Design of Fluorinated Elastomeric Electrolyte for Solid-State Lithium Metal Batteries Operating at Low Temperature and High Voltage

This work demonstrates the low-temperature operation of solid-state lithium metal batteries (LMBs) through the development of a fluorinated and plastic-crystal-embedded elastomeric electrolyte (F-PCEE). The F-PCEE is formed via polymerization-induced phase separation between the polymer matrix and plastic crystal phase, offering a high mechanical strain (≈300%) and ionic conductivity (≈0.23 mS cm-1) at -10 °C. Notably, strong phase separation between two phases leads to the selective distribution of lithium (Li) salts within the plastic crystal phase, enabling superior elasticity and high ionic conductivity at low temperatures. The F-PCEE in a Li/LiNi0.8Co0.1Mn0.1O2 full cell maintains 74.4% and 42.5% of discharge capacity at -10 °C and -20 °C, respectively, compared to that at 25 °C. Furthermore, the full cell exhibits 85.3% capacity retention after 150 cycles at -10 °C and a high cut-off voltage of 4.5 V, representing one of the highest cycling performances among the reported solid polymer electrolytes for low-temperature LMBs. This work attributes the prolonged cycling lifetime of F-PCEE at -10 °C to the great mechanical robustness to suppress the Li-dendrite growth and ability to form superior LiF-rich interphases. This study establishes the design strategies of elastomeric electrolytes for developing solid-state LMBs operating at low temperatures and high voltages.

CRISPR-Cas9 and beyond: identifying target genes for developing disease-resistant plants

Throughout the history of crop domestication, desirable traits have been selected in agricultural products. However, such selection often leads to crops and vegetables with weaker vitality and viability than their wild ancestors when exposed to adverse environmental conditions. Considering the increasing human population and climate change challenges, it is crucial to enhance crop quality and quantity. Accordingly, the identification and utilization of diverse genetic resources are imperative for developing disease-resistant plants that can withstand unexpected epidemics of plant diseases. In this review, we provide a brief overview of recent progress in genome-editing technologies, including zinc-finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs), and clustered regularly interspaced short palindromic repeats (CRISPR)-associated protein 9 (Cas9) technologies. In particular, we classify disease-resistant mutants of Arabidopsis thaliana and several crop plants based on the roles or functions of the mutated genes in plant immunity and suggest potential target genes for molecular breeding of genome-edited disease-resistant plants. Genome-editing technologies are resilient tools for sustainable development and promising solutions for coping with climate change and population increases.

Effect of bimatoprost sustained-release intracameral implant on intraocular pressure and medication burden in patients with prior glaucoma surgery

The present retrospective study evaluated intraocular pressure (IOP) and medication burden after bimatoprost sustained-release (bimatoprost SR, Durysta, Allergan) implantation in patients with glaucoma. A secondary objective was to examine an effect of bimatoprost SR in a subset of patients with prior minimally invasive and incisional glaucoma surgery. A retrospective chart review of 122 eyes that received bimatoprost SR by 6 glaucoma specialists at Wills Eye Hospital between March 2020 and September 2021 was performed. One hundred and eighteen eyes from 84 patients had a reduction in IOP (18.5±5.7mmHg vs. 16.0±5.4mmHg, P<0.01) and required fewer glaucoma medications (2.1±1.4 vs. 1.2±1.2, P<0.01) after bimatoprost SR implantation. In 41 eyes from 31 patients who previously underwent glaucoma surgery (including iStent, goniotomy, trabeculectomy, Xen Gel Stent, or tube shunt surgery), medication burden was decreased after bimatoprost SR implantation (1.9±1.3 vs. 1.0±1.0, P<0.001). These data suggest that bimatoprost SR is an efficacious treatment modality for glaucoma, even in post-surgical patients.

ESQmodel: biologically informed evaluation of 2-D cell segmentation quality in multiplexed tissue images

MOTIVATION

Single cell segmentation is critical in the processing of spatial omics data to accurately perform cell type identification and analyze spatial expression patterns. Segmentation methods often rely on semi-supervised annotation or labeled training data which are highly dependent on user expertise. To ensure the quality of segmentation, current evaluation strategies quantify accuracy by assessing cellular masks or through iterative inspection by pathologists. While these strategies each address either the statistical or biological aspects of segmentation, there lacks a unified approach to evaluating segmentation accuracy.

RESULTS

In this article, we present ESQmodel, a Bayesian probabilistic method to evaluate single cell segmentation using expression data. By using the extracted cellular data from segmentation and a prior belief of cellular composition as input, ESQmodel computes per cell entropy to assess segmentation quality by how consistent cellular expression profiles match with cell type expectations.

AVAILABILITY AND IMPLEMENTATION

Source code is available on Github at: https://github.com/Roth-Lab/ESQmodel.

Fracture Resistance of Chairside CAD/CAM Lithium Disilicate-reinforced Ceramic Occlusal Veneers With and Without Margin and Full Coverage Crowns

OBJECTIVE

The aim of this investigation was to compare the fracture resistance of chairside computer-aided design and computer-aided manufacturing (CAD/CAM) lithium disilicate-reinforced ceramic occlusal veneers with and without margin and traditional full coverage premolar crowns.

METHODS AND MATERIALS

A total of 60 chairside CAD/CAM lithium disilicate-reinforced ceramic (Amber Mill, Hass Bio) restorations were designed and fabricated with a chairside CAD/CAM system (CEREC Dentsply Sirona). The restorations were divided into three groups (n=20): 1) occlusal veneer with 1.0-mm uniform occlusal thickness and with chamfer margin; 2) occlusal veneer with 1.0-mm uniform occlusal thickness and without margin; and 3) full coverage crown with uniform occlusal thickness and gingival margin. Occlusal veneers and crowns were cemented with dual cured resin luting cement (Multilink, Ivoclar Vivadent) to printed resin dies, load cycled (5 million load cycles at 1 Hz with 275 N force), and then loaded until fracture. Load at break (LB) and peak load (PL) until fracture were recorded. Scanning electron microscope images of the tested restorations on the abutments were obtained.

RESULTS

Fracture strengths were different depending on the design of the restoration. There was no significant difference in fracture strength between the two types of occlusal veneer (LB: 1132.45 N; PL: 1143.30 N for veneers with margin; LB: 1149.25 N; PL: 1219.05 N for veneers without margin). Full coverage crowns showed the lowest fracture resistance (LB: 936.26 N, PL: 976.42 N), which was significantly lower than both designs of occlusal veneer.

CONCLUSIONS

The fracture resistance of the CAD/CAM lithium disilicate-reinforced ceramic restorations was influenced by the design. Occlusal veneers with and without margin displayed higher fracture resistance than traditional crowns.

Achieving Fast Oxygen Reduction on Oxide Electrodes by Creating 3D Multiscale Micro-Nano Structures for Low-Temperature Solid Oxide Fuel Cells

Fast oxygen reduction reaction (ORR) at the cathode is a key requirement for the realization of low-temperature solid oxide fuel cells (SOFCs). While the design of three-dimensional (3D) structures has emerged as a new and promising approach to improving the electrochemical performance of SOFC cathodes, achieving versatile structures and structural stability is still challenging. In this study, we demonstrate a novel architectural design for a superior cathode with fast ORR activity. By employing a completely new fabrication process comprising a 3D printing technique and pulsed laser deposition (PLD), we design 3D La0.8Sr0.2CoO3-δ (LSC) micro-nano structures with the desired shape. 3D-printed yttria-stabilized ZrO2 (YSZ) microstructures significantly increase the ratio of surface area to volume while maintaining suitable ionic conductivity comparable to that of single-crystalline YSZ substrates. Scanning electron microscopy and energy dispersive X-ray microanalysis reveal the formation of crack- or void-free YSZ microstructures and the uniform deposition of LSC films by PLD on the YSZ microstructures. The 3D LSC micro-nano structures show significantly enhanced oxygen surface exchange coefficients (kchem) extracted from electrical conductivity relaxation (ECR) measurements by up to 3 orders of magnitude relative to the bulk LSC. Furthermore, electrochemical impedance spectroscopy measurements verify the kchem values from ECR and no directional difference in the measured ORR activity depending on the shape of 3D microstructures. The dramatic enhancement of the ORR activity of LSC is attributed to the increased film surface areas resulting from the 3D YSZ microstructures.

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

INTRODUCTION

The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures.

METHODS

In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025.

FINDINGS

Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation.

INTERPRETATION

After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification.

FUNDING

UK Research and Innovation and National Institute for Health Research.

A Comparison of Treatment Plan Adaptation Methods on PTV Margin Coverage in MR-Linac Prostate SBRT

PURPOSE/OBJECTIVE(S)

MRI-Linac guided radiotherapy is a novel treatment modality allowing for daily online adaptation of contours and treatment planning. MRI-Linac prostate SBRT (MRL-SBRT) has recently been shown to provide a tangible benefit in decreasing both acute and late toxicity, due to the ability to evaluate soft tissue contrast, directly monitor organ motion, and anatomical changes during the entire treatment course. Multiple MRI-Linac platforms are available, which provide different advantages with regards to imaging and motion management. We undertook this study to assess coverage of the clinical target volume with use of a standard PTV margin in patients receiving either adapt-to-position (ATP) only treatment or a combination of adapt-to-position and adapt-to-shape (ATP+ATS) on the Elekta Unity MR-Linac.

MATERIALS/METHODS

Data was collected retrospectively in patients who underwent prostate SBRT using a 1.5 T MR-Linac (Unity, Elekta AB, Stockholm, Sweden). Prior to each fraction, determination of ATP or ATS planning was at the discretion of the treating physician. Prostate and organs at risk (OAR's) were contoured on the reference MRI and daily MR image sets acquired prior to each fraction. The prostate PTV consisted of a 5mm margin, except 3mm posteriorly. Contours were merged to account for target and OAR volumes during all fractions. Target volumes from the reference plan were then compared to the clinical target volume (CTV) on pre-treatment MR-Linac imaging as well as intersection with OAR's.

RESULTS

Nineteen men, median age 72 years (range 67-75), with prostate cancer underwent treatment from May 2021 to January 2023 with MRL-SBRT. The average time for ATP vs ATP+ATS was 45 minutes (range 35-60) and 60 minutes (range 50-80), respectively. The mean CTV treated was 43.4cc (range 31-60) for ATP and 51.8cc (range 36-67) for ATP+ATS. Prior to plan adaptation, target volumes in 92.6% of fractions were not covered completely by the PTV. In the ATP cohort, 89% of fractions had a portion of the CTV uncovered with an average of 2.9cc. In the ATP+ATS cohort, 96.4% had a portion of the CTV uncovered, with an average of 6.9cc. There was no difference in the amount of PTV intersection for ATP or ATP+ATS plans with the rectum (1.1cc vs. 1.5cc) and bladder (9.2cc vs. 12.6cc), respectively. All patients completed the planned course of treatment.

CONCLUSION

Adaptive radiation therapy for prostate cancer utilizing an MR-Linac based approach with the Elekta Unity was feasible for patients requiring either ATP only or ATP+ATS plans. As expected, ATS plans required longer treatment time, allowing for improved coverage of the target when deemed clinically necessary. Despite a larger overall volume treated in ATS plans, there was no difference in overlap with OARs between ATP and ATS plans. Adaption for each daily fraction and intrafraction motion monitoring improved CT coverage with our pre-specified PTV margin.

The Ninth and Tenth Costal Cartilages Are Available and Safe Options for Rhinoplasty: A Cadaveric Anatomical Study

SUMMARY

Some practitioners prefer the ninth costal cartilage for autogenous rhinoplasty, but few anatomical studies focus on tapering shape and harvesting safety regarding pneumothorax risk. Therefore, the authors studied the size and related anatomy of the ninth and tenth costal cartilages. Twelve fresh cadavers (24 ribs) were studied. The authors measured the length, width, and thickness of the ninth and tenth costal cartilages at the osteochondral junction (OCJ), midpoint, and tip. To evaluate safety during harvesting, the authors measured the thickness of the transversus abdominis muscle beneath the costal cartilage. The mean lengths of the ninth and tenth cartilages were 99.1 ± 25.0 and 60.6 ± 22.5 mm, respectively. The ninth cartilage was 11.8 ± 2.6, 9.0 ± 2.4, and 2.5 ± 0.5 mm wide, and the tenth cartilage was 9.9 ± 2.0, 7.1 ± 2.0, and 2.7 ± 0.5 mm wide at the OCJ, midpoint, and tip, respectively. The ninth cartilage was 8.4 ± 2.0, 6.4 ± 1.5, and 2.4 ± 0.6 mm thick, and the tenth cartilage was 7.0 ± 2.2, 5.1 ± 1.7, and 2.3 ± 0.5 mm thick at each point. For the transversus abdominis muscle, the thickness was 2.1 ± 0.9, 3.7 ± 1.0, and 4.5 ± 1.3 mm at the ninth cartilage and 1.9 ± 0.5, 2.9 ± 1.1, and 3.7 ± 1.4 mm at the tenth cartilage at each point. The size of the cartilage was sufficient for autogenous rhinoplasty. The transversus abdominis muscle provides thickness for safe harvesting. Furthermore, if this muscle is breached during cartilage harvest, the abdominal cavity is exposed, but the pleural cavity is not. Consequently, there is a very low risk of pneumothorax at this level.

Assessment of Daily Target Motion to Optimize ITV Margins in Online Adaptive Plan for Liver and Pancreatic SBRT on MR-LINAC

PURPOSE/OBJECTIVE(S)

Accurate measurement of daily target motion on online plan adaptation is essential for re-optimizing the internal target volume (ITV) margins. In this study, by analyzing 2D cine MR images acquired in a 1.5T MR-Linac, we assessed daily target motion and its inter-fractional variations, which is then used to customize ITV margins for MR-based online adaptive plan of liver and pancreatic stereotactic body radiotherapy (SBRT).

MATERIALS/METHODS

Twenty-threepatients, enrolled in this study, underwent MR-guided online adaptive SBRT on 1.5 T MR-Linac: liver (n = 12 without compression belt (CB), n = 2 with CB) and pancreas (n = 9 with CB). Target motion in a 2D coronal and sagittal MR images (> 200 cine images to cover multiple breathing cycles), as well as a set of 4D-CT images during the simulation, was analyzed to determine patient specific ITV margins for a reference plan. On every fraction of online adaptive SBRT, the 2D MR images were exported to commercially available software along with a planning MR images: a T1-wighted MR image set for pancreas and or a navigated T2-wighted MR image set for liver. Daily target motion was then measured by overlaying the orthogonal cine image set on the T1- or T2-wighted image set. The ITV margin was adjusted when required prior to online plan optimization RESULTS: Thisstudy successfully assessed the daily target motion and inter-fractional variations in 23 liver or pancreatic cancer patients. We found a discrepancy of daily target motion of orthogonal 2D cine MR images from that of 4D-CT, required to adjust the ITV margin for online plan adaptation. In liver SBRT without CB, 15 out of 45 fractions from 12 patients (33.3 %) went through adjusted ITV margin. The tumor motion was large up to a 2.2 cm along the inferior direction in a patient without CB and thus the patient was treated on a conventional Linac with the active breathing control (ABC) unit for breath-hold. On the other hand, no adjustments were necessary for 2 liver patients with CB. In 9 patients with pancreatic cancers, we found the inter-fractional ITV variations in 3 out of 45 fractions (6.7 %) adjusted the ITV margin. The daily target motion in the pancreatic patients with CB was more stable and relatively smaller than that of the liver patients.

CONCLUSION

Theorthogonal 2D cine MR images are evidently essential for assessing daily target motion to evaluate the inter-fractional variation and achieve daily ITV-customized liver and pancreatic SBRT in the 1.5 T MR-Linac. The customized ITV approach will improve the treatment outcome of the MR-guided online adaptive therapy.

Goals for girls: a cluster-randomized trial to investigate a school-based sexual health programme amongst female learners in South Africa

The delivery of comprehensive sexuality education to adolescents at school is recognized as a long-term strategy to support adolescent health. Suboptimal sexual and reproductive health (SRH) outcomes among South African adolescents necessitate the ongoing development and optimization of SRH education and promotion models. We conducted a cluster-randomized controlled trial amongst secondary schools (n = 38) in Cape Town, South Africa, to evaluate a sport-based, near-peer-led SRH curriculum, SKILLZ, amongst female learners (n = 2791). Biomedical (sexually transmitted infections [STIs], human immunodeficiency virus [HIV] and pregnancy) and socio-behavioural (social support, gender norms and self-concept) outcomes were assessed pre and post intervention. Attendance at SKILLZ was low and intervention participants did not show an improvement in SRH outcomes, with HIV and pregnancy incidence remaining stable and STI prevalence remaining high and increasing in both control and intervention arms. Although evidence of positive socio-behavioural measures was present at baseline, participants with high attendance showed further improvement in positive gender norms. SKILLZ did not demonstrate the capacity to significantly impact clinical SRH outcomes. Modest improvements in outcomes amongst high attenders suggest that the impact may be possible with improved attendance; however, in the absence of optimal attendance, alternative intervention strategies may be required to improve SRH outcomes amongst adolescents.

Tuning Ionic Conductivity in Fluorite Gd-Doped CeO2-Bixbyite RE2O3 (RE = Y and Sm) Multilayer Thin Films by Controlling Interfacial Strain

Interfacial strain in heteroepitaxial oxide thin films is a powerful tool for discovering properties and recognizing the potential of materials performance. Particularly, facilitating ion conduction by interfacial strain in oxide multilayer thin films has always been seen to be a highly promising route to this goal. However, the effect of interfacial strain on ion transport properties is still controversial due to the difficulty in deconvoluting the strain contribution from other interfacial phenomena, such as space charge effects. Here, we show that interfacial strain can effectively tune the ionic conductivity by successfully growing multilayer thin films composed of an ionic conductor Gd-doped CeO2 (GDC) and an insulator RE2O3 (RE = Y and Sm). In contrast to compressively strained GDC-Y2O3 multilayer films, tensile strained GDC-Sm2O3 multilayer films demonstrate the enhanced ionic conductivity of GDC, which is attributed to the increased concentration of oxygen vacancies. In addition, we demonstrate that increasing the number of interfaces has no impact on the further enhancement of the ionic conductivity in GDC-Sm2O3 multilayer films. Our findings demonstrate the unambiguous role of interfacial strain on ion conduction of oxides and provide insights into the rational design of fast ion conductors through interface engineering.

Layer-Dependent Interaction Effects in the Electronic Structure of Twisted Bilayer Graphene Devices

Near the magic angle, strong correlations drive many intriguing phases in twisted bilayer graphene (tBG) including unconventional superconductivity and chern insulation. Whether correlations can tune symmetry breaking phases in tBG at intermediate (≳ 2°) twist angles remains an open fundamental question. Here, using ARPES, we study the effects of many-body interactions and displacement field on the band structure of tBG devices at an intermediate (3°) twist angle. We observe a layer- and doping-dependent renormalization of bands at the K points that is qualitatively consistent with moiré models of the Hartree-Fock interaction. We provide evidence of correlation-enhanced inversion symmetry-breaking, manifested by gaps at the Dirac points that are tunable with doping. These results suggest that electronic interactions play a significant role in the physics of tBG even at intermediate twist angles and present a new pathway toward engineering band structure and symmetry-breaking phases in moiré heterostructures.

How important is it to avoid indices of deprivation that include health variables in analyses of health inequalities?

OBJECTIVES

This study aimed to quantify the difference in mortality inequalities using the Scottish Index of Multiple Deprivation (SIMD) and the Income and Employment Index (IEI; a subindex of SIMD, which excludes health) as ranking measures in Scotland.

STUDY DESIGN

This ecological study was a cross-sectional analysis of routine administrative data.

METHODS

Data from the 2020 SIMD and the subindex using data from only the Income and Employment domains, the IEI, were obtained. The correlation between data zones, percentage of data zones that changed deprivation tenth and differences in the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) for Standardised Mortality Ratios (SMRs) across tenths were compared when data zones were ranked by SIMD and IEI.

RESULTS

There was a close correlation between data zones ranked by SIMD and IEI (R² = 0.96). When data zones were ranked by IEI, 18.7% of data zones moved to a lower deprivation tenth, and 20.8% of data zones moved to a higher deprivation tenth, compared with SIMD. However, only a negligible number of data zones moved two or more tenths. The SMRs across deprivation tenths were very similar between the SIMD and IEI, as were the summary health inequality measures of SII (87.3 compared with 85.7) and RII (0.88 and 0.86).

CONCLUSION

Although there is a logical problem in using deprivation indices that include health outcomes to rank areas to calculate the scale of health inequalities, the impact of using an alternative subindex containing only data from the income and employment domains is minimal. For population-wide analyses of health inequalities in Scotland, the SIMD does not introduce a substantial bias in the health inequalities summary measures despite substantial movement of small areas between ranked population tenths. Although not examined here, this is likely to be relevant to other similar indices across the United Kingdom.

Spin-orbit coupling-enhanced valley ordering of malleable bands in twisted bilayer graphene on WSe2

Recent experiments in magic-angle twisted bilayer graphene have revealed a wealth of novel electronic phases as a result of interaction-driven spin-valley flavour polarisation. In this work, we investigate correlated phases due to the combined effect of spin-orbit coupling-enhanced valley polarisation and the large density of states below half filling of the moiré band in twisted bilayer graphene coupled to tungsten diselenide. We observe an anomalous Hall effect, accompanied by a series of Lifshitz transitions that are highly tunable with carrier density and magnetic field. The magnetisation shows an abrupt change of sign near half-filling, confirming its orbital nature. While the Hall resistance is not quantised at zero magnetic fields-indicating a ground state with partial valley polarisation-perfect quantisation and complete valley polarisation are observed at finite fields. Our results illustrate that singularities in the flat bands in the presence of spin-orbit coupling can stabilise ordered phases even at non-integer moiré band fillings.

A9 INTESTINAL ORGANOID TRANSPLANTATION REVERSED THE INTESTINAL EPITHELIUM DAMAGE IN EXPERIMENTAL NECROTIZING ENTEROCOLITIS

NOT PUBLISHED AT AUTHOR’S REQUEST

Mesenchymal Stem-Like Cells Derived from the Ventricle More Effectively Enhance Invasiveness of Glioblastoma Than Those Derived from the Tumor

PURPOSE

Glioblastoma (GBM) is one of the most lethal human tumors with a highly infiltrative phenotype. Our previous studies showed that GBM originates in the subventricular zone, and that tumor-derived mesenchymal stem-like cells (tMSLCs) promote the invasiveness of GBM tumorspheres (TSs). Here, we extend these studies in terms of ventricles using several types of GBM patient-derived cells.

MATERIALS AND METHODS

The invasiveness of GBM TSs and ventricle spheres (VSs) were quantified via collagen-based 3D invasion assays. Gene expression profiles were obtained from microarray data. A mouse orthotopic xenograft model was used for in vivo experiments.

RESULTS

After molecular and functional characterization of ventricle-derived mesenchymal stem-like cells (vMSLCs), we investigated the effects of these cells on the invasiveness of GBM TSs. We found that vMSLC-conditioned media (CM) significantly accelerated the invasiveness of GBM TSs and VSs, compared to the control and even tMSLC-CM. Transcriptome analyses revealed that vMSLC secreted significantly higher levels of several invasiveness-associated cytokines. Moreover, differentially expressed genes between vMSLCs and tMSLCs were enriched for migration, adhesion, and chemotaxis-related gene sets, providing a mechanistic basis for vMSLC-induced invasion of GBM TSs. In vivo experiments using a mouse orthotopic xenograft model confirmed vMSLC-induced increases in the invasiveness of GBM TSs.

CONCLUSION

Although vMSLCs are non-tumorigenic, this study adds to our understanding of how GBM cells acquire infiltrative features by vMSLCs, which are present in the region where GBM genesis originates.

How well do area-based deprivation indices identify income- and employment-deprived individuals across Great Britain today?

BACKGROUND

Area-based deprivation indices are used in many countries to target interventions and policies to populations with the greatest needs. Analyses of the Carstairs deprivation index applied to postcode sectors in 2001 identified that less than half of all deprived individuals lived in the most deprived areas.

OBJECTIVE

This article examines the specificity and sensitivity of deprivation indices across Great Britain in identifying individuals claiming income- and employment-related social security benefits.

STUDY DESIGN

This was a descriptive analysis of cross-sectional administrative data.

METHODS

The data sets for the 2020 Scottish Index of Multiple Deprivation, Scottish Income and Employment Index, the 2019 English Index of Multiple Deprivation and the 2019 Welsh Index of Multiple Deprivation were obtained. For each data set, small areas were ranked by increasing overall deprivation, and the cumulative proportions of individuals who were income and employment deprived were calculated. Receiver operating characteristic curves were plotted to show the sensitivity and specificity of each index, and the percentages of income- and employment-deprived individuals captured at different overall deprivation thresholds were calculated.

RESULTS

Across all indices, the sensitivity and specificity for detecting income- and employment-deprived individuals were low, with less than half living in the most deprived 20% of areas. Between 55% and 62% of income-deprived people and between 56% and 63% of employment-deprived people were missed across the indices at the 20% deprivation threshold. The sensitivity and specificity were slightly higher for income deprivation than employment deprivation across indices and slightly higher for the Scottish Index of Multiple Deprivation and Scottish Income and Employment Index than for the English Index of Multiple Deprivation and Welsh Index of Multiple Deprivation.

CONCLUSION

Area-based deprivation measures in Great Britain have limited sensitivity and specificity for identifying individuals who are income or employment deprived. Place-based policies and interventions are unlikely to be effective at reducing inequalities as a result. Creation of individually linked data sets and interventions that recognise the social and economic relationships between social groups are likely to be more effective.

A Survey on Procedural Sedation and Analgesia for Pediatric Facial Laceration Repair in Korea

Background  Most children with facial lacerations require sedation for primary sutures. However, sedation guidelines for invasive treatment are lacking. This study evaluated the current status of the sedation methods used for pediatric facial laceration repair in Korea. Methods  We surveyed one resident in each included plastic surgery training hospital using face-to-face interviews or e-mail correspondence. The health care center types (secondary or tertiary hospitals), sedation drug types, usage, and dosage, procedure sequence, monitoring methods, drug effects, adverse events, and operator and guardian satisfaction were investigated. Results  We included 45/67 hospitals (67%) that used a single drug, ketamine in 31 hospitals and chloral hydrate in 14 hospitals. All health care center used similar sedatives. The most used drug administered was 5 mg/kg intramuscular ketamine (10 hospitals; 32%). The most common chloral hydrate administration approach was oral 50 mg/kg (seven hospitals; 50%). Twenty-two hospitals (71%) using ketamine followed this sequence: administration of sedatives, local anesthesia, primary repair, and imaging work-up. The most common sequence used for chloral hydrate (eight hospitals; 57%) was local anesthesia, administration of sedatives, imaging work-up, and primary repair. All hospitals that used ketamine and seven (50%) of those using chloral hydrate monitored oxygen saturation. Median operator satisfaction differed significantly between ketamine and chloral hydrate (4.0 [interquartile range, 4.0-4.0] vs. 3.0 [interquartile range, 3.0-4.0]; p <0.001). Conclusion  The hospitals used various procedural sedation methods for children with facial lacerations. Guidelines that consider the patient's condition and drug characteristics are needed for safe and effective sedation.

Vulvar Reconstruction Using Keystone Flaps Based on the Perforators of Three Arteries

Various flaps are used to reconstruct skin and soft tissue defects of the vulva following resection of malignancies. Whenever possible, reconstruction using local flaps is the standard treatment. Here, we describe vulvar defect reconstruction using keystone flaps. Standard keystone flaps are based on randomly located vascular perforators. However, we designed a keystone flap that includes perforators of three named arteries (the anterior labial artery of the external pudendal artery, cutaneous branches of the obturator artery, and posterior labial artery of the internal pudendal artery) and the pudendal nerve, which accompanies the internal pudendal artery. Four patients with squamous cell carcinoma and extramammary Paget's disease of the vulva underwent radical vulvectomy and keystone flaps including perforators of three arteries. Depending on the morphology of the defects, keystone flaps were used with different designs. For elliptical and unilateral vulvar defects, a standard keystone flap was designed, and for defects on both sides of the vulva, a double opposing keystone flap was used. For oval defects, the omega variant keystone flap was designed, and when the morphology of the defect needed rotation of the flap, a rotational keystone flap was designed. All the patients showed good function and sensation, with an acceptable cosmetic appearance.

The Relationship Between Thiamine Intake and Long Sleep Duration: Results From the Korea National Health and Nutrition Examination Survey

OBJECTIVES

Thiamine is thought to modify sleeping patterns, while alcohol use diminishes internal thiamine levels. We investigated the association between thiamine intake and sleep duration and explored possible heterogeneity in the effect according to alcohol use.

METHODS

In total, 15 384 participants aged 19-64 were obtained from the Korea National Health and Nutrition Examination Survey 2012-2016. Nutrient intake, including thiamine, was measured using a food frequency questionnaire. Sleep duration was measured by a self-reported questionnaire. The highest thiamine intake quartile was set as the reference group. Participants were divided into 3 groups, with 7-8 hours of daily sleep as a reference group and those who slept more or less than that as "oversleeping" and "insufficient sleeping," respectively. Multivariate logistic regression was used, adjusting for socioeconomic, medical, and nutritional factors. Additionally, participants were stratified according to high-risk alcohol use defined by the World Health Organization standards on alcohol use.

RESULTS

Low thiamine intake was associated with oversleeping (Q3: odds ratio [OR], 1.06; 95% confidence interval [CI], 0.86 to 1.32; Q2: OR, 1.24; 95% CI, 0.99 to 1.55; Q1: OR, 1.49; 95% CI, 1.16 to 1.91) and showed a significant trend for higher ORs at lower intake levels (p-trend&lt;0.001). The effect was stronger in the high-risk alcohol use group (Q1: OR, 1.78; 95% CI, 1.28 to 2.49).

CONCLUSIONS

Low thiamine intake was associated with oversleeping, and alcohol use intensified that association. These results were found in a context where overt clinical symptoms due to thiamine deficiency are considered rare. More awareness of the potential relationship of thiamine intake with oversleeping and its related risks should be considered.

Tissue Niche Miniature of Glioblastoma Patient Treated with Nano-Awakeners to Induce Suicide of Cancer Stem Cells

Patient-specific cancer therapies can evolve by vitalizing the mother tissue-like cancer niche, cellular profile, genetic signature, and drug responsiveness. This evolution has enabled the elucidation of a key mechanism along with development of the mechanism-driven therapy. After surgical treatment, glioblastoma (GBM) patients require prompt therapy within 14 days in a patient-specific manner. Hence, this study approaches direct culture of GBM patient tissue (1 mm diameter) in a microchannel network chip. Cancer vasculature-mimetic perfusion can support the preservation of the mother tissue-like characteristic signatures and microenvironment. When temozolomide and radiation are administered within 1 day, the responsiveness of the tissue in the chip reflected the clinical outcomes, thereby overcoming the time-consuming process of cell and organoid culture. When the tissue chip culture is continued, the intact GBM signature gets lost, and the outward migration of stem cells from the tissue origin increases, indicating a leaving-home effect on the family dismantle. Nanovesicle production using GBM stem cells enables self-chasing of the cells that escape the temozolomide effect owing to quiescence. The anti-PTPRZ1 peptide display and temozolomide loading to nanovesicles awakes cancer stem cells from the quiescent stage to death. This study suggests a GBM clinic-driven avatar platform and mechanism-learned nanotherapy for translation.

Patterns of anticoagulant prescribing and renal function changes in patients with atrial fibrillation

Background

The prevalence of atrial fibrillation (AF) is nearly three times higher in patients with chronic kidney disease (CKD) than the general population. These patients have an increased risk of stroke and systemic thromboembolism (SSE) as well as bleeding. The role for direct oral anticoagulants (DOACs) in those with advanced CKD and AF remains controversial. Studies show that patients on DOACs for AF with advanced CKD have similar risk of SSE and bleeding compared to those on warfarin, but these failed to account for changes in renal function over time.

Purpose

We sought to evaluate the pattern of oral anticoagulant prescribing, class switching, discontinuation and renal function trajectory in patients with AF in the last decade, coinciding with the development of DOACs.

Methods

Using linked administrative databases, we assessed patients 66 years of age and older with a new diagnosis of non-valvular AF between April 1, 2012 and March 31, 2020 who were started on oral anticoagulation within 90 days of diagnosis. Participants required a baseline serum creatinine (Cr) measurement in the year preceding AF diagnosis. Cr values were used to calculate the estimated glomerular filtration rate (eGFR) using the CKD Epidemiology Collaboration equation. Kidney function was tracked at baseline and longitudinally among patients prescribed DOACs versus warfarin using the Laboratories Information System. Anticoagulant class switching was tracked and discontinuation was defined if a new prescription for anticoagulation was not filled after 90 days of their last prescription ending.

Results

A total of 57,574 participants were included in the study; 48,662 were started on DOACs and 8,912 were started on warfarin. In April 2012, 83.8% of patients were prescribed warfarin; however, the proportion of first prescriptions significantly evolved over time to DOACs (Figure 1). Of those started on DOACs, 13,383 (27.5%) discontinued therapy, 34,918 (71.8%) remained on therapy and 361 (0.7%) switched to warfarin. The rate of discontinuation among those started on warfarin was higher with 4,144 (46.5%) stopping, 3,172 (35.6%) continuing therapy and 1,596 (17.9%) switching to DOACs. Most patients (75.6%) who switched to DOACs from warfarin remained on DOACs until the occurrence of dialysis, renal transplantation, death, or the last follow-up date (March 31, 2020). At baseline, the mean eGFR in the warfarin group was 56.2 compared with 66.3 mL/min/1.73 m2 in the DOAC group (p&lt;0.01). Over the course of study, more than half of the subjects in both groups had a 20% or more decline in eGFR (Figure 2).

Conclusion

Given the degree of renal function decline and frequency of anticoagulant class switching in our cohort, existing observational studies comparing DOACs to warfarin in patients with AF and CKD may be limited. In order to better compare DOACs to warfarin in this population, time-varying covariates like renal function should be included in modelling.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): CIHR Foundation Grant

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Post-fracture care programs for prevention of subsequent fragility fractures: a literature assessment of current trends

Post-fracture care (PFC) programs evaluate and manage patients with a minimal trauma or fragility fracture to prevent subsequent fractures. We conducted a literature review to understand current trends in PFC publications, evaluate key characteristics of PFC programs, and assess their clinical effectiveness, geographic variations, and cost-effectiveness. We performed a search for peer-reviewed articles published between January 2003 and December 2020 listed in PubMed or Google Scholar. We categorized identified articles into 4 non-mutually exclusive PFC subtopics based on keywords and abstract content: PFC Types, PFC Effectiveness/Success, PFC Geography, and PFC Economics. The literature search identified 784 eligible articles. Most articles fit into multiple PFC subtopics (PFC Types, 597; PFC Effectiveness/Success, 579; PFC Geography, 255; and PFC Economics, 98). The number of publications describing how PFC programs can improve osteoporosis treatment rates has markedly increased since 2003; however, publication gaps remain, including low numbers of publications from some countries with reported high rates of osteoporosis and/or hip fractures. Fracture liaison services and geriatric/orthogeriatric services were the most common models of PFC programs, and both were shown to be cost-effective. We identified a need to expand and refine PFC programs and to standardize patient identification and reporting on quality improvement measures. Although there is an increasing awareness of the importance of PFC programs, publication gaps remain in most countries. Improvements in established PFC programs and implementation of new PFC programs are still needed to enhance equitable patient care to prevent occurrence of subsequent fractures.

Extraordinarily aggressive cutaneous sarcomatoid squamous cell carcinoma of the face: a case report

Sarcomatoid squamous cell carcinoma (SSCC), a biphasic malignant tumor consisting of atypical squamous epithelial and mesenchymal elements mixed with epithelioid and spindle cells, is a variant of squamous cell carcinoma. Cutaneous SSCC is very rare and aggressive and has a poor prognosis. Here, we report a case of cutaneous SSCC with satellites and in-transit metastases. A 79-year-old woman presented with a protruding mass on the left temporal area sized 1.2×1.0 cm. The punch biopsy report indicated keratoacanthoma or well-differentiated squamous cell carcinoma. The size of the tumor increased to 2.7×2.0 cm after 8 days. An excisional biopsy was performed with a 2 mm safety margin. The tumor was identified as SSCC with a clear resection margin. Reoperation was performed thrice with an increased safety margin of 10 mm; however, the cancer recurred along with satellites and in-transit metastases. Chemoradiotherapy was administered; however, the size of the tumor increased along with satellites and in-transit metastases. The patient expired 162 days after the initial excision. Complete excision and immediate multidisciplinary approach should be combined during the early stages due to the aggressiveness and poor prognosis of cutaneous SSCC with satellites and in-transit metastasis.