause. The most common symptom at presentation is dyspnea. Other complaints include fatigue, chest pain, syncope, leg edema, and palpitations. Right heart catheterization is diagnostic, showing a mean PAP >25 mmHg at rest and >30 mmHg during exercise, with a normal pulmonary capillary wedge pressure. In the National Institutes of Health-PPH registry, the median survival period was 2.8 years. Treatment is aimed at lowering PAP, increasing cardiac output, and decreasing in situ thrombosis. Vasodilators have been used with some success in the treatment of PPH. They include prostacyclin, calcium-channel blockers, nitric oxide and adenosine. Anticoagulation has also been advised for the prevention of deep vein thrombosis, pulmonary embolism, and in situ thromboses of the lungs. New drug treatments under investigation include L-arginine, plasma endothelin-I, and bosentan. Use of oxygen, digoxin, and diuretics for symptomatic relief have also been recommended. Patients with severe PPH refractory to medical management should be considered for surgery.

An unusual presentation of metastatic colon cancer to the lung

A 75-year-old man with a history of resected colon carcinoma presented to his primary care physician because of a new onset of coughing. The patient had expectorated a small piece of solid tissue; pathologic examination of the tissue found it to be consistent with metastatic colon adenocarcinoma. After further work-up, a right upper lobectomy was performed. The surgical specimen removed during the lobectomy showed a tumor that was histologically identical to the patient's prior colonic primary tumor.

Cost efficient management of educational material

We retrospectively examined direct and indirect costs of providing a programmed text in Respiratory Pathophysiology using World-Wide Web (WWW) technology as compared to printed paper. The direct costs were $3678 and $3988 respectively. Neither of these costs includes the substantial cost of original development of the educational material. The indirect cost of distributing printed material is $1800. The indirect cost for electronic material is $1430 but this assumes an institutional commitment to a technology infrastructure which will be used for purposes other than just educational material distribution. Given such a commitment, educational material can be managed in a way that provides efficient distribution at less cost than traditional paper distribution. The effectiveness of electronic methods is dependent on usage. A comparison study of use and satisfaction of paper and electronic versions of the material is planned.

[Detection and determination of acetone using semiconductor sensors]

Investigations to examine not only the factors of influence on evaluation of acetone by self-prepared semiconductor gas sensors, but also to prove analytical properties, were carried out using different tools. A sensor temperature of 600 degrees C and a carrier gas flow-rate of 5 l/h were found to be suitable conditions for the measurement of flow-injection apparatus. The determination of 1 microliter-samples of aqueous solutions containing 1-700 g of acetone/l yielded deviations of 4 to 33%. Using a head space method, the working temperature of 370 degrees C led to a maximum sensor response, the detection limit ranged from 37.5 to 50 mg of acetone/l. After quantifying 5 microliters-sample solutions of 40-600 mg/l, results with an accuracy of 1 to 36% were obtained. The method showed the possibility of distinguishing concentrations of acetone below and above 40 mg/l according to physiological and pathological urinary values. The tests carried out on 100 human urine samples provide a good agreement with the Legal reference method for samples containing physiological or strong pathological amounts of ketone bodies, but not for those including traces and small amounts. False-positive results might be caused by a possible presence of ethanol in urine.

Respiratory muscle dysfunction in hereditary motor sensory neuropathy, type I

Pulmonary function tests were performed on ten patients who were shown to have hereditary motor sensory neuropathy, type I. Mean values for spirometry, static lung volumes, and diffusion capacity were all greater than 80% of the predicted normal values for the group. In contrast, both inspiratory and expiratory muscle testing showed substantial reductions in function for the group. These abnormalities have not previously been reported, and they may be important in the management of these patients and in patients with other neuromuscular diseases.

Pulmonary embolism: diagnosis and treatment

Pulmonary embolism is a condition with a potentially high mortality that often goes unrecognized. Prompt diagnosis and treatment effectively reduce the mortality rate. Clinical judgment alone is insufficient for diagnosis; objective testing is needed. Once the diagnosis is made, effective treatment should be instituted. Treatments differ, based on several factors including disease severity, contraindications to treatment and pre-existing diseases. The major thrust of training should be to teach medical care workers how to prevent deep vein thrombosis and its most serious complication, pulmonary embolism.

Pulmonary embolism

It is reasonable to conclude by considering an approach to the diagnosis and treatment of pulmonary embolism. When the diagnosis is suspect, and in the absence of contraindications, or hemodynamic instability, treatment with heparin may be begun and an arterial blood gas and perfusion lung scan obtained. If the Pao2 and perfusion scan are normal, it is unlikely that significant pulmonary embolism has occurred. The presence of a perfusion scan defect and hypoxemia should suggest that a ventilation scan and/or evaluation for deep vein thrombosis is performed. A ventilation scan which shows absence of ventilation in areas where there is a perfusion defect, or failure to demonstrate deep vein disease, strongly mitigate against the diagnosis of pulmonary embolism. If the diagnosis is in doubt, pulmonary angiography should be performed. If the patient presents in shock, an angiogram should be performed, while heparin is administered and supportive measures are begun. If anticoagulants are contraindicated, or if re-embolization occurs after adequate anticoagulant therapy, consideration should be given to placement of a transcaval umbrella filter.

[Treatment of occlusive hydrocephalus with Torkilksen's drainage]

Seventy-three Torkildsen drainages are reported, of which 61 and 12 were performed on tumor patients and in the case of benign aqueduct occlusions due to congenital malformations or chronic inflammations, respectively. The results are quite satisfactory providing due consideration is given to both the basic ailment and the preoperative condition. The Torkildsen drain has proven extremely useful in the therapy of selected cases of occlusive hydrocephalus.

Severe pleural restriction: the maximum static pulmonary recoil pressure as an acid in diagnosis

Three patients with pleural restriction are presented in detail. One patient had had a right pneumonectomy and died of ventilatory failure due to left-sided restrictive pleurisy. The second patient had neoplastic pleural effusion and inactive tuberculosis. The third patient had systemic lupus erythematosus with bilateral restrictive pleuritis. The physiologic picture was similar in the three cases, with marked decrease of lung volumes, increase of the RV/TLC ratio, absence of airways obstruction, decrease of the Dco and decrease of dynamic lung compliance. In addition, each of these three patients and others with severe pleural restriction had a lower than normal maximum static pulmonary recoil pressure (Pmax). Since in pulmonary restrictive disease, the Pmax was found to be elevated, it was a useful test for distinguishing pulmonary restriction from pleural restriction.

The effect of ethanol on the cough reflex

1. Coughing was induced in ten healthy subjects with various threshold concentrations of nebulized citric acid. The citric acid aerosol method of cough induction proved a reliable and reproducible tool for assessing the cough threshold in an individual. The subjects were retested after consumption of 1 ml of ethanol/kg body weight. Coughing was significantly suppressed in nine of the ten subjects.

2. The marked suppression of the cough reflex by the moderate amounts of ethanol used in this study provides confirmatory evidence for the suspected causal links between ethanol abuse and certain pulmonary infections caused by aspiration.