Mammographic features and risk of breast cancer death among women with invasive screen-detected cancer in BreastScreen Norway 1996-2020.

OBJECTIVES: We explored associations between mammographic features and risk of breast cancer death among women with small (<15 mm) and large (≥15 mm) invasive screen-detected breast cancer. METHODS: We included data from 17,614 women diagnosed with invasive breast cancer as a result of participation in BreastScreen Norway, 1996-2020. Data on mammographic features (mass, spiculated mass, architectural distortion, asymmetric density, density with calcification and calcification alone), tumour diameter and cause of death was obtained from the Cancer Registry of Norway. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for breast cancer death by mammographic features using spiculated mass as reference, adjusting for age, tumour diameter and lymph node status. All analyses were dichotomised by tumour diameter (small versus large). RESULTS: Mean age at diagnosis was 60.8 (standard deviation, SD=5.8) for 10,160 women with small tumours and 60.0 (SD=5.8) years for 7454 women with large tumours. The number of breast cancer deaths was 299 and 634, respectively. Mean time from diagnosis to death was 8.7 (SD=5.0) years for women with small tumours and 7.2 (4.6) years for women with large tumours. Using spiculated mass as reference, adjusted HR for breast cancer death among women with small tumours was 2.48 (95% CI 1.67-3.68) for calcification alone, while HR for women with large tumours was 1.30 (95% CI 1.02-1.66) for density with calcification. CONCLUSIONS: Small screen-detected invasive cancers presenting as calcification and large screen-detected cancers presenting as density with calcification were associated with the highest risk of breast cancer death. CLINICAL RELEVANCE STATEMENT: Small tumours (<15 mm) presented as calcification alone and large tumours (≥ 15 mm) presented as density with calcification were associated with the highest risk of breast cancer death among women with screen-detected invasive breast cancer diagnosed 1996-2020. KEY POINTS: • Women diagnosed with invasive screen-detected breast cancer 1996-2020 were analysed. • Small screen-detected cancers presenting as calcification alone resulted in the highest risk of breast cancer death. • Large screen-detected cancers presenting as density with calcification resulted in the highest risk of breast cancer death.

Does it matter for the radiologists' performance whether they read short or long batches in organized mammographic screening?

OBJECTIVE: To analyze the association between radiologists' performance and image position within a batch in screen reading of mammograms in Norway. METHOD: We described true and false positives and true and false negatives by groups of image positions and batch sizes for 2,937,312 screen readings performed from 2012 to 2018. Mixed-effects models were used to obtain adjusted proportions of true and false positive, true and false negative, sensitivity, and specificity for different image positions. We adjusted for time of day and weekday and included the individual variation between the radiologists as random effects. Time spent reading was included in an additional model to explore a possible mediation effect. RESULT: True and false positives were negatively associated with image position within the batch, while the rates of true and false negatives were positively associated. In the adjusted analyses, the rate of true positives was 4.0 per 1000 (95% CI: 3.8-4.2) readings for image position 10 and 3.9 (95% CI: 3.7-4.1) for image position 60. The rate of true negatives was 94.4% (95% CI: 94.0-94.8) for image position 10 and 94.8% (95% CI: 94.4-95.2) for image position 60. Per 1000 readings, the rate of false negative was 0.60 (95% CI: 0.53-0.67) for image position 10 and 0.62 (95% CI: 0.55-0.69) for image position 60. CONCLUSION: There was a decrease in the radiologists' sensitivity throughout the batch, and although this effect was small, our results may be clinically relevant at a population level or when multiplying the differences with the number of screen readings for the individual radiologists. KEY POINTS: • True and false positive reading scores were negatively associated with image position within a batch. • A decreasing trend of positive scores indicated a beneficial effect of a certain number of screen readings within a batch. • False negative scores increased throughout the batch but the association was not statistically significant.

[The effect of mobile air filter systems on aerosol concentrations in large volume scenarios against the background of the risk of infection of COVID-19. Can classroom teaching be resumed?] / Der Effekt von mobilen Luftfiltersystemen auf die Aerosolbelastung in Großraumszenarien vor dem Hintergrund des Infektionsrisikos der COVID-19-Erkrankung. Kann die Präsenzlehre wieder aufgenommen werden?

BACKGROUND: As a consequence of the corona pandemic, universities nationwide had stopped classroom teaching by the start of the summer semester 2020. As part of the second lockdown, in many states schools and day care centers were also closed or reduced to a minimum. In this context the effect of room air filters has already been discussed multiple times; however, mobile devices for air filtration are currently not recommended by the German Federal Environment Agency. The following investigation shows the real effects of mobile air filters on aerosol concentrations when used in lecture theaters, canteens or school learning centers. METHODS: The effects of a mobile air purifier (DEMA-airtech, Stuttgart, Germany) were measured in three large rooms (a lecture theater, a company canteen and a learning center of a grammar school). Aerosol and carbon dioxide concentrations were determined with devices from the company Palas (Karlsruhe, Germany). RESULTS: All three scenarios showed a relevant and permanent decrease in aerosol concentrations through the use of air filters. The effect partly even surpassed the effectiveness of simple ventilation by opening the windows. CONCLUSION: In addition to social distancing and wearing highly efficient face masks, the use air filters is recommended. This measure could enable classroom teaching to be resumed.

[Chronic nonbacterial osteomyelitis : Imaging and differential diagnoses]. / Chronische nichtbakterielle Osteomyelitis : Bildgebung und Differenzialdiagnosen.

Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease in childhood and adolescence with a preference for the female gender. It is manifested with multiple osseous lesions, with a predilection for the metaphyseal end zones of the long bones of the lower extremities. These bone lesions usually occur multifocally, can recur and develop a different appearance depending on the bone structure affected. Patients present with a longer disease history, changing clinical symptoms and unspecific paraclinical signs. Magnetic resonance imaging (MRI) is the imaging of choice and particularly as a whole body examination can speed up the diagnosis and is an important component of follow-up controls. Differential diagnoses include numerous inflammatory, benign and malignant bone diseases. Therefore, it is essential to know the diagnosis of CNO and to take it into consideration in cases of an unclear inflammatory bone process in young patients.

Moraxella catarrhalis induces CEACAM3-Syk-CARD9-dependent activation of human granulocytes.

The human restricted pathogen Moraxella catarrhalis is an important causal agent for exacerbations in chronic obstructive lung disease in adults. In such patients, increased numbers of granulocytes are present in the airways, which correlate with bacteria-induced exacerbations and severity of the disease. Our study investigated whether the interaction of M. catarrhalis with the human granulocyte-specific carcinoembryonic antigen-related cell adhesion molecule (CEACAM)-3 is linked to NF-κB activation, resulting in chemokine production. Granulocytes from healthy donors and NB4 cells were infected with M. catarrhalis in the presence of different inhibitors, blocking antibodies and siRNA. The supernatants were analysed by enzyme-linked immunosorbent assay for chemokines. NF-κB activation was determined using a luciferase reporter gene assay and chromatin-immunoprecipitation. We found evidence that the specific engagement of CEACAM3 by M. catarrhalis ubiquitous surface protein A1 (UspA1) results in the activation of pro-inflammatory events, such as degranulation of neutrophils, ROS production and chemokine secretion. The interaction of UspA1 with CEACAM3 induced the activation of the NF-κB pathway via Syk and the CARD9 pathway and was dependent on the phosphorylation of the CEACAM3 ITAM-like motif. These findings suggest that the CEACAM3 signalling in neutrophils is able to specifically modulate airway inflammation caused by infection with M. catarrhalis.

[Weaning Unit of the University Medicine Greifswald - Institutional Structure and Weaning Results from Prolonged Ventilation over 10 Years]. / Weaningzentrum Greifswald ­ Struktur und Ergebnisse bei der Entwöhnung von der Langzeitbeatmung über zehn Jahre.

The increasing importance of intensive care medicine including mechanical ventilation has been accompanied by the demand of weaning opportunities for patients undergoing prolonged mechanical ventilation. Consequently, specialised clinical institutions, focusing on the weaning from mechanical ventilation, have been established since the 1980 s.The present article illustrates the structural development and results of such a specialised institution at the University Medicine Greifswald, using data of 616 patients collected within the past ten years (2006 - 2015). Across the years, a shift in the underlying disease leading to mechanical ventilation can be found, with rising numbers of patients suffering from pneumonia/sepsis and declining numbers of patients who underwent cardiac surgery in advance. The days with mechanical ventilation outside (p = 0.004) and within the investigated institution (p = 0.02) are significantly declining. The percentage of successfully weaned patients increased from 62.7 % (2006 - 2010) to 77.3 % (2011 - 2015), p < 0.001. Consecutively, the percentage of patients who remained mechanically ventilated decreased from 16.4 % to 9.6 % (p < 0.001) and the share of in-hospital deceased patients significantly declined from 20.9 % to 13.0 % (p < 0.001). Furthermore, the one-year-survival after hospital discharge in successful weaned patients was 72 percent. The present data, collected at the University Medicine Greifswald are quite comparable to data of other German institutions that are specialised on weaning from mechanical ventilation.

ATP-Evoked Intracellular Ca²âº Signaling of Different Supporting Cells in the Hearing Mouse Hemicochlea.

Hearing and its protection is regulated by ATP-evoked Ca(2+) signaling in the supporting cells of the organ of Corti, however, the unique anatomy of the cochlea hampers observing these mechanisms. For the first time, we have performed functional ratiometric Ca(2+) imaging (fura-2) in three different supporting cell types in the hemicochlea preparation of hearing mice to measure purinergic receptor-mediated Ca(2+) signaling in pillar, Deiters' and Hensen's cells. Their resting [Ca(2+)]i was determined and compared in the same type of preparation. ATP evoked reversible, repeatable and dose-dependent Ca(2+) transients in all three cell types, showing desensitization. Inhibiting the Ca(2+) signaling of the ionotropic P2X (omission of extracellular Ca(2+)) and metabotropic P2Y purinergic receptors (depletion of intracellular Ca(2+) stores) revealed the involvement of both receptor types. Detection of P2X2,3,4,6,7 and P2Y1,2,6,12,14 receptor mRNAs by RT-PCR supported this finding and antagonism by PPADS suggested different functional purinergic receptor population in pillar versus Deiters' and Hensen's cells. The sum of the extra- and intracellular Ca(2+)-dependent components of the response was about equal with the control ATP response (linear additivity) in pillar cells, and showed supralinearity in Deiters' and Hensen's cells. Calcium-induced calcium release might explain this synergistic interaction. The more pronounced Ca(2+) leak from the endoplasmic reticulum in Deiters' and Hensen's cells, unmasked by cyclopiazonic acid, may also suggests the higher activity of the internal stores in Ca(2+) signaling in these cells. Differences in Ca(2+) homeostasis and ATP-induced Ca(2+) signaling might reflect the distinct roles these cells play in cochlear function and pathophysiology.

Leaching and selective copper recovery from acidic leachates of Três Marias zinc plant (MG, Brazil) metallurgical purification residues.

Zinc plant purification residue (ZPR), a typical Zn-hydrometallurgical waste, was collected from the Três Marias Zn plant (MG, Brazil). ZPR was characterized for its metal content and fractionation, mineralogy, toxicity and leachability. Toxicity characteristics leaching procedure (TCLP) and European Community Bureau of Reference (BCR) sequential extraction results revealed that this ZPR displays high percentages of metals (Cd, Cu, Zn and Pb) in the highly mobilizable fractions, increasing its hazardous potential. Bulk chemical analysis, pH dependent leaching and acid (H2SO4) leaching studies confirm that the ZPR is polymetallic, rich in Cd, Cu and Zn. The sulfuric acid concentration (1 M), agitation speed (450 rpm), temperature (40 °C) and pulp density (20 g L(-1)) were optimized to leach the maximum amount of heavy metals (Cd, Cu and Zn). Under optimum conditions, more than 50%, 70% and 60% of the total Cd, Cu and Zn present in the ZPR can be leached, respectively. The metals in the acid leachates were investigated for metal sulfide precipitation with an emphasis on selective Cu recovery. Metal sulfide precipitation process parameters such as initial pH and Cu to sulfide ratio were optimized as pH 1.5 and 1:0.5 (Cu:sulfide) mass ratio, respectively. Under optimum conditions, more than 95% of Cu can be selectively recovered from the polymetallic ZPR leachates. The Cu precipitates characterization studies reveal that they are approximately 0.1 µm in diameter and mainly consist of Cu and S. XRD analysis showed covellite (CuS), chalcanthite (CuSO4·5H2O) and natrochalcite (NaCu2(SO4)2(OH)·H2O) as the mineral phases. ZPRs can thus be considered as an alternative resource for copper production.

Origin of Perpendicular Magnetic Anisotropy and Large Orbital Moment in Fe Atoms on MgO.

We report on the magnetic properties of individual Fe atoms deposited on MgO(100) thin films probed by x-ray magnetic circular dichroism and scanning tunneling spectroscopy. We show that the Fe atoms have strong perpendicular magnetic anisotropy with a zero-field splitting of 14.0±0.3 meV/atom. This is a factor of 10 larger than the interface anisotropy of epitaxial Fe layers on MgO and the largest value reported for Fe atoms adsorbed on surfaces. The interplay between the ligand field at the O adsorption sites and spin-orbit coupling is analyzed by density functional theory and multiplet calculations, providing a comprehensive model of the magnetic properties of Fe atoms in a low-symmetry bonding environment.

[Whole-body ferromagnetic detector systems in clinical MRI]. / Ganzkörperferrodetektorsysteme in der klinischen MRT.

CLINICAL/METHODICAL ISSUE: In spite of technical and organizational measures, ferromagnetic objects still find their way into the magnetic resonance imaging (MRI) room and can cause severe injuries. STANDARD RADIOLOGICAL METHODS: A detailed patient education and MRI safety training for personnel are necessary to avoid MRI incidents with ferromagnetic objects. METHODICAL INNOVATIONS: Whole body ferromagnetic detection systems should increase patient safety and minimize risks for personnel and MRI equipment in the clinical routine. PERFORMANCE: In a clinical MRI setting, a screener system used for outpatients and inpatients (n = 400) identified unknown ferrous objects in 2 % of the cases. In two of these cases patients were found to be in possession of unknown foreign ferrous objects. Furthermore, a door guard system only used for outpatients (n = 2500) detected unknown ferromagnetic objects in 0.3 % of the cases. ACHIEVEMENTS: The number of ferrous objects that are unknowingly brought into the scanner room can be reduced with a whole body ferromagnetic detection system. For an optimal benefit of the system a ferrous-free environment and perfectly ferrous-free clothing for the medical personnel are necessary. In the clinical routine, the benefit of the system is limited particularly for immobile patients who have to remain in a horizontal position. PRACTICAL RECOMMENDATIONS: A whole body ferromagnetic detection system can complement but not replace patient education and MRI safety training.

Magnetism in single metalloorganic complexes formed by atom manipulation.

The magnetic properties of molecular structures can be tailored by chemical synthesis or bottom-up assembly at the atomic scale. We used scanning tunneling microscopy to study charge and spin transfer in individual complexes of transition metals with the charge acceptor, tetracyanoethylene (TCNE). The complexes were formed on a thin insulator, Cu2N on Cu(100), by manipulation of individual atoms and molecules. The Cu2N layer decouples the complexes from Cu electron density, enabling direct imaging of the TCNE molecular orbitals as well as spin-flip inelastic electron tunneling spectroscopy. Results were obtained at low temperature down to 1 K and in magnetic fields up to 7 T in order to resolve splitting of spin states in the complexes. We also performed spin-polarized density functional theory calculations to compare with the experimental data. Our results indicate that charge transfer to TCNE leads to a change in spin magnitude, Kondo resonance, and magnetic anisotropy for the metal atoms.

The role of stimulus complexity, spectral overlap, and pitch for gap-detection thresholds in young and old listeners.

Thresholds for detecting a gap between two complex tones were determined for young listeners with normal hearing and old listeners with mild age-related hearing loss. The leading tonal marker was always a 20-ms, 250-Hz complex tone with energy at 250, 500, 750, and 1000 Hz. The lagging marker, also tonal, could differ from the leading marker with respect to fundamental frequency (f0), the presence versus absence of energy at f0, and the degree to which it overlapped spectrally with the leading marker. All stimuli were presented with steeper (1 ms) and less steep (4 ms) envelope rise and fall times. F0 differences, decreases in the degree of spectral overlap between the markers, and shallower envelope shape all contributed to increases in gap-detection thresholds. Age differences for gap detection of complex sounds were generally small and constant when gap-detection thresholds were measured on a log scale. When comparing the results for complex sounds to thresholds obtained for pure-tones in a previous study by Heinrich and Schneider [(2006). J. Acoust. Soc. Am. 119, 2316-2326], thresholds increased in an orderly fashion from markers with identical (within-channel) pure tones to different (between-channel) pure tones to complex sounds. This pattern of results was true for listeners of both ages although younger listeners had smaller thresholds overall.

Higher precision level at individual laying performance tests in noncage housing systems.

With the Weihenstephan funnel nest box, 12 laying hen flocks were tested for their individual laying performance, egg quality, and nesting behavior in a noncage environment. During the whole observation period of 8 yr, a transponder-based data recording system was continuously improved and resulted in a recording accuracy of 97%. At peak production, heritabilities for the number of eggs laid are in some flocks higher than expected. With improved data accuracy, heritability estimates on individual egg weights are more stable. Heritabilities for nesting behavior traits range between a low to moderate level, providing very useful information for laying hen selection to help improve traits that cannot be recorded in cages. Over the years, the benefits of the Weihenstephan funnel nest box for laying hen breeders have grown. This is due to higher data recording accuracies and extended testing capacities, which result in more reliable genetic parameters.

[Value of non-IOP lowering therapy for glaucoma]. / Stellenwert der "nicht Augendruck senkenden Glaukomtherapie"

It is well established that an IOP reduction improves, on average, the prognosis of all types of glaucoma. It is also known, however, that even an ideal IOP does not stop progression in all patients. The insight into the pathogenesis of glaucomatous damage leads to new therapeutic approaches. Whilst most of these new avenues of treatment are still in the experimental phase, others, such as magnesium, Ginkgo, salt and fludrocortisone are already used by some physicians. Blood pressure dips can be avoided by intake of salt or fludrocortisone. Vascular regulation can be improved either locally by carbonic anhydrase inhibitors or systemically with magnesium or with low doses of calcium channel blockers. A number of other food ingredients such as polyphenolic flavonoids occurring in tea, coffee, dark chocolate or red wine and anthocyanosides found in bilberries have potential antioxidative effects. The oxidative stress at the level of the mitochondria can be reduced by Ginkgo biloba. Experimentally, glaucomatous optic neuropathy can be prevented by inhibition of astrocyte activation, either by blockage of epidermal growth factor receptor or by counteracting endothelin. Glaucomatous optic neuropathy can also be prevented by nitric oxide-2 synthase inhibition. Inhibition of matrix metalloproteinase-9 inhibits apoptosis of retinal ganglion cells and tissue remodelling. Up-regulation of heat shock proteins protects the retinal ganglion cells and the optic nerve head.

[Posttraumtic stress disorder after deployment of German soldiers : does the risk increase with deployment duration?]. / Posttraumatische Belastungsstörungen nach Auslandseinsätzen deutscher Soldaten : Steigt das Risiko mit der Einsatzdauer?

International studies suggest a growing risk of posttraumatic stress disorder (PTSD) with an increasing duration of deployment. There are no data available for the German armed forces that would allow an assessment of the average mission duration of about 4 months. Analyses are based on a stratified random sample of 1,483 ISAF soldiers. Standardized diagnostic interviews were conducted about 12 months after soldiers returned from mission. Deployment duration was categorized into 1-2 months, 3-5 months, and 5-8 months. Additionally, dimensional analyses of deployment duration were performed. Deployment duration was associated with the number of stressful and traumatic events. Notwithstanding, we found no linear relationship between mission duration and PTSD risk, neither in the total sample nor in the defined subgroups. However, we found a bimodal distribution suggesting an increased PTSD risk in the first 2 months and - less pronounced and limited to the Kunduz location - for deployment durations of at least 6 months. There was no general increase in PTSD risk with increasing deployment durations for German soldiers in this naturalistic study. The higher risk for soldiers with short deployments might be explained by selection of vulnerable subjects and different deployment characteristics. Further, there is some evidence of an increased PTSD risk for soldiers deployed for longer periods to high-risk locations (e.g., Kunduz).

Ginkgo biloba: an adjuvant therapy for progressive normal and high tension glaucoma.

Gingko biloba has been used for hundreds of years to treat various disorders such as asthma, vertigo, fatigue and, tinnitus or circulatory problems. Two of the main extracts are EGb761 and LI 1370. Most pharmacological, toxicological and clinical studies have focused on the neuroprotective value of these two main extracts. Neuroprotection is a rapidly expanding area of research. This area is of particular interest due to the fact that it represents a new avenue of therapy for a frustrating disease that may progress despite optimal treatment. One such disease is glaucoma.Glaucoma leads to the loss of retinal ganglion cells and their axons but also to tissue remodelling which involves both the optic nerve head and the retina. In the retina the astrocytes get activated. In addition, the optic nerve gets thinner and the cells of the lateral geniculate ganglion disappear partially. On average, ocular blood flow (OBF) is reduced in glaucoma patients in various tissues of the eye. Increased intraocular pressure (IOP) is a major risk factor for glaucomatous damage. Nevertheless, there is little doubt that other risk factors besides IOP are involved. One such risk factor is a primary vascular dysregulation (PVD) occurring in patients with a disturbed autoregulation, another risk factor is oxidative stress.

Magnetic resonance imaging of the active second stage of labour: proof of principle.

OBJECTIVE: To prove that magnetic resonance imaging of foetal anatomy during the active second stage of vaginal delivery is feasible. MATERIALS AND METHODS: Initially, five pregnant volunteers around the 30th week of gestation were examined in an open MRI. Based on the findings, one vaginal delivery was acquired under real-time imaging. To monitor the birth status during image acquisition, an MR-compatible wireless cardiotocography (CTG) system was built. Single-shot sequence parameters were optimised to compensate motion artefacts during labour. RESULTS: Safety requirements to monitor the birth process under real-time MR imaging were met. High-resolution MR images were acquired immediately before and after delivery. In one patient, TSE single-shot cinematic sequences of the active second stage of labour were obtained. All sequences were adapted to tolerate movement of the mother and infant, as well as residual noise from the CTG. Furthermore, the MR imaging during labour showed only minor image artefacts. CONCLUSION: CTG-monitored acquisition of MRI series during the active second stage of delivery is feasible. Image quality should allow various further studies to improve models for birth simulation as well as potential investigation of obstructed labour and obstetric complications.

[Clinical radiological evaluation of teeth-part 2 : Caries, inflammatory dental changes and important differential diagnoses]. / Klinisch-radiologische Beurteilung der Zähne ­ Teil 2 : Karies, entzündliche Zahnveränderungen und wichtige Differenzialdiagnosen.

Inflammatory diseases of the teeth and periodontium are widespread and are frequent secondary diagnoses in head and neck examinations. Periapical inflammation can be the cause of sinusitis or abscess formation in the oral and maxillofacial region. Early detection is important for the patient's course of treatment. For further diagnostics, a dental presentation should be carried out. Dental radiological examinations, such as panoramic radiographs and dental films are used for specific diagnostics. This article is intended to provide an overview of the different stages of caries, the most important inflammatory dental changes and their most frequent differential diagnoses.

[Clinical radiological evaluation of teeth-part 1 : Anatomy and anomalies]. / Klinisch-radiologische Beurteilung der Zähne ­Teil 1 : Anatomie und Anomalien.

Radiological assessment of the teeth and periodontium is often left to the dentist. Nevertheless, it is useful to know the anatomy and possible anomalies of the teeth in order to correctly assess pathological processes in both projection radiographic and slice imaging. Dental radiological examinations, such as panoramic slice imaging (PSA) and dental film are used for targeted diagnostics. In the case of incidental findings, a dental presentation should be made for further clarification. This article first provides an overview of the anatomy and anomalies of teeth.

Engineering atomic-scale magnetic fields by dysprosium single atom magnets.

Atomic scale engineering of magnetic fields is a key ingredient for miniaturizing quantum devices and precision control of quantum systems. This requires a unique combination of magnetic stability and spin-manipulation capabilities. Surface-supported single atom magnets offer such possibilities, where long temporal and thermal stability of the magnetic states can be achieved by maximizing the magnet/ic anisotropy energy (MAE) and by minimizing quantum tunnelling of the magnetization. Here, we show that dysprosium (Dy) atoms on magnesium oxide (MgO) have a giant MAE of 250 meV, currently the highest among all surface spins. Using a variety of scanning tunnelling microscopy (STM) techniques including single atom electron spin resonance (ESR), we confirm no spontaneous spin-switching in Dy over days at ≈ 1 K under low and even vanishing magnetic field. We utilize these robust Dy single atom magnets to engineer magnetic nanostructures, demonstrating unique control of magnetic fields with atomic scale tunability.