Evaluation of PD-1 T lymphocytes in bronchoalveolar lavage in lung cancer compared to benign lung diseases

The expression of the programmed cell death protein 1 (PD-1) has been shown to be markedly increased in tumor-infiltrating lymphocytes. However, the proportion of PD-1 + T cells in the bronchoalveolar lavage (BAL) of lung cancer patients has not been sufficiently evaluated so far. In this prospective study, the proportion of PD-1 + CD4 + as well as PD-1 + CD8 + T cells in BAL samples, isolated from patients with lung cancer, asthma or interstitial lung disease (ILD), were determined via flow cytometry and compared for differences. Bronchoalveolar lavage was performed in 34 patients (14 patients with lung cancer, 10 patients with asthma, 10 patients with ILD). The highest median proportion of PD-1 + CD4 + or PD-1 + CD8 + T cells were found in patients with ILD (83.1% [IQR 72.1; 87.5] and 73.8% [IQR 60.3; 86.3]) followed by patients with lung cancer (66.4% [IQR 59; 69] and 77.1% [IQR 35.8; 82.3]) and patients with asthma (61.3% [IQR 57.4; 70.5] and 57.3% [IQR 46; 65]). Thereby, the difference in the proportion of PD-1 + CD3 + CD4 + BAL cells between ILD patients and asthmatics was significantly different (p = 0.04). The proportion of PD-1 + CD4 + and PD-1 + CD8 + T cells in the BAL of patients with lung cancer did not differ significantly to patients with benign lung diseases. The highest proportion was observed in ILD patients suggesting further research to evaluate the role of the PD-1/PD-L1 pathway in ILD patients.

Second Data Release from the European Pulsar Timing Array: Challenging the Ultralight Dark Matter Paradigm

Pulsar Timing Array experiments probe the presence of possible scalar or pseudoscalar ultralight dark matter particles through decade-long timing of an ensemble of galactic millisecond radio pulsars. With the second data release of the European Pulsar Timing Array, we focus on the most robust scenario, in which dark matter interacts only gravitationally with ordinary baryonic matter. Our results show that ultralight particles with masses 10^{-24.0}  eV≲m≲10^{-23.3}  eV cannot constitute 100% of the measured local dark matter density, but can have at most local density ρ≲0.3  GeV/cm^{3}.

Improved Measurement of the Evolution of the Reactor Antineutrino Flux and Spectrum at Daya Bay

Reactor neutrino experiments play a crucial role in advancing our knowledge of neutrinos. In this Letter, the evolution of the flux and spectrum as a function of the reactor isotopic content is reported in terms of the inverse-beta-decay yield at Daya Bay with 1958 days of data and improved systematic uncertainties. These measurements are compared with two signature model predictions: the Huber-Mueller model based on the conversion method and the SM2018 model based on the summation method. The measured average flux and spectrum, as well as the flux evolution with the ^{239}Pu isotopic fraction, are inconsistent with the predictions of the Huber-Mueller model. In contrast, the SM2018 model is shown to agree with the average flux and its evolution but fails to describe the energy spectrum. Altering the predicted inverse-beta-decay spectrum from ^{239}Pu fission does not improve the agreement with the measurement for either model. The models can be brought into better agreement with the measurements if either the predicted spectrum due to ^{235}U fission is changed or the predicted ^{235}U, ^{238}U, ^{239}Pu, and ^{241}Pu spectra are changed in equal measure.

Precision Measurement of Reactor Antineutrino Oscillation at Kilometer-Scale Baselines by Daya Bay

We present a new determination of the smallest neutrino mixing angle θ_{13} and the mass-squared difference Δm_{32}^{2} using a final sample of 5.55×10^{6} inverse beta-decay (IBD) candidates with the final-state neutron captured on gadolinium. This sample is selected from the complete dataset obtained by the Daya Bay reactor neutrino experiment in 3158 days of operation. Compared to the previous Daya Bay results, selection of IBD candidates has been optimized, energy calibration refined, and treatment of backgrounds further improved. The resulting oscillation parameters are sin^{2}2θ_{13}=0.0851±0.0024, Δm_{32}^{2}=(2.466±0.060)×10^{-3}  eV^{2} for the normal mass ordering or Δm_{32}^{2}=-(2.571±0.060)×10^{-3}  eV^{2} for the inverted mass ordering.

Neutron star mass estimates from gamma-ray eclipses in spider millisecond pulsar binaries

Reliable neutron star mass measurements are key to determining the equation of state of cold nuclear matter, but such measurements are rare. Black widows and redbacks are compact binaries consisting of millisecond pulsars and semi-degenerate companion stars. Spectroscopy of the optically bright companions can determine their radial velocities, providing inclination-dependent pulsar mass estimates. Although inclinations can be inferred from subtle features in optical light curves, such estimates may be systematically biased due to incomplete heating models and poorly understood variability. Using data from the Fermi Large Area Telescope, we have searched for gamma-ray eclipses from 49 spider systems, discovering significant eclipses in 7 systems, including the prototypical black widow PSR B1957+20. Gamma-ray eclipses require direct occultation of the pulsar by the companion, and so the detection, or significant exclusion, of a gamma-ray eclipse strictly limits the binary inclination angle, providing new robust, model-independent pulsar mass constraints. For PSR B1957+20, the eclipse implies a much lighter pulsar (1.81 ± 0.07 solar masses) than inferred from optical light curve modelling.

Effects of targeted therapy on blood gas analysis in pulmonary arterial hypertension – a retrospective analysis

Background

In pulmonary arterial hypertension (PAH), there is an excessive respiratory drive, which leads to inefficient ventilation with subsequent hypocapnia. Changes in blood gas analysis (BGA) may correlate with symptom severity and outcome. Data on impact of targeted PAH therapy on BGA are scarce and it remains unclear if these values can be used for risk stratification purposes.

Purpose

To assess capillary BGA in PAH at diagnosis and to evaluate the effect of targeted therapy on classical and calculated BGA parameters.

Methods

147 patients (62.3±17.1 years; female/male ratio: 66.7/33.3%) with newly diagnosed PAH were treated with targeted PAH therapy. 12-month follow-up included assessment of capillary blood gases and clinical variables. Patients underwent repeat RHC after 15.9±15.5 months.

Results

At diagnosis, both pcO2 (66.8±1.3 mmHg) and pcCO2 (32.7±0.5 mmHg) were slightly reduced. At 12-month follow-up, pcCO2 increased significantly to values within normal range (35.3±0.4 mmHg), while pcO2 showed no significant changes. After using the formula to calculate standard pcO2, baseline values were even lower, but there were significant improvements at 12-month follow-up, also reaching normal values. Changes in pcCO2 and standard pcO2 at diagnosis correlated with hemodynamics and survival at follow-up. Repeated RHC demonstrated significant reductions in mean PAP (48.9±1.2 to 39.9±1.0 mmHg; −18.4%), and PVR (11.3±0.7 to 6.2±0.3 WU; −45.1%), and an increase in cardiac index (2.1±0.04 to 2.6±0.1 ml/min/m2; +23.8%) (all p<0.05). Hemodynamic improvements correlated with improved clinical parameters, including 6-minute walking distance (344±9 to 393±9 m), NTproBNP serum levels (2.163±219 to 772±84 ng/l, both p<0.05) and WHO-FC at 12 months, resulting in improved risk status.

Conclusions

Targeted PAH therapy leads to significantly improved cardiopulmonary hemodynamics with subsequent increase in pcCO2, presumably due to less hyperventilation. Changes in pcCO2 and standard pcO2 (but not pcO2) correlate with hemodynamics and survival, potentially serving as non-invasive parameters for risk assessment and therapeutic response. The discrepancy between pcO2 and standard pcO2 at diagnosis suggests that pcO2 is upregulated by the hyperventilatory state. Standard pcO2 represents an easy-to-calculate parameter that can help more accurately identify PAH patients requiring O2 therapy in addition to targeted therapy. Further studies are needed in this context.

Funding Acknowledgement

Type of funding sources: None.

Retrospective evaluation of surgical technique, complications and long-term outcome of lateral and medial humeral condylar fractures in 80 dogs

CASE HISTORY

Medical records of a single veterinary teaching hospital in Giessen, Germany were retrospectively reviewed for dogs presented for medial or lateral humeral condylar fractures (HCF) between 2007 and 2019. Data regarding surgical technique and complications were collected from the medical records. The latter was supplemented through information obtained from telephone interviews with referral veterinarians and from an owner questionnaire completed ≥12 months after surgical repair, which also provided data regarding outcome.

CLINICAL FINDINGS

Eighty dogs with 85 HCF were identified: 13 (15.3%) HCF were medial (bilateral in two dogs) and 72 (84.7%) were lateral (bilateral in three dogs). French Bulldogs (n = 19/80; 23.8%) were most commonly affected. Patients were predominantly skeletally immature and light-weight, with a median age at the time of presentation of 3 (min 2, max 118) months and with a median body weight of 6.4 (min 1, max 46) kg. There were 38 female (47.5%) and 42 male (52.5%) dogs. Fractures developed most frequently secondary to minor trauma (67/77; 87.0%). Dogs were presented in 35/84 (41.7%) cases more than 24 hours after fracture occurrence.

TREATMENT AND OUTCOME

Surgical treatment was performed in 80/85 (94.1%) HCF. An open reduction and internal fixation approach was chosen in all cases. A transcondylar screw (TS) combined with a supracondylar (SC) K-wire (67/80; 83.8%) was the most frequently used fixation technique. Considering all fracture fixation methods, complications (26/80; 32.5%) were classed as minor in 10 (12.5%), major in 14 (17.5%) and catastrophic in two (2.5%) of the 80 surgically treated HCF. Long-term outcome was excellent in 68.6% (24/35 HCF) and very good in 22.9% (8/35 HCF) of the cases for which follow-up information was obtained. Additionally, owner information revealed that 85.7% of dogs (30/35 HCF) were free of lameness in the long-term.

CLINICAL RELEVANCE

This case series demonstrates that surgical repair of lateral and medial HCF with a TS and SC K-wire is a viable option to consider in skeletally immature and light-weight patients. Complications occur frequently after surgical fixation of HCF, but owners can expect a very good to excellent long-term outcome in the majority of cases.

First Measurement of High-Energy Reactor Antineutrinos at Daya Bay

This Letter reports the first measurement of high-energy reactor antineutrinos at Daya Bay, with nearly 9000 inverse beta decay candidates in the prompt energy region of 8-12 MeV observed over 1958 days of data collection. A multivariate analysis is used to separate 2500 signal events from background statistically. The hypothesis of no reactor antineutrinos with neutrino energy above 10 MeV is rejected with a significance of 6.2 standard deviations. A 29% antineutrino flux deficit in the prompt energy region of 8-11 MeV is observed compared to a recent model prediction. We provide the unfolded antineutrino spectrum above 7 MeV as a data-based reference for other experiments. This result provides the first direct observation of the production of antineutrinos from several high-Q_{β} isotopes in commercial reactors.

Joint Determination of Reactor Antineutrino Spectra from ^{235}U and ^{239}Pu Fission by Daya Bay and PROSPECT

A joint determination of the reactor antineutrino spectra resulting from the fission of ^{235}U and ^{239}Pu has been carried out by the Daya Bay and PROSPECT Collaborations. This Letter reports the level of consistency of ^{235}U spectrum measurements from the two experiments and presents new results from a joint analysis of both data sets. The measurements are found to be consistent. The combined analysis reduces the degeneracy between the dominant ^{235}U and ^{239}Pu isotopes and improves the uncertainty of the ^{235}U spectral shape to about 3%. The ^{235}U and ^{239}Pu antineutrino energy spectra are unfolded from the jointly deconvolved reactor spectra using the Wiener-SVD unfolding method, providing a data-based reference for other reactor antineutrino experiments and other applications. This is the first measurement of the ^{235}U and ^{239}Pu spectra based on the combination of experiments at low- and highly enriched uranium reactors.

A bimodal burst energy distribution of a repeating fast radio burst source

The event rate, energy distribution and time-domain behaviour of repeating fast radio bursts (FRBs) contain essential information regarding their physical nature and central engine, which are as yet unknown^1,2. As the first precisely localized source, FRB 121102 (refs. ^3-5) has been extensively observed and shows non-Poisson clustering of bursts over time and a power-law energy distribution^6-8. However, the extent of the energy distribution towards the fainter end was not known. Here we report the detection of 1,652 independent bursts with a peak burst rate of 122 h^-1, in 59.5 hours spanning 47 days. A peak in the isotropic equivalent energy distribution is found to be approximately 4.8 × 10³⁷ erg at 1.25 GHz, below which the detection of bursts is suppressed. The burst energy distribution is bimodal, and well characterized by a combination of a log-normal function and a generalized Cauchy function. The large number of bursts in hour-long spans allows sensitive periodicity searches between 1 ms and 1,000 s. The non-detection of any periodicity or quasi-periodicity poses challenges for models involving a single rotating compact object. The high burst rate also implies that FRBs must be generated with a high radiative efficiency, disfavouring emission mechanisms with large energy requirements or contrived triggering conditions.

Erratum: Azimuthal Anisotropy of K_{S}^{0} and Λ+Λ[over ¯] Production at Midrapidity from Au+Au Collisions at sqrt[s]_{NN}=130 GeV [Phys. Rev. Lett. 89, 132301 (2002)]

This corrects the article DOI: 10.1103/PhysRevLett.89.132301.

Erratum: Azimuthal Anisotropy at the Relativistic Heavy Ion Collider: The First and Fourth Harmonics [Phys. Rev. Lett. 92, 062301 (2004)]

This corrects the article DOI: 10.1103/PhysRevLett.92.062301.

Comparing critical speed modelling approaches and exploring relationships with match-play variables in elite male youth soccer players

Background

A novel bi-exponential method has emerged to estimate critical speed (CS) and D-prime (D') from a 3-min all-out test (3MT).

Objectives

To compare CS analysis methods to determine whether parameter estimations were interchangeable. Reference values and relationships with key soccer match-play variables were explored.

Methods

Thirteen elite male youth (14-15 years old) players completed a 30 m shuttle run 3MT to estimate CS, D', rate of speed decline time constant, maximal speed (S _max), time to S _max (t _max), and fatigue index (FI), using the traditional method and bi-exponential model on average (Bi-Exp_Average) and max speed settings (Bi-Exp_Max-Speed). High-speed running (HSR) and sprinting distances and counts, and the number of accelerations were collected from two matches. Magnitude-based inferences (p < 0.05) with smallest worthwhile change of 0.2 effect sizes were used to analyse differences. Pearson's and Spearman's correlation coefficients were used to measure associations between CS model variables and match-play parameters.

Results

There were significant differences between the traditional method and both bi-exponential models for CS and D', as well as between the bi-exponential models for all variables except t _max. Using the Bi-Exp_Average model, strong correlations (r = 0.70-0.73; p < 0.05) were observed for D' and FI with the number of standardised and individualised HSRs, respectively. With the Bi-Exp_Max-Speed model, there were strong correlations (r/ρ = 0.64-0.68; p < 0.05) between D' and the number of standardised HSRs and sprints, and the number of individualised sprints.

Conclusion

There is a lack of interchangeability between analysis methods. It appears that D' and FI from the bi-exponential models could be associated with high-intensity actions in soccer match-play.

Genetic background of lumbosacral transitional vertebrae in German shepherd dogs

OBJECTIVES

Estimation of genetic parameters of lumbosacral transitional vertebrae based on data derived from radiographic screening of 27,597 German shepherd dogs.

MATERIALS AND METHODS

Results of radiographic screening for lumbosacral transitional vertebrae classified according to a published scheme were collected. Obtained data were used for estimating variance components in single and multiple trait linear animal models to obtain heritabilities and additive genetic correlations for different types of lumbosacral transitional vertebrae.

RESULTS

Estimations indicated a moderate heritability of lumbosacral transitional vertebrae of h²  = 0.27. Trait definitions reflecting the different types of lumbosacral transitional vertebrae revealed positive additive genetic correlations of r_g  > 0.5 between those types usually categorised as pathologic.

CLINICAL SIGNIFICANCE

Results of comprehensive genetic analyses enable the development of breeding measures against lumbosacral transitional vertebrae to reduce their prevalence and support management of potentially correlated diseases in German shepherd dogs.

SAUL, a single-arm study of atezolizumab for chemotherapy-pretreated locally advanced or metastatic carcinoma of the urinary tract: outcomes by key baseline factors, PD-L1 expression and prior platinum therapy

Background

The impact of pretreatment factors on immune checkpoint inhibition in platinum-refractory advanced urothelial cancer (aUC) deserves further evaluation. The aim was to study the association of Bellmunt risk factors, time from last chemotherapy (TFLC), previous therapy and PD-L1 expression with atezolizumab efficacy in platinum-refractory aUC.

Patients and methods

This was a post-hoc analysis of patients who had received prior cisplatin or carboplatin in the prospective, single-arm, phase IIIb SAUL study (NCT02928406). Patients were treated with 3-weekly atezolizumab 1200 mg intravenously. The primary outcome was overall survival (OS). Relationships were analysed using Cox regression and long-rank test.

Results

Of 997 patients in SAUL, 969 were eligible for this analysis. The number of Bellmunt risk factors was associated with OS (P < 0.001); median OS (mOS) for 0, 1 and 2-3 risk factors was 17.9, 8.9 and 3.3 months, respectively. Significant associations were also observed between OS and TFLC (P < 0.001), programmed death-ligand 1 (PD-L1) expression (P = 0.002), and prior perioperative chemotherapy (P = 0.013); mOS was 6.97 versus 11.63 months for TFLC ≤6 versus >6 months, 7.75 versus 11.6 months for PD-L1 expression on <1% of tumour-infiltrating immune cells (ICs) (IC0)/expression on 1% to <5% of tumour-infiltrating ICs (IC1) versus expression on ≥5% of tumour-infiltrating ICs (IC2/3) and 10.2 versus 7.8 months for prior versus no prior perioperative chemotherapy, respectively. The type of platinum compound and number of previous treatment lines were not associated with outcomes.

Conclusions

Post-platinum atezolizumab is active in aUC, irrespective of previous platinum compound and lines of therapy. Bellmunt risk stratification, PD-L1 expression, TFLC and perioperative chemotherapy were identified as prognostic factors for OS with second-line atezolizumab, indicating the need for novel prognostic signatures for immunotherapy-treated patients with aUC.

•

Bellmunt stratification is an accepted risk algorithm in second-line chemotherapy for aUC.

•

The impact of pretreatment factors on immune checkpoint inhibition in aUC requires further evaluation.

•

We studied the prognostic significance of pretreatment factors in post-platinum immunotherapy of aUC in real-world setting.

•

Bellmunt factors, TFLC, prior therapy and PD-L1 expression were identified as prognostic factors.

•

Our results suggest a need for novel prognostic signatures for immunotherapy in aUC.

Accelerometery vs. video-derived stroke parameters in high-level swimmers

Background

Swimming is a multifaceted sport with nuanced performance parameters that tend to vary according to the swimmer's stroke style. The extraction and analyses of swim parameters, such as lap time (LT), stroke length (SL), stroke rate (SR) and velocity are time-consuming. This may be eased and to some extent automated by the use of cost-effective tri-axial accelerometers.

Objectives

To determine the validity of tri-axial accelerometers across all four stroke styles, and to investigate kinematic differences in stroke styles using accelerometer-based data.

Methods

Twelve elite swimmers were recruited for the study. The group consisted of five male (age: 22.2 ± 2.6 years; height: 1.84 ± 0.08 m; weight: 76.2 ± 3.6 kg) and seven female (age: 20.7 ± 2.1 years; height: 1.68 ± 0.08 cm; weight: 62.0 ± 6.3 kg) swimmers.

Results

There was a small but significant bias for accelerometery data compared to video data across most parameters and stroke styles except for stroke length and stroke count (p > 0.05). However, accelerometery-derived SR, SL and velocity can be considered practically useful based on the training requirements of coaches. Parameters derived from video analysis compared to accelerometery were highly correlated (r > 0.91) and therefore consistent regardless of the method of analysis.

Conclusion

Although slight differences were present between the video and accelerometer data, these differences were not practically meaningful.

Using the Working Model of Adjustment to Chronic Illness to explain the burden of recurrent urinary tract infection: A survey-based study

Introduction

The treatment of recurrent urinary tract infection (RUTI) with antibiotics is causing concern as patients are often prescribed an inappropriate course of antibiotics, and the recurrence rate remains at 30–44% following treatment (1). Overprescription of antibiotics can also cause antimicrobial resistance. Given the current lack of adequate clinical guidelines for RUTI treatment, it is necessary for this population to adjust to living with a chronic condition, and research suggests that RUTI may be associated with poor mental health and a lower quality of life. Thus, there is a need for a more interdisciplinary approach to understanding RUTI, to inform additional treatment options.

Aim

The current study aimed to use the Working Model of Adjustment to Chronic Illness (WMACI) (see Figure 1) to explore the personal, physical and social burden of RUTI (2).

Methods

A cross-sectional survey was employed, which was informed by existing questionnaires and reviewed by experts including pain specialists (n = 6). 5,078 participants accessed liveutifree.com to seek information regarding their condition and completed the Live UTI Free survey. Participants provided information on their experiences with RUTI (recurrence rate, symptoms, pain intensity, triggers and comorbidity) and the associated burden. Binomial logistic regressions were conducted to assess the effect of RUTI characteristics on the likelihood of experiencing personal, physical and social burden.

Results

RUTI predicted greater likelihood of personal burden (enjoyment of life; enjoyment of favourite activities; mental health) (R² = 18.8 – 20.8, p = &lt;.001), physical burden (sleep; activities of daily living; maintaining a healthy lifestyle; sexual behaviour) (R² = 21.1 – 35.9, p = &lt;.001), and social burden (normal work; finances; relationships with friends and family; relationships with partners) (R² = 17.0 - 25.8, p = &lt;.001), with the burden associated with sexual behaviour showing the largest amount of variance. Rate of recurrence, symptom burden, pain intensity, and having an additional diagnosis of Interstitial Cystitis (IC) were most predictive of participant burden.

Conclusion

RUTI was associated with all areas of burden. Some factors, including pain intensity and having an additional diagnosis of IC, affected a majority of areas. Predicted burden from having an additional diagnosis of IC may be a result of lack of clarity between the two diagnoses, which have shared symptom indicators and rely on urine culture testing, which has been demonstrated to be inaccurate. Misdiagnosis, or a dual diagnosis, may consequently contribute to burden. The WMACI was used to suggest how burden can lead to poor illness adjustment. Limitations of the study were that it did not explore the possibility of misdiagnosis and its impact, or investigate the effects of SES and country-level differences. However, the findings of the study have important clinical implications, as patients worldwide who are suffering with RUTI are required to manage significant burden that is associated with the condition, and this is an important issue which needs to be addressed in primary care settings. An interdisciplinary approach in primary care settings is recommended, which acknowledges the psychosocial burden that persists when treatment fails to resolve physical symptoms.

References

1. Gupta K, Trautner BW. Diagnosis and management of recurrent urinary tract infections in non-pregnant women. BMJ (Online). 2013; 346: f3140.

2. Moss-Morris R. Adjusting to chronic illness: Time for a unified theory. British Journal of Health Psychology. 2013; 681–686.

Prevention of hepatic encephalopathy by administration of rifaximin and lactulose in patients with liver cirrhosis undergoing placement of a transjugular intrahepatic portosystemic shunt (TIPS): a multicentre randomised, double blind, placebo controlled trial (PEARL trial)

Introduction

Cirrhotic patients with portal hypertension can suffer from variceal bleeding or refractory ascites and can benefit from a transjugular intrahepatic portosystemic shunt (TIPS). Post-TIPS hepatic encephalopathy (HE) is a common (20%–54%) and often severe complication. A prophylactic strategy is lacking.

Methods and analysis

The Prevention of hepatic Encephalopathy by Administration of Rifaximin and Lactulose in patients with liver cirrhosis undergoing placement of a TIPS (PEARL) trial, is a multicentre randomised, double blind, placebo controlled trial. Patients undergoing covered TIPS placement are prescribed either rifaximin 550 mg two times per day and lactulose 25 mL two times per day (starting dose) or placebo 550 mg two times per day and lactulose 25 mL two times per day from 72 hours before and until 3 months after TIPS placement. Primary endpoint is the development of overt HE (OHE) within 3 months (according to West Haven criteria). Secondary endpoints include 90-day mortality; development of a second episode of OHE; time to development of episode(s) of OHE; development of minimal HE; molecular changes in peripheral and portal blood samples; quality of life and cost-effectiveness. The total sample size is 238 patients and recruitment period is 3 years in six hospitals in the Netherlands and one in Belgium.

Ethics and dissemination

This study protocol was approved in the Netherlands by the Medical Research Ethics Committee of the Academic Medical Centre, Amsterdam (2018-332), in Belgium by the Ethics Committee Research UZ/KU Leuven (S62577) and competent authorities. This study will be conducted in accordance with Good Clinical Practice guidelines and the principles of the Declaration of Helsinki. Study results will be submitted for publication in a peer-reviewed journal.

Trial registration numbers

ClinicalTrials.gov (NCT04073290) and EudraCT database (2018-004323-37).

Improved Constraints on Sterile Neutrino Mixing from Disappearance Searches in the MINOS, MINOS+, Daya Bay, and Bugey-3 Experiments

Searches for electron antineutrino, muon neutrino, and muon antineutrino disappearance driven by sterile neutrino mixing have been carried out by the Daya Bay and MINOS+ collaborations. This Letter presents the combined results of these searches, along with exclusion results from the Bugey-3 reactor experiment, framed in a minimally extended four-neutrino scenario. Significantly improved constraints on the θ_{μe} mixing angle are derived that constitute the most constraining limits to date over five orders of magnitude in the mass-squared splitting Δm_{41}^{2}, excluding the 90% C.L. sterile-neutrino parameter space allowed by the LSND and MiniBooNE observations at 90% CL_{s} for Δm_{41}^{2}<13  eV^{2}. Furthermore, the LSND and MiniBooNE 99% C.L. allowed regions are excluded at 99% CL_{s} for Δm_{41}^{2}<1.6 eV^{2}.

The involvement of the substance P/neurokinin 1 receptor system in viral infection: focus on the gp120 fusion protein and homologous dipeptide domains

The human immunodeficiency virus (HIV) envelope, via a key extracellular amino acid sequence, may simulate the functionality of native undecapeptide substance P (SP) acting through the host's neurokinin 1 (SP preferring) receptor (NK-1R). Human monocytes and macrophages express both NK-1Rs and SP. In HIV/AIDS the NK-1R may function as a chemokine-like G-protein coupled co-receptor that: 1) fuses to the outer envelope of HIV; 2) enables intracellular entry of the envelope-capsid-NK-1R complex; 3) co-opts immune defence via its physiological interaction with the SP-like envelope; 4) may contribute to resistance of CD4/chemokine entry inhibitor type drugs; 5) relaxes the blood-brain barrier to support entry of the HIV into the central nervous system, and 6) mediates most of the common clinical sequelae of HIV/AIDS (encephalopathy and AIDS dementia complex). The data support the idea that NK-1R antagonists could be useful to treat HIV/AIDS. Keywords: human immunodeficiency virus; NK-1 receptor; NK-1 receptor antagonist; aprepitant; fusion protein; virus.

Extraction of the ^{235}U and ^{239}Pu Antineutrino Spectra at Daya Bay

This Letter reports the first extraction of individual antineutrino spectra from ^{235}U and ^{239}Pu fission and an improved measurement of the prompt energy spectrum of reactor antineutrinos at Daya Bay. The analysis uses 3.5×10^{6} inverse beta-decay candidates in four near antineutrino detectors in 1958 days. The individual antineutrino spectra of the two dominant isotopes, ^{235}U and ^{239}Pu, are extracted using the evolution of the prompt spectrum as a function of the isotope fission fractions. In the energy window of 4-6 MeV, a 7% (9%) excess of events is observed for the ^{235}U (^{239}Pu) spectrum compared with the normalized Huber-Mueller model prediction. The significance of discrepancy is 4.0σ for ^{235}U spectral shape compared with the Huber-Mueller model prediction. The shape of the measured inverse beta-decay prompt energy spectrum disagrees with the prediction of the Huber-Mueller model at 5.3σ. In the energy range of 4-6 MeV, a maximal local discrepancy of 6.3σ is observed.

Approach for analytical characterization and toxicological assessment of ozonation products in drinking water on the example of acesulfame

The monitoring and control of drinking water quality is generally important as it significantly contributes to the health of the population. In this context, particular attention has to be paid to the use of treatment techniques during drinking water treatment. It is known that the formation of reaction products (transformation products) has to be taken into account when oxidizing agents such as ozone are used. Different transformation products are classified as critical to health and require analytical examination. The risk assessment for previously unknown transformation products can be difficult as far as not all transformation products are present as single substances or the individual substances are not present in a sufficient high concentration or cannot be isolated from the original solution. The aim of this work is to show exemplarily the identification and quantification of ozonation products (OPs) after ozonation and their toxicological characterization, using the artificial sweetener acesulfame. It was shown that OPs can be fully characterized using ion chromatography in combination with different detection systems. A major OP could be recovered as a pure substance by crystallization and direct genotoxicological testing was possible without previous enrichment processes. Acesulfame samples of different concentrations in ultrapure and in drinking water after ozonation were tested in several genotoxicity tests. These tests revealed genotoxic effects of acesulfame after ozonation in ultrapure water in several genotoxicological test systems (micronucleus test, umu test, Ames-fluctuation-test and comet assay). In contrast, the crystallized ozonation product OP168 did not show any positive effects. Therefore, it seems likely that the observed effect was caused by the second major product OP170. However, a sufficiently large amount of analytically pure substance OP170 could not be obtained. It was also shown that the rate of the OP170 formation in drinking water is significantly lower than in ultrapure water and that ozonation in drinking water did not induce genotoxic effects.

Measurement of the Electron Antineutrino Oscillation with 1958 Days of Operation at Daya Bay

We report a measurement of electron antineutrino oscillation from the Daya Bay Reactor Neutrino Experiment with nearly 4 million reactor ν[over ¯]_{e} inverse β decay candidates observed over 1958 days of data collection. The installation of a flash analog-to-digital converter readout system and a special calibration campaign using different source enclosures reduce uncertainties in the absolute energy calibration to less than 0.5% for visible energies larger than 2 MeV. The uncertainty in the cosmogenic ^{9}Li and ^{8}He background is reduced from 45% to 30% in the near detectors. A detailed investigation of the spent nuclear fuel history improves its uncertainty from 100% to 30%. Analysis of the relative ν[over ¯]_{e} rates and energy spectra among detectors yields sin^{2}2θ_{13}=0.0856±0.0029 and Δm_{32}^{2}=(2.471_{-0.070}^{+0.068})×10^{-3}  eV^{2} assuming the normal hierarchy, and Δm_{32}^{2}=-(2.575_{-0.070}^{+0.068})×10^{-3}  eV^{2} assuming the inverted hierarchy.

Inconclusive benefit of adjuvant 90Yttrium hydroxyapatite to radiosynovectomy for diffuse-type tenosynovial giant-cell tumour of the knee

Aims

Intra-articular 90Yttrium (90Y) is an adjunct to surgical treatment by synovectomy for patients with diffuse-type tenosynovial giant-cell tumour (dtTGCT) of the knee, with variable success rates. Clinical information is, however, sparse and its value remains unclear. We investigated the long-term outcome of patients who underwent synovectomy with and without adjuvant treatment with 90Yttrium.

Patients and Methods

All patients with dtTGCT of the knee who underwent synovectomy between 1991 and 2014 were included in the study. Group A patients underwent synovectomy and an intra-articular injection of 90Yttrium between six and eight weeks after surgery. Group B patients underwent surgery alone.

Results

There were 34 patients in group A and 22 in group B. Recurrence of dtTGCT was identified by MRI, which was undertaken in patients with further symptoms. At a mean follow-up of 7.3 years (2.5 to 25.4), there was residual disease in 15 patients in group A and 11 in group B (p < 0.363). The mean Musculoskeletal Tumor Society (MSTS) score at final follow-up was 85% and 83%, respectively (p < 0.91).

Conclusion

There were no significant differences in outcome between patients treated surgically for dtTGCT of the knee with or without an adjuvant intra-articular injection of 90Yttrium. We were unable to provide conclusive evidence of any benefits derived from the adjuvant treatment. Cite this article: Bone Joint J 2018;100-B:984–8.

The prospects of pulsar timing with new-generation radio telescopes and the Square Kilometre Array

Pulsars are highly magnetized and rapidly rotating neutron stars. As they spin, the lighthouse-like beam of radio emission from their magnetic poles sweeps across the Earth with a regularity approaching that of the most precise clocks known. This precision combined with the extreme environments in which they are found, often in compact orbits with other neutron stars and white dwarfs, makes them excellent tools for studying gravity. Present and near-future pulsar surveys, especially those using the new generation of telescopes, will find more extreme binary systems and pulsars that are more precise 'clocks'. These telescopes will also greatly improve the precision to which we can measure the arrival times of the pulses. The Square Kilometre Array will revolutionize pulsar searches and timing precision. The increased number of sources will reveal rare sources, including possibly a pulsar-black hole binary, which can provide the most stringent tests of strong-field gravity. The improved timing precision will reveal new phenomena and also allow us to make a detection of gravitational waves in the nanohertz frequency regime. It is here where we expect to see the signature of the binary black holes that are formed as galaxies merge throughout cosmological history.This article is part of a discussion meeting issue 'The promises of gravitational-wave astronomy'.

Rare disruptive variants in the DISC1 Interactome and Regulome: association with cognitive ability and schizophrenia

Schizophrenia (SCZ), bipolar disorder (BD) and recurrent major depressive disorder (rMDD) are common psychiatric illnesses. All have been associated with lower cognitive ability, and show evidence of genetic overlap and substantial evidence of pleiotropy with cognitive function and neuroticism. Disrupted in schizophrenia 1 (DISC1) protein directly interacts with a large set of proteins (DISC1 Interactome) that are involved in brain development and signaling. Modulation of DISC1 expression alters the expression of a circumscribed set of genes (DISC1 Regulome) that are also implicated in brain biology and disorder. Here we report targeted sequencing of 59 DISC1 Interactome genes and 154 Regulome genes in 654 psychiatric patients and 889 cognitively-phenotyped control subjects, on whom we previously reported evidence for trait association from complete sequencing of the DISC1 locus. Burden analyses of rare and singleton variants predicted to be damaging were performed for psychiatric disorders, cognitive variables and personality traits. The DISC1 Interactome and Regulome showed differential association across the phenotypes tested. After family-wise error correction across all traits (FWERacross), an increased burden of singleton disruptive variants in the Regulome was associated with SCZ (FWERacross P=0.0339). The burden of singleton disruptive variants in the DISC1 Interactome was associated with low cognitive ability at age 11 (FWERacross P=0.0043). These results identify altered regulation of schizophrenia candidate genes by DISC1 and its core Interactome as an alternate pathway for schizophrenia risk, consistent with the emerging effects of rare copy number variants associated with intellectual disability.

Necrotizing Choroiditis-Retinitis as Presenting Symptom of Disseminated Aspergillosis after Lung Transplantation

Background.

Endogenous endophthalmitis due to Aspergillus is rare affecting the severely immunosuppressed population, in particular recipients of heart and lung transplants. Ocular involvement of aspergillosis has always been observed late in the course of the disease.

Subject.

A young woman noted blurred vision in one eye three weeks after lung transplantation. At this stage, no systemic manifestations of fungal infection were detected and the ocular findings were attributed to viral infection.

Results.

Twenty-four hours after the original ocular complaint, an aggressive endophthalmitis developed in the left eye. The possibility of fungal endophthalmitis was raised. Within 48 hours of her first ocular complaint the patient died. Cultures from a vitreous tap and from autopsy ocular specimens were positive for Aspergillus fumigatus.

Conclusions.

Aspergillus endophthalmitis may occur in patients undergoing lung transplantation despite antifungal therapy. Increased awareness of this unusual entity may be life and vision saving in these patients.

Allogeneic hematopoietic cell transplantation in intermediate risk acute myeloid leukemia negative for FLT3-ITD, NPM1- or biallelic CEBPA mutations

Background

The value of allogeneic hematopoietic cell transplantation (alloHCT) as postremission treatment is not well defined for patients with intermediate-risk acute myeloid leukemia (AML) without FLT3-ITD, biallelic CEBPA-, or NPM1 mutations (here referred to as NPM1mut-neg/CEBPAdm-neg/FLT3-ITDneg AML) in first complete remission (CR1).

Patients and methods

We addressed this question using data from two prospective randomized controlled trials on intensive induction- and risk-stratified postremission therapy. The NPM1mut-neg/CEBPAdm-neg/FLT3-ITDneg AML subgroup comprised 497 patients, aged 18-60 years.

Results

In donor versus no-donor analyses, patients with a matched related donor had a longer relapse-free survival (HR 0.5; 95% CI 0.3-0.9, P = 0.02) and a trend toward better overall survival (HR 0.6, 95% CI 0.3-1.1, P = 0.08) compared with patients who received postremission chemotherapy. Notably, only 58% of patients in the donor group were transplanted in CR1. We therefore complemented the donor versus no-donor analysis with multivariable Cox regression analyses, where alloHCT was tested as a time-dependent covariate: overall survival (HR 0.58, 95% CI 0.37-0.9, P = 0.02) and relapse-free survival (HR 0.51, 95% CI 0.34-0.76; P = 0.001) for patients who received alloHCT compared with chemotherapy in CR1 were significantly longer.

Conclusion

Outside clinical trials, alloHCT should be the preferred postremission treatment of patients with intermediate risk NPM1mut-neg/CEBPAdm-neg/FLT3-ITDneg AML in CR1.

Cinicaltrials.gov identifier

NCT00180115, NCT00180102.

Inclusion of Signal Analysis in a Hybrid Medical Decision Support System

Objectives: Signal analysis has played an important role in cardiac diagnosis, both as a separate entity and in conjunction with clinical parameters. Hybrid systems are an effective method for developing higher-order decision models in which biomedical signal data can be incorporated.

Methods: The hybrid system components include a knowledge-based system that utilizes approximate reasoning techniques, a neural network model based on a potential function approach to supervised learning that uses the general class of Cohen orthogonal functions as potential functions, and a signal analysis component that relies on continuous chaotic modeling to produce a degree of variability in the time series. The hybrid system is illustrated in an application for differentiation among different types of dementia.

Results: Application of this method to cardiac diagnosis shows that chaotic parameters alone contribute significantly to correct classification while the addition of clinical parameters increases the sensitivity, specificity, and accuracy. Applications to electroencephalogram analysis indicate that the second-order difference plots display significant differences for the different types of EEG waves identifiable by frequency, both in shape and degree of dispersion. Hence the identification of these waves, and the duration of their occurrence, may provide suitable variables for chaotic analysis.

Conclusions: Results from studies in cardiology demonstrate that using chaotic measures for ECG analysis provide useful information for classification. Sensitivity, specificity, and accuracy are increased if these methods are combined with other clinical parameters in a hybrid system. This approach has been extended to new applications based on EEG analysis combined with other relevant information.

Comparison of in vitro test systems using bacterial and mammalian cells for genotoxicity assessment within the "health-related indication value (HRIV) concept

In numerous cases, the German health-related indication value (HRIV) concept has proved its practicability for the assessment of drinking water relevant trace substances (Umweltbundesamt 2003). The HRIV is based on the toxicological profile of a substance. An open point of the HRIV concept has been the assignment of standardized test procedures to be used for the assessment. The level of the HRIV is at its lowest as soon as the genotoxicity of the substance is detected. As a single test on its own, it is not sufficient enough to assess the human toxicological relevance of a genotoxic effect or exclude it in the case of a negative result; a reasonable test battery was required, technically oriented towards the already harmonized international, hierarchical evaluation for toxicological assessment of chemicals. Therefore, an important aim of this project was to define a strategy for the genotoxicological assessment of anthropogenic trace substances. The basic test battery for genotoxicity of micropollutants in drinking water needs to fulfill several requirements. Although quick test results are needed for the determination of HRIV, a high degree of transferability to human genotoxicity should be ensured. Therefore, an in vitro genotoxicity test battery consisting of the Ames fluctuation test with two tester strains (ISO 11350), the umu test and the micronucleus test, or from the Ames test with five tester strains (OECD 471) and the micronucleus test is proposed. On the basis of selected test substances, it could be shown that the test battery leads to positive, indifferent, and negative results. Given indifferent results, the health authority and the water supplier must assume that it is a genotoxic substance. Genetically modified tester strains are being sensitive to different chemical classes by expression of selected mammalian key enzymes for example nitroreductase, acetyltransferase, and glutathione-S-transferase. These strains may provide valuable additional information and may give a first indication of the mechanism of action. To check this hypothesis, various additional strains expressing specific human-relevant enzymes were investigated. It could be shown that the additional use of genetically modified tester strains can enhance the detectable substance spectrum with the bacterial genotoxicological standard procedures or increase the sensitivity. The additional use provides orienting information at this level as a lot of data can be obtained quite quickly and with little effort. These indications of the mechanism of action should be however verified with a test system that uses mammalian cells, better human cells, to check their actual relevance. The selection of appropriate additional tester strains has to be defined from case to case depending on the molecular structure and also still requires some major expertise.

Die sonographische Untersuchung des Kniegelenks beim Hund

Die Sonographie stellt ein kostengünstiges, nicht invasives und am wachen Patienten durchführbares Verfahren dar, das bei einer Lahmheit der Hintergliedmaße mit Lokalisation im Bereich des Kniegelenks wertvolle Befunde liefern kann. Der vorliegende erste Teil dieses Artikels beschreibt technische Voraussetzungen, Limitationen, anatomische Grundlagen sowie eine standardisierte Vorgehensweise für die sonographische Untersuchung des Kniegelenks. Sonomorphologische Veränderungen, die im Zusammenhang mit häufigen Erkrankungen des Kniegelenks (Gelenkerguss, Ruptur des kranialen Kreuzbands und Meniskuspathologien) auftreten, werden dargestellt. Die sonographische Diagnostik weiterer pathologischer Kniegelenkveränderungen ist Thema des zweiten Teils dieser Arbeit.

Muskulotendinopathie des Musculus gastrocnemius bei einem Labrador Retriever

Die Muskulotendinopathie des Musculus (M.) gastrocnemius stellt eine seltene Erkrankung des Ursprungs dieses Muskels dar, die durch eine chronische Überbelastung des Muskel-Sehnen-Übergangs beim Sporteinsatz entsteht und zumeist bei Hütehunden beschrieben wurde. Klinisch zeigen die Patienten eine chronische Hinterhandlahmheit sowie Schmerzhaftigkeit bei Druck auf die laterale Fabella. Eine Kniegelenkinstabilität fehlt. Radiologische Befunde (osteophytäre Neuformationen im Bereich des Muskelursprungs und der lateralen Fabella) geben ebenfalls Hinweise auf das Vorliegen der Erkrankung. In der magnetresonanztomographischen Untersuchung zeigen sich Ödeme im Bereich des Ursprungs des lateralen Gastrocnemiuskopfes und eine Anreicherung von Kontrastmittel nach intravenöser Applikation. Die Muskulotendinopathie des M. gastrocnemius hat bei konsequenter konservativer Therapie (Ruhighaltung, Gabe nichtsteroidaler Antiphlogistika und Physiotherapie) eine gute Prognose. Der Fallbericht beschreibt die klinischen Befunde, bildgebende Diagnostik (Röntgen und Magnetresonanztomographie) sowie die Therapie und das Langzeitergebnis dieser Erkrankung bei einem sportlich geführten Labrador Retriever.

Computertomographische Untersuchung des Schädels von Katzen mit kraniofazialem Trauma im Hinblick auf Maxilla- und Orbitafrakturen

Gegenstand und Ziel: Computertomographische Untersuchung des Schädels von Katzen mit einem kraniofazialen Trauma. Auswertung der Befunde hinsichtlich des isolierten und gemeinsamen Auftretens von Maxilla-und Orbitafrakturen.

Material und Methoden: Prospektive Studie (August 2006 – Juni 2010): Bei Katzen mit kraniofazialem Trauma erfolgte eine computertomographische Untersuchung des Schädels.

Ergebnisse: Bei den 38 untersuchten Tieren handelte es sich mit Ausnahme einer Maine-Coonund einer Somali-Katze um Europäische Kurzhaarkatzen. Das Alter der Katzen lag zwischen 11 und 187 Monaten (Durchschnitt 53 Monate). Das Verhältnis männlicher zu weiblicher Tiere betrug 22:16 (1,4). Insgesamt wiesen 27 (71%) Tiere mindestens eine Maxillafraktur auf. Multiple Maxillafrakturen (≥ 2) bestanden bei 16 (42%) Katzen. Die Orbita war bei 28 (74%) Tieren in das Frakturgeschehen involviert. Maxilla-und Orbitafrakturen traten statistisch signifikant (p < 0,001) häufig gemeinsam auf und wurden bei 26 (68%) Katzen diagnostiziert. Die Odds Ratio für das gemeinsame Auftreten dieser Frakturen betrug 87 (p < 0,001). Multiple Frakturen (≥ 2) der knöchernen Augenhöhle kamen bei 16 (57%) der 28 Katzen mit Orbitafrakturen vor. Beidseitige Orbitafrakturen wiesen 25 (67%) Patienten auf (95%-Konfidenzintervall: 48–79%). Am häufigsten (66%) fanden sich Frakturen im Bereich der medialen Orbitawand, gefolgt von Frakturen des Orbitabodens (61%).

Schlussfolgerung: Der Einsatz der Computertomographie (CT) zeigte, dass Maxilla-und Orbitafrakturen bei Katzen mit einem kraniofazialen Trauma deutlich häufiger vorkommen als bisher angenommen und bei über der Hälfte der Patienten kombiniert auftreten. Bei Katzen mit Orbitafrakturen ist überwiegend die mediale und ventrale Orbitawand in das Frakturgeschehen involviert.

Klinische Relevanz: Maxilla-und Orbitafrakturen kommen bei Katzen mit einem kraniofazialen Trauma häufig vor. Die mittels CT gewonnenen Informationen könnten zukünftig zu einer Optimierung des Behandlungsregimes beitragen.

Lumbosakraler Übergangswirbel beim Deutschen Schäferhund: Häufigkeit, Formen, Genetik und Korrelation zur Hüftgelenksdysplasie

Ziel der vorliegenden Arbeit war, die Häufigkeit verschiedener Formen lumbosakraler Übergangswirbel (LÜW) beim Deutschen Schäferhund (DSH) festzustellen. Es sollte überprüft werden, ob eine genetische Basis vorliegt, und eine Einschätzung der Heritabilität (h2) erfolgen. Zusätzlich sollte der Einfluss von LÜW auf die Entstehung von Hüftgelenksdysplasie (HD) bestimmt werden. Material und Methoden: An Röntgenbildern von 4386 DSH mit Abstammungsnachweis wurde die Häufigkeit von LÜW insgesamt sowie bestimmter Formen ermittelt. Es erfolgte eine Heritabilitätsschätzung für das Merkmal LÜW. Neben der Erfassung des offiziellen HD-Befunds nach Fédération Cynologique Internationale (FCI) fand eine HD-Beur teilung nach dem Züricher Punkteschema statt, um Unterschiede zwischen rechtem und linkem Hüftgelenk zu ermitteln. Vorliegen und Formen von LÜW wurden in Korrelation zum HD-Befund gebracht. Ergebnisse: Der festgestellte Anteil an LÜW (29,0%) lag höher als bisher in der Literatur angegeben. Den Großteil der LÜW (78%) bildete die Form mit ausschließlich isoliertem Proc. spinosus am ersten Kreuzbeinwirbel. Unter den ausgeprägteren Formen waren symmetrische (12%) und asymmetrische (10%) LÜW etwa gleich häufig vertreten. Das Geschlecht hatte keinen Einfluss auf das Auftreten eines LÜW. Die Heritabilität lag bei 20–30%. Das Vorliegen eines LÜW stellte keine Prädisposition für HD dar. Schlussfolgerungen und klini sche Relevanz: Die ermittelte Heritabilität für LÜW ermöglicht zuchthygienische Maßnahmen zur Reduzierung von LÜW beim DSH, was im Hinblick auf eine mögliche Korrelation zwischen LÜW und Cauda-equina-Syndrom von Bedeutung sein könnte. Ein Zusammenhang zwischen LÜW und HD war nicht sicher nachweisbar.