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Columnar-jointed tuffs (bentonites) are located below the Lower Carboniferous Tideswell Dale Sill, Derbyshire, in an abandoned quarry. There are three zones of prismatic joints, columnar joints (∼60 cm thick and mean column width of 4.1 cm) and massive, conchoidally fractured rock sequentially from the dolerite contact downwards. The rocks are very fine-grained (1–10 µm) and consist mainly of sanidine, interlayered illite/smectite, and hematite, with minor quartz, apatite, montmorillonite, anatase and detrital minerals. High K2O and Fe2O3, low Na2O and low MgO are interpreted as due to alteration of felsic volcanic ash. The bentonite was contact-metamorphosed by the sill to temperatures of c. 300 °C. The progression of fracture geometries, thermal considerations and application of theories of column formation indicate that columns formed downwards away from the sill, due to prograde contact metamorphism of the originally clay-rich bentonite. The formation of columnar fracture networks by shrinkage due to igneous heating may have implications for the effectiveness of bentonite as a barrier for disposal of high-level radioactive waste. Regional dimensions include documenting widespread felsic explosive volcanism and inferring a Triassic oxidation event from palaeomagnetic data.

Purpose This all-comers registry aimed to assess safety and early efficacy of venous embolization in patients with venogenic erectile dysfunction due to venous leak in an unselected cohort. Methods Between October 2019 and September 2022, patients with venogenic erectile dysfunction resistant to phosphodiesterase-5-inhibitors were treated with venous embolization using ultrasound-guided anterograde access via a deep dorsal penile vein in a single center. A mix of ethiodized oil and modified cyanoacrylate-based glue n-butyl 2 cyanoacrylate (NBCA) monomer plus methacryloxy-sulpholane monomer (Glubran-2, GEM, Italy) was used as liquid embolic agent. Prior to embolization, venous leak had been verified based on penile duplex sonography and computed tomography cavernosography. Procedural success was defined as technically successful and complete target vein embolization. The primary safety outcome measure was any major adverse event 6 weeks after the procedure. The primary feasibility outcome measure was IIEF-15 (International Index of Erectile Function-15) score improvement ≥ 4 points in ≥ 50% of subjects on 6 weeks follow-up post intervention. Results Fifty consecutive patients (mean age 61.8 ± 10.0 years) with severe erectile dysfunction due to venous leak underwent venous embolization. Procedural success was achieved in 49/50 (98%) of patients with no major adverse events on follow-up. The primary feasibility outcome measure at 6 weeks was reached by 34/50 (68%) of patients. Conclusion Venous leak embolization via deep dorsal penile vein access using a liquid embolic agent was safe for all and efficacious in the majority of patients with severe venogenic erectile dysfunction on 6 weeks follow-up.

Summary: Background: The extent of arterial disease in patients with erectile dysfunction (ED) non-responsive to intracavernosal injection of Alprostadil is of importance for therapeutic options. However, published evidence, in particular angiographically validated is scarce. Here we investigated arterial lesion patterns in this specific patient cohort by selective angiography. Patients and methods: A cohort of 239 patients received a clinical and duplex-sonographic workup for ED of suspected vascular origin. Duplex ultrasound of the cavernosal arteries was performed after intracavernosal injection of 10 μg Alprostadil. Consequently, standardized workup included grading of the erectile and determination of peak systolic velocity (PSV) and end-diastolic velocity (EDV) in both cavernosal arteries. PSV-values below 30 cm/sec indicated reduced arterial flow, whereas EDV-values above 15 cm/sec indicated a venous leak of the pudendal veins. All patients with suspected arterial ED based on duplex sonography underwent contrast-enhanced computed tomography. Endovascular therapy was carried out in ED patients not responsive or with significant side effects to PDE-5-inhibitors or Alprostadil by selective angiographic depiction of erection-related arteries. Results: 54 patients with a mean age of 61.2 (±9.8) years underwent angioplasty of erectionr elated arteries. Out of these 48/54 (89%) patients presented with an erection considered insufficient for penetration (E0-E3) subsequent to intracavernous application of 10 μg Alprostadil. 14/48 (29%) patients had bilateral arterial obstructions and 34/48 (71%) had unilateral disease. Commonly affected was the internal pudendal artery (n = 31, 65%), followed closely by the common penile artery (n = 30, 64%). The least affected arteries were the dorsal penile (n = 6, 13%), hypogastric (n = 4, 8%), common iliac (n = 4, 8%), cavernosal (n = 4, 8%), and inferior gluteal (n = 1, 2%) arteries. Conclusions: Arterial obstructions amenable to endovascular revascularization are frequent in patients non-responsive to intracavernosal prostaglandin administration. Therapeutic strategies in ED patients non-responsive to conservative measures should therefore consider endovascular treatment opportunities.

A detailed study of the influence of molecular beam epitaxial growth conditions on the structural and magnetic characteristics of CuMnSb films on lattice matched GaSb is presented. For a set of nine 40~nm thick layers, the Mn and Sb fluxes are varied to produce material with different elemental compositions. It is found that the layers grown under a relative Mn to Sb flux ratio of $\Phi_{\text{Mn}}$/$\Phi_{\text{Sb}}=1.24\pm0.02$ are closest to the stoichiometric composition, for which the N\'{e}el temperature ($T_\text{N}$) attains its maximum values. Mn-related structural defects are believed to be the driving contribution to changes in the vertical lattice parameter. Having established the optimum growth conditions, a second set of samples with CuMnSb layer thickness varied from 5 to 510 nm is fabricated. We show that for sufficiently large thicknesses, the magnetic characteristics ($T_\text{N}\simeq62$ K, Curie-Weiss temperature $\Theta_\text{CW} = -100$ K) of the stoichiometric layers do correspond to the parameters reported for bulk samples. On the other hand, we observe a reduction of $T_\text{N}$ as a function of the CuMnSb thickness for our thinnest layers. All findings reported here are of particular relevance for studies aiming at the demonstration of N\'{e}el vector switching and detection in this noncentrosymmetric antiferromagnet, which have been recently proposed., Comment: The following article has been accepted by Applied Physics Letters. After it is published, it will be found at https://doi.org/10.1063/5.0092828

Purpose Reducing physiologic stress including bradycardia during staging eye exams for retinopathy of prematurity (ROP) is desirable. We observed heart rate change during routine retinopathy of prematurity eye examinations and compared the response with our ongoing study of oculocardiac reflex (OCR) elicited by uniform EOM tension during strabismus surgery. Patients and Methods Electrocardiograph was prospectively monitored during ROP exams featuring indirect ophthalmoscopy with Alfonso lid speculum and see-through scleral depressor without topical anesthesia. Clinical data were retrieved from ROP-Check software. OCR was defined as maximally changed heart rate (HR) as a percent of baseline. Strabismus surgery patients under general anesthesia served as controls. Results From 10/2017 to 9/2020, 281 infants had ROP exams, and the median OCR was 55.9% of baseline HR (IQR 41.4% to 72.6%), the kurtosis 0.93 and skewness 1.01 representing a drop from HR 169 ± 16 bpm to 102 ± 39 bpm. In comparison, 1493 adult and pediatric strabismus surgery patients had less OCR median bradycardia 87.8% (IQR 72-98%), kurtosis 1.60 and skewness -1.18. ROP %OCR correlated with birth gestational age (%OCR = 2.5 (GA) - 11, r(279)=0.33, p

Background The evidence base for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is nascent. We sought to characterize SARS-CoV-2 transmission within US households and estimate the household secondary infection rate (SIR) to inform strategies to reduce transmission. Methods We recruited patients with laboratory-confirmed SARS-CoV-2 infection and their household contacts in Utah and Wisconsin during 22 March 2020–25 April 2020. We interviewed patients and all household contacts to obtain demographics and medical histories. At the initial household visit, 14 days later, and when a household contact became newly symptomatic, we collected respiratory swabs from patients and household contacts for testing by SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (rRT-PCR) and sera for SARS-CoV-2 antibodies testing by enzyme-linked immunosorbent assay (ELISA). We estimated SIR and odds ratios (ORs) to assess risk factors for secondary infection, defined by a positive rRT-PCR or ELISA test. Results Thirty-two (55%) of 58 households secondary infection among household contacts. The SIR was 29% (n = 55/188; 95% confidence interval [CI], 23%–36%) overall, 42% among children (aged Conclusions We found substantial evidence of secondary infections among household contacts. People with COVID-19, particularly those with immunocompromising conditions or those with household contacts with diabetes, should take care to promptly self-isolate to prevent household transmission.

Background During 2017, in response to a physician’s report, the Wisconsin Department of Health Services, Division of Public Health, began investigating an outbreak of febrile illness among attendees of a retreat where never frozen, intentionally undercooked, locally harvested venison was served. Preliminary testing tentatively identified the illness as toxoplasmosis. Methods Confirmatory human serology panels and testing of the venison to confirm and categorize the presence and type of Toxoplasma gondii were completed by French and American national reference laboratories. All 12 retreat attendees were interviewed; medical records were reviewed. Results All attendees were male; median age was 51 years (range: 22–75). After a median incubation period of 7 days, 9 (82%) of 11 exposed persons experienced illness lasting a median of 12 days. All 9 sought outpatient healthcare for symptoms including fever, chills, sweats, and headache (100%) and ocular disturbances (33%). Testing confirmed the illness as toxoplasmosis and venison as the infection source. Multiple laboratory results were atypical for toxoplasmosis, including transaminitis (86%), lymphocytopenia (88%), thrombocytopenia (38%), and leukopenia (63%). One exposed but asymptomatic person was seronegative; the other had immunity from prior infection. The T. gondii strain was identified as closely related to an atypical genotype (haplogroup 12, polymerase chain reaction restriction fragment length polymorphism genotype 5) common in North American wildlife but with previously uncharacterized human clinical manifestations. Conclusions The T. gondii strain contaminating the venison might explain the unusual clinical presentations. In North America, clinicians and venison consumers should be aware of risk for severe or unusual presentations of acute toxoplasmosis after consuming undercooked game meat.

International audience; No abstract available

An internationally distributed learning factory (IDLF) provides opportunities to make students aware of intercultural challenges in global production networks. An IDLF is a scalable network of learning factories with value creation processes in spatially distributed locations. It enables collaboration and competition between student groups in distant locations and considers manual and automatic process methods. Due to the high number of design alternatives for IDLFs, a systematic approach for describing attractive characteristics is required. This paper shows design alternatives for IDLFs structural and process organization on the example of learning factories in Germany, Turkey and Vietnam.

Background To facilitate evidence-based medicine (EBM) on an individual level, it may be important for clinical practice guidelines (CPGs) to incorporate the performance parameters of diagnostic studies and therapeutic interventions (such as likelihood ratio and absolute benefit or harm), and to incorporate relevant patient contexts that may influence decision-making. We sought to determine the extent to which heart failure CPGs currently incorporate this information. Methods We reviewed the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) 2013 Heart Failure CPG, the 2017 ACCF/AHA/HFSA update, and European Society of Cardiology (ESC) 2016 Heart Failure CPG. We abstracted variables for each CPG recommendation from the following domains: quality of evidence, strength of recommendation, diagnostic and therapeutic performance parameters, and patient context. Results We examined 169 recommendations from the ACCF/AHA 2013 CPGs and 2017 update and 187 recommendations from the 2016 ESC CPGs. Performance parameters for diagnostic studies (2013 ACCF/AHA: 13%; 2017 ACCF/AHA/HFSA update: 0%; 2016 ESC: 0%) and therapeutic interventions (2013 ACCF/AHA: 65%; 2017 ACCF/AHA/HFSA update: 64%; 2016 ESC: 16%) were not commonly included in CPGs. Patient context was included in about half of ACCF/AHA recommendations and a quarter of ESC recommendations. Conclusions The majority of recommendations from heart failure CPGs lack information on diagnostic and therapeutic performance parameters and patient context. Given the importance of these components to effectively implement EBM, particularly for a heterogeneous heart failure population, innovative strategies are needed to optimize CPGs so they provide comprehensive yet succinct recommendations that can improve population-level outcomes and ensure optimal patient-centered care.

Objective An understanding of the etiologic heterogeneity of colorectal cancer (CRC) is critical for improving precision prevention, including individualized screening recommendations and the discovery of novel drug targets and repurposable drug candidates for chemoprevention. Known differences in molecular characteristics and environmental risk factors among tumors arising in different locations of the colorectum suggest partly distinct mechanisms of carcinogenesis. The extent to which the contribution of inherited genetic risk factors for CRC differs by anatomical subsite of the primary tumor has not been examined. Design To identify new anatomical subsite-specific risk loci, we performed genome-wide association study (GWAS) meta-analyses including data of 48 214 CRC cases and 64 159 controls of European ancestry. We characterised effect heterogeneity at CRC risk loci using multinomial modelling. Results We identified 13 loci that reached genome-wide significance (p

Background In the phase III IMpassion130 trial, combining atezolizumab with first-line nanoparticle albumin-bound-paclitaxel for advanced triple-negative breast cancer (aTNBC) showed a statistically significant progression-free survival (PFS) benefit in the intention-to-treat (ITT) and programmed death-ligand 1 (PD-L1)-positive populations, and a clinically meaningful overall survival (OS) effect in PD-L1-positive aTNBC. The phase III KEYNOTE-355 trial adding pembrolizumab to chemotherapy for aTNBC showed similar PFS effects. IMpassion131 evaluated first-line atezolizumab–paclitaxel in aTNBC. Patients and methods Eligible patients [no prior systemic therapy or ≥12 months since (neo)adjuvant chemotherapy] were randomised 2:1 to atezolizumab 840 mg or placebo (days 1, 15), both with paclitaxel 90 mg/m2 (days 1, 8, 15), every 28 days until disease progression or unacceptable toxicity. Stratification factors were tumour PD-L1 status, prior taxane, liver metastases and geographical region. The primary endpoint was investigator-assessed PFS, tested hierarchically first in the PD-L1-positive [immune cell expression ≥1%, VENTANA PD-L1 (SP142) assay] population, and then in the ITT population. OS was a secondary endpoint. Results Of 651 randomised patients, 45% had PD-L1-positive aTNBC. At the primary PFS analysis, adding atezolizumab to paclitaxel did not improve investigator-assessed PFS in the PD-L1-positive population [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.60-1.12; P = 0.20; median PFS 6.0 months with atezolizumab–paclitaxel versus 5.7 months with placebo–paclitaxel]. In the PD-L1-positive population, atezolizumab–paclitaxel was associated with more favourable unconfirmed best overall response rate (63% versus 55% with placebo–paclitaxel) and median duration of response (7.2 versus 5.5 months, respectively). Final OS results showed no difference between arms (HR 1.11, 95% CI 0.76-1.64; median 22.1 months with atezolizumab–paclitaxel versus 28.3 months with placebo–paclitaxel in the PD-L1-positive population). Results in the ITT population were consistent with the PD-L1-positive population. The safety profile was consistent with known effects of each study drug. Conclusion Combining atezolizumab with paclitaxel did not improve PFS or OS versus paclitaxel alone. ClinicalTrials.gov NCT03125902.

This paper presents a competency model for mediating Industry 4.0 in Learning Factories. It allows assessing existing Learning Factories towards their readiness for Industry 4.0 competencies differentiated by social, technical, methodological, and personal aspects. Industry 4.0 has long since ceased to be an issue reserved solely for research. Companies are pursuing a wide variety of strategies in order to gain the advantages predicted by digitalisation and thus be able to stand up to global competition. In the meantime, there is also a general awareness in industry that the real implementation of such a strategy goes beyond the implementation of technologies and that above all the qualification of employees determine this success. Different models show the dimensions of Industry 4.0 that should be addressed in the qualification of employees. Here, Learning Factories are already recognized vehicles for the transfer of the respective competencies, which represent the link between theoretical knowledge and the practical ability of the learner. Nevertheless, there is hardly more detailed information available about the level of competencies and to which extend this level is beneficial along the stages of implementation of Industry 4.0 according to a comprehensive company strategy. On the example of a concept for an internationally distributed Learning Factory between Universities in Germany, Turkey, and Vietnam, the competency model is applied. We assess this Learning Factory network and show how and to what extend Industry 4.0 competencies can be achieved. Based on this analysis potential development stages for higher levels of Industry 4.0 competencies for the exemplarily chosen distributed Learning Factory are illustrated in order to cover the core requirements for the implementation of Industry 4.0 in industry.

We report the growth of CuMnSb thin films by molecular beam epitaxy on InAs (001) substrates. The CuMnSb layers are compressively strained (0.6 %) due to lattice mismatch. The thin films have a $\ensuremath{\omega}$ full width at half-maximum of 7.7 arcsec according to high resolution x-ray diffraction, and a root-mean-square roughness of 0.14 nm as determined by atomic force microscopy. Magnetic and electrical properties are found to be consistent with reported values from bulk samples. We find a N\'eel temperature of 62 K, a Curie-Weiss temperature of \ensuremath{-}65 K, and an effective moment of $5.9\phantom{\rule{0.16em}{0ex}}{\ensuremath{\mu}}_{B}/\mathrm{f}.\mathrm{u}.$ Transport measurements confirm the antiferromagnetic transition and show a residual resistivity at 4 K of $35\phantom{\rule{4pt}{0ex}}\ensuremath{\mu}$\textohm{} cm.

BACKGROUND Arteriogenic erectile dysfunction is a common disease oftentimes not satisfactory treatable with medical therapy. AIM To assess the safety and clinical success rate of endovascular revascularization of erection-related arteries with the angiolite BTK stent in patients with arteriogenic erectile dysfunction. METHODS A total of 100 consecutive men (61.8������10��years) with atherosclerotic lesions in erection-related arteries agreed to participate and were included into a single-center all-comers registry. Endovascular therapy with angiolite BTK drug-eluting stents was performed on a total of 211 lesions. Patients received a baseline International Index of Erectile Function (IIEF)-15 questionnaire at first presentation and 3 and 12��months after stenting. An improvement by 4 points in the erectile function domain consisting of 6 questions (IIEF-6) was defined as minimal clinically important difference. A total of 24 patients with 52 stented arterial lesions underwent angiographic follow-up of the initially treated arterial side during secondary revascularization of the contralateral side (angiographic sub-study). OUTCOME Clinical improvement of erections in 100 patients undergoing endovascular revascularization of erection-related arteries. RESULTS No major adverse events occurred during endovascular revascularization or within 30��days thereafter. Technical success was achieved in all lesions and procedural success in all patients. At 1��year, 55 of 97 patients (56.7%) improved by at least 4 points in IIEF-6 score and thus achieved a clinically relevant improvement of erectile function.In the angiographic sub-study, arterial patency and binary restenosis were observed in 46 of 52 (88.5%) and in 8 of 52 (15.4%), respectively, after a mean follow-up of 9.6������5.8��months. CLINICAL IMPLICATIONS In patients with arteriogenic erectile dysfunction, endovascular therapy with a novel thin-strut sirolimus eluting stent is a safe and feasible treatment option. STRENGTHS & LIMITATIONS This real-world arterial revascularization registry included patients with a multitude of risk factors for ED, thereby representing the heterogeneity in patients in the clinical practice, which is one of its strengths but also one of its weaknesses. Another strength was the focus being laid on analyzing outcomes of patients with arteriogenic ED using only a single endovascular device. Further studies are warranted to better define subgroups of patients with impaired clinical outcomes. CONCLUSION Within the present all-comers registry, endovascular therapy of erectile dysfunction with the angiolite BTK stent was shown to be a safe and feasible treatment option resulting in clinical improvement rates comparable to earlier clinical trials although also showing that further research is warranted to define patient subgroups with particular benefits of endovascular therapy. Sch��nhofen J, R��ber L, Kn��chel J, et��al. Endovascular Therapy for Arteriogenic Erectile Dysfunction With a Novel Sirolimus-Eluting Stent. J Sex Med 2021;18:315-326.

Resume Introduction Les metastases osseuses sont source de douleurs et alterent la qualite de vie des patients. La radiotherapie est un des traitements antalgiques de reference. L’objectif de cette etude etait de comparer les pratiques courantes d’un service de radiotherapie francais pour le traitement des metastases osseuses non compliquees avec les donnees de la litterature dans le but d’ameliorer et d’optimiser la prise en charge des patients. Materiel et methodes Une etude retrospective monocentrique des patients ayant beneficie d’une irradiation palliative de metastases osseuses non compliquees a ete menee. Resultats Quatre-vingt-onze patients ont beneficie de 116 radiotherapies de metastases osseuses non compliquees sur la periode etudiee, dont 44 hommes (48 %) et 47 femmes (52 %), âges en moyenne de 63 ans (25–88 ans). Les tumeurs primitives les plus frequemment retrouvees etaient mammaires (35 %), pulmonaires (16 %) et prostatiques (12 %). Les schemas therapeutiques utilises etaient dans 29 % des cas 30 Gy en dix fractions, dans 21 % des cas 20 Gy en cinq fractions, dans 22 % des cas 8 Gy en une seance et dans 28 % des cas 23,31 Gy en trois fractions en conditions stereotaxiques. L’etat general du patient (indice de performance selon l’Organisation mondiale de la sante et indice de Karnofsky) (p Conclusion Cette etude a montre que la population des patients analysee etait comparable aux populations de differentes etudes. Des facteurs predictifs de choix du schema therapeutique ont ete identifies. Le traitement non fractionne etait sous-utilise, alors que le traitement en conditions stereotaxiques etait de plus en plus prescrit, ce qui montre une evolution dans la prise en charge des patients.

Learnstruments are artefacts, which automatically demonstrate their functionality to the learner. They can be used directly at the workplace and aim at increasing the learning and teaching productivity. The huge variety of design paths for Learnstruments requires a systematic approach for their development. A morphology for Learnstruments is introduced. Exemplary learning-conducive applications for manual assembly in international organizations like 3D-PDFs and a Smart-Assembly-Workplace are presented. They help avoiding assembly errors and improve productivity by providing interactive instructions to the learners. By implementing these along the morphology guideline, the consideration of important didactical and technical criteria is ensured.

Objectives There is wide variation in long-term acute care hospital (LTACH) use nationwide, the most intensive and expensive post-acute care setting, although appropriateness of use is uncertain. Therefore, we examined the appropriateness and reasons for transfer in a high-use region, and how Medicare criteria for LTACH payment identifies appropriate transfers. Design Multicenter retrospective observational cohort. Setting and Participants Consecutive hospitalized Medicare beneficiaries transferred to an LTACH from 2017 to 2018 from an accountable care organization in Texas. Methods The primary outcome was clinical appropriateness of transfer ascertained by 2 physician reviewers. We abstracted patients’ characteristics and primary reasons for transfer. We examined the positive predictive value (PPV) of meeting Medicare criteria for full LTACH payment [preceding intensive care unit (ICU) stay ≥3 days or prolonged mechanical ventilation] for identifying appropriate transfers, and how this differed if Medicare adopted an 8-day minimum ICU stay criterion recommended by the Medicare Payment Advisory Commission (MedPAC). Results Of 105 LTACH transfers, 33 (31.4%) were clinically appropriate. The most common reason among appropriate transfers was respiratory care (58%), but 42% had other indications. Inappropriate transfers most commonly were for wound care (28%), intravenous medication infusions (28%), or patient (17%) and physician preference (26%). The PPV for meeting Medicare LTACH payment criteria was 55%. The PPV improved to 77% if Medicare adopted the 8-day minimum ICU stay criterion, with only a modest absolute increase in appropriate transfers not meeting the more stringent criteria (12% to 17%). Conclusions and Implications Two-thirds of LTACH transfers in a high-LTACH-use region are clinically inappropriate, and are most commonly transferred for wound care, intravenous infusions, or patient and physician preference. Medicare payment criteria modestly distinguished between appropriate and inappropriate transfers. Adoption of MedPAC's recommended 8-day minimum ICU stay criterion could safely reduce inappropriate transfers, although generalizability to low LTACH-use regions is uncertain.

Background Rupture of the anterior cruciate ligament (ACL) is one of the most common injuries of the knee. Common techniques for ACL reconstruction require a graft fixation using interference screws. Nowadays, these interference screws are normally made of titanium or polymer/ceramic composites. The main challenge of application of a fixation device made entirely of bioactive ceramic is in relation to the low strength of such materials. The purpose of this study was to evaluate a novel geometry for a fixation device made of pure hydroxyapatite for ACL reconstructions that can overcome some problems of the titanium and the polymer/ceramic screws. Methods Finite Element Analysis was used for optimization of the stress distribution in conventional interference screw geometry. For experimental evaluation of the new fixation device, ex vivo tests were performed. Results The innovative screw-like fixation device is characterized by multiple threads with a large thread pitch. The novel design enabled the insertion of the screw into the bone without the application of an external torque or a screwdriver. In turn, it also allowed for the use of low-strength and high-bioactivity materials, like hydroxyapatite. Ex vivo tests showed that the novel screw can sustain pull-out forces up to 476 N, which is comparable to that of the commercially available BioComposite™ interference screws (Arthrex Inc., Germany), as a reference. Conclusions In summary, the novel screw design is a promising strategy to develop all-ceramic fixation devices for ACL reconstructions, which may eliminate some drawbacks of the current interference screws.

Aim To analyse the incidental findings during computed tomographic angiography (CTA) diagnostic work-up in patients with arteriogenic erectile dysfunction (ED). Patients and methods The medical records of all patients with suspected arteriogenic ED were entered into a database. Risk factors and underlying comorbidities were also collected. Pathological CTA findings were extracted from the CT readings and entered into the database. Incidental findings on CTA were classified as those requiring immediate medical treatment, requiring deferred medical treatment or of no clinical importance. Results A total of 200 patients underwent CTA for suspected arteriogenic ED. Mean patient age was 59.6 p 11.7 years. Of these, 181 patients (90.5%) had obstructions of erection-related arteries. In 168 patients (84.0%), CTA showed multiple incidental pathological findings. Eighty-five of 200 patients (42.5%) exhibited incidental findings requiring immediate further medical workup and/or treatment: coronary artery calcification was diagnosed in 75/200 (37.5%), aorto-iliac aneurysms in 8/200 (4%) of patients and incidentally detected embolism in 1/200 patient. Pancreatic and liver tumours were less frequent (incidence 1.5% and 1%, respectively). Incidental findings requiring deferred medical workup and/or treatment were detected in 175/200 patients (87.5%). The findings with the highest prevalence were liver steatosis followed by colon diverticulosis and prostate hyperplasia. Findings of little to no clinical importance were reported in 117 (58.5%) patients. These included uncomplicated renal cysts, spinal degeneration and renal vascular anomalies. Almost every second patient presenting with ED had an incidental finding which required immediate treatment. Conclusions Incidental findings not directly related to ED were common among patients undergoing CTA scans for suspected arterial obstructions. Coronary artery calcification was the leading finding requiring further medical workup and/or treatment. Thus, the benefit of CTA investigations extends beyond the anatomic description of arterial obstructions of erection-related arteries.

[No abstract]

This study assesses whether American Thoracic Society clinical practice guidelines are substantiated by high-quality evidence and can be used to promote evidence-based medicine.

Purpose: To report the 1-year outcomes of a single-center, all-comers registry aimed to assess effectiveness and safety of endovascular revascularization for atherosclerotic erectile dysfunction (ED) in an unselected patient cohort. Materials and Methods: Between April 2016 and October 2017, 50 consecutive patients (mean age 59.6±10.3 years) underwent endovascular revascularization for ED owing to >50% stenosis in 82 erection-related arteries. Patients were treated by means of standard balloon angioplasty (16%), drug-coated balloon angioplasty (27%), or drug-eluting stent (55%) implantation. The primary feasibility outcome measure was the incidence of a minimum clinically relevant improvement of ≥4 in the 6-question International Index of Erectile Function Questionnaire (IIEF-6) score at 12 months. Clinical effectiveness was improvement in erectile function as quantified in the mean difference (MD) of the IIEF-15 score at 3 and 12 months as well as the mean changes in IIEF-15 questions 3 and 4. Results: Procedure success was achieved in 49 (98%) of 50 patients. At 12 months, 30 (65%) of 46 patients achieved a minimum clinically relevant improvement in the IIEF-6 score. The overall IIEF-15 score, as well as scores for questions 3 and 4, improved in 32 (65%) of 49 patients, 28 (57%) of 49 patients, and 29 (60%) of 48 patients, respectively. Change in the overall IIEF-15 score at 12 months was consistent among subgroups, except for elderly patients [MD −5.0 (95% CI −9.7 to −0.2), p=0.041] and those with hypertension [MD −11.0 (95% CI −20.5 to −1.5), p=0.025], who showed less improvement. Conclusion: Endovascular revascularization was safe and efficacious in the majority of ED patients through 1 year.

Several approaches had been performed to group similar properties of nanomaterials for the purpose of risk assessment. In addition to material and release properties, exposure during selected machining processes at workplaces was investigated. During exposure, transport and transformation processes between source and recipient also affect the materials. Ways of structuring the determination of risk are proposed for a risk assessment in activities involving nanomaterials in the workplace. The exposure during sanding of nanocomposites was found to depend on the matrix material rather than on the nano-additive.

Background: Bone marrow is one of the organs at risk of complications during irradiation due to its radiosensitivity. Hematopoietic toxicity remains one of the main toxicities during irradiation of pelvis. Modern radiotherapy techniques, such as intensity modulation and three-dimensional conformal radiotherapy, allow for better dose compliance in target volumes while optimally sparing organs at risk. There is a lack of prospective studies and comparative trials specifying the dose constraints according to the presence or absence of chemotherapy and correlating with the patient’s bone marrow potential.Methods: This monocentric and prospective study conducted by the Strasbourg Europe Cancerology Institute aims to evaluate the hematological toxicity in patients treated with pelvic irradiation for prostate, rectum, anal canal, endometrium, or cervix cancer. One hundred patients will be included. The primary objective is to quantify the relationship between acute hematological toxicity and delivered doses and irradiated volumes in pelvic bone marrow for pelvic cancers. The prescribed dose to the pelvis depends on the tumor location, from 25 Gy in 5 fractions for rectal cancer to 78 Gy in 39 fractions for low-risk prostate cancer. Hematological toxicity will be measured by weekly blood count during radiotherapy and at one month and three months after the end of radiotherapy.Conclusions: The aim of this study is to improve and optimize radiotherapy if a dose limit or volume constraint is imposed by the results of the study. To our knowledge, this is the first study including several types of pelvic cancers and involving patients treated exclusively with radiotherapy, chemoradiotherapy or radiohormonotherapy.Trial Registration: Trial registration number is NCT04626466.

Background To assess relevance of ESMO-ESSO-ESTRO treatment guidelines in a retrospective analysis of patients with anal canal or anal margin cancers. Material and methods 155 patients were separated into standard treatment group (STG), treated according to or closely the guidelines, and an altered treatment group (ATG). Results The median follow-up time was 50.7 months. In the STG, the 5- and 10-year LR-DFS rates were 75.2% and 72.7%; in the ATG, they were 66.8% and 61.2%, respectively. In the STG, the 5- and 10-year OS rates were 81.8% and 68%; in the ATG, they were 63.3% and 49.5%, respectively (p = 0.037). In the multivariate analysis, favorable prognostic factors for OS included the standard treatment, age 50.4 Gy. Conclusion This study identifies the superiority of treatment according to standard guidelines compared to altered treatment. Our results corroborate the guidelines.

Organic contamination of sedimentary rocks can produce artefacts in studies of hydrocarbon composition, and this can have significant negative consequences for interpretations of the geobiological record. False positives - that is cases of non-syngenetic hydrocarbon biomarkers - are common in Precambrian studies, and significant challenges persist despite the intensive effort devoted to these studies. Efforts to standardize the 'burden of proof' for distinguishing between contamination and syngenetic material have to date failed to yield a simple or universal protocol, yet the need remains great, as both bitumen-lean rocks and bitumen-rich samples can be vulnerable to the accumulation of false-positive signals. In an effort to determine the best approach to quality control, we tested the capability of different blank materials to collect ambient contamination by assessing their capacity to adsorb hydrocarbons during storage in plastic bags and found that commonly used Quartz sand does not provide an adequate measure of storage- or laboratory-induced contamination. Brick blanks, having the advantage that they can parallel rock samples even during the sawing process, are characterized by similar poor adsorption properties. Primarily steered by mineralogy, organic carbon content and surface area, model-black shales can adsorb up to 20 times more contaminants than sand blanks and up to 200 times more contaminants than organic-free model-carbonates. This observation provides an explanation for reports and observations of seemingly systematic stratigraphic variation of contaminants, but mostly should raise awareness for the evaluation of procedural blanks, in particular of sample-to-blank ratios, when studying bitumen-lean rock samples of varying lithologies. Additionally, differences between the hydrocarbon profiles in plastic bags and the hydrocarbon signatures transferred to blank materials emphasize difficulties in the unequivocal detection of contamination sources. Artificial black shale pellets can provide enhanced contamination control in biomarker studies - particularly for exceptionally vulnerable samples such as Precambrian rocks, meteorites or extraterrestrial sample-return material.

Background: Pathological complete response (pCR) is associated with improved prognosis in TNBC, but optimal chemotherapy remains unclear. Use of weekly nab- paclitaxel (Nab-Pac) vs. conventional paclitaxel and also addition of carboplatinum(Carbo) to anthracycline-taxane(A/T) containing chemotherapy results in significantly higher pCR rates in TNBC with unclear impact on survival and increased toxicity. The ADAPT study seeks to compare Carbo vs. gemcitabine(Gem) added to nab- paclitaxel as a short 12-week A-free regimen. It also assesses efficacy in early responders vs. non-responders by 3-week proliferation and/or imaging response. Methods: ADAPT TN compares 12-week neoadjuvant regimens: Carbo vs. Gem combined with Nab-Pac and aims to identify early-response markers for pCR (yPN0 and ypT0/is). TNBC patients (centrally confirmed ER/PR Results: 336 patients were enrolled from 47 centers between 06/13-02/15 (n=182 ArmA: Nab-Pac/Gem and n=154 ArmB: Nab-Pac/Carbo). 90% and 95% completed therapy according to protocol respectively (n.s.). Median age was 50y. At baseline: A/B: 73% and 74%% had G3 tumors, median Ki-67 of 70% and 75%; 62.6% and 62.9%% had cT2-4c tumors, pN0 status prior to chemotherapy was confirmed in 50.5% and 50%, respectively. pCR (ypT0/is/ypN0) was A: 28.7% and B: 45.9% (p Nab/Gem arm was associated with significantly higher frequency of dose reductions (20.6% vs. 11.9% (p=0.03), treatment related SAE's (13% vs. 5%, p=0.02), grade 3-4 infections (6.1% vs. 1.3%, p=0.04) and ALAT elevations (11.7 vs. 3.3%, p=0.01) compared to the Nab-Carbo arm. Within the planned interim analysis (n=130: A/B: 69/61), baseline Ki-67 (Nab- Pac/Carbo arm), age>50 years, and low cellularity ( Validation of responder definitions for the whole study will be presented at the meeting. Conclusions: This is the first large randomized study comparing two short 12-week anthracycline- free regimens in unselected TNBC. Our results suggest superior efficacy and excellent toxicity of Nab-Pac/Carbo vs. Gem. Longer A/T-Carbo containing regimens render quite comparable pCR rates, thus overtreatment by 4xEC in unselected TNBC may be present in some patients. Early response criteria seem to differ according to regimen; their assessment may be impaired by substantial tumor necrosis already after the first therapy cycle. Citation Format: Gluz O, Nitz U, Liedtke C, Christgen M, Sotlar K, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Bangemann N, Lindner C, Kuemmel S, Clemens M, Potenberg J, Staib P, Kohls A, Pelz E, Kates RE, Wuerstlein R, Kreipe HH, Harbeck N. Comparison of 12 weeks neoadjuvant Nab-paclitaxel combined with carboplatinum vs. gemcitabine in triple- negative breast cancer: WSG-ADAPT TN randomized phase II trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-13-01.

The half-metal ferromagnet NiMnSb, with its high spin polarization, low magnetic damping and tunable magnetic anisotropy, is a promising material for applications in spin torque devices. We develop the epitaxial growth of NiMnSb/ZnTe/NiMnSb heterostructures, aiming towards the realization of an all-NiMnSb based magnetic tunneling junction (MTJ). Layers are grown in situ by Molecular Beam Epitaxy (MBE) and Atomic Layer Epitaxy (ALE) methods. By tuning Mn content, the magnetic anisotropy of each of the two NiMnSb layers is adjusted in order to achieve mutually orthogonal uniaxial anisotropies. SQUID measurements of the magnetization along orthogonal crystal directions [110] and [ 1 1 ¯ 0 ] confirm that the two layers have mutually orthogonal anisotropy. High Resolution X-Ray Diffraction measurements and simulations confirm the nominal layer stack and demonstrate the high crystalline quality of the individual layers. Such layer stacks provide a potential basis for TMR-based spin-torque devices such as spin-torque oscillators.

Metamorphic petrology observations on rubies found in-situ in their host-rock are combined with geochemical measurements and optical microscopy observations on the same rubies, with the aim of connecting the ruby-forming metamorphic reaction to a unique fingerprint for these minerals. The Fiskenaesset complex in Greenland is used as an area of this case study. Isochemical pressure-temperature sections were calculated based on electron microprobe and whole-rock geochemistry analyses, and compared to field observations. Rubies formed from reaction between olivine/serpentine and anorthite, triggered by the intrusion of a 2.71 Ga pegmatite. Al is sourced from the anorthite reacting to calcic amphibole, silica from the pegmatite reacts with olivine/serpentine to anthophyllite, Cr3+ is mobile in the pegmatitic fluid, giving colour to the rubies. The ruby-forming reaction occurs at about 640 °C and 7 kbar. In order to establish the unique fingerprint for this ruby-bearing ultramafic complex, laser-ablation inductively-coupled-plasma mass-spectrometry trace-element measurements, oxygen isotope compositions, optical microscopy and scanning electron microscopy were applied. Due to the setting in an ultramafic rock-anorthosite-leucogabbro complex, the fingerprint of the rubies from the Fiskenaesset complex is rather unique. Compared to rubies from other localities, Fiskenaesset complex rubies contain high Cr, intermediate Fe, and low V, Ga, and Ti concentrations, low oxygen isotope values (1.6–4.2‰) and a rarely-observed combination of optical growth features and mineral inclusions like anthophyllite+biotite. Results for other Greenland localities are presented and discussed as well. Even though these are derived from ultramafic rock settings too, they record different trace-element ratios and oxygen isotope values, resulting from variations in the Archaean ruby-forming reaction.