Craniectomy size and decompression of the temporal base using the altered posterior question-mark incision for decompressive hemicraniectomy

The altered posterior question-mark incision for decompressive hemicraniectomy (DHC) was proposed to reduce the risk of intraoperative injury of the superficial temporal artery (STA) and demonstrated a reduced rate of wound-healing disorders after cranioplasty. However, decompression size during DHC is essential and it remains unclear if the new incision type allows for an equally effective decompression. Therefore, this study evaluated the efficacy of the altered posterior question-mark incision for craniectomy size and decompression of the temporal base and assessed intraoperative complications compared to a modified standard reversed question-mark incision. The authors retrospectively identified 69 patients who underwent DHC from 2019 to 2022. Decompression and preservation of the STA was assessed on postoperative CT scans and CT or MR angiography. Forty-two patients underwent DHC with the standard reversed and 27 patients with the altered posterior question-mark incision. The distance of the margin of the craniectomy to the temporal base was 6.9 mm in the modified standard reversed and 7.2 mm in the altered posterior question-mark group (p = 0.77). There was no difference between the craniectomy sizes of 158.8 mm and 158.2 mm, respectively (p = 0.45), and there was no difference in the rate of accidental opening of the mastoid air cells. In both groups, no transverse/sigmoid sinus was injured. Twenty-four out of 42 patients in the modified standard and 22/27 patients in the altered posterior question-mark group had a postoperative angiography, and the STA was preserved in all cases in both groups. Twelve (29%) and 5 (19%) patients underwent revision due to wound-healing disorders after DHC, respectively (p = 0.34). There was no difference in duration of surgery. Thus, the altered posterior question-mark incision demonstrated technically equivalent and allows for an equally effective craniectomy size and decompression of the temporal base without increasing risks of intraoperative complications. Previously described reduction in wound-healing complications and cranioplasty failures needs to be confirmed in prospective studies to demonstrate the superiority of the altered posterior question-mark incision.

Pre-stroke socioeconomic status predicts upper limb motor recovery after inpatient neurorehabilitation

BACKGROUND

Lower socioeconomic status (SES) is associated with higher mortality rates and the likelihood of receiving less evidence-based treatment after stroke. In contrast, little is known about the impact of SES on recovery after discharge from inpatient rehabilitation. The aim of this study was to investigate the influence of SES on long-term recovery after stroke.

PATIENTS AND METHODS

In a prospective, observational, multicentre study, inpatients were recruited towards the end of rehabilitation. The 12-month follow-up focussed on upper limb motor recovery, measured by the Fugl-Meyer score. A clinically relevant improvement of ≥5.25 points was considered recovery. Patient-centric measures such as the Patient-reported Outcomes Measurement Information System-Physical Health (PROMIS-10 PH) provided secondary outcomes. Information on schooling, vocational training, income and occupational status pre-stroke entered a multidimensional SES index. Multivariate logistic regression models calculating odds ratios (ORs) and corresponding confidence intervals (CIs) were applied. SES was added to an initial model including age, sex and baseline neurological deficit. Additional exploratory analyses examined the association between SES and outpatient treatment.

RESULTS

One hundred and seventy-six patients were enrolled of whom 98 had SES and long-term recovery data. Model comparisons showed the SES-model superior to the initial model (Akaike information criterion (AIC): 123 vs. 120, Pseudo R²: 0.09 vs. 0.13). The likelihood of motor recovery (OR = 17.12, 95%CI = 1.31; 224.18) and PROMIS-10 PH improvement (OR = 20.76, 95%CI = 1.28; 337.11) were significantly increased with higher SES, along with more frequent use of outpatient therapy (p = .02).

CONCLUSIONS

Higher pre-stroke SES is associated with better long-term recovery after discharge from rehabilitation. Understanding these factors can improve outpatient long-term stroke care and lead to better recovery.KEY MESSAGEHigher pre-stroke socioeconomic status (SES) is associated with better long-term recovery after discharge from rehabilitation both in terms of motor function and self-reported health status.Higher SES is associated with significantly higher utilization of outpatient therapies.Discharge management of rehabilitation clinics should identify and address socioeconomic factors in order to detect individual needs and to improve outpatient recovery. Article registration: clinicaltrials.gov NCT04119479.

COGNITION: a prospective precision oncology trial for patients with early breast cancer at high risk following neoadjuvant chemotherapy

BACKGROUND

COGNITION (Comprehensive assessment of clinical features, genomics and further molecular markers to identify patients with early breast cancer for enrolment on marker driven trials) is a diagnostic registry trial that employs genomic and transcriptomic profiling to identify biomarkers in patients with early breast cancer with a high risk for relapse after standard neoadjuvant chemotherapy (NACT) to guide genomics-driven targeted post-neoadjuvant therapy.

PATIENTS AND METHODS

At National Center for Tumor Diseases Heidelberg patients were biopsied before starting NACT, and for patients with residual tumors after NACT additional biopsy material was collected. Whole-genome/exome and transcriptome sequencing were applied on tumor and corresponding blood samples.

RESULTS

In the pilot phase 255 patients were enrolled, among which 213 were assessable: thereof 48.8% were identified to be at a high risk for relapse following NACT; 86.4% of 81 patients discussed in the molecular tumor board were eligible for a targeted therapy within the interventional multiarm phase II trial COGNITION-GUIDE (Genomics-guided targeted post neoadjuvant therapy in patients with early breast cancer) starting enrolment in Q4/2022. An in-depth longitudinal analysis at baseline and in residual tumor tissue of 16 patients revealed some cases with clonal evolution but largely stable genetic alterations, suggesting restricted selective pressure of broad-acting cytotoxic neoadjuvant chemotherapies.

CONCLUSIONS

While most precision oncology initiatives focus on metastatic disease, the presented concept offers the opportunity to empower novel therapy options for patients with high-risk early breast cancer in the post-neoadjuvant setting within a biomarker-driven trial and provides the basis to test the value of precision oncology in a curative setting with the overarching goal to increase cure rates.

Levels of serum Phosphorylated Neurofilament Heavy subunit in clinically healthy Standardbred horses

Neurofilaments heavy chain proteins (pNF-H) have been identified as useful serum biomarkers for humans and animals with neurologic conditions, some of which can lead to poor performance and athletic injuries. However, there are no published reports that describe a reference range for serum pNF-H levels in healthy racehorses. This cross-sectional study was carried out to determine the serum concentration of pNF-H in 1349 samples collected from 1291 clinically healthy standardbred (SB) racehorses. Data on age, time of sampling (pre-race or post-race), and finishing position during a race were collected. The concentration of pNF-H in serum samples was determined using an enzyme-linked immunosorbent assay (ELISA). The appropriate statistical techniques were used to determine the median serum concentration of pNF-H in these horses, if the serum concentration of pNF-H changed with age, if there were changes in the serum concentration of pNF-H during a race, and if there was an association between serum concentration of pNF-H and the finishing position for the horse. The median serum concentration of pNF-H in this group of clinically healthy SB horses was 0.0 ng/ml. The concentration of pNF-H in serum was not associated with the age of the horses in this study as was determined by regression analysis. There was no significant change in the serum concentration of pNF-H before and after a race in paired samples. There was no association of serum concentration of pNF-H and the finishing position of the horses after the race. The data from this study supports use of < 0.412 ng/ml as a reference interval for measurement of serum levels of pNF-H in SB racehorses as 95% of the collected samples fell into the range 0.0 - 0.412 ng/ml.

[Methods for analysing spatial data : Using the example of skin cancer prevalence in Germany]

BACKGROUND

Studies show a spatial variation in skin cancer frequencies, but the causes have not been fully understood. When analysing spatial patterns and correlations, different approaches need to be considered, as the data have special features due to their spatial structure.

AIM OF THE STUDY

Why the spatial consideration of skin cancer frequencies is important at all, and which methods of analysis are useful is considered in more detail in this article. The article provides an introduction and overview of statistical methods that are important for the spatial analysis of skin cancer frequencies.

MATERIALS AND METHODS

At first it is shown which descriptive methods, such as statistical smoothing, can be applied. Next, spatial cluster and regression analyses will be discussed. Testing for spatial autocorrelation will be considered.

RESULTS

In particular, the spatial dependence of the data on neighbouring regions, which if ignored can lead to biased estimates, is of particular importance in the analysis of spatial data and requires special spatial analysis methods.

DISCUSSION

This article provides an introduction and overview of statistical methods relevant to the spatial analysis of skin cancers.

Control Strategies for Reactive Extrusion of Polypropylene by Peroxide Degradation A Brief Review and an Experimental Study

Industry 4.0 and digitalization are widely argued for the future success of numerous industrial solutions. Big data management might lead to the assumption that every issue can be solved numerically without any physical background. To some extent, this strategy will help within the plastics industry in general and in the extrusion technology in particular. However, a deep process knowledge together with process-relevant sensors, as well as the right process arrangements within the processing chain combined with smart data mining methods will be still the key success of industry 4.0. This presentation illustrates, based on a brief review on existing control strategies (Part 1), including sensory and predictive control models for reactive extrusion applied at a real-life on-site best practice project (Part 2), possibilities in combination of process tasks with digitalization approaches for PP-Polymer production. Specifically, rheological research conducted with a novel, patented multi-point rheometer (part 3), will provide a deeper insight into dynamic processes such as reactive extrusion. With those results and derivations thereof, improvements in predictive process control in addition to artificial control systems are made and might even lead to further interesting opportunities.

Effectiveness and safety analysis of home-treatment models in child and adolescent psychiatric care

Background

The Austrian child and adolescent psychiatric care landscape is characterised by substantial deficits on the intramural and extramural level. To overcome these supply shortfalls alternative outreach approaches, such as home-treatment (HT) can be introduced, which shall facilitate the reduction of hospitalisations. Thus, we aimed to systematically characterise international HT models considering their efficacy and safety in the area of child and adolescent psychiatry.

Methods

A systematic literature search in six databases, as well as an extended hand search, was conducted. Taking into account the predefined inclusion criteria, six HT studies were eligible for the qualitative synthesis; comprising two randomised controlled trials (RCTs), two non-randomised controlled trials (NRCTs) and two observational studies.

Results

The following four effectiveness measures were investigated: change in symptoms, hospitalisation, treatment satisfaction and need for further treatment. A benefit of HT models compared to stationary care could be identified considering patient symptoms, espeicially psychopathological symptoms; however, solely in the longer-term treatment. Studies have also shown that HT is associated with fewer days of hospitalisation, but with a higher need for further treatments. Inconclusive evidence was identified considering treatment satisfaction. Safety endpoints were not evaluated by any included study.

Conclusions

The results are limited by a moderate to high risk of bias due to several factors (e.g. small sample sizes, various assessment instruments). However, the evidence indicates that in long-term, HT can lead to an improvement in psychopathological symptoms and supports the transition from inpatient to outpatient care. Therefore, HT may be considered as an alternative or supplement to the stationary child and adolescent psychiatric care. However, further evidence is needed considering safety outcomes.

Key messages

In the long-term, home-treatment can lead to a bigger improvement in psychopathological symptoms for the children and adolescent compared to stationary care. Further evidence is needed especially regarding possible adverse events of home-treatment in the field of child and adolescent psychiatry.

Field-effect silicon-plasmonic photodetector for coherent T-wave reception

Plasmonic internal photoemission detectors (PIPED) have recently been shown to combine compact footprint and high bandwidth with monolithic co-integration into silicon photonic circuits, thereby opening an attractive route towards optoelectronic generation and detection of waveforms in the sub-THz and THz frequency range, so-called T-waves. In this paper, we further expand the PIPED concept by introducing a metal-oxide-semiconductor (MOS) interface with an additional gate electrode that allows to control the carrier dynamics in the device and the degree of internal photoemission at the metal-semiconductor interfaces. We experimentally study the behavior of dedicated field-effect (FE-)PIPED test structures and develop a physical understanding of the underlying principles. We find that the THz down-conversion efficiency of FE-PIPED can be significantly increased when applying a gate potential. Building upon the improved understanding of the device physics, we further perform simulations and show that the gate field increases the carrier density in the conductive channel below the gate oxide to the extent that the device dynamics are determined by ultra-fast dielectric relaxation rather than by the carrier transit time. In this regime, the bandwidth can be increased to more than 1 THz. We believe that our experiments open a new path towards understanding the principles of internal photoemission in plasmonic structures, leading to PIPED-based optoelectronic signal processing systems with unprecedented bandwidth and efficiency.

Agent-based modeling: Population limits and large timescales

Modeling, simulation, and analysis of interacting agent systems is a broad field of research, with existing approaches reaching from informal descriptions of interaction dynamics to more formal, mathematical models. In this paper, we study agent-based models (ABMs) given as continuous-time stochastic processes and their pathwise approximation by ordinary and stochastic differential equations (SDEs) for medium to large populations. By means of an appropriately adapted transfer operator approach, we study the behavior of the ABM process on long time scales. We show that, under certain conditions, the transfer operator approach allows us to bridge the gap between the pathwise results for large populations on finite timescales, i.e., the SDE limit model, and approaches built to study dynamical behavior on long time scales like large deviation theory. The latter provides a rigorous analysis of rare events including the associated asymptotic rates on timescales that scale exponentially with the population size. We demonstrate that it is possible to reveal metastable structures and timescales of rare events of the ABM process by finite-length trajectories of the SDE process for large enough populations. This approach has the potential to drastically reduce computational effort for the analysis of ABMs.

Cerebrovascular Autoregulation Monitoring in the Management of Adult Severe Traumatic Brain Injury: A Delphi Consensus of Clinicians

BACKGROUND

Several methods have been proposed to measure cerebrovascular autoregulation (CA) in traumatic brain injury (TBI), but the lack of a gold standard and the absence of prospective clinical data on risks, impact on care and outcomes of implementation of CA-guided management lead to uncertainty.

AIM

To formulate statements using a Delphi consensus approach employing a group of expert clinicians, that reflect current knowledge of CA, aspects that can be implemented in TBI management and CA research priorities.

METHODS

A group of 25 international academic experts with clinical expertise in the management of adult severe TBI patients participated in this consensus process. Seventy-seven statements and multiple-choice questions were submitted to the group in two online surveys, followed by a face-to-face meeting and a third online survey. Participants received feedback on average scores and the rationale for resubmission or rephrasing of statements. Consensus on a statement was defined as agreement of more than 75% of participants.

RESULTS

Consensus amongst participants was achieved on the importance of CA status in adult severe TBI pathophysiology, the dynamic non-binary nature of CA impairment, its association with outcome and the inadvisability of employing universal and absolute cerebral perfusion pressure targets. Consensus could not be reached on the accuracy, reliability and validation of any current CA assessment method. There was also no consensus on how to implement CA information in clinical management protocols, reflecting insufficient clinical evidence.

CONCLUSION

The Delphi process resulted in 25 consensus statements addressing the pathophysiology of impaired CA, and its impact on cerebral perfusion pressure targets and outcome. A research agenda was proposed emphasizing the need for better validated CA assessment methods as well as the focused investigation of the application of CA-guided management in clinical care using prospective safety, feasibility and efficacy studies.

Incidence of presenting complaints and diagnoses in insured Australian dogs

Knowledge of the most common presenting complaints and diagnoses in companion animals is valuable in preparing veterinary students and veterinarians to manage the most frequently observed conditions in clinical practice. Pet insurance databases provide access to large sample populations and have been previously used to describe disease incidence in companion animals. The aim of this study was to determine the incidence of presenting complaints and diagnoses in insured Australian dogs through the use of a pet insurance database. Analysis of a de-identified dataset containing pet insurance claims associated with presenting complaints and diagnoses from 488,472 insured Australian dogs insured in the years 2016 and 2017, was performed. Annual incidence rates of presenting complaints and diagnoses were calculated and expressed as, number of events per 1,000 dog years at risk. The presenting complaints with the highest incidence were vomiting (14.21 events per 1,000 dog years at risk in 2016, 15.80 events per 1,000 dog years at risk in 2017) and pruritus (8.79 events per 1,000 dog years at risk in 2016, 10.30 events per 1,000 dog years at risk in 2017). Presenting complaints affecting the gastrointestinal system were the most common (19.20 events per 1,000 dog years at risk in 2016, 20.77 events per 1,000 dog years at risk in 2017). The diagnoses with the highest incidence were otitis externa (34.12 events per 1,000 dog years at risk in 2016, 34.82 events per 1,000 dog years at risk in 2017) and dermatitis (28.05 events per 1,000 dog years at risk in 2016, 29.99 events per 1,000 dog years at risk in 2017). Diagnoses affecting the integument were the most common (216.56 events per 1,000 dog years at risk in 2016, 219.06 events per 1,000 dog years at risk in 2017). The results from this study can aid in the design of relevant veterinary curricula and may be helpful in prioritising research on common clinical conditions.

Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study

Background

In traumatic brain injury (TBI) patients desmopressin administration may induce rapid decreases in serum sodium and increase intracranial pressure (ICP).

Aim

In an international multi-centre study, we aimed to report changes in serum sodium and ICP after desmopressin administration in TBI patients.

Methods

We obtained data from 14 neurotrauma ICUs in Europe, Australia and UK for severe TBI patients (GCS ≤ 8) requiring ICP monitoring. We identified patients who received any desmopressin and recorded daily dose, 6-hourly serum sodium, and 6-hourly ICP.

Results

We studied 262 severe TBI patients. Of these, 39 patients (14.9%) received desmopressin. Median length of treatment with desmopressin was 1 [1–3] day and daily intravenous dose varied between centres from 0.125 to 10 mcg. The median hourly rate of decrease in serum sodium was low (− 0.1 [− 0.2 to 0.0] mmol/L/h) with a median period of decrease of 36 h. The proportion of 6-h periods in which the rate of natremia correction exceeded 0.5 mmol/L/h or 1 mmol/L/h was low, at 8% and 3%, respectively, and ICPs remained stable. After adjusting for IMPACT score and injury severity score, desmopressin administration was independently associated with increased 60-day mortality [HR of 1.83 (1.05–3.24) (p = 0.03)].

Conclusions

In severe TBI, desmopressin administration, potentially representing instances of diabetes insipidus is common and is independently associated with increased mortality. Desmopressin doses vary markedly among ICUs; however, the associated decrease in natremia rarely exceeds recommended rates and median ICP values remain unchanged. These findings support the notion that desmopressin therapy is safe.

Individualized positive end-expiratory pressure in obese patients during general anaesthesia: a randomized controlled clinical trial using electrical impedance tomography

Background

General anaesthesia leads to atelectasis, reduced end-expiratory lung volume (EELV), and diminished arterial oxygenation in obese patients. We hypothesized that a combination of a recruitment manoeuvre (RM) and individualized positive end-expiratory pressure (PEEP) can avoid these effects.

Methods

Patients with a BMI ≥35 kg m -2 undergoing elective laparoscopic surgery were randomly allocated to mechanical ventilation with a tidal volume of 8 ml kg -1 predicted body weight and (i) an RM followed by individualized PEEP titrated using electrical impedance tomography (PEEP IND ) or (ii) no RM and PEEP of 5 cm H 2 O (PEEP 5 ). Gas exchange, regional ventilation distribution, and EELV (multiple breath nitrogen washout method) were determined before, during, and after anaesthesia. The primary end point was the ratio of arterial partial pressure of oxygen to inspiratory oxygen fraction ( P aO 2 / F iO 2 ).

Results

For PEEP IND ( n =25) and PEEP 5 ( n =25) arms together, P aO 2 / F iO 2 and EELV decreased by 15 kPa [95% confidence interval (CI) 11-20 kPa, P <0.001] and 1.2 litres (95% CI 0.9-1.6 litres, P <0.001), respectively, after intubation. Mean ( sd ) PEEP IND was 18.5 (5.6) cm H 2 O. In the PEEP IND arm, P aO 2 / F iO 2 before extubation was 23 kPa higher (95% CI 16-29 kPa; P <0.001), EELV was 1.8 litres larger (95% CI 1.5-2.2 litres; P <0.001), driving pressure was 6.7 cm H 2 O lower (95% CI 5.4-7.9 cm H 2 O; P <0.001), and regional ventilation was more equally distributed than for PEEP 5 . After extubation, however, these differences between the arms vanished.

Conclusions

In obese patients, an RM and higher PEEP IND restored EELV, regional ventilation distribution, and oxygenation during anaesthesia, but these differences did not persist after extubation. Therefore, lung protection strategies should include the postoperative period.

Clinical trial registration

German clinical trials register DRKS00004199, www.who.int/ictrp/network/drks2/en/ .

[Psychiatric care of refugees in Africa and the Middle East : Challenges and solutions]

Violence, flight, famine, and natural disasters as well as the absence of a psychosocial healthcare system are major psychological burdens for refugees. The level of provision of mental healthcare is particularly low in developing countries. Internally displaced people and refugees place high demands on the healthcare system because they often suffer from psychiatric disorders, such as depression, posttraumatic stress disorder, and substance use disorders. We present first initiatives to improve psychiatric care in refugee camps in Ethiopia, Kenya, and Sudan. Moreover, we provide first insights into a project based in Northern Iraq and Germany aimed at the treatment of people who were severely traumatized by the terror regime of the so-called Islamic State (IS).

Fast high-precision distance metrology using a pair of modulator-generated dual-color frequency combs

We demonstrate fast high-precision non-contact distance measurements to technical surfaces using a pair of dual-color electro-optic frequency combs for synthetic-wavelength interferometry (SWI). The dual-color combs are generated from continuous-wave (cw) lasers at 1300 nm and 1550 nm, which are jointly fed to a pair of high-speed dual-drive Mach-Zehnder modulators. The dual-color approach is used for continuous and dead-zone-free compensation of temperature-induced fiber drift. We achieve standard deviations below 2 µm at an acquisition time of 9.1 µs for measurements through 7 m of single-mode fiber. Despite the technical simplicity of our scheme, our concept can well compete with other comb-based distance metrology approaches, and it can maintain its accuracy even under industrial operating conditions. The viability of the concept is demonstrated by attaching the fiber-coupled sensor head to an industrial coordinate measuring machine for acquisition of surface profiles of various technical samples. Exploiting real-time signal processing along with continuous fiber drift compensation, we demonstrate the acquisition of point clouds of up to 5 million data points during continuous movement of the sensor head.

Phased array Doppler reflectometry at Wendelstein 7-X

A passive phased array Doppler reflectometry system has recently been installed in the Wendelstein-7X stellarator. In contrast to conventional Doppler reflectometry systems, the microwave beam can be steered on short time scales in the measurement plane perpendicular to the magnetic field in the range of ±25° without mechanical steering components. This paper characterizes the design and properties of the phased array antenna system and presents the first measurement results from the latest OP1.2a campaign.

Ultrafast optical ranging using microresonator soliton frequency combs

Light detection and ranging is widely used in science and industry. Over the past decade, optical frequency combs were shown to offer advantages in optical ranging, enabling fast distance acquisition with high accuracy. Driven by emerging high-volume applications such as industrial sensing, drone navigation, or autonomous driving, there is now a growing demand for compact ranging systems. Here, we show that soliton Kerr comb generation in integrated silicon nitride microresonators provides a route to high-performance chip-scale ranging systems. We demonstrate dual-comb distance measurements with Allan deviations down to 12 nanometers at averaging times of 13 microseconds along with ultrafast ranging at acquisition rates of 100 megahertz, allowing for in-flight sampling of gun projectiles moving at 150 meters per second. Combining integrated soliton-comb ranging systems with chip-scale nanophotonic phased arrays could enable compact ultrafast ranging systems for emerging mass applications.

Levocabastine Eye Drops do not Affect Accommodative Capacity in Volunteers and Intraocular Pressure in Glaucoma Patients

Levocabastine is a potent and highly selective H1-receptor antagonist specifically developed for the topical treatment of allergic conjunctivitis. This study assessed the effects of levocabastine eye drops on accommodative capacity in 20 healthy volunteers and on parameters influencing glaucoma in 12 glaucoma patients. A single dose of levocabastine (0.5 mg/ml) did not influence accommodative capacity, pupil diameter, or intraocular pressure (IOP) in volunteers. Similarly, levocabastine (0.5 mg/ml, one drop in each eye twice daily) for two weeks was well tolerated by patients with glaucoma. Measurement of IOP, iridocorneal angle, depth of the anterior chamber, visual acuity and near-point in these patients provided no evidence of exacerbation of glaucoma or interactions with concurrent antiglaucoma medication. Application site reactions (local irritation and ocular pain) were the only adverse effects, with an incidence comparable to placebo-treated controls. In conclusion, ocular levocabastine appears to be well tolerated, with no apparent effects on accommodative capacity or glaucoma.

Olfaction after Endoscopic Endonasal Ethmoidectomy

A detailed preoperative and postoperative examination of the olfactory function of 111 patients with chronic polypoid ethmoiditis was carried out. Eighty-seven patients required a complete endoscopic endonasal sphenoethmoidectomy. In 24 patients an endoscopic partial resection of the ethmoidal cell system was performed. Before surgery a normosmia was ascertained in 39 patients (35%). Thirty-four patients (31%) were hyposmic, and 38 patients (34%) suffered from anosmia. In the postoperative olfactory function test 89 patients (80%) had a normal sense of smell; 13 patients (12%) showed hyposmia, and nine patients (8%) experienced anosmia. Seventy-eight percent of the patients with impaired olfactory function had marked improvement after the operation. Patients who had previously undergone a polypectomy had a less favorable prognosis. None of the preoperatively normosmic patients became hyposmic or even anosmic after endoscopic sinus surgery. The sense of smell of only two of the 34 patients with preexisting hyposmia worsened after surgery. The postoperative size of the middle nasal turbinate did not correlate with the ability to smell. More important was the accessibility of the olfactory cleft.

Coherent modulation up to 100 GBd 16QAM using silicon-organic hybrid (SOH) devices

We demonstrate the generation of higher-order modulation formats using silicon-based inphase/quadrature (IQ) modulators at symbol rates of up to 100 GBd. Our devices exploit the advantages of silicon-organic hybrid (SOH) integration, which combines silicon-on-insulator waveguides with highly efficient organic electro-optic (EO) cladding materials to enable small drive voltages and sub-millimeter device lengths. In our experiments, we use an SOH IQ modulator with a π-voltage of 1.6 V to generate 100 GBd 16QAM signals. This is the first time that the 100 GBd mark is reached with an IQ modulator realized on a semiconductor substrate, leading to a single-polarization line rate of 400 Gbit/s. The peak-to-peak drive voltages amount to 1.5 V_pp, corresponding to an electrical energy dissipation in the modulator of only 25 fJ/bit.

Conditional reprogramming of pediatric airway epithelial cells: A new human model to investigate early-life respiratory disorders

BACKGROUND

Airway epithelial cells (AEC) are quite difficult to access in newborns and infants. It is critically important to develop robust life-extended models to conduct translational studies in this age group. We propose the use of a recently described cell culture technology (conditionally reprogrammed cells-CRC) to generate continuous primary cell cultures from nasal and bronchial AEC of young children.

METHODS

We collected nasal and/or bronchial AEC from a total of 23 subjects of different ages including newborns/infants/toddlers (0-2 years; N = 9), school-age children (4-11 years; N = 6), and a group of adolescent/adult donors (N = 8). For CRC generation, we used conditioned medium from mitotically inactivated 3T3 fibroblasts and Rho-associated kinase (ROCK) inhibitor (Y-27632). Antiviral immune responses were studied using 25 key antiviral genes and protein production of type III epithelial interferon (IFN λ1) after double-stranded (ds) RNA exposure.

RESULTS

CRC derived from primary AEC of neonates/infants and young children exhibited: (i) augmented proliferative capacity and life extension, (ii) preserved airway epithelial phenotype after multiple passages, (iii) robust immune responses characterized by the expression of innate antiviral genes and parallel nasal/bronchial production of IFN λ1 after exposure to dsRNA, and (iv) induction of airway epithelial inflammatory and remodeling responses to dsRNA (eg, CXCL8 and MMP9).

CONCLUSION

Conditional reprogramming of AEC from young children is a feasible and powerful translational approach to investigate early-life airway epithelial immune responses in humans.

Model Based Targeting of IL-6-Induced Inflammatory Responses in Cultured Primary Hepatocytes to Improve Application of the JAK Inhibitor Ruxolitinib

IL-6 is a central mediator of the immediate induction of hepatic acute phase proteins (APP) in the liver during infection and after injury, but increased IL-6 activity has been associated with multiple pathological conditions. In hepatocytes, IL-6 activates JAK1-STAT3 signaling that induces the negative feedback regulator SOCS3 and expression of APPs. While different inhibitors of IL-6-induced JAK1-STAT3-signaling have been developed, understanding their precise impact on signaling dynamics requires a systems biology approach. Here we present a mathematical model of IL-6-induced JAK1-STAT3 signaling that quantitatively links physiological IL-6 concentrations to the dynamics of IL-6-induced signal transduction and expression of target genes in hepatocytes. The mathematical model consists of coupled ordinary differential equations (ODE) and the model parameters were estimated by a maximum likelihood approach, whereas identifiability of the dynamic model parameters was ensured by the Profile Likelihood. Using model simulations coupled with experimental validation we could optimize the long-term impact of the JAK-inhibitor Ruxolitinib, a therapeutic compound that is quickly metabolized. Model-predicted doses and timing of treatments helps to improve the reduction of inflammatory APP gene expression in primary mouse hepatocytes close to levels observed during regenerative conditions. The concept of improved efficacy of the inhibitor through multiple treatments at optimized time intervals was confirmed in primary human hepatocytes. Thus, combining quantitative data generation with mathematical modeling suggests that repetitive treatment with Ruxolitinib is required to effectively target excessive inflammatory responses without exceeding doses recommended by the clinical guidelines.