The infrared absorption spectrum of phenylacetylene and its deuterated isotopologue in the mid- to far-IR

Anharmonicity strongly influences the absorption and emission spectra of polycyclic aromatic hydrocarbon (PAH) molecules. Here, IR-UV ion-dip spectroscopy experiments together with detailed anharmonic computations reveal the presence of fundamental, overtone, as well as 2- and 3-quanta combination band transitions in the far- and mid-infrared absorption spectra of phenylacetylene and its singly deuterated isotopologue. Strong absorption features in the 400-900 cm-1 range originate from CH(D) in-plane and out-of-plane wags and bends, as well as bending motions including the C≡C and CH bonds of the acetylene substituent and the aromatic ring. For phenylacetylene, every absorption feature is assigned either directly or indirectly to a single or multiple vibrational mode(s). The measured spectrum is dense, broad, and structureless in many regions but well characterized by computations. Upon deuteration, large isotopic shifts are observed. At frequencies above 1500 cm-1 for d1-phenylacetylene, a one-to-one match is seen when comparing computations and experiments with all features assigned to combination bands and overtones. The C≡C stretch observed in phenylacetylene is not observed in d1-phenylacetylene due to a computed 40-fold drop in intensity. Overall, a careful treatment of anharmonicity that includes 2- and 3-quanta modes is found to be crucial to understand the rich details of the infrared spectrum of phenylacetylene. Based on these results, it can be expected that such an all-inclusive anharmonic treatment will also be key for unraveling the infrared spectra of PAHs in general.

A far-ultraviolet-driven photoevaporation flow observed in a protoplanetary disk

Most low-mass stars form in stellar clusters that also contain massive stars, which are sources of far-ultraviolet (FUV) radiation. Theoretical models predict that this FUV radiation produces photodissociation regions (PDRs) on the surfaces of protoplanetary disks around low-mass stars, which affects planet formation within the disks. We report James Webb Space Telescope and Atacama Large Millimeter Array observations of a FUV-irradiated protoplanetary disk in the Orion Nebula. Emission lines are detected from the PDR; modeling their kinematics and excitation allowed us to constrain the physical conditions within the gas. We quantified the mass-loss rate induced by the FUV irradiation and found that it is sufficient to remove gas from the disk in less than a million years. This is rapid enough to affect giant planet formation in the disk.

Optimizing surgical strategy in locally advanced breast cancer: a comparative analysis between preoperative MRI and postoperative pathology after neoadjuvant chemotherapy

PURPOSE

In the treatment of breast cancer, neo-adjuvant chemotherapy is often used as systemic treatment followed by tumor excision. In this context, planning the operation with regard to excision margins relies on tumor size measured by MRI. The actual tumor size can be determined through pathologic evaluation. The aim of this study is to investigate the correlation and agreement between pre-operative MRI and postoperative pathological evaluation.

METHODS

One hundred and ninety-three breast cancer patients that underwent neo-adjuvant chemotherapy and subsequent breast surgery were retrospectively included between January 2013 and July 2016. Preoperative tumor diameters determined with MRI were compared with postoperative tumor diameters determined by pathological analysis. Spearman correlation and Bland-Altman agreement methods were used. Results were subjected to subgroup analysis based on histological subtype (ER, HER2, ductal, lobular).

RESULTS

The correlation between tumor size at MRI and pathology was 0.63 for the whole group, 0.39 for subtype ER + /HER2-, 0.51 for ER + /HER2 + , 0.63 for ER-/HER2 +, and 0.85 for ER-/HER2-. The mean difference and limits of agreement (LoA) between tumor size measured MRI vs. pathological assessment was 4.6 mm (LoA -27.0-36.3 mm, n = 195). Mean differences and LoA for subtype ER + /HER2- was 7.6 mm (LoA -31.3-46.5 mm, n = 100), for ER + /HER2 + 0.9 mm (LoA -8.5-10.2 mm, n = 33), for ER-/HER2+ -1.2 mm (LoA -5.1-7.5 mm, n = 21), and for ER-/HER- -0.4 mm (LoA -8.6-7.7 mm, n = 41).

CONCLUSION

HER2 + and ER-/HER2- tumor subtypes showed clear correlation and agreement between preoperative MRI and postoperative pathological assessment of tumor size. This suggests that MRI evaluation could be a suitable predictor to guide the surgical approach. Conversely, correlation and agreement for ER + /HER2- and lobular tumors was poor, evidenced by a difference in tumor size of up to 5 cm. Hence, we demonstrate that histological tumor subtype should be taken into account when planning breast conserving surgery after NAC.

Formation of the methyl cation by photochemistry in a protoplanetary disk

Forty years ago, it was proposed that gas-phase organic chemistry in the interstellar medium can be initiated by the methyl cation CH3+ (refs. 1-3), but so far it has not been observed outside the Solar System4,5. Alternative routes involving processes on grain surfaces have been invoked6,7. Here we report James Webb Space Telescope observations of CH3+ in a protoplanetary disk in the Orion star-forming region. We find that gas-phase organic chemistry is activated by ultraviolet irradiation.

The Evolving HTAi Statement on COVID-19 Vaccines

Developments in COVID-19 have gone unprecedently fast, and HTAs have tried to keep pace, for example, in HTA-committees like the Joint Committee of Vaccination & Immunization. Necessarily, HTAs of COVID-19 related issues have been numerous and of a dynamic character to adequately cope with the rapidly changing landscape. HTAi drafted a statement on COVID-19 vaccines in the 2nd half of 2020 and an update in the 1st half of 2021. Here, we will address the role of real-world data (RWD) on effectiveness, safety and benefit/risk coming from the close monitoring programs around implementation in selected countries. Notably, an abundance of data came from Israel and the United Kingdom. Where the initial vaccination programs were designed based on clinical trials, HTA-committees continuously monitored observational data and dynamically re-designed the programs based on these. RWD have sometimes enhanced an increasing generic view on the vaccines, for example, concerning the use in older adults, as well as prioritizing specific ones for specific groups. RWD clearly show the effects of the vaccination programs on hospitalizations and deaths, in particular in those countries with an early kick-start of vaccination. Typically, cost-effectiveness analysis has so far not played any role in HTAs within crisis situations. We will address this in our presentation, illustrating potential value-for-money of the current vaccines in various country-specific settings looking at dynamic modelling and extensive data needs underlying economic assessments. Correspondingly, these models were initially populated with clinical trial data and are currently undergoing continuous updates as RWD come. Increasing interest in cost-effectiveness, dynamic pricing, tiered pricing in different parts of the world and enhanced competition will further shift attention to the economic aspects, further illustrating the dynamic character of HTAs in this field and HTAi's statement as an overall concept.

Exploratory Analysis of the Economically Justifiable Price of a Hypothetical RSV Vaccine for Older Adults in the Netherlands and the United Kingdom

Background

In older adults, the burden of respiratory syncytial virus (RSV) resembles that of influenza and may even be considered worse due to the lack of preventive interventions. This study was performed to identify the available literature on RSV infection in older adults, and to provide updated exploratory results of the cost-effectiveness of a hypothetical RSV vaccine in the Netherlands and the United Kingdom.

Methods

A literature search was performed in Medline and EMBASE on 11 November 2019, which served as input for a static decision-tree model that was used to estimate the EJP, for an RSV vaccine applying different willingness-to-pay (WTP) thresholds. WTP thresholds applied were €20 000 and €50 000 per quality-adjusted life-year for the Netherlands, and £20 000 and £30 000 per quality-adjusted life-year for the United Kingdom. Analyses were—in line with country-specific guidelines—conducted from a societal perspective for the Netherlands and a third-party payer perspective for the United Kingdom. The robustness of the cost-effectiveness results was tested in sensitivity analysis.

Results

After screening the literature, 3 studies for the Netherlands and 6 for the United Kingdom remained to populate the country-specific models. In the base case analysis for the Netherlands (mean RSV incidence, 3.32%), justifiable vaccine prices of €16.38 and €50.03 were found, based on applying the lower and higher WTP thresholds, respectively. Similarly, for the United Kingdom (mean incidence, 7.13%), vaccine prices of £72.29 and £109.74 were found, respectively.

Conclusion

RSV vaccination may well be cost-effective in both the Netherlands and the United Kingdom, depending on the exact RSV incidence, vaccine effectiveness and price. However, sensitivity analysis showed that the results were robust based on varying the different parameter estimates and assumptions. With RSV vaccines reaching the final stages of development, a strong need exists for cost-effectiveness studies to understand economically justifiable pricing of the vaccine.

Plant Robot for At-Home Behavioral Activation Therapy Reminders to Young Adults with Depression

Adolescents with depression who participate in behavioral activation therapy may find it hard to be motivated to perform tasks at home that their therapists recommend. We describe the initial design and usability evaluation of a home device (“PlantBot”) that could be used to remind young adults with depression at home of their behavioral activation therapy-related tasks. The prototype features electronics in a two-layer base, with a fake plant on top and supported using the Amazon Echo voice agent. We use an online panel study to evaluate the usability of our system with youth with past depression ( N = 30). Initial findings highlight the device’s usability, potential benefit, and attractiveness of the plant component, as well as multiple improvements to be made.

Cost-effectiveness analysis on elderly pneumococcal vaccination in the Netherlands: Challenging the Dutch Health Council's advice

Recently, the Dutch Health Council advised on elderly pneumococcal vaccination favouring the conventional polysaccharide vaccine over the novel conjugated vaccine. This advice was strongly inspired by a cost-effectiveness analysis considered to show favourable outcomes for the polysaccharide but not for the conjugated vaccine. We argue that using the same data and methods as presented by the Health Council, a different perspective on the results leads to a conclusion that not only the polysaccharide but also the conjugated pneumococcal vaccine is cost-effective. Our alternative perspective concerns the use of realistic vaccine prices, and applying an adequate time horizon for cost-effectiveness modelling. Notably, for one-off vaccination of 65-years old elderly, in all investigated analyses, also the conjugated vaccine seems cost-effective; i.e. well below the threshold of €20,000 per quality-adjusted life year, reflecting the most stringent threshold used for vaccines in the Netherlands.

Abstract P5-22-02: Surgical strategy after neoadjuvant therapy in patients with operable breast cancer can be optimized by knowledge of the level of agreement of measured tumor size on MRI after neoadjuvant therapy and final pathologic assessment

Introduction

Neoadjuvant chemotherapy (NAC) is increasingly applied in the treatment of patients with operable breast cancer. Wide local excision after NAC aims to remove the complete residual tumor with no tumor on ink, without compromising cosmetics. Therefore, surgical strategies are determined based on the remaining tumor size after NAC visualized on magnetic resonance imaging (MRI). Recent studies on the correlation between preoperative MRI and pathological response demonstrate inconsistent results. A need remains to adequately guide surgical decisions after NAC. The aim of this study was to not only investigate the correlation between MRI and pathological evaluation but to gain knowledge of the exact level of agreement, specified for different tumor subtypes, which could further guide surgical decision making.

Methods

All patients operated for breast cancer after NAC between January 2013 and July 2016 in a large teaching hospital were retrospectively included. Longest residual tumor diameter was determined with MRI and correlated with postoperative pathological findings. Tumors were subdivided based on estrogen receptor (ER) status and human epidermal growth factor receptor 2 (HER2). Spearman correlation was used to correlate MRI and pathological tumor size findings. Bland-Altman method was used to evaluate the agreement between both measurements.

Results

193 patients with 195 breast cancers were included. The correlation between tumor size at MRI and pathology was 0.63 for the whole group, 0.39 for tumors with subtype ER+/HER2-, 0.55 for ER+/HER2+, 0.63 for ER-/HER2+ and 0.85 for ER-/HER2-. The correlation for lobular carcinomas was 0.44. The mean difference and limits of agreement (LoA), between tumor size measured at MRI and pathological size was 4.6 mm (LoA -27.0 to 36.3 mm, n=195). Mean difference and LoA for subtype ER+/HER2- was 7.6 mm (LoA -31.3 to 46.5 mm, n=100), for ER+/HER2+ 0.9 mm (LoA -8.5 mm to 10.2 mm, n=33), for ER-/HER2+ -1.2 mm (LoA -5.1 to 7.5 mm, n=21), for ER-/HER- -0.4 mm (LoA -8.6 to 7.7 mm, n=41) and 19.4 mm (LoA -16.8 to 55.6 mm, n=14) for lobular carcinoma.

Conclusion

The correlation and agreement between the post-NAC MRI and postoperative pathological assessment of residual tumor size for ER+/Her2- and lobular tumors is weak. The agreement shows a wide variation in over- and underestimation of tumor size in mm by MRI and thus surgical strategy can still be poorly guided. It does however provide us with exact information on the possible range of margins we should take into account at surgery. As demonstrated in other studies ER+/HER2+, ER-/HER2+ and ER-/HER2- tumors demonstrate a clear correlation. Also, the level of agreement in these tumor subtypes shows that we can use MRI evaluation as a reliable predictive tool of tumor residual size to base our surgical strategy upon with a small variation in over- and underestimation of tumor size. Because the lobular carcinoma and HER2+ subgroups were small, conclusions should of course be viewed cautiously.

Citation Format: Boersma C, van Veen JLC, Maaskant JM, Van der Starre-Gaal J, Van 't Veer-Ten Kate M, Francken AB, Noorda EM. Surgical strategy after neoadjuvant therapy in patients with operable breast cancer can be optimized by knowledge of the level of agreement of measured tumor size on MRI after neoadjuvant therapy and final pathologic assessment [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-22-02.

Abstract P5-22-06: Less axillary lymph node dissections in patients with locally advanced breast cancer since implementation of the MARI-procedure

Introduction

Over the last years patients with locally advanced breast cancer are increasingly treated with neoadjuvant chemotherapy (NAC). This can lead to downstaging of the breast tumor, leading to less extensive surgery and can also impact axillary tumor burden. In multiple reported series downstaging of axillary lymphogenic metastasis has been reported to complete pathological response (pCR) in 20-42% of patients. Radioactive iodine seeds have been used to mark the axillary metastatic node (MARI-procedure). This node is selectively removed after NAC. The need for additional surgery or radiotherapy of the axilla depends on the postoperative pathological outcome. This study shows the results of implementation of the MARI-procedure and its impact on postoperative axillary treatment.

Methods

A retrospective analysis done on outcome of the MARI-procedure in consecutive patients from 2015 - 2017 treated with NAC for stage III breast cancer in a large teaching hospital. Patients' axillary status was determined pre-NAC by axillary ultrasonography, FNA and PET-scan. In these patients the metastatic lymph node was selectively marked with iodine seed. At surgery post-NAC the lymph node was removed. Adjuvant treatment was determined in the tumor board depending on the pathological result. Table 1 demonstrates the used algorithm for adjuvant axillary treatment. Descriptive statistics in terms of measured frequencies and central tendencies were used to describe the outcomes.

Table 1: adjuvant axillary treatment algorithm   FNA proven axillary lymph node metastasis    N1   N2-3 pCR Residual tumor pCR Residual tumorNo axillary treatment Axillary radiotherapy Axillary radiotherapy ALND + axillary radiotherapy

Results

In total 50 consecutive patients were included and analyzed. Thirty one patients were staged cN1. Ten of these patients demonstrated a complete pathological response (ypN0) and did not receive any adjuvant axillary treatment. Sixteen patients had residual pathological tumour activity (ypN1) and received axillary radiotherapy. Five patients with residual disease underwent ALND (two patients ypN1, three patients ypN2). In the two patients staged ypN1, the algorithm was not followed due to progressive disease in the breast and the other because of occult axillary disease.Nineteen patients were staged cN2. Twelve of these patients had a complete pathological response (ypN0) and received axillary radiotherapy and seven patients had residual disease (ypN1 or ypN2) and treated with ALND. If ypN2 axillary radiotherapy was added. In total, 20% of patients did not receive any adjuvant axillary treatment, 56% received adjuvant axillary radiotherapy and 24% patients underwent ALND.

Conclusion

The number of patients with locally advanced breast cancer treated with ALND is obviously decreased since implementation of the MARI procedure after NAC. Hereby, one out of five patients could be spared any adjuvant axillary treatment. There is a need for follow up of long term results to assess recurrence risk and overall survival.

Citation Format: Boersma C, Koopman-Kuin D, Van der Starre-Gaal J, Korte JH, Roeloffzen EMA, Francken AB, Noorda EM. Less axillary lymph node dissections in patients with locally advanced breast cancer since implementation of the MARI-procedure [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-22-06.

The economics of mesalazine in active ulcerative colitis and maintenance in the Netherlands

BACKGROUND

In this study we investigate the costs and benefits of topical mesalazine combined with oral mesalazine therapy for active ulcerative colitis (UC), and once daily (OD ) mesalazine 2 grams versus twice daily (BID ) for maintaining UC remission.

METHODS

Two decision analytic models were constructed to evaluate treatment costs and quality-adjusted life years (QALYs) associated with mesalazine. The first model explored 4 g oral mesalazine in combination with 1 g topical mesalazine during active UC compared with 4 g oral mesalazine monotherapy for achieving clinical remission. The second model compared remission rates at one year for OD 2 g oral mesalazine compared with BID 1 g adjusted for compliance. All direct costs were obtained from established treatment costs in the Netherlands.

RESULTS

The average cost of treatment to transition an active UC patient into remission using oral plus topical mesalazine or oral mesalazine monotherapy was v2207 (95% CI: v1402 to v3332) and v2945 (95% CI: v1717 to v4592), respectively. The annual average cost-saving of adding topical mesalazine delivered for four weeks during active UC was v738. The average annual costs of maintenance of remission with OD and BID therapy were v1293 (95% CI: v1062 to v1496) and v1502 (95% CI: v1262 to 1708), respectively with an annual average per person savings of v209.

CONCLUSION

Topical mesalazine during acute UC flares results in lower costs due to reduced healthcare consumption attributed to faster symptom resolution. Furthermore, as a result of lower costs and modest QALY gains, maintenance therapy using OD mesalazine is the dominant treatment option if compared with BID mesalazine.

[Psychiatric symptoms in systemic lupus erythematosus]

This article focuses on two patients with psychiatric symptoms arising from systemic lupus erythematosus (SLE). Affective and psychotic symptoms frequently occur in SLE, often in combination with cognitive disturbances, and can be a first manifestation of the disorder. The diagnosis and treatment of a possible case of neuropsychiatric SLE should preferably take place in a multidisciplinary setting.

Switch patterns before and after patent expiry of omeprazole: a case study in The Netherlands

BACKGROUND

An increase of therapeutic substitution after patent expiry might have a negative effect on cost-savings generated with newly introduced generic drugs. To evaluate influences of patent expiry on therapeutic substitution, switch behaviour before and after patent expiry was investigated.

AIM

To describe proton pump inhibitor use and investigate substitution patterns from omeprazole before and after patent expiry.

METHODS

Data were obtained from the InterAction DataBase. Proportional proton-pump inhibitor use was identified per quarter during the study period 2000-2003. For the second part two cohorts--one before and one after patent expiry--were defined. The number of switchers was quarterly identified during 2-year follow-up period. For statistical analyses the chi-square test and hazard ratio were used.

RESULTS

In proportional use, a downward trend for omeprazole was found. After patent expiry, significantly more patients switched to other proton pump inhibitors (P < 0.001). The hazard ratio of 0.62 (95% CI: 0.57-0.69), indicates that for every six patients switching before patent expiry, 10 patients switch after patent expiry.

CONCLUSION

After patent expiry more patients switch to another proton pump inhibitor. In light of the total savings achieved with generic omeprazole, the importance of this negative impact on total cost-savings on proton pump inhibitors is unclear.

Estrogen receptors alpha and beta: two receptors of a kind?

Ever since the discovery of estradiol and the elucidation of its chemical structure, there has been a great deal of interest in its mechanism of action and its potential therapeutic value. It is now well established that estrogens have many different functions in many different cell-types. With respect to the potential use of estrogens as therapeutics, there is an interest in controlling reproductive function, bone metabolism, cardiovascular disease, as well as in the prevention of hot flushes, mood changes and Alzheimer s disease. For over a decade, it was believed that estrogens signal through a a single estrogen receptor, now referred to as ERalpha, which belongs to a family of ligand-activated transcription factors. More recently, however, a second estrogen receptor ERbeta was identified. The current review describes similarities as well as differences between these two distinct estrogen receptors. Both ERalpha and ERbeta bind 17beta-estradiol with high affinity and they bind to classical estrogen response elements in a similar if not identical fashion. However, there are also major differences between ERalpha and ERbeta for instance with respect to their tissue distribution, the phenotype of the corresponding knock-out mice and their transcriptional activities. It is anticipated that a better understanding of these two receptors will eventually lead to more selective ways of modulating physiological processes which are influenced by estrogens. For this purpose, the development of ERalpha and ERbeta specific ligands, both agonists as well as antagonists, will be of great importance.

Identification of Bordetella avium using the polymerase chain reaction

A DNA fragment from Bordetella pertussis, encoding the fim2 fimbrial subunit gene with adjacent sequences, was used as a probe for the detection of homologous sequences in chromosomal DNA of Bordetella avium. A 1.8 kb Sa1I-PstI fragment from the genome of B. avium, which hybridized with the probe, was isolated and sequenced. No fimbrial subunit gene was located on the B. avium DNA fragment. Two regions could be distinguished in the sequence of the fragment. Region 1, which was 80% identical to the sequence upstream of the fim2 gene of B. pertussis and region 2, which had no identity with any known sequence. A 491 bp EagI DNA fragment (probe A) within region 1 and a 650 bp EagI DNA fragment (probe B) within region 2 were used as DNA probes on restriction endonuclease digests of chromosomal DNA from various bacterial species. This hybridization experiment showed that the region 2 sequence was specific for B. avium. A polymerase chain reaction (PCR) with specific primers within region 2 resulted in the amplification of a 500 bp DNA fragment with B. avium DNA only. This PCR is a useful method for the rapid detection of B. avium and appeared useful to discriminate B. avium from other Bordetella species and also from Alcaligenes faecalis.