Impact of KRASG12 mutations on survival with trifluridine/tipiracil plus bevacizumab in patients with refractory metastatic colorectal cancer: post hoc analysis of the phase III SUNLIGHT trial

BACKGROUND

In metastatic colorectal cancer (mCRC), KRAS mutations are often associated with poorer survival; however, the prognostic impact of specific point mutations is unclear. In the phase III SUNLIGHT trial, trifluridine/tipiracil (FTD/TPI) plus bevacizumab significantly improved overall survival (OS) versus FTD/TPI alone. We assessed the impact of KRASG12 mutational status on OS in SUNLIGHT.

PATIENTS AND METHODS

In the global, open-label, randomized, phase III SUNLIGHT trial, adults with mCRC who had received no more than two prior chemotherapy regimens were randomized 1 : 1 to receive FTD/TPI alone or FTD/TPI plus bevacizumab. In this post hoc analysis, OS was assessed according to the presence or absence of a KRASG12 mutation in the overall population and in patients with RAS-mutated tumors.

RESULTS

Overall, 450 patients were analyzed, including 302 patients in the RAS mutation subgroup (214 with a KRASG12 mutation and 88 with a non-KRASG12RAS mutation). In the overall population, similar OS outcomes were observed in patients with and without a KRASG12 mutation [median 8.3 and 9.2 months, respectively; hazard ratio (HR) 1.09, 95% confidence interval (CI) 0.87-1.4]. Similar OS outcomes were also observed in the subgroup analysis of patients with a KRASG12 mutation versus those with a non-KRASG12RAS mutation (HR 1.03, 95% CI 0.76-1.4). FTD/TPI plus bevacizumab improved OS compared with FTD/TPI alone irrespective of KRASG12 mutational status. Among patients with a KRASG12 mutation, the median OS was 9.4 months with FTD/TPI plus bevacizumab versus 7.2 months with FTD/TPI alone (HR 0.67, 95% CI 0.48-0.93), and in patients without a KRASG12 mutation, the median OS was 11.3 versus 7.1 months, respectively (HR 0.59, 95% CI 0.43-0.81).

CONCLUSIONS

The presence of a KRASG12 mutation had no detrimental effect on OS among patients treated in SUNLIGHT. The benefit of FTD/TPI plus bevacizumab over FTD/TPI alone was confirmed independently of KRASG12 status.

588 An Audit on CT Staging of Patients Prior To Robotically Assisted Radical Cystectomy

Introduction

Muscle invasive bladder cancer(MIBC) is a complex disease requiring aggressive management. CT of the Thorax, Abdomen and pelvis is the optimal form of staging including CT urography for complete examination, according to the European Association of Urology. Cure is unlikely in the presence of metastases. The aim was to assess if patients were appropriately staged prior to Robotically Assisted Radical Cystectomy (RARC)

Method

Retrospective review of medical records of all RARC between Jan 2020 – June 2020 at our district general hospital. Demographics, date of cystectomies and date of imaging was collected.

Results

Seventeen patients were recruited. Median age of patients was 73years and the male to female ratio was 7:3. All (100%) of them had CT Thorax, abdomen and pelvis done prior to RARC. Of the patients studied 24% of them did not have CT Urography done. CT staging of 53% of patients was within 30 days prior to Cystectomy, 35% had CT staging between 30 – 90 days and 12% had CT staging between 90 and 200 days.

Conclusions

Findings showed good adherence to the guidelines requiring CT staging prior to RARC. To prevent understaging of MIBC prior to RARC, clarifications of timeframe between CT staging and RARC is required.

Transjugular Intrahepatic Portosystemic Shunt for Very Severe Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome (VOD/SOS) after Unmanipulated Haploidentical Hematopoietic Stem Cell Transplantation with Post-transplantation Cyclophosphamide

Hepatic veno-occlusive disease or sinusoidal obstruction syndrome (VOD/SOS) is a threatening complication after both autologous and allogeneic hematopoietic stem cell transplantation (HSCT), with high mortality rates despite early medical treatment, including the use of defibrotide (DF). We retrospectively analyzed 185 unmanipulated haploidentical (haplo-) HSCT with post-transplantation cyclophosphamide as graft-versus-host disease prophylaxis performed consecutively between 2011 and June 2019 in a single center. Seventeen patients (9.2%) were diagnosed with VOD/SOS. Based on revised European Society for Blood and Marrow Transplantation severity criteria, the VOD/SOS cases were classified as mild in 2 patients (11.7%), moderate in 2 (11.7%), severe in 2 (11.7%), and very severe in 11 (64.9%). Thirteen patients (76%) were treated with DF, including all patients with severe or very severe VOD/SOS, except 1 patient with CNS hemorrhage. Sixteen patients (94%) were alive at day +100 after HSCT. Seven patients (41%) with very severe VOD/SOS were treated with transjugular intrahepatic portosystemic shunt (TIPS) owing to rapid clinical or analytical deterioration or refractory hepatorenal syndrome despite medical treatment, including DF. TIPS insertion was performed at a median time since VOD/SOS diagnosis of 4 days (range, 1 to 28 days) without technical complications in any case. The median hepatic venous pressure gradient before and after TIPS treatment was 24 mmHg (range, 14 to 29 mmHg) and 7 mmHg (range, 2 to 11 mmHg), respectively, with a median drop of 16 mmHg (range, 9 to 19 mmHg). Following TIPS insertion, all patients showed clinical improvement with hepatomegaly, ascites, and renal failure resolution, and all showed analytical improvement with reduced alanine aminotransferase (ALT), creatinine, and international normalized ratio values, except for patient 2, whose indication for TIPS was refractory hepatorenal syndrome with a normal ALT level. The 6 patients who had initiated DF before TIPS insertion completed 21 days of treatment. All patients met the criteria for complete remission (CR) at a median of 8 days after TIPS insertion (range, 2 to 82 days). The 100-day overall survival was 100%. For patients with rapid progressive VOD/SOS, early TIPS insertion allowed completion of DF therapy. The use of TIPS together with DF resulted in CR and no associated complications with no VOD/SOS-associated mortality despite high severity. In our experience, timely and individualized use of TIPS significantly improves outcomes of very severe VOD/SOS after haplo-HSCT. Therefore, TIPS should be promptly considered in rapidly progressive cases.

Unravelling the polarity of InN quantum dots using a modified approach of negative-spherical-aberration imaging

InN quantum dots (QDs) are considered to be promising nanostructures for different device applications. For any hexagonal AB-stacking semiconductor system, polarity is an important feature which affects the electronic properties. Therefore, the determination of this characteristic on any wurtzite (semi)polar III-N compound or alloy is essential for defining its applicability. In this paper, the polarity of InN QDs grown on silicon by indium droplet epitaxy plus nitridation and annealing was determined by a modified approach combining exit wave reconstruction with negative-spherical-aberration high-resolution lattice imaging using TEM. Comparing the micrographs of two QDs from the same TEM specimen with the simulated images of InN slab structures generated under the same conditions as of the experiments, it was confirmed that the QDs of the present study are N polar. Given that the settlement of material's polarity has always been a tedious, indirect and controversial issue, the major value of our proposal is to provide a straightforward procedure to determine the polar direction from atomic-resolution focal series images.

Electron Tomography of Pencil-Shaped GaN/(In,Ga)N Core-Shell Nanowires

The three-dimensional structure of GaN/(In,Ga)N core-shell nanowires with multi-faceted pencil-shaped apex is analyzed by electron tomography using high-angle annular dark-field mode in a scanning transmission electron microscope. Selective area growth on GaN-on-sapphire templates using a patterned mask is performed by molecular beam epitaxy to obtain ordered arrays of uniform nanowires. Our results of the tomographic reconstruction allow the detailed determination of the complex morphology of the inner (In,Ga)N multi-faceted shell structure and its deviation from the perfect hexagonal symmetry. The tomogram unambiguously identifies a dot-in-a-wire configuration at the nanowire apex including the exact shape and size, as well as the spatial distribution of its chemical composition.

Using a new device to prevent pulmonary embolisms during pharmacomechanical thrombectomy

We have used a new device to prevent pulmonary embolism during pharmacomechanical thrombectomy in a 25-year-old postpartum woman. The Angel® catheter (BiO2 Medical Inc., Golden, CO, USA) is a temporary device that combines the functions of a vena cava filter (VCF) with those of a triple-lumen central venous catheter. Normally, a VCF is implanted to prevent pulmonary embolism during pharmacomechanical thrombectomy. However, the complications associated with VCFs increase with time, not all of the filter can always be retrieved, and there can be iatrogenic effects both during implantation and retrieval. In our experience, this new device is much simpler to deploy and to retrieve. As is shown in this case, this temporary device can be an interesting alternative to a VCF for preventing pulmonary embolisms during pharmacomechanical thrombectomy.

First-in-class inhibitor of the T cell receptor for the treatment of autoimmune diseases

Modulating T cell activation is critical for treating autoimmune diseases but requires avoiding concomitant opportunistic infections. Antigen binding to the T cell receptor (TCR) triggers the recruitment of the cytosolic adaptor protein Nck to a proline-rich sequence in the cytoplasmic tail of the TCR's CD3ε subunit. Through virtual screening and using combinatorial chemistry, we have generated an orally available, low-molecular weight inhibitor of the TCR-Nck interaction that selectively inhibits TCR-triggered T cell activation with an IC₅₀ (median inhibitory concentration) ~1 nM. By modulating TCR signaling, the inhibitor prevented the development of psoriasis and asthma and, furthermore, exerted a long-lasting therapeutic effect in a model of autoimmune encephalomyelitis. However, it did not prevent the generation of a protective memory response against a mouse pathogen, suggesting that the compound might not exert its effects through immunosuppression. These results suggest that inhibiting an immediate TCR signal has promise for treating a broad spectrum of human T cell-mediated autoimmune and inflammatory diseases.

Selective area growth of AlN/GaN nanocolumns on (0001) and (11-22) GaN/sapphire for semi-polar and non-polar AlN pseudo-templates

Despite the strong interest in optoelectronic devices working in the deep ultraviolet range, no suitable low cost, large-area, high-quality AlN substrates have been available up to now. The aim of this work is the selective area growth of AlN nanocolumns by plasma assisted molecular beam epitaxy on polar (0001) and semi-polar (11-22) GaN/sapphire templates. The resulting AlN nanocolumns are vertically oriented with semi-polar {1-103} top facets when grown on (0001) GaN/sapphire, or oriented at 58° from the template normal and exposing {1-100} non-polar top facets when growing on (11-22) GaN/sapphire, in both cases reaching filling factors ≥80%. In these kinds of arrays each nanostructure could function as a building block for an individual nano-device or, due to the large filling factor values, the overall array top surfaces could be seen as a quasi (semi-polar or non-polar) AlN pseudo-template.

Quantitative parameters for the examination of InGaN QW multilayers by low-loss EELS

We present a detailed examination of a multiple InxGa1-xN quantum well (QW) structure for optoelectronic applications. The characterization is carried out using scanning transmission electron microscopy (STEM), combining high-angle annular dark field (HAADF) imaging and electron energy loss spectroscopy (EELS). Fluctuations in the QW thickness and composition are observed in atomic resolution images. The impact of these small changes on the electronic properties of the semiconductor material is measured through spatially localized low-loss EELS, obtaining band gap and plasmon energy values. Because of the small size of the InGaN QW layers additional effects hinder the analysis. Hence, additional parameters were explored, which can be assessed using the same EELS data and give further information. For instance, plasmon width was studied using a model-based fit approach to the plasmon peak; observing a broadening of this peak can be related to the chemical and structural inhomogeneity in the InGaN QW layers. Additionally, Kramers-Kronig analysis (KKA) was used to calculate the complex dielectric function (CDF) from the EELS spectrum images (SIs). After this analysis, the electron effective mass and the sample absolute thickness were obtained, and an alternative method for the assessment of plasmon energy was demonstrated. Also after KKA, the normalization of the energy-loss spectrum allows us to analyze the Ga 3d transition, which provides additional chemical information at great spatial resolution. Each one of these methods is presented in this work together with a critical discussion of their advantages and drawbacks.

[Nephrectomies in poor or non-functioning kidneys. Is it the right thing to do?]

AIM OF THE STUDY

To review our management and outcomes of nephrectomies performed in patients with non-functioning kidneys.

METHODS

Retrospective analysis of the patients who underwent nephrectomy surgery in our hospital between 2010 and 2014. Data was collected from the patient charts paying special attention to the clinical resolution of the symptoms that motivated surgery.

MAIN RESULTS

A total of 18 nephrectomies were performed. Median age was of 6,5 years (range: 11 months to 15 years). Surgery was indicated by recurrent urinary tract infections (UTI) in 7 cases, renovascular hypertension (RHT) in 5, pain in 2, increasing size in 2 and parents' preference due to poor compliance with follow up in 2 patients. 16 nephrectomies were performed laparoscopically and 2 were open procedures. Median hospital length of stay was 48 hours. Complication rate was 5.55% both for the intraoperatively (1 case of bleeding) and post operatively (1 case of subcutaneous emphysema). Signs and symptoms were successfully resolved in all cases except for 3, 2 patients had an UTI and 1 persistent RHT.

CONCLUSIONS

Nephrectomy is a safe surgical procedure in children with a low rate of complications. An appropriate selection of the cases and a thorough preoperative multidisciplinary assessment are essential aspects to obtain good clinical results and to avoid post-operative complications.

Titanium induced polarity inversion in ordered (In,Ga)N/GaN nanocolumns

We report on the formation of polarity inversion in ordered (In,Ga)N/GaN nanocolumns grown on a Ti-masked GaN-buffered sapphire substrate by plasma assisted molecular beam epitaxy. High-resolution transmission electron microscopy and electron energy-loss spectroscopy reveal a stacking fault-like planar defect at the homoepitaxial GaN interface due to Ti incorporation, triggering the generation of N-polar domains in Ga-polar nanocolumns. Density functional theory calculations are applied to clarify the atomic configurations of a Ti monolayer occupation on the GaN (0002) plane and to prove the inversion effect. The polarity inversion leads to an enhanced indium incorporation in the subsequent (In,Ga)N segment of the nanocolumn. This study provides a deeper understanding of the effects of Ti mask in the well-controlled selective area growth of (In,Ga)N/GaN nanocolumns.

Distinguishing cubic and hexagonal phases within InGaN/GaN microstructures using electron energy loss spectroscopy

3D InGaN/GaN microstructures grown by metal organic vapor phase epitaxy (MOVPE) and molecular beam epitaxy (MBE) have been extensively studied using a range of electron microscopy techniques. The growth of material by MBE has led to the growth of cubic GaN material. The changes in these crystal phases has been investigated by Electron Energy Loss Spectroscopy, where the variations in the fine structure of the N K‐edge shows a clear difference allowing the mapping of the phases to take place. GaN layers grown for light emitting devices sometimes have cubic inclusions in the normally hexagonal wurtzite structures, which can influence the device electronic properties. Differences in the fine structure of the N K‐edge between cubic and hexagonal material in electron energy loss spectra are used to map cubic and hexagonal regions in a GaN/InGaN microcolumnar device. The method of mapping is explained, and the factors limiting spatial resolution are discussed.

Formation mechanisms of GaN nanowires grown by selective area growth homoepitaxy

This work provides experimental evidence and theoretical explanations regarding the formation mechanisms of GaN nanowires grown by selective area growth on GaN-on-sapphire templates. The first growth stage, driven by selective area growth kinetics, consists of initial nucleation (along the nanohole inner periphery), coalescence onset and full coalescence, producing a single nanocrystal within each nanohole. In the second growth stage, driven by free-surface-energy minimization, the formed nanocrystal undergoes morphological evolution, exhibiting initial cylindrical-like shape, intermediate dodecagonal shape and a final, thermodynamically stable hexagonal shape. From this point on, the nanowire vertical growth proceeds while keeping the stable hexagonal form.

Light-emitting-diodes based on ordered InGaN nanocolumns emitting in the blue, green and yellow spectral range

The growth of ordered arrays of InGaN/GaN nanocolumnar light emitting diodes by molecular beam epitaxy, emitting in the blue (441 nm), green (502 nm), and yellow (568 nm) spectral range is reported. The device active region, consisting of a nanocolumnar InGaN section of nominally constant composition and 250 to 500 nm length, is free of extended defects, which is in strong contrast to InGaN (planar) layers of similar composition and thickness. Electroluminescence spectra show a very small blue shift with increasing current (almost negligible in the yellow device) and line widths slightly broader than those of state-of-the-art InGaN quantum wells.

Investigation of III-V nanowires by plan-view transmission electron microscopy: InN case study

We discuss observations of InN nanowires (NWs) by plan-view high-resolution transmission electron microscopy (TEM). The main difficulties arise from suitable methods available for plan-view specimen preparation. We explore different approaches and find that the best results are obtained using a refined preparation method based on the conventional procedure for plan-view TEM of thin films, specifically modified for the NW morphology. The fundamental aspects of such a preparation are the initial mechanical stabilization of the NWs and the minimization of the ion-milling process after dimpling the samples until perforation. The combined analysis by plan-view and cross-sectional TEM of the NWs allows determination of the degree of strain relaxation and reveals the formation of an unintentional shell layer (2-3-nm thick) around the InN NWs. The shell layer is composed of bcc In2O3 nanocrystals with a preferred orientation with respect to the wurtzite InN: In2O3 [111] || InN [0001] and In2O3<110>||InN<1120>.

Luminescence of Be-doped GaN layers grown by molecular beam epitaxy on Si (111)

Low temperature photoluminescence spectra of Be-doped layers grown on Si (111) by molecular beam epitaxy have been analyzed. Emissions at 3.466 eV and 3.384 eV, and a broad band centered at 2.4-2.5 eV are observed. Their evolution with temperature and excitation power, and time resolved PL measurements ascribe an excitonic character for the luminescence at 3.466 eV, whereas the emission at 3.384 eV is associated with a donor-acceptor pair transition. This recombination involves residual donors and Be-related acceptors, which are located around 90meV above the valence band, confirming Be as the shallowest acceptor reported in GaN. The intensity of the band at 2.4-2.5 eV increases with the Be content. This emission involves a band of deep acceptors generated by Be complex defects, as suggested by the parameter g = 2.008 ± 0.003 obtained by photoluminescence-detected electron paramagnetic resonance.

Yellow Band and Deep levels in Undoped MOVPE GaN

Undoped layers of GaN grown by MOVPE on sapphire substrates have been characterized by photoluminescence, photocapacitance and photoinduced current transient spectroscopy (PICTS). Photocapacitance reveals in all samples two specific signatures at photon energies of 1 eV and 2.5 eV. The photocapacitance decrease observed at 1 eV seems to be due to an electron capture process from the valence band, whereas the capacitance increase at 2.5 eV is related to an electron emission process. The fact that the capacitance step at 1 eV is only seen after photoionization at energies above 2.5 eV, and the observed correlation between its amplitude and the photoluminescence intensity of the “yellow band”, lead us to conclude that both transitions are linked to the same trap, which is also suggested to be responsible for the yellow band. The position of this trap, at 2.5 eV below the conduction band, is confirmed by PICTS measurements, that show a hole thermal emission activation energy of 0.9 eV at 350 K.

Yellow luminescence in Mg-doped GaN

Optical thresholds, that correspond to a level located at 1 eV above the valence band, are observed by photocapacitance techniques in n-type Mg-doped GaN. In undoped GaN, this level has been previously related to the yellow emission detected by photoluminescence. In Mg-doped GaN, this yellow luminescence is only observed for excitation energies below the Mg-related band (2.9 - 3 eV). This result evidences that Mg-doping may reduce but not avoid the formation of the yellow band related defects in n-type and semiinsulating Mg-doped samples. The fact that the yellow luminescence is not observed for excitation energies above the bandgap may be justified by a higher efficiency of the Mg-related recombination path.

Study of high quality AlN layers grown on Si(111) substrates by plasma-assisted molecular beam epitaxy

High quality AlN layers with full widths at half maximum values of 10 arcmin and average surface roughness (rms) of 48Å were grown by molecular beam epitaxy on Si(111) substrates. A systematic study and optimization of the growth conditions was performed in order to use these AlN layers as buffers in the growth of GaN films. Atomic force microscopy (AFM) and X-ray diffraction (XRD) techniques were employed to determine the surface and structural quality of the layers. Best AlN films were obtained at high substrate temperatures (Tsubs>900°C) and III/V ratios close to stoichiometry. Growth conditions with III/V ratios beyond stoichiometry (Al-rich) did not further improve the crystal quality. In these cases a higher substrate temperature is needed to prevent condensation of Al on the surface. GaN films with full width at half maximum of 10 arcmin and improved optical properties were grown on top of optimized AlN buffer layers.

XPS study of Au/GaN and Pt/GaN contacts

Au/GaN and Pt/GaN contacts have been studied with XPS. According to XPS depth profiling, the N signal is weak in the region below the metal contact and the Pt or Au signal decreases much more slowly than expected for a sharp interface. Next, we have performed in situ studies of the formation of Au contacts on GaN. In contrast to the results from depth profiling, we observe 2D growth and little or no chemical interaction between Au and GaN. This suggests that conventional calculations of sputtering yields and ion-beam-induced mixing cannot be applied to the analysis of noble metal/GaN depth profiles. Heating during or after Au deposition results in strong clustering, observed by both XPS and AFM. The Schottky barrier height measured by XPS is 1.15 eV.

Characterization and Modeling of Photoconductive GaN Ultraviolet Detectors

In this work high gain GaN photoconductive UV detectors have been fabricated and characterized, and a novel gain mechanism, dominant in these detectors, is described. DC responsivities higher than 103A/W have been measured for an incident power of lW/m2 at room temperature. The photoconductive gain depends directly on the bias voltage and scales with incident power as P−k (k ≈ 0.9) for more than five decades. A decrease of both gain and k parameter with temperature has also been observed. As a consequence of the slow non-exponential transient response, AC gain measurements result in lower values for gain and k parameter, which are frequency dependent. The high responsivity, non-linear behavior and slow non-exponential transient response, are all modeled taking into account a modulation mechanism of the layer conductive volume. Such spatial modulation is due to the photovoltaic response of the potential barriers related to the surface and charged dislocations arrays.

Crystal Morphology and Optical Emissions of GaN layers grown on Si(111) substrates by Molecular Beam Epitaxy

Crystal morphology of GaN layers grown on Si(111) evolves from whisker-like microcrystals to compact films as a function of the III/V ratio. Small changes in the III/V ratio (from Ga-rich to N-rich) during the growth of a compact layer result in the appearance of microcrystals on the top of the layer, indicating a sharp transition between the two growth regimes.

Four different morphologies are obtained by increasing the III/V ratio: a) completely columnar whisker-like samples exhibiting a pair of intense excitonic emissions at 3.471−3.478 eV; b) a mixture of compact regions with columnar microcrystals showing two pairs of excitonic emissionsnbsp c) compact layers with very small microcrystals on the top surface with a weaker dominant transition at 3.415 eV (±5meV) and, d) full compact and smooth layers with a single dominant excitonic emission at 3.466 eV. A combination of PL measurements with SEM photographs and CL imaging reveals that both pairs of emissions in samples b) come from the columnar microcrystals. The high energy pair (3.471−3.478eV) is attributed to the free-exciton A and a donor-bound exciton while the low energy pair (3.452−3.458eV) is assigned to acceptor-bound excitons associated to valence bands Γ9v and Γ7uv. Power and temperature dependence together with time-resolved data show that the dominant peak at 3.415eV (± 5meV) present in samples c) correspond to a donor-acceptor transition. CL measurements as a function of electron beam energy (depth) also indicate that this emission is more intense towards the interface between the layer and the sample. Finally, the excitonic emission in samples d) is shifted to lower energies due to residual biaxial tensile strain of thermal origin.

Vesical schistosomiasis with terminal hematuria in sub-Saharan patients

OBJECTIVES

To know the characteristics of vesical schistosomiasis caused by schistosoma hematobium in immigrant patients.

MATERIAL AND METHODS

The retrospective study of 41 cases microbiologically diagnosed in our hospital over the last 16 years is presented. Data was collected on origin, age, presentation form, diagnostic tests and treatment.

RESULTS

All were African patients whose ages ranged from 4 to 32 years and who had terminal macroscopic hematuria. Most of the patients (85%) were men. In all of the cases, diagnosis was by a urinary microbiological study and in one case, cystoscopy with a biopsy of a typical vesical lesion. Terminal hematuria is the most representative clinical sign. They were treated with praziquantel.

CONCLUSIONS

The epidemiology and intermittent terminal hematuria in African patients should lead to the suspicion of vesical schistosomiasis as the first diagnostic option. Urinary microbiological study is a rapid, non-invasive, test with high diagnostic yield that would avoid performing invasive studies. Its simple treatment assures high level of compliance and consequent efficacy.

β-Arrestin-1 mediates the TCR-triggered re-routing of distal receptors to the immunological synapse by a PKC-mediated mechanism

T-cell receptors (TCR) recognize their antigen ligand at the interface between T cells and antigen-presenting cells, known as the immunological synapse (IS). The IS provides a means of sustaining the TCR signal which requires the continual supply of new TCRs. These are endocytosed and redirected from distal membrane locations to the IS. In our search for novel cytoplasmic effectors, we have identified β-arrestin-1 as a ligand of non-phosphorylated resting TCRs. Using dominant-negative and knockdown approaches we demonstrate that β-arrestin-1 is required for the internalization and downregulation of non-engaged bystander TCRs. Furthermore, TCR triggering provokes the β-arrestin-1-mediated downregulation of the G-protein coupled chemokine receptor CXCR4, but not of other control receptors. We demonstrate that β-arrestin-1 recruitment to the TCR, and bystander TCR and CXCR4 downregulation, are mechanistically mediated by the TCR-triggered PKC-mediated phosphorylation of β-arrestin-1 at Ser163. This mechanism allows the first triggered TCRs to deliver a stop migration signal, and to promote the internalization of distal TCRs and CXCR4 and their translocation to the IS. This receptor crosstalk mechanism is critical to sustain the TCR signal.

Self-regulated radius of spontaneously formed GaN nanowires in molecular beam epitaxy

We investigate the axial and radial growth of GaN nanowires upon a variation of the Ga flux during molecular beam epitaxial growth. An increase in the Ga flux promotes radial growth without affecting the axial growth rate. In contrast, a decrease in the Ga flux reduces the axial growth rate without any change in the radius. These results are explained by a kinetic growth model that accounts for both the diffusion of Ga adatoms along the side facets toward the nanowire tip and the finite amount of active N available for the growth. The model explains the formation of a new equilibrium nanowire radius after increasing the Ga flux and provides an explanation for two well-known but so far not understood experimental facts: the necessity of effectively N-rich conditions for the spontaneous growth of GaN nanowires and the increase in nanowire radius with increasing III/V flux ratio.

Insight into the compositional and structural nano features of AlN/GaN DBRs by EELS-HAADF

III-V nitride (AlGa)N distributed Bragg reflector devices are characterized by combined high-angle annular dark-field (HAADF) and electron energy loss spectroscopy (EELS) in the scanning transmission electron microscope. Besides the complete structural characterization of the AlN and GaN layers, the formation of AlGaN transient layers is revealed using Vegard law on profiles of the position of the bulk plasmon peak maximum. This result is confirmed by comparison of experimental and simulated HAADF intensities. In addition, we present an advantageous method for the characterization of nano-feature structures using low-loss EELS spectrum image (EEL-SI) analysis. Information from the materials in the sample is extracted from these EEL-SI at high spatial resolution.The log-ratio formula is used to calculate the relative thickness, related to the electron inelastic mean free path. Fitting of the bulk plasmon is performed using a damped plasmon model (DPM) equation. The maximum of this peak is related to the chemical composition variation using the previous Vegard law analysis. In addition, within the context of the DPM, information regarding the structural properties of the material can be obtained from the lifetime of the oscillation. Three anomalous segregation regions are characterized, revealing formation of metallic Al islands.

Selective area growth of In(Ga)N/GaN nanocolumns by molecular beam epitaxy on GaN-buffered Si(111): from ultraviolet to infrared emission

Selective area growth of In(Ga)N/GaN nanocolumns was performed on GaN-buffered Si(111) substrates by plasma-assisted molecular beam epitaxy. Undoped and Si-doped GaN buffer layers were first grown on Si(111) substrates, showing photoluminescence excitonic emission without traces of other low energy contributions, in particular, the yellow band. The GaN buffer surface roughness (between 10 and 14 nm, the rms value in a 10 × 10 μm(2) area) was low enough to allow the fabrication of a thin (7 nm thick) well defined Ti nanohole mask, for the selective area growth. Ordered In(Ga)N/GaN nanocolumns emitting from the ultraviolet (3.2 eV) to the infrared (0.78 eV) were obtained. The morphology and the emission efficiency of the In(Ga)N/GaN nanocolumns emitting at a given wavelength could be substantially improved by tuning the In/Ga and total III/N ratios. An estimated internal quantum efficiency of 36% was derived from photoluminescence data for green emitting nanocolumns.

Plasmon excitation in electron energy-loss spectroscopy for determination of indium concentration in (In,Ga)N/GaN nanowires

We demonstrate the potential of low-loss electron energy-loss spectroscopy in transmission electron microscopy as a quick and straightforward method to determine the local indium compositions in (In,Ga)N/GaN nanowires. The (In,Ga)N/GaN nanowire heterostructures are grown by plasma assisted molecular beam epitaxy on Si(111) substrates in a self-assembled way, and on patterned GaN templates in an ordered way. A wide range of indium contents is realized by varying the substrate temperatures. The plasmon peak in low-loss electron energy-loss spectroscopy exhibits a linear relation with respect to indium concentration in (In,Ga)N nanowires, allowing for a direct compositional analysis. The high spatial resolution of this method in combination with structural information from transmission electron microscopy will contribute to a basic understanding of the lattice pulling effect during (In,Ga)N/GaN nanowire growth.

Optoelectronic properties of InAlN/GaN distributed bragg reflector heterostructure examined by valence electron energy loss spectroscopy

High-resolution monochromated electron energy loss spectroscopy (EELS) at subnanometric spatial resolution and <200 meV energy resolution has been used to assess the valence band properties of a distributed Bragg reflector multilayer heterostructure composed of InAlN lattice matched to GaN. This work thoroughly presents the collection of methods and computational tools put together for this task. Among these are zero-loss-peak subtraction and nonlinear fitting tools, and theoretical modeling of the electron scattering distribution. EELS analysis allows retrieval of a great amount of information: indium concentration in the InAlN layers is monitored through the local plasmon energy position and calculated using a bowing parameter version of Vegard Law. Also a dielectric characterization of the InAlN and GaN layers has been performed through Kramers-Kronig analysis of the Valence-EELS data, allowing band gap energy to be measured and an insight on the polytypism of the GaN layers.

Critical aspects of substrate nanopatterning for the ordered growth of GaN nanocolumns

Precise and reproducible surface nanopatterning is the key for a successful ordered growth of GaN nanocolumns. In this work, we point out the main technological issues related to the patterning process, mainly surface roughness and cleaning, and mask adhesion to the substrate. We found that each of these factors, process-related, has a dramatic impact on the subsequent selective growth of the columns inside the patterned holes. We compare the performance of e-beam lithography, colloidal lithography, and focused ion beam in the fabrication of hole-patterned masks for ordered columnar growth. These results are applicable to the ordered growth of nanocolumns of different materials.

Polarity determination by electron energy-loss spectroscopy: application to ultra-small III-nitride semiconductor nanocolumns

Channeling-enhanced electron energy-loss spectroscopy is applied to determine the polarity of ultra-small nitride semiconductor nanocolumns in transmission electron microscopy. The technique demonstrates some practical advantages in the nanostructure analysis, especially for feature sizes of less than 50 nm. We have studied GaN and (Al, Ga)N nanocolumns grown in a self-assembled way by molecular beam epitaxy directly on bare Si(111) substrates and on AlN buffer layers, respectively. The GaN nanocolumns on Si show an N polarity, while the (Al, Ga)N nanocolumns on an AlN buffer exhibit a Ga polarity. The different polarities of nanocolumns grown in a similar procedure are interpreted in terms of the specific interface bonding configurations. Our investigation contributes to the understanding of polarity control in III-nitride nanocolumn growth.

Thrombosed aneurysm of ductus arteriosus: a case report

Spontaneous aneurysms of the ductus arteriosus are rare complications of a patent ductus arteriosus. It is met at any age but it is most commonly seen in children under two months of age. Echocardiography is the best test to diagnose a ductus arteriosus, but actually the role of thoracoscopy is to help in differential diagnosis of mediastinal masses. Surgery should be recommended without delay, to avoid fatal complications, with the resection of the thrombosed aneurysm of the ductus arteriosus.

Columnar AlGaN/GaN nanocavities with AlN/GaN Bragg reflectors grown by molecular beam epitaxy on Si(111)

Self-assembled columnar AlGaN/GaN nanocavities, with an active region of GaN quantum disks embedded in an AlGaN nanocolumn and cladded by top and bottom AlN/GaN Bragg mirrors, were grown. The nanocavity has no cracks or extended defects, due to the relaxation at the Si interface and to the nanocolumn free-surface to volume ratio. The emission from the active region matched the peak reflectivity by tuning the Al content and the GaN disks thickness. Quantum confinement effects that depend on both the disk thickness and the inhomogeneous strain distribution within the disks are clearly observed.

Lack of correlation of functional scintigraphy with (99m)technetium-methoxyisobutylisonitrile with histological necrosis following induction chemotherapy or measures of P-glycoprotein expression in high-grade osteosarcoma

In osteosarcoma, some studies have suggested P-glycoprotein expression is a prognostic factor. The clearance of (99m)technetium hexakis-2-methoxyisobutylisonitrile ((99m)Tc-MIBI) has been used in some tumor systems as an in vivo measure of P-glycoprotein-mediated efflux. In this study we explored the correlation between (99m)Tc-MIBI clearance and histological necrosis following induction chemotherapy and P-glycoprotein expression in osteosarcoma. The primary tumors of 20 patients with high-grade osteosarcoma were imaged at diagnosis with (99m)Tc-MIBI, and the uptake ratios and biological half-lives were calculated. P-Glycoprotein expression in the tumor tissue was determined immunohistochemically and by measuring mRNA expression of the multidrug resistance-1 gene. The histological necrosis following induction chemotherapy was assessed by the Huvos grading system. The biological half-life of (99m)Tc-MIBI ranged from 1.4 to 52.5 h. Seven of the 20 tumor samples had a favorable extent of necrosis following induction chemotherapy. The (99m)Tc-MIBI half-life and uptake ratio showed no correlation with histological necrosis following induction chemotherapy. The (99m)Tc-MIBI half-life and uptake ratio did not correlate with either measure of P-glycoprotein expression. The results of this pilot study indicate that (99m)Tc-MIBI imaging is not an effective predictor of histological necrosis following induction chemotherapy in high-grade osteosarcoma. (99m)Tc-MIBI imaging did not correlate with measures of P-glycoprotein expression in the tumor tissue.

United States multicenter study of arsenic trioxide in relapsed acute promyelocytic leukemia

PURPOSE

To determine the safety and efficacy of arsenic trioxide (ATO) in patients with relapsed acute promyelocytic leukemia (APL).

PATIENTS AND METHODS

Forty patients experiencing first (n = 21) or > or = second (n = 19) relapse were treated with daily infusions of ATO to a maximum of 60 doses or until all leukemic cells in bone marrow were eliminated. Patients who achieved a complete remission (CR) were offered one consolidation course of ATO that began 3 to 4 weeks later. Patients who remained in CR were eligible to receive further cycles of ATO therapy on a maintenance study.

RESULTS

Thirty-four patients (85%) achieved a CR. Thirty-one patients (91%) with CRs had posttreatment cytogenetic tests negative for t(15;17). Eighty-six percent of the patients who were assessable by reverse transcriptase polymerase chain reaction converted from positive to negative for the promyelocytic leukemia/retinoic acid receptor-alpha transcript by the completion of their consolidation therapy. Thirty-two patients received consolidation therapy, and 18 received additional ATO as maintenance. Eleven patients underwent allogeneic (n = 8) or autologous (n = 3) transplant after ATO treatment. The 18-month overall and relapse-free survival (RFS) estimates were 66% and 56%, respectively. Twenty patients (50%) had leukocytosis (> 10,000 WBC/microL) during induction therapy. Ten patients developed signs or symptoms suggestive of the APL syndrome and were effectively treated with dexamethasone. Electrocardiographic QT prolongation was common (63%). One patient had an absolute QT interval of > 500 msec and had an asymptomatic 7-beat run of torsades de pointe. Two patients died during induction, neither from drug-related causes.

CONCLUSION

This study establishes ATO as a highly effective therapy for patients with relapsed APL.

Topotecan combined with myeloablative doses of thiotepa and carboplatin for neuroblastoma, brain tumors, and other poor-risk solid tumors in children and young adults

Topotecan appears to be relatively unaffected by the most common multidrug resistance mechanisms, may potentiate cytotoxicity of alkylators, has good penetration into the central nervous system, is active against a variety of neoplasms, and has myelosuppression as its paramount toxicity. We present our experience with a myeloablative regimen that includes topotecan. Twenty-one patients with poor-prognosis tumors and intact function of key organs received topotecan 2 mg/m2 by 30-min intravenous (i.v.) infusion on days -8, -7, -6, -5, -4; thiotepa 300 mg/m2 by 3 h i.v. infusion on days -8, -7, -6; and carboplatin by 4 h i.v. infusion on days -5, -4, -3 with a daily dose derived from the pediatric Calvert formula, using a targeted area under the curve of seven mg/ml* min ( approximately 500 mg/m2/day). Stem cell rescue was on day 0. The patients were 1 to 29 (median 4) years old; 18 were in complete remission (CR) and three in partial remission (PR). Early toxicities were severe mucositis and erythema with superficial peeling in all patients and a seizure, hypertension, and renal insufficiency followed by veno-occlusive disease in one patient each. Post-transplant treatment included radiotherapy alone (four patients) or plus biological agents (11 patients with neuroblastoma). With a follow-up of 6+ to 32+ (median 11+) months, event-free survivors include 10/11 neuroblastoma patients (first CR), 4/5 brain tumor patients (second PR or CR), 1/3 patients with metastatic Ewing's sarcoma (first or second CR), and a patient transplanted for multiply recurrent immature ovarian teratoma; a patient with desmoplastic small round-cell tumor (second PR) had progressive disease at 8 months. Favorable results for disease control, manageable toxicity, and the antitumor profiles of topotecan, thiotepa, and carboplatin, support use of this three-drug regimen in the treatment of neuroblastoma and brain tumors; applicability to other tumors is still uncertain.

Is it necessary to test patients with immune thrombocytopenic purpura (ITP) for seropositivity to HTLV-1?

HTLV-111 (HIV-1) has been shown to be associated with thrombocytopenia of a type resembling immune thrombocytopenic purpura (ITP). HTLV-1 is a retrovirus similar to HIV-I (HTLV-III) in a number of features, such as CD4 tropism. It is responsible for several clinical entities, including adult T-cell leukemia/lymphoma. The relationship, if any, of HTLV-1 and thrombocytopenia has not been systematically studied. To determine how frequently ITP patients are commonly infected with HTLV-1, the following study was performed. Frozen serum samples from 123 randomly selected patients with ITP were thawed and tested for antibodies to HTLV-1 by enzyme-linked immunoabsorbent assay. Positives were confirmed by Western blot. Three patients were initially found to be positive for HTLV-1. One was a female of Caribbean ancestry, one was a male HIV-1+ patient, and one was an adolescent female with no known risk factors for HIV-1. The two females later tested negative for HTLV-1. As a screening program for HTLV-1 antibodies was not introduced into blood banks until November 1988, there may have been passive transfer of the virus from intravenous immunoglobulin that these patients had received. This study of a large number of ITP patients shows that it is extremely unlikely that they are infected with HTLV-1, and, therefore, it is unnecessary to screen ITP patients for seropositivity to HTLV-1.

Complete remission after treatment of acute promyelocytic leukemia with arsenic trioxide

BACKGROUND

Two reports from China have suggested that arsenic trioxide can induce complete remissions in patients with acute promyelocytic leukemia (APL). We evaluated this drug in patients with APL in an attempt to elucidate its mechanism of action.

METHODS

Twelve patients with APL who had relapsed after extensive prior therapy were treated with arsenic trioxide at doses ranging from 0.06 to 0.2 mg per kilogram of body weight per day until visible leukemic cells were eliminated from the bone marrow. Bone marrow mononuclear cells were serially monitored by flow cytometry for immunophenotype, fluorescence in situ hybridization, reverse-transcription-polymerase-chain-reaction (RT-PCR) assay for PML-RAR-alpha fusion transcripts, and Western blot analysis for expression of the apoptosis-associated proteins caspases 1, 2, and 3.

RESULTS

Of the 12 patients studied, 11 achieved complete remission after treatment that lasted from 12 to 39 days (range of cumulative doses, 160 to 495 mg). Adverse effects were relatively mild and included rash, lightheadedness, fatigue, and musculoskeletal pain. Cells that expressed both CD11b and CD33 (antigens characteristic of mature and immature cells, respectively), and which were found by fluorescence in situ hybridization to carry the t(15;17) translocation, increased progressively in number during treatment and persisted in the early phase of complete remission. Eight of 11 patients who initially tested positive for the PML-RAR-alpha fusion transcript by the RT-PCR assay later tested negative; 3 other patients, who persistently tested positive, relapsed early. Arsenic trioxide induced the expression of the proenzymes of caspase 2 and caspase 3 and activation of both caspase 1 and caspase 3.

CONCLUSIONS

Low doses of arsenic trioxide can induce complete remissions in patients with APL who have relapsed. The clinical response is associated with incomplete cytodifferentiation and the induction of apoptosis with caspase activation in leukemic cells.

Therapeutic targeting of transcription in acute promyelocytic leukemia by use of an inhibitor of histone deacetylase

BACKGROUND

Acetylation of DNA-associated histones is linked to activation of gene transcription, whereas histone deacetylation is associated with transcriptional repression. Recent studies have shown that inhibitors of histone deacetylases can relieve transcriptional repression caused by the products of certain oncogenes. We tested whether these findings could be applied clinically to a patient with highly resistant acute promyelocytic leukemia.

METHODS

A patient who had experienced multiple relapses was treated with all-trans-retinoic acid alone and in combination with sodium phenylbutyrate, an inhibitor of histone deacetylases. Immunohistochemistry and western blot analysis were used to assay for histone hyperacetylation in mononuclear cells from the patient's blood and bone marrow. Marrow mononuclear cells and reverse transcription-polymerase chain reaction (RT-PCR) analysis of messenger RNA encoded by the PML/RAR-alpha oncogene were used to assess minimal residual disease.

RESULTS

The patient proved clinically resistant to treatment with all-trans-retinoic acid alone. However, 23 days after sodium phenylbutyrate was added to the treatment regimen, visible leukemic cells had been eliminated from her bone marrow, and she achieved a complete clinical and cytogenetic remission shortly thereafter. With a second treatment course, analysis for minimal residual disease by RT-PCR proved negative. Immunofluorescence and western blot analysis showed that phenylbutyrate caused a time-dependent increase in histone acetylation in blood and bone marrow mononuclear cells.

CONCLUSIONS

Clinical treatment with an inhibitor of histone deacetylase induces histone hyperacetylation in target cells and may restore sensitivity to the anti-leukemic effects of all-trans-retinoic acid in acute promyelocytic leukemia. Similar therapy may prove useful in other neoplastic diseases that are associated with oncogenic repression of gene transcription due to recruitment of histone deacetylases.

GaN-Based Solar-Ultraviolet Detection Instrument

We report on the fabrication of a solar-UV monitoring system that uses GaN-based photodetectors. GaN photoconductors, p-n junction photodiodes, and Schottky barrier photodiodes have been fabricated and characterized as UV sensors. The best performances are obtained in Schottky photodiodes, which show a linear response, a flat responsivity of 100 mA/W, a visible rejection ratio higher than 10(3), and a noise-equivalent power of 1 nW/Hz(-1/2). Preliminary data on Al(x)Ga(1-x)N (x = 0.15, 0.22) detectors are also presented. Using GaN Schottky diodes, we fabricate and evaluate a complete solar-UV detection head.