Disorder-to-order transition of long fibers contained in evaporating sessile drops

A liquid drop containing a long fiber is a complex system whose configuration is determined by an interplay of elastic stresses in the fiber and capillary forces due to the liquid. We study the morphological evolution of fibers that are much longer than the drop diameter in evaporating sessile drops. After insertion, the fibers are either found in an ordered or disordered state, with increasing disorder for increasing fiber length. Upon evaporation, the order increases, in such a way that the final configuration deposited on the solid surface is either a circle, an ellipse, or 8-shaped. The morphology of the deposit depends on the fiber length and the elastocapillary length, both non-dimensionalized with the characteristic drop size, which we classify in a morphology regime map. The disorder-to-order transition allows depositing ordered fiber structures on solid surfaces even in cases of a strongly disordered state after fiber insertion. Combined with technologies such as inkjet printing, this process could open new avenues to decorate surfaces with filamental structures whose morphology can be controlled by varying the fiber length.

Amplitude Analysis of the B^{0}→K^{*0}μ^{+}μ^{-} Decay

An amplitude analysis of the B^{0}→K^{*0}μ^{+}μ^{-} decay is presented using a dataset corresponding to an integrated luminosity of 4.7  fb^{-1} of pp collision data collected with the LHCb experiment. For the first time, the coefficients associated to short-distance physics effects, sensitive to processes beyond the standard model, are extracted directly from the data through a q^{2}-unbinned amplitude analysis, where q^{2} is the μ^{+}μ^{-} invariant mass squared. Long-distance contributions, which originate from nonfactorizable QCD processes, are systematically investigated, and the most accurate assessment to date of their impact on the physical observables is obtained. The pattern of measured corrections to the short-distance couplings is found to be consistent with previous analyses of b- to s-quark transitions, with the largest discrepancy from the standard model predictions found to be at the level of 1.8 standard deviations. The global significance of the observed differences in the decay is 1.4 standard deviations.

Fraction of χ_{c} Decays in Prompt J/ψ Production Measured in pPb Collisions at sqrt[s_{NN}]=8.16 TeV

The fraction of χ_{c1} and χ_{c2} decays in the prompt J/ψ yield, F_{χ_{c}→J/ψ}=σ_{χ_{c}→J/ψ}/σ_{J/ψ}, is measured by the LHCb detector in pPb collisions at sqrt[s_{NN}]=8.16  TeV. The study covers the forward (1.5 Collapse

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Observation of Cabibbo-Suppressed Two-Body Hadronic Decays and Precision Mass Measurement of the Ω_{c}^{0} Baryon

The first observation of the singly Cabibbo-suppressed Ω_{c}^{0}→Ω^{-}K^{+} and Ω_{c}^{0}→Ξ^{-}π^{+} decays is reported, using proton-proton collision data at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 5.4  fb^{-1}, collected with the LHCb detector between 2016 and 2018. The branching fraction ratios are measured to be B(Ω_{c}^{0}→Ω^{-}K^{+})/B(Ω_{c}^{0}→Ω^{-}π^{+})=[6.08±0.51(stat)±0.40(syst)]%,B(Ω_{c}^{0}→Ξ^{-}π^{+})/B(Ω_{c}^{0}→Ω^{-}π^{+})=[15.81±0.87(stat)±0.44(syst)±0.16(ext)]%. In addition, using the Ω_{c}^{0}→Ω^{-}π^{+} decay channel, the Ω_{c}^{0} baryon mass is measured to be M(Ω_{c}^{0})=2695.28±0.07(stat)±0.27(syst)±0.30(ext)  MeV, improving the precision of the previous world average by a factor of 4.

Enhanced Production of Λ_{b}^{0} Baryons in High-Multiplicity pp Collisions at sqrt[s]=13 TeV

The production rate of Λ_{b}^{0} baryons relative to B^{0} mesons in pp collisions at a center-of-mass energy sqrt[s]=13  TeV is measured by the LHCb experiment. The ratio of Λ_{b}^{0} to B^{0} production cross sections shows a significant dependence on both the transverse momentum and the measured charged-particle multiplicity. At low multiplicity, the ratio measured at LHCb is consistent with the value measured in e^{+}e^{-} collisions, and increases by a factor of ∼2 with increasing multiplicity. At relatively low transverse momentum, the ratio of Λ_{b}^{0} to B^{0} cross sections is higher than what is measured in e^{+}e^{-} collisions, but converges with the e^{+}e^{-} ratio as the momentum increases. These results imply that the evolution of heavy b quarks into final-state hadrons is influenced by the density of the hadronic environment produced in the collision. Comparisons with several models and implications for the mechanisms enforcing quark confinement are discussed.

Improved Measurement of CP Violation Parameters in B_{s}^{0}→J/ψK^{+}K^{-} Decays in the Vicinity of the ϕ(1020) Resonance

The decay-time-dependent CP asymmetry in B_{s}^{0}→J/ψ(→μ^{+}μ^{-})K^{+}K^{-} decays is measured using proton-proton collision data, corresponding to an integrated luminosity of 6  fb^{-1}, collected with the LHCb detector at a center-of-mass energy of 13 TeV. Using a sample of approximately 349 000 B_{s}^{0} signal decays with an invariant K^{+}K^{-} mass in the vicinity of the ϕ(1020) resonance, the CP-violating phase ϕ_{s} is measured, along with the difference in decay widths of the light and heavy mass eigenstates of the B_{s}^{0}-B[over ¯]_{s}^{0} system, ΔΓ_{s}, and the difference of the average B_{s}^{0} and B^{0} meson decay widths, Γ_{s}-Γ_{d}. The values obtained are ϕ_{s}=-0.039±0.022±0.006  rad, ΔΓ_{s}=0.0845±0.0044±0.0024  ps^{-1}, and Γ_{s}-Γ_{d}=-0.0056_{-0.0015}^{+0.0013}±0.0014  ps^{-1}, where the first uncertainty is statistical and the second systematic. These are the most precise single measurements to date and are consistent with expectations based on the Standard Model and with the previous LHCb analyses of this decay. These results are combined with previous independent LHCb measurements. The phase ϕ_{s} is also measured independently for each polarization state of the K^{+}K^{-} system and shows no evidence for polarization dependence.

Measurement of CP Violation in B^{0}→ψ(→ℓ^{+}ℓ^{-})K_{S}^{0}(→π^{+}π^{-}) Decays

A measurement of time-dependent CP violation in the decays of B^{0} and B[over ¯]^{0} mesons to the final states J/ψ(→μ^{+}μ^{-})K_{S}^{0}, ψ(2S)(→μ^{+}μ^{-})K_{S}^{0} and J/ψ(→e^{+}e^{-})K_{S}^{0} with K_{S}^{0}→π^{+}π^{-} is presented. The data correspond to an integrated luminosity of 6  fb^{-1} collected at a center-of-mass energy of sqrt[s]=13  TeV with the LHCb detector. The CP-violation parameters are measured to be S_{ψK_{S}^{0}}=0.717±0.013(stat)±0.008(syst) and C_{ψK_{S}^{0}}=0.008±0.012(stat)±0.003(syst). This measurement of S_{ψK_{S}^{0}} represents the most precise single measurement of the CKM angle β to date and is more precise than the current world average. In addition, measurements of the CP-violation parameters of the individual channels are reported and a combination with the LHCb Run 1 measurements is performed.

Evaluating the risk factors for the development of benign disorders of defaecation: a surgical perspective

PURPOSE

There remains uncertainty as to which risk factors are important for the development of defaecatory problems as a result of heterogeneity of published evidence. Understanding the impact of risk factors may be important in selecting targets for disease prevention or reversal. The aim of this study was to identify and evaluate risk factors for faecal incontinence and chronic constipation.

METHODS

Risk factors for chronic constipation and faecal incontinence were long-listed from scientific literature, then anonymously evaluated (by 50 predominantly colorectal surgical experts from the UK Pelvic Floor Society) using a Delphi technique. Each risk factor was rated as independent, a co-factor, or not a risk factor. Independent risk factors were rated between 1 (not important) and 10 (critically important) with mean (± standard deviation) calculated.

RESULTS

Thirty-eight risk factors for chronic constipation were evaluated. Eighteen were classed as independent and 16 as co-factors. Opioid analgesia (7.87 ± 2.05), eating disorders (7.80 ± 1.72), and history of abuse (7.70 ± 1.89) were scored as most important independent risk factors. Female sex (6.60 ± 2.02) was considered an independent risk factor but increasing age was rated a co-factor. Thirty-three risk factors for faecal incontinence were evaluated. Twenty were classed as independent and eight as co-factors. Third- or fourth-degree tear (8.88 ± 1.57), instrumental delivery (8.47 ± 1.58), and grand multiparity (8.00 ± 1.63) were rated most important. Increasing age (7.41 ± 2.14) and female sex (7.58 ± 2.05) were both considered independent risk factors.

CONCLUSIONS

Several risk factors for chronic constipation and faecal incontinence were selected by Delphi approach. These factors will feed forward into Bayesian models of disease prediction that combine data and expert knowledge.

Pronounced cortisol response to acute psychosocial stress in type 2 diabetes patients with and without complications

It is increasingly recognized that psychological stress is linked with type 2 diabetes mellitus and its late complications. Thus, the aim of the current study was to investigate the psychophysiological response to acute psychosocial stress in patients with type 2 diabetes. In total, 53 type 2 diabetes patients with complications, 16 type 2 diabetes patients without complications, and 47 age and gender matched non-diabetic participants underwent the Trier Social Stress Test. Subjective as well as biological parameters (i.e., blood levels of cortisol, adrenocorticotropic hormone (ACTH), norepinephrine, methylglyoxal) were assessed repeatedly before and after stress induction. Data were analyzed by means of multilevel regression. Patients with type 2 diabetes showed an exaggerated cortisol response to acute stress as compared to age matched control participants (diabetes*T2 est. = 1.23, p < .001), while stress-induced alterations of ACTH and subjective parameters did not differ. Norepinephrine levels were lower among patients (diabetes est. = -4.36, p = .044) and tended to decrease earlier than in controls. The subjective reaction of type 2 diabetes patients with complications was stronger than that of patients without complications (complication*T2 est. = -1.83, p = .032), while their endocrine response to stress was similar. Stress had no effect on methylglyoxal level, and there were no group differences regarding methylglyoxal response. These results show that the cortisol reactivity of patients with type 2 diabetes to acute psychosocial stress is increased compared to a control group. Thus, alterations of the hypothalamus-pituitary-adrenal axis - especially regarding its dynamic regulation - are a plausible link between psychological stress and type 2 diabetes and its complications.

Assessing the perspective of well-being of older patients with multiple morbidities by using the LAVA tool - a person-centered approach

Background

Older patients with multiple morbidities are a particularly vulnerable population that is likely to face complex medical decisions at some time in their lives. A patient-centered medical care fosters the inclusion of the patients’ perspectives, priorities, and complaints into clinical decision making.

Methods

This article presents a short and non-normative assessment tool to capture the priorities and problems of older patients. The so-called LAVA (“Life and Vitality Assessment”) tool was developed for practical use in seniors in the general population and for residents in nursing homes in order to gain more knowledge about the patients themselves as well as to facilitate access to the patients. The LAVA tool conceptualizes well-being from the perspectives of older individuals themselves rather than from the perspectives of outside individuals.

Results

The LAVA tool is graphically presented and the assessment is explained in detail. Exemplarily, the outcomes of the assessments with the LAVA of three multimorbid older patients are presented and discussed. In each case, the assessment pointed out resources as well as at least one problem area, rated as very important by the patients themselves.

Conclusions

The LAVA tool is a short, non-normative, and useful approach that encapsulates the perspectives of well-being of multimorbid patients and gives insights into their resources and problem areas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02342-3.

[Diagnosis and treatment of rare testicular tumors using the example of malignant mesothelioma of the tunica vaginalis testis and Sertoli cell tumors]

BACKGROUND

Rare tumors of the testis not originating from germinal epithelium are a diagnostic and therapeutic challenge.

OBJECTIVES

To present current approaches in rare tumors of the testis using the examples of Sertoli cell tumor (SCT) and malignant mesothelioma of the tunica vaginal testis (MMTVT).

METHODS

A literature search in PubMed and the abstract databases of ASCO and ESMO was performed. Articles and book chapters were selected based on relevance to everyday treatment.

RESULTS

The low incidence of testicular tumors not originating from the germinal epithelium makes a standardized approach difficult. Diagnosis and treatment depend on the underlying diagnosis. While most SCT are benign, malignant subtypes require extensive resection including metastatic surgery if complete resection is possible. In MMTVT, multimodality treatment concepts are followed, according to the malignant mesotheliomas of the pleura.

CONCLUSION

Systematic registration of rare testicular tumors and comprehensive molecular pathological analysis are urgently needed to improve the understanding of tumor biology and to develop new therapeutic strategies.

POS0077 PHYSICAL ACTIVITY AND SPORT PARTICIPATION: A COMPARISON BETWEEN CHILDREN AND ADOLESCENTS WITH JUVENILE IDIOPATHIC ARTHRITIS (JIA) AND THE GERMAN GENERAL POPULATION

Background:

Physical activity (PA), including sport participation is essential for children throughout their growth and maturation. It improves physiological and psychosocial health and limits the risk of developing metabolic disorders. The beneficial effect of PA specifically in patients with JIA has also been linked to its potential regulatory effect on the balance between pro- and anti-inflammatory responses [1].

Objectives:

The study aimed i) to quantify the frequency of PA and participation in (organised) sports compared to the general population, ii) to determine self-reported reasons for not practicing sports, and iii) to identify clinical parameters associated with non-participation in sports.

Methods:

Data from children and adolescents with JIA recorded in the National Paediatric Rheumatological Database (NPRD) in the year 2019 were considered for the analyses. In accordance with the methodology used in the general population survey (KIGGS) [2], achievement of the WHO recommendations on PA for at least 60 minutes per day as well as sport-related data were determined on the basis of self-reported outcomes in individuals aged 3 to 17 years. In order to compare PA-related data with the general population, a sex- and age-matched sample was drawn. A logistic regression model was used to explore the association between non-participation in sports and patients’ clinical outcomes.

Results:

Data of 5.333 matched-pairs (mean age 11.0 ± 4.3 years, female 67%, patients’ disease duration 4.8 ± 3.8 years, persistent oligoarthritis 43%) were available for evaluation. Almost 38% of patients aged 3 to 17 years met the recommended PA amount (76% aged 3 to 6; 48% aged 7 to 10; 30% aged 11 to 13; 15% aged 14 to 17). In matched controls, 21% fulfilled the WHO recommendations on PA (41% aged 3 to 6; 23% aged 7 to 10; 17% aged 11 to 13; 10% aged 14 to 17). Largest differences across JIA categories were found in persistent oligoarthritis (43%) and enthesitis-related arthritis (22%). 64% of patients and 74% of controls reported participating in sports, of which 72% of patients and 58% of controls stating to participate in a formally organised way. In both groups, boys indicated organised sports participation more often than girls. Among those who declared not participating in sports, “no interest” (patients 27% vs. controls 29%), “no suitable offer nearby” (patients 25% vs. controls 31%), “health restrictions” (patients 22% vs. controls 4%) and “no time” (patients 15% vs. controls 23%) were the most frequently mentioned reasons (multiple responses possible). CJADAS-10 (OR = 1.02, 95% CI = 1.00-1.04), CHAQ (OR = 1.79, 95% CI = 1.50-2.14), DMARD use (OR = 1.32, 95% CI = 1.15-1.53) and disease duration (OR = 0.97, 95% CI = 0.95-0.99) were significantly associated with non-participation in sports.

Conclusion:

Based on self-reported data, children and adolescents with JIA meet the WHO recommendation on PA more often than general population controls. Patients are less frequently engaged in sports, but more often involved in formally organised forms. In order to bring joyful, interesting PA opportunities in line with WHO recommendations, further components (e.g. intensity), facilitators and barriers to PA and sports need to be addressed in the future while controlling for JADAS and CHAQ.

References:

[1]Rochette E et al. JIA and physical activity: possible inflammatory and immune modulation and tracks for interventions in young populations. Autoimmun Rev 2015;14:726–734.

[2]Finger JD et al. Körperliche Aktivität von Kindern und Jugendlichen in Deutschland - Querschnittergebnisse aus KiGGS Welle 2 und Trends. Journal of Health Monitoring 2018;3:24-31.

Acknowledgements:

The National Paediatric Rheumatological Database has been funded by AbbVie, Chugai, Novartis and GSK.

Disclosure of Interests:

Florian Milatz: None declared, Martina Niewerth: None declared, Jens Klotsche: None declared, Jana Hörstermann: None declared, Sandra Hansmann: None declared, Tilmann Kallinich: None declared, Christoph Rietschel: None declared, Ralf Trauzeddel: None declared, Joachim Peitz: None declared, Matthias Hartmann: None declared, Hermann Girschick: None declared, Kirsten Minden Speakers bureau: Pfizer, AbbVie, Consultant of: Novartis.

Diabetic patients treated with novel thin composite-wire strut zotarolimus-eluting stents versus ultrathin strut sirolimus-eluting stents in the BIONYX trial: 2-year results of a prespecified analysis

Background/Introduction

The novel thin composite-wire strut zotarolimus-eluting stent (ZES) is a drug-eluting stent that is frequently used for treating patients with obstructive coronary artery disease, but so far no clinical outcome data have been published in patients with diabetes. In all-comer patients, the BIONYX trial (NCT02508714) has established non-inferiority of the ZES versus the ultrathin strut biodegradable-polymer sirolimus-eluting stent (SES) regarding the primary composite endpoint of target vessel failure at 1 year follow-up.

Purpose

To assess in patients with diabetes, the 2-year safety and efficacy of the current generation thin composite-wire strut ZES, compared to the ultrathin strut SES.

Methods

In the international, multicentre BIONYX trial, randomisation was stratified for sex and the presence of diabetes mellitus. We performed a prespecified subgroup analysis of patients with diabetes. The main endpoint target vessel failure was a composite of safety and efficacy, consisting of cardiac death, target vessel-related myocardial infarction or clinically indicated target vessel revascularisation. Secondary endpoints, such as target lesion revascularisation and stent thrombosis were also assessed.

Results

A total of 510/2488 (20.5%) BIONYX trial participants had diabetes, and were therefore included in this analysis. Patients were on average 66.4±10.3 years old, and 28.6% were female. Most participants presented with acute coronary syndromes (65.1%), and 182/510 (35.7%) patients were insulin dependent. Two-year follow up was available in 500 of 510 (98.0%) patients. Target vessel failure occurred in 31/260 (12.2%) patients assigned to ZES versus 26/250 (10.7%) patients assigned to SES (HR 1.14, 95%-CI 0.68–1.92; P-logrank=0.63). Kaplan Meier curves of target vessel failure are displayed in Figure 1. There were no significant between-stent differences in the individual components of this endpoint. Target lesion revascularisation occurred in 15/260 (6.0%) patients treated with ZES versus 9/250 (3.7%) patients treated with SES (HR 1.61, 95%-CI 0.71–3.68; P-logrank=0.25). Definite stent thrombosis was an infrequent event and did not differ significantly between stent-arms (0.4% vs. 1.2%; HR 0.32, 95%-CI 0.03–3.06; P-logrank=0.30).

Conclusion

In patients with diabetes, the novel thin composite-wire strut durable polymer ZES was similarly safe and efficacious as compared to the ultrathin cobalt-chromium strut biodegradable-polymer SES at 2-year follow-up.

Figure1. Target vessel failure at 2 years

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): The BIONYX trial was equally funded by Biotronik and Medtronic.

Comparison of two iterations of the zotarolimus-eluting stents: an analysis of all-comer patients from two consecutive randomised clinical trials

Background

The newest iteration of the durable polymer zotarolimus-eluting stents (ZES) is designed with thin swaged shape composite-wire struts (inner platinum–iridium core and outer cobalt–chromium layer). It is of interest to compare the clinical performance of this novel device with its predecessor in all-comers.

Purpose

The purpose of the present study is to assess 2-year clinical outcome in all-comer patients who were treated with the novel ZES versus the previous iteration ZES.

Methods

We did a post-hoc analysis of clinical outcome data of 2374 patients who were treated with the novel or the previous generation ZES (only nominal stent diameters that were available for both devices) in two consecutive large-scale randomised all-comer trials. A total of 1201 trial participants were treated with the novel ZES, and 1173 were treated with the previous generation ZES. The main outcome parameter target vessel failure is a composite of safety (cardiac death, target vessel myocardial infarction) and efficacy (target vessel revascularisation). Clinical outcome data were analysed with Kaplan-Meier methods and hazard ratios were computed with Cox regression analysis. An additional analysis was done in a subgroup of patients who presented with chronic coronary syndromes.

Results

The mean age of the study population was 63.9±10.9 years, 611 (25.7%) were female and 1669 (70.3%) presented with acute coronary syndromes. Two-year follow-up was available in 2346 (98.8%) participants. After 2 years, there was no significant difference between stent-groups in the rates of target vessel failure (7.2% vs. 8.3%, HR 0.85, 95% CI 0.64–1.14, p-logrank = 0.28; Figure 1) or its individual components. Peri-procedural myocardial infarction occurred less often in patients treated with the novel ZES (0.7% vs. 2.1%, p-logrank &lt;0.01), and definite-or-probable stent thrombosis rates were low in both ZES groups (0.3% vs. 0.8%, p-logrank = 0.15). In a subgroup of 705 patients with chronic coronary syndromes, the rate of target vessel myocardial infarction tended to be lower with novel ZES (1.8% vs. 4.2%, p-logrank = 0.05).

Conclusions

The novel ZES showed similar 2-year clinical outcomes as compared to its predecessor. Furthermore, there was a positive safety signal regarding the incidence of target vessel myocardial infarction and a particularly low stent thrombosis rates with the novel ZES.

Figure 1. Target vessel failure at 2 years

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Thoraxcentrum Twente has received institutional research grants provided by Abbott Vascular, Biotronik, Boston Scientific and Medtronic. The present analysis received no funding.

Two new species in a new genus and a critical revision of Brachybasidiaceae (Exobasidiales, Basidiomycota) in honor of Franz Oberwinkler

The Brachybasidiaceae are a family of 22 known species of plant-parasitic microfungi belonging to Exobasidiales, Basidiomycota. Within this family, species of the largest genus Kordyana develop balls of basidia on top of stomatal openings. Basidial cells originate from fungal stroma filling substomatal chambers. Species of Kordyana typically infect species of Commelinaceae. During fieldwork in the neotropics, fungi morphologically similar to Kordyana spp. were found on Goeppertia spp. (syn. Calathea spp., Marantaceae), namely on G. panamensis in Panama and on G. propinqua in Bolivia. These specimens are proposed as representatives of a genus new to science, Marantokordyana, based on the distinct host family and molecular sequence data of ITS and LSU rDNA regions. The specimens on the two host species represent two species new to science, M. oberwinkleriana on G. panamensis and M. boliviana on G. propinqua. They differ by the size and shape of their basidia, molecular sequence data of ITS and LSU rDNA regions, and host plant species. In the past, the understanding of Brachybasidiaceae at order and family level was significantly improved by investigation realized by Franz Oberwinkler and his collaborators at the University of Tübingen, Germany. On species level, however, our knowledge is still very poor due to incomplete species descriptions of several existing names in literature, scarceness of specimens, as well as sequence data lacking for many taxa and for further barcode regions. Especially species of Kordyana and species of Dicellomyces are in need of revision.

Can obligate apomixis and more stable reproductive assurance explain the distributional successes of asexual triploids in Hieracium alpinum (Asteraceae)?

Although reproductive assurance has been suggested to be one of the most important factors shaping the differential distributional patterns between sexuals and asexuals (geographic parthenogenesis), it has only rarely been studied in natural populations of vascular plants with autonomous apomixis. Moreover, there are almost no data concerning the putative relationship between the level of apomictic versus sexual plant reproduction on one hand, and reproductive assurance on the other. We assessed the level of sexual versus apomictic reproduction in diploid and triploid plants of Hieracium alpinum across its distributional range using flow cytometric analyses of seeds, and compared the level of potential and realized seed set, i.e. reproductive assurance, between the two cytotypes under field and greenhouse conditions. Flow cytometric screening of embryos and endosperms of more than 4,100 seeds showed that diploids produced solely diploid progeny sexually, while triploids produced triploid progeny by obligate apomixis. Potential fruit set was much the same in diploids and triploids from the field and the greenhouse experiment. While in the pollination-limited environment in the greenhouse apomictic triploids had considerably higher realized fruit set than sexual diploids, there was no significant difference between cytotypes under natural conditions. In addition, sexuals varied to a significantly larger extent in realized fruit set than asexuals under both natural and greenhouse conditions. Our results indicate that triploid plants reproduce by obligate apomixis, assuring more stable and predictable fruit reproduction when compared to sexual diploids. This advantage could provide apomictic triploids with a superior colonisation ability, mirrored in a strong geographic parthenogenesis pattern observed in this species.

[Positron emission tomography in germ cell tumors in men : Possibilities and limitations]

BACKGROUND

Conventional radiographic imaging may fail to safely distinguish clinical stage I from stage IIA germ cell cancer, to localize isolated tumor marker relapses, and to equivocally identify the viability of postchemotherapy residual masses.

OBJECTIVES

To provide an overview of the diagnostic value and limitations of functional imaging by positron emission tomography with 2‑deoxy-2-[fluorine-18]fluoro-D-glucose with computed tomography (¹⁸F-FDG-PET-CT) in male germ cell cancer.

MATERIALS AND METHODS

A narrative review based on a literature search of PubMed/MEDLINE for original articles published from 1990-2018 and conference proceedings of ASCO (American Society of Clinical Oncology) and EAU (European Association of Urology) annual meetings 2014-2017 is presented.

RESULTS

¹⁸F-FDG-PET-CT does not improve diagnostic accuracy compared to conventional CT imaging clinical stage (CS) I disease. Particularly PET-negativity of postchemotherapy residual masses of seminomas >3 cm in size guide decision-making against further additional treatment. Even PET-positive residues must not result in relapse. For nonseminoma, the value of PET imaging is reduced by potential mature teratoma components, which are commonly PET negative.

CONCLUSIONS

Current guidelines recommend ¹⁸F-FDG-PET-CT 6-8 weeks postchemotherapy for viability assessment of seminoma residues >3 cm in size. Exceptional circumstances, in which ¹⁸F-FDG-PET-CT may be helpful, include: (1) detection of active disease in CS IS, (2) viability assessment of residual masses >1 cm where complete secondary resection is impossible, (3) staging at marker relapse with unconspicuous conventional CT scan, (4) early response assessment during chemotherapy.

Electronic Signature for Medical Documents – Integration and Evaluation of a Public Key Infrastructure in Hospitals

Objectives: Our objectives were to determine the user-oriented and legal requirements for a Public Key Infrastructure (PKI) for electronic signatures for medical documents, and to translate these requirements into a general model for a signature system. A prototype of this model was then implemented and evaluated in clinical routine use.

Methods: Analyses of documents, processes, interviews, observations, and of the available literature supplied the foundations for the development of the signature system model. Eight participants of the Department of Dermatology of the Heidelberg University Medical Center evaluated the implemented prototype from December 2000 to January 2001, during the course of an intervention study. By means of questionnaires, interviews, observations and database analyses, the usefulness and user acceptance of the electronic signature and its integration into electronic discharge letters were established.

Results: Since the major part of medical documents generated in a hospital are signature-relevant, they will require electronic signatures in the future. A PKI must meet the multitude of responsibilities and security needs required in a hospital. Also, the signature functionality must be integrated directly into the workflow surrounding document creation. A developed signature model, fulfilling user-oriented and legal requirements, was implemented using hard and software components that conform to the German Signature Law. It was integrated into the existing hospital information system of the Heidelberg University Medical Center. At the end of the intervention study, the average acceptance scores achieved were x = 3,90; sD = 0,42 on a scale of 1 (very negative attitude) to 5 (very positive attitude) for the electronic signature procedure. Acceptance of the integration into computer-supported discharge letter writing reached x = 3,91; sD = 0,47. On average, the discharge letters were completed 7.18 days earlier.

Conclusion: The electronic signature is indispensable for the further development of electronic patient records. Application-independent hard and software components, in accordance with the signature law, must be integrated into electronic patient records, and provided to certification services using standardized interfaces. Signature-oriented workflow and document management components are essential for user acceptance in routine clinical use.

Computation of the asymptotic states of modulated open quantum systems with a numerically exact realization of the quantum trajectory method

Quantum systems out of equilibrium are presently a subject of active research, both in theoretical and experimental domains. In this work, we consider time-periodically modulated quantum systems that are in contact with a stationary environment. Within the framework of a quantum master equation, the asymptotic states of such systems are described by time-periodic density operators. Resolution of these operators constitutes a nontrivial computational task. Approaches based on spectral and iterative methods are restricted to systems with the dimension of the hosting Hilbert space dimH=N≲300, while the direct long-time numerical integration of the master equation becomes increasingly problematic for N≳400, especially when the coupling to the environment is weak. To go beyond this limit, we use the quantum trajectory method, which unravels the master equation for the density operator into a set of stochastic processes for wave functions. The asymptotic density matrix is calculated by performing a statistical sampling over the ensemble of quantum trajectories, preceded by a long transient propagation. We follow the ideology of event-driven programming and construct a new algorithmic realization of the method. The algorithm is computationally efficient, allowing for long "leaps" forward in time. It is also numerically exact, in the sense that, being given the list of uniformly distributed (on the unit interval) random numbers, {η_{1},η_{2},...,η_{n}}, one could propagate a quantum trajectory (with η_{i}'s as norm thresholds) in a numerically exact way. By using a scalable N-particle quantum model, we demonstrate that the algorithm allows us to resolve the asymptotic density operator of the model system with N=2000 states on a regular-size computer cluster, thus reaching the scale on which numerical studies of modulated Hamiltonian systems are currently performed.

High ligation of the saphenofemoral junction is necessary!

Neovascularisation can compromise the success of high ligation and resection of the greater saphenous vein. Studies using duplexultrasound to classify recurrent groin veins have described rates of neovascularisation as high as 60% and raised the question whether high ligation is actually able to prevent groin recurrences. In the present study, recurrent groin veins were excised and examined histologically in order to prove whether neovascularisation is the main cause for sapheno-femoral recurrences. Patients, methods: 419 patients accounting for 458 legs with clinically symptomatic groin recurrences were included in a country-wide multicenter study. The recurrent groin veins were excised in a standardized fashion and subsequently divided into the different types of recurrence based on histopathological criteria. Results: 427 specimen (93%) were available for histopathological examination. In 69 cases (16.2%) a neovascularisation was found to be the cause of recurrence. 311 specimen (72.8%) contained a long residual stump of the greater saphenous vein, out of which 32 (7.5%) showed additional neovascularisation at the site of the ligation. In 29 cases (6.8%) a venous side branch was found to be the recurrent groin vein. 11 specimen (2.6%) did not contain any evidence of venous material and in another 7 cases (1.6%) it was not possible to clearly identify the cause of recurrence during the histo pathological workup. Conclusion: The high rates of neovascularisation described in several duplex ultrasound studies could not be confirmed in our investigation. Recurrences seem to be mainly caused by a technically incorrect initial operation which leaves a long residual stump of the saphenous vein in place. Following a technically correct high ligation, clinically relevant recurrences appear to be rare. This finding underlines the necessity of a high ligation of the saphenous vein according to current guidelines.

Der lang belassene Saphenastumpf

Ziel: Nach endovenöser Hitzeablation der V. saphena magna verbleibt im Bereich der Krosse nahezu regelhaft bis zu 5 cm langer Venenstumpf unverschlossen. Aufgrund fehlender Langzeiterfahrungen ist unklar, ob sich aus dem zurückgelassenen Stumpf im Spätverlauf ein Leistenrezidiv entwickelt. Um Anhaltspunkte für den potenziellen Zeitpunkt der Rezidiventwicklung zu gewinnen, sollte bei Pat. mit histologisch gesichertem Saphenastumpfrezidiv geklärt werden, wie lange es dauerte, bis nach dem Ersteingriff Rezidiv klinisch apperent wird. Methoden: Im Rahmen einer an sieben Zentren durchgeführten Multizenterstudie wurden operativ exstirpierte Leistenrezidive histologisch klassifiziert. Die Pat. mit eindeutigem Saphenastumpfrezidiv wurden anhand eines standardisierten Fragebogens nach den ersten Rezidivzeichen befragt. Anhand der Angaben wurde das beschwerdefreie Intervall ermittelt, das Zeitraum zwischen dem Ersteingriff und dem ersten Auftreten von Rezidivzeichen kennzeichnet. Ergebnisse: Bei 251 Pat. wurde an 278 Extremitäten ein lang belassener Saphenastumpf als Ursache des Leistenrezidivs ermittelt. den meisten Pat. bestand nach dem Ersteingriff ein beschwerdefreies Intervall, das im Durchschnitt 7,4 ± 5,70 Jahre betrug. Rezidivvarizen kündigten nach durchschnittlich 6,3 ± 5,68 Jahre und Stauungsbeschwerden nach durchschnittlich 8,5 ± 5,71 Jahre das Rezidiv an. Schlussfolgerungen: Überträgt man die Erfahrungen aus operativen Therapie auf die unverschlossenen Krossestümpfe nach endovenöser Therapie, so ist frühestens nach 7–8 Jahren mit den klinischen Zeichen eines Leistenrezidivs zu rechnen. Die gegenwärtig vorhandenen Nachbeobachtungszeiten reichen nicht aus, um den Langzeitverlauf nach endovenöser Therapie beurteilen zu können.

Saphenofemoraler Neoreflux nach Lasertherapie, Crossektomie/ Stripping oder Crossektomie/ Lasertherapie

Einleitung: In der vorliegenden Arbeit gilt es, mittelfristige Refluxbefunde nach 2 und 6 Monaten sowie die klinischen und sonografischen Befunde im Bereich der Magnacrosse zu beschreiben, die für eine langfristige Entwicklung von Bedeutung sein könnten.

Material und Methode: Die offene multizentrisch prospektiv randomisierte kontrollierte 3-armige Vergleichsstudie zwischen der endoluminalen Lasertherapie und der invaginierend durchgeführten modifizierten offen operativen Therapie der Stammvarikosis der Vena saphena magna (VSM) hat den primären Endpunkt der Beobachtung der mittelund langfristigen Rezidiventwicklung mit einem Ausgangspunkt im Inguinalbereich. (Laserprozedur mit 980 nm Laser (Biolitec), Continous-Mode-Verfahren mit 30 Watt). Um die Bedeutung der Crossektomie in Bezug zur Entstehung eines Crosserezidivs herauszuarbeiten wurde eine dritte Gruppe gebildet, in der die Lasertherapie des Stammvenenabschnitts mit einer Crossektomie der Vena saphena magna kombiniert wurde.

Ergebnisse: 449 Patienten wurden perioperativ und nach 2 Monaten untersucht. 388 Patienten konnten nach 6 Monaten nachuntersucht werden. Nach 2 und 6 Monaten zeigten sich signifikant mehr inguinale Refluxe und Seitenäste in den Lasergruppen.

Ausblick: Die Befunde werden in einer derzeit laufenden Nachuntersuchung überprüft und auf ihre klinische Relevanz für das Langzeitergebnis getestet.

Increase in the incidence of severe hypoglycaemia in people with Type 2 diabetes in spite of new drugs: analysis based on health insurance data from Germany

AIM

To evaluate the use of new anti-hyperglycaemic agents that offer effective glycaemic control while reducing risk of hypoglycaemia, by analysing the incidence rates of severe hypoglycaemia in 2006 vs 2011 in relation to the medication.

METHODS

This cross-sectional, population-based study used German health insurance data. All adults diagnosed with Type 2 diabetes mellitus (extrapolated to the German population: 6.35 million in 2006 and 7.52 million in 2011) were screened for severe hypoglycaemia. Anti-hyperglycaemic agents were identified by their Anatomical Therapeutic Chemical code, and defined daily doses of each medication were calculated.

RESULTS

The severe hypoglycaemic event rate was 460 per 100,000 people/year in 2006 and 490 per 100,000 people/year in 2011. In 2006 and 2011, 10.9% and 7.3%, respectively, of all people with severe hypoglycaemia were on sulfonylureas, while 12.7% and 9.3%, respectively, were on a combination therapy of metformin and sulfonylureas. Among those with severe hypoglycaemia, there were no prescriptions of dipeptidyl peptidase-4 inhibitors or glucagon-like peptide-1 receptor agonists in 2006, but in 2011, 1.55% and 0.17%, of those with severe hypoglycaemia were receiving the respective treatments. In 2006 vs 2011, human insulin was prescribed for 11.3% vs 10.3% of people with severe hypoglycaemia, while insulin analogues were prescribed for 5.4% vs 8.1%, and mixed human insulins for 19.7% vs 14.0% of patients with severe hypoglycaemia. People receiving insulin analogue therapy had a higher risk of severe hypoglycaemia than those receiving metformin, after adjusting for age, gender, nephropathy diagnosis and year of survey (odds ratio 14.6; CI 13.3-15.9).

CONCLUSION

The incidence of severe hypoglycaemic events in Germany increased between 2006 and 2011, despite increased use of newer anti-hyperglycaemic agents and decreased use of insulins.

Reduced electrode arrays for the automated detection of rhythmic and periodic patterns in the intensive care unit: Frequently tried, frequently failed?

OBJECTIVE

To investigate the effect of systematic electrode reduction from a common 10-20 EEG system on pattern detection sensitivity (SEN).

METHODS

Two reviewers rated 17130 one-minute segments of 83 prospectively recorded cEEGs according to the ACNS standardized critical care EEG terminology (CCET), including burst suppression patterns (BS) and unequivocal electrographic seizures. Consensus annotations between reviewers were used as a gold standard to determine pattern detection SEN and specificity (SPE) of a computational algorithm (baseline, 19 electrodes). Electrodes were than reduced one by one in four different variations. SENs and SPEs were calculated to determine the most beneficial assembly with respect to the number and location of electrodes.

RESULTS

High automated baseline SENs (84.99-93.39%) and SPEs (90.05-95.6%) were achieved for all patterns. Best overall results in detecting BS and CCET patterns were found using the "hairline+vertex" montage. While the "forehead+behind ear" montage showed an advantage in detecting ictal patterns, reaching a 15% drop of SEN with 10 electrodes, all montages could detect BS sufficiently if at least nine electrodes were available.

CONCLUSION

For the first time an automated approach was used to systematically evaluate the effect of electrode reduction on pattern detection SEN in cEEG.

SIGNIFICANCE

Prediction of the expected detection SEN of specific EEG patterns with reduced EEG montages in ICU patients.

Applicability of NeuroTrend as a bedside monitor in the neuro ICU

OBJECTIVE

To assess whether ICU caregivers can correctly read and interpret continuous EEG (cEEG) data displayed with the computer algorithm NeuroTrend (NT) with the main attention on seizure detection and determination of sedation depth.

METHODS

120 screenshots of NT (480h of cEEG) were rated by 18 briefly trained nurses and biomedical analysts. Multirater agreements (MRA) as well as interrater agreements (IRA) compared to an expert opinion (EXO) were calculated for items such as pattern type, pattern location, interruption of recording, seizure suspicion, consistency of frequency, seizure tendency and level of sedation.

RESULTS

MRA as well as IRA were almost perfect (80-100%) for interruption of recording, spike-and-waves, rhythmic delta activity and burst suppression. A substantial agreement (60-80%) was found for electrographic seizure patterns, periodic discharges and seizure suspicion. Except for pattern localization (70.83-92.26%), items requiring a precondition and especially those who needed interpretation like consistency of frequency (47.47-79.15%) or level of sedation (41.10%) showed lower agreements.

CONCLUSIONS

The present study demonstrates that NT might be a useful bedside monitor in cases of subclinical seizures. Determination of correct sedation depth by ICU caregivers requires a more detailed training.

SIGNIFICANCE

Computer algorithms may reduce the workload of cEEG analysis in ICU patients.

Misreporting of Product Adherence in the MTN-003/VOICE Trial for HIV Prevention in Africa: Participants' Explanations for Dishonesty

Consistent over-reporting of product use limits researchers' ability to accurately measure adherence and estimate product efficacy in HIV prevention trials. While lying is a universal characteristic of the human condition, growing evidence of a stark discrepancy between self-reported product use and biologic or pharmacokinetic evidence demands examination of the reasons research participants frequently misrepresent product use in order to mitigate this challenge in future research. This study (VOICE-D) was an ancillary post-trial study of the vaginal and oral interventions to control the epidemic (VOICE) phase IIb trial (MTN 003). It was conducted in three African countries to elicit candid accounts from former VOICE trial participants about why actual product use was lower than reported. In total 171 participants were enrolled between December 2012 and March 2014 in South Africa (n = 47), Uganda (n = 59) and Zimbabwe (n = 65). Data suggested that participants understood the importance of daily product use and honest reporting, yet acknowledged that research participants typically lie. Participants cited multiple reasons for misreporting adherence, including human nature, self-presentation with study staff, fear of repercussions (study termination resulting in loss of benefits and experience of HIV-related stigma), a permissive environment in which it was easy to get away with misreporting, and avoiding inconvenient additional counseling. Some participants also reported mistrust of the staff and reciprocal dishonesty about the study products. Many suggested real-time blood-monitoring during trials would encourage greater fidelity to product use and honesty in reporting. Participants at all sites understood the importance of daily product use and honesty, while also acknowledging widespread misreporting of product use. Narratives of dishonesty may suggest a wider social context of hiding products from partners and distrust about research, influenced by rumors circulating in clinic waiting-rooms and surrounding communities. Prevailing power hierarchies between staff and participants may exacerbate misreporting. Participants recognized and suggested that objective, real-time feedback is needed to encourage honest reporting.

Mycophenolate mofetil and skin diseases

Mycophenolate mofetil (MMF) is an immunosuppressive drug the efficiency of which has been established in renal transplantation. Recent studies suggest that it may also be effective in the treatment of variant skin diseases especially if the skin lesions are triggered by lymphocytes. Studies have shown efficacy in autoimmune bullous dermatoses, atopic dermatitis and psoriasis. However, there are no placebo-controlled trials that support the use of MMF as first line therapy in these skin diseases.

Mycophenolate mofetil and skin diseases

Mycophenolate mofetil (MMF) is an immunosuppressive drug the efficiency of which has been established in renal transplantation. Recent studies suggest that it may also be effective in the treatment of variant skin diseases especially if the skin lesions are triggered by lymphocytes. Studies have shown efficacy in autoimmune bullous dermatoses, atopic dermatitis and psoriasis. However, there are no placebo-controlled trials that support the use of MMF as first line therapy in these skin diseases.

Determination of rate constants for trifluoromethyl radical addition to various alkenes via a practical method

A simple method for the determination of CF3-radical addition rate constants to various π-acceptors is introduced.

Anxiety and depression in long-term testicular germ cell tumor survivors

OBJECTIVE

Despite a good prognosis, the typically young age at diagnosis and physical sequelae may cause psychological distress in germ cell tumor survivors. We aimed to determine the frequency of anxiety and depression and analyze the impact of demographic and disease-related factors.

METHOD

We enrolled N=164 testicular germ cell tumor survivors receiving routine follow-up care at the University Cancer Center Hamburg and a specialized private practice (mean, 11.6 years after diagnosis). Patients completed the Generalized Anxiety Disorder Screener-7, the Patient Health Questionnaire-9 and the Memorial Symptom Assessment Scale-Short Form.

RESULTS

We found clinically significant anxiety present in 6.1% and depression present in 7.9% of survivors. A higher number of physical symptoms and having children were significantly associated with higher levels of both anxiety and depression in multivariate regression analyses controlling for age at diagnosis, cohabitation, socioeconomic status, time since diagnosis, metastatic disease and relapse. Younger age at diagnosis and shorter time since diagnosis were significantly associated with higher anxiety.

CONCLUSION

Although rates of clinically relevant anxiety and depression were comparably low, attention toward persisting physical symptoms and psychosocial needs related to a young age at diagnosis and having children will contribute to address potential long-term psychological distress in germ cell tumor survivors.

Group Singing as a Therapy during Diabetes Training--A Randomized Controlled Pilot Study

Comprehensive diabetes treatment has been shown to reduce quality of life in diabetic patients. However, there is evidence to suggest that group singing can have positive effects on quality of life in various clinical settings. In this randomized controlled pilot study, the effect of singing as a therapy to reduce stress and improve quality of life was investigated in insulin-dependent diabetic patients, undergoing a lifestyle intervention program. Patients from the singing group felt less discontented following treatment. This effect, however, was lost after 3 months. No effect on serum cortisol and plasma adrenocorticotropic hormone (ACTH) levels could be seen when comparing the singing group with the control group, although reduced levels of ACTH and cortisol 3 days after treatment could be found and were still present after 3 months within the group of patients who undertook singing as a therapy. Singing led to an increase in bodyweight, which interestingly had no effect on glucose control or methylglyoxal levels. Therefore, singing during a lifestyle intervention program for insulin-dependent diabetic patients had a short lasting and weak effect on patients' mood without affecting glucose control, but no significant effect on stress related hormones.