Exciton-polariton topological insulator.

Topological insulators-materials that are insulating in the bulk but allow electrons to flow on their surface-are striking examples of materials in which topological invariants are manifested in robustness against perturbations such as defects and disorder1. Their most prominent feature is the emergence of edge states at the boundary between areas with different topological properties. The observable physical effect is unidirectional robust transport of these edge states. Topological insulators were originally observed in the integer quantum Hall effect2 (in which conductance is quantized in a strong magnetic field) and subsequently suggested3-5 and observed6 to exist without a magnetic field, by virtue of other effects such as strong spin-orbit interaction. These were systems of correlated electrons. During the past decade, the concepts of topological physics have been introduced into other fields, including microwaves7,8, photonic systems9,10, cold atoms11,12, acoustics13,14 and even mechanics15. Recently, topological insulators were suggested to be possible in exciton-polariton systems16-18 organized as honeycomb (graphene-like) lattices, under the influence of a magnetic field. Exciton-polaritons are part-light, part-matter quasiparticles that emerge from strong coupling of quantum-well excitons and cavity photons19. Accordingly, the predicted topological effects differ from all those demonstrated thus far. Here we demonstrate experimentally an exciton-polariton topological insulator. Our lattice of coupled semiconductor microcavities is excited non-resonantly by a laser, and an applied magnetic field leads to the unidirectional flow of a polariton wavepacket around the edge of the array. This chiral edge mode is populated by a polariton condensation mechanism. We use scanning imaging techniques in real space and Fourier space to measure photoluminescence and thus visualize the mode as it propagates. We demonstrate that the topological edge mode goes around defects, and that its propagation direction can be reversed by inverting the applied magnetic field. Our exciton-polariton topological insulator paves the way for topological phenomena that involve light-matter interaction, amplification and the interaction of exciton-polaritons as a nonlinear many-body system.

Kerr Enhanced Backaction Cooling in Magnetomechanics.

Optomechanics is a prime example of light matter interaction, where photons directly couple to phonons, allowing the precise control and measurement of the state of a mechanical object. This makes it a very appealing platform for testing fundamental physics or for sensing applications. Usually, such mechanical oscillators are in highly excited thermal states and require cooling to the mechanical ground state for quantum applications, which is often accomplished by using optomechanical backaction. However, while massive mechanical oscillators are desirable for many tasks, their frequency usually decreases below the cavity linewidth, significantly limiting the methods that can be used to efficiently cool. Here, we demonstrate a novel approach relying on an intrinsically nonlinear cavity to backaction-cool a low frequency mechanical oscillator. We experimentally demonstrate outperforming an identical, but linear, system by more than 1 order of magnitude. Furthermore, our theory predicts that with this approach we can also surpass the standard cooling limit of a linear system. By exploiting a nonlinear cavity, our approach enables efficient cooling of a wider range of optomechanical systems, opening new opportunities for fundamental tests and sensing.

Primary school mobile dental program in New South Wales, Australia: protocol for the evaluation of a state government oral health initiative.

BACKGROUND: Socioeconomically disadvantaged children are disproportionately affected by oral disease. Mobile dental services help underserved communities overcome barriers to accessing health care, including time, geography, and trust. The NSW Health Primary School Mobile Dental Program (PSMDP) is designed to provide diagnostic and preventive dental services to children at their schools. The PSMDP is mainly targeted toward high-risk children and priority populations. This study aims to evaluate the program's performance across five local health districts (LHDs) where the program is being implemented. METHODS: The evaluation will use routinely collected administrative data, along with other program-specific data sources, from the district public oral health services to conduct a statistical analysis that determines the reach and uptake of the program, its effectiveness, and the associated costs and cost-consequences. The PSMDP evaluation program utilises data from Electronic Dental Records (EDRs) and other data sources, including patient demographics, service mix, general health, oral health clinical data and risk factor information. The overall design includes cross-sectional and longitudinal components. The design combines comprehensive output monitoring across the five participating LHDs and investigates the associations between socio-demographic factors, service patterns and health outcomes. Time series analysis using difference-in-difference estimation will be conducted across the four years of the program, involving services, risk factors, and health outcomes. Comparison groups will be identified via propensity matching across the five participating LHDs. An economic analysis will estimate the costs and cost-consequences for children who participate in the program versus the comparison group. DISCUSSION: The use of EDRs for oral health services evaluation research is a relatively new approach, and the evaluation works within the limitations and strengths of utilising administrative datasets. The study will also provide avenues to improve the quality of data collected and system-level improvements to better enable future services to be aligned with disease prevalence and population needs.

Associations between prenatal exposure to power plants and birth outcomes across the United States.

OBJECTIVES: Although there is growing evidence that in utero exposure to power plants increases the risk of adverse birth outcomes, studies have focused on coal-fired plants and single US locations, limiting generalizability. We used birth certificate data from 50 states and DC to examine the associations between prenatal exposure to power plants and birth outcomes overall and by race/ethnicity. METHODS: We linked 2009-2018 county-level microdata natality files on 34,674,911 singleton births from 50 states and DC with 9-month county-level averages of power plant fuel consumption based on month/year of birth. We estimated linear regression models for birth weight and gestational age and probit models for the dichotomous outcomes of low birth weight, small for gestational age (SGA), and preterm birth. We subsequently examined interactions between plant fuel consumption and race/ethnicity. RESULTS: Overall, 69.1% of counties had any power plant fuel consumption. Although we found no overall effects of prenatal exposure to power plants on birth weight or SGA, a significant interaction (both P < 0.01) revealed that a 10% increase in fuel consumption was associated with infants born to White women having slightly lower birth weights (1.76 g; 95% confidence interval = -2.87, -0.65) and higher risk of being born SGA (0.0002; 95% confidence interval = 0.0002, 0.0002). CONCLUSION: Power plants have negative effects on infant health, which exist independent of locality.

Effect of transcutaneous electrical nerve stimulation (TENS) on knee pain and physical function in patients with symptomatic knee osteoarthritis: the ETRELKA randomized clinical trial.

OBJECTIVE: To determine the effectiveness of TENS at relieving pain and improving physical function as compared to placebo TENS, and to determine its safety, in patients with knee osteoarthritis. METHODS: Multi-centre, parallel, 1:1 randomized, double-blind, placebo-controlled clinical trial conducted in six outpatient clinics in Switzerland. We included 220 participants with knee osteoarthritis recruited between October 15, 2012, and October 15, 2014. Patients were randomized to 3 weeks of treatment with TENS (n = 108) or placebo TENS (n = 112). Our pre-specified primary endpoint was knee pain at the end of 3-weeks treatment assessed with the WOMAC pain subscale. Secondary outcome measures included WOMAC physical function subscale and safety outcomes. RESULTS: There was no difference between TENS and placebo TENS in WOMAC pain at the end of treatment (mean difference -0.06; 95%CI -0.41 to 0.29; P = 0.74), nor throughout the trial duration (P = 0.98). Subgroup analyses did not indicate an interaction between patient/treatment characteristics and treatment effect on WOMAC pain at the end of treatment (P-interaction ≥0.22). The occurrence of adverse events was similar across groups, with 10.4% and 10.6% of patients reporting events in the TENS and placebo TENS groups, respectively (P = 0.95). No relevant differences were observed in secondary outcomes. CONCLUSIONS: TENS does not improve knee osteoarthritis pain when compared to placebo TENS. Therapists should consider other potentially more effective treatment modalities to decrease knee osteoarthritis pain and facilitate strengthening and aerobic exercise. Our findings are conclusive and further trials comparing TENS and placebo TENS in this patient population are not necessary.

Crossover from exciton-polariton condensation to photon lasing in an optical trap.

Optical trapping has been proven to be an effective method of separating exciton-polariton condensates from the incoherent high-energy excitonic reservoir located at the pumping laser position. This technique has significantly improved the coherent properties of exciton-polariton condensates, when compared to a quasi-homogeneous spot excitation scheme. Here, we compare two experimental methods on a sample, where a single spot excitation experiment allowed us only to observe photonic lasing in the weak coupling regime. In contrast, the ring-shaped excitation resulted in the two-threshold behavior, where an exciton-polariton condensate manifests itself at the first and photon lasing at the second threshold. Both lasing regimes are trapped in an optical potential created by the pump. We interpret the origin of this confining potential in terms of repulsive interactions of polaritons with the reservoir at the first threshold and as a result of the excessive free-carrier induced refractive index change of the microcavity at the second threshold. This observation offers a way to achieve multiple phases of photonic condensates in samples, e.g., containing novel materials as an active layer, where two-threshold behavior is impossible to achieve with a single excitation spot.

Enhancing Ground-State Population and Macroscopic Coherence of Room-Temperature WS_{2} Polaritons through Engineered Confinement.

Exciton polaritons (polaritons herein) in transition-metal dichalcogenide monolayers have attracted significant attention due to their potential for polariton-based optoelectronics. Many of the proposed applications rely on the ability to trap polaritons and to reach macroscopic occupation of their ground energy state. Here, we engineer a trap for room-temperature polaritons in an all-dielectric optical microcavity by locally increasing the interactions between the WS_{2} excitons and cavity photons. The resulting confinement enhances the population and the first-order coherence of the polaritons in the ground state, with the latter effect related to dramatic suppression of disorder-induced inhomogeneous dephasing. We also demonstrate efficient population transfer into the trap when optically injecting free polaritons outside of its periphery.

Propagative Oscillations in Codirectional Polariton Waveguide Couplers.

We report on novel exciton-polariton routing devices created to study and purposely guide light-matter particles in their condensate phase. In a codirectional coupling device, two waveguides are connected by a partially etched section that facilitates tunable coupling of the adjacent channels. This evanescent coupling of the two macroscopic wave functions in each waveguide reveals itself in real space oscillations of the condensate. This Josephson-like oscillation has only been observed in coupled polariton traps so far. Here, we report on a similar coupling behavior in a controllable, propagative waveguide-based design. By controlling the gap width, channel length, or propagation energy, the exit port of the polariton flow can be chosen. This codirectional polariton device is a passive and scalable coupler element that can serve in compact, next generation logic architectures.

Orbital Complexity in Intrinsic Magnetic Topological Insulators MnBi_{4}Te_{7} and MnBi_{6}Te_{10}.

Using angle-resolved photoelectron spectroscopy (ARPES), we investigate the surface electronic structure of the magnetic van der Waals compounds MnBi_{4}Te_{7} and MnBi_{6}Te_{10}, the n=1 and 2 members of a modular (Bi_{2}Te_{3})_{n}(MnBi_{2}Te_{4}) series, which have attracted recent interest as intrinsic magnetic topological insulators. Combining circular dichroic, spin-resolved and photon-energy-dependent ARPES measurements with calculations based on density functional theory, we unveil complex momentum-dependent orbital and spin textures in the surface electronic structure and disentangle topological from trivial surface bands. We find that the Dirac-cone dispersion of the topologial surface state is strongly perturbed by hybridization with valence-band states for Bi_{2}Te_{3}-terminated surfaces but remains preserved for MnBi_{2}Te_{4}-terminated surfaces. Our results firmly establish the topologically nontrivial nature of these magnetic van der Waals materials and indicate that the possibility of realizing a quantized anomalous Hall conductivity depends on surface termination.

Evaluation of the combination of endothelin receptor antagonists (ERA) and phosphodiesterase-5 inhibitors for the treatment of pulmonary arterial hypertension (PAH) in pathologic human pulmonary arteries in an ex-vivo organ bath model.

PURPOSE: Medical combination therapy of pulmonary arterial hypertension (PAH) may alleviate the drawbacks of monotherapy by avoiding drug tolerance and by increasing effectiveness, as shown by the combination of ambrisentan and tadalafil (AMBITION trial). The present ex-vivo study evaluated the combination of the endothelin receptor antagonists (ERA) macitentan and bosentan with the phosphodiesterase-5 (PDE-5) inhibitor vardenafil in pulmonary arteries from patients suffering from terminal lung disease as a model of PAH. METHODS: Segments of the pulmonary vessels were excised from resected lungs of patients requiring lung transplantation (LTX). Contraction of pulmonary arteries (PA) was elicited by consecutive dose-response curves of endothelin-1 (ET-1) followed by norepinephrine (NE) to allow inhibition by different pathways. Forces were measured isometrically in an organ bath in the presence and absence of ERA and PDE-5 inhibitors and their combination. RESULTS: PA of 38 patients were examined between October 2016 and November 2019. Bosentan (1E-7 M) and macitentan (1E-8 M, 3E-8 M, 1E-7 M) inhibited ET-1 induced contractions, whereas vardenafil (1E-6 M, 3E-6 M, 1E-5 M) inhibited only the NE induced part of the contractions. Vardenafil enhanced bosentan-induced inhibition of vasoconstriction in a dose-dependent fashion. Combination effects exceeded single bosentan at 3E-6 M and 1E-5 M vardenafil, and they exceeded single vardenafil at the lower vardenafil concentrations. Macitentan showed a more pronounced inhibition than bosentan regardless of the lower concentrations. Accordingly, combination effects with vardenafil resembled those of macitentan alone. CONCLUSIONS: Macitentan and bosentan were potent antagonists of vasoconstriction in PA of LTX patients. The benefit of drug combinations was demonstrated at selected concentrations only owing to a narrow therapeutic range of vardenafil in this ex-vivo model. These results suggest the utility of drug combinations other than the established pair of ambrisentan and tadalafil in PAH treatment but also make a case for a further assessment of vasodilator properties of drugs complementing ERA.

Observation of non-Hermitian degeneracies in a chaotic exciton-polariton billiard.

Exciton-polaritons are hybrid light-matter quasiparticles formed by strongly interacting photons and excitons (electron-hole pairs) in semiconductor microcavities. They have emerged as a robust solid-state platform for next-generation optoelectronic applications as well as for fundamental studies of quantum many-body physics. Importantly, exciton-polaritons are a profoundly open (that is, non-Hermitian) quantum system, which requires constant pumping of energy and continuously decays, releasing coherent radiation. Thus, the exciton-polaritons always exist in a balanced potential landscape of gain and loss. However, the inherent non-Hermitian nature of this potential has so far been largely ignored in exciton-polariton physics. Here we demonstrate that non-Hermiticity dramatically modifies the structure of modes and spectral degeneracies in exciton-polariton systems, and, therefore, will affect their quantum transport, localization and dynamical properties. Using a spatially structured optical pump, we create a chaotic exciton-polariton billiard--a two-dimensional area enclosed by a curved potential barrier. Eigenmodes of this billiard exhibit multiple non-Hermitian spectral degeneracies, known as exceptional points. Such points can cause remarkable wave phenomena, such as unidirectional transport, anomalous lasing/absorption and chiral modes. By varying parameters of the billiard, we observe crossing and anti-crossing of energy levels and reveal the non-trivial topological modal structure exclusive to non-Hermitian systems. We also observe mode switching and a topological Berry phase for a parameter loop encircling the exceptional point. Our findings pave the way to studies of non-Hermitian quantum dynamics of exciton-polaritons, which may uncover novel operating principles for polariton-based devices.

Enzymatic effects of Pleurotus ostreatus spent substrate on whole-plant corn silage and performance of lactating goats.

Pleurotus ostreatus (oyster mushroom) synthesizes enzymes that degrade lignin, cellulose, and hemicellulose. The objectives of this study were to evaluate the effect of Pleurotus ostreatus spent substrate (POSS) on whole-plant corn silage (WPCS) chemical composition, antioxidant capacity, lignin monomers, and in vitro digestibility, as well as the performance of lactating goats fed corn silage treated with different levels of POSS. In experiment 1, 4 levels of lignocellulolytic enzymes were tested in a complete randomized design: 0, 10, 20, and 30 mg of lignocellulosic enzymes per kilogram of fresh matter, 4 replicates per treatment (vacuum-sealed bags). The bags were opened 60 d after ensiling. In experiment 2, corn silage treated with 3 enzyme levels (0, 10, or 30 mg/kg of fresh matter) was fed to lactating goats as part of the total mixed ration. Nine lactating Saanen goats (62.68 ± 7.62 kg BW; 44 ± 8 d in milk; 2.91 ± 0.81 kg of milk/day, mean ± SD) were assigned to three 3 × 3 Latin squares. Data were analyzed using the GLIMMIX procedure of SAS (version 9.4, SAS Institute Inc.), and means were compared by linear and quadratic orthogonal contrast. In experiment 1, neutral detergent fiber (NDF), acid detergent fiber (ADF), lignin, and cellulose quadratically decreased in the WPCS treated with POSS. At the nadir point, POSS decreased NDF by 14.1%, ADF by 19.5%, lignin by 9.07%, and cellulose by 22.1% compared with the untreated silage. Therefore, POSS led to a quadratic increase in in vitro dry matter digestibility of WPCS (+8.88% at the vertex) compared with the untreated silage. In experiment 2, POSS quadratically increased the in vivo total-tract ADF digestibility. Also, the concentration of polyphenols in the milk of goats linearly increased with the addition of POSS, and no differences were observed among treatments for milk yield and composition. In summary, adding 10 mg of lignocellulolytic enzymes from POSS per kilogram of fresh matter of whole-plant corn at ensiling had a more evident reduction in lignin and cellulose concentration, leading to greater in vitro digestibility, as well as greater in vivo ADF digestibility; however, milk yield was not different among treatments.

[Psychological effects of emergency calls management on medical dispatcher assistants in a SAMU-Center 15]. / Répercussions psychologiques de la prise en charge des appels d'urgence sur les assistants de régulation médicale (ARM) d'un SAMU­Centre 15.

INTRODUCTION: In France, the emergency call center is called SAMU (service d'aide médicale d'urgence). The Medical Dispatcher Assistant (MDA) is the first responder and is exposed to first calls of distress and has a high risk of stress disorder. AIM: Psychological impact of emergency calls on MDA. METHOD: National multicenter prospective study from January to August 2018 by electronic surveys, including all MDA of 13 SAMU, subdivided in 5 sections: population characteristics, PCL-5 scale (DSM-5) assessing post-traumatic stress disorder (PTSD), ProQOL assessing professional quality of life, call categories and an MDA's emotional perception, and work impacts on an MDA's quality of life. Univariate descriptive statistical analysis of the group with PCL-5≥34 (=complete PTSD group) and with PCL-5<34 (=group without complete PTSD). RESULTS: Of 400 MDA asked to be interviewed, 283 (71 %) replied of whom 72 % (205) were women and 28 % (79) men. Age groups: 9 % (25) for 18-25 yrs, 39 % (110) for 26-35 yrs, 31 % (89) 36-45 yrs, 15 % (43) 46-55 yrs and 6 % (16) for more than 56 yrs. All MDA reported having been exposed to death experience. For 46 % (129) the most recent traumatic event occurred within the last 7 months. 78 % (219) have reported intense fear, feeling helpless, or even sensed horror when answering the calls. 97 % (273) could talk about it with colleagues but only 64 % (180) with family. 72 % (203) felt lack of recognition at work. 78 % (220) had no knowledge about psycho-traumatic disorder. While 11 % (30) suffered symptoms suggestive of a complete PTSD, 15 % (42) an incomplete PTSD, 3 % (8) suffer burnout and 4 % (11) compassion fatigue, none reported secondary traumatic stress. The only significant difference (P<0.05) between the two groups characteristics was on the education level. 74 % (22) of the MDA with a complete PTSD had a High School diploma or less. MDA with symptoms suggestive of complete PTSD developed significantly (P<0.001) more stress reduction strategies (alcohol, drugs, medication) (13 % vs 2 %), had more food disorders (80.5 % vs 38 %), more sleeping problems (75.5 % vs 21 %), more anxiety (67 % vs 17 %), and more sick leaves (13 % vs 4 %) than the group without complete PTSD. CONCLUSION: Part of the surveyed MDAs showed symptoms suggestive of PTSD. The study highlights that MDAs is a vulnerable population, and PTSD prevention techniques should be systematically implemented for them. The study also highlights that a higher education level prevents the psycho traumatic process with its accompanying disorders.

Demonstration of a polariton step potential by local variation of light-matter coupling in a van-der-Waals heterostructure.

The large oscillator strength of excitons in transition metal dichalcogenide layers facilitates the formation of exciton-polariton resonances for monolayers and van-der-Waals heterostructures embedded in optical microcavities. Here, we show, that locally changing the number of layers in a WSe2/hBN/WSe2 van-der-Waals heterostructure embedded in a monolithic, high-quality-factor cavity gives rise to a local variation of the coupling strength. This effect yields a polaritonic stair case potential, which we demonstrate at room temperature. Our result paves the way towards engineering local polaritonic potentials at length scales down to atomically sharp interfaces, based on purely modifying its real part contribution via the coherent light-matter coupling strength g.

Single-Photon Cooling in Microwave Magnetomechanics.

Cavity optomechanics, where photons are coupled to mechanical motion, provides the tools to control mechanical motion near the fundamental quantum limits. Reaching single-photon strong coupling would allow to prepare the mechanical resonator in non-Gaussian quantum states. Preparing massive mechanical resonators in such states is of particular interest for testing the boundaries of quantum mechanics. This goal remains however challenging due to the small optomechanical couplings usually achieved with massive devices. Here we demonstrate a novel approach where a mechanical resonator is magnetically coupled to a microwave cavity. We measure a single-photon coupling of g_{0}/2π∼3 kHz, an improvement of one order of magnitude over current microwave optomechanical systems. At this coupling we measure a large single-photon cooperativity with C_{0}≳10, an important step to reach single-photon strong coupling. Such a strong interaction allows us to cool the massive mechanical resonator to a third of its steady state phonon population with less than two photons in the microwave cavity. Beyond tests for quantum foundations, our approach is also well suited as a quantum sensor or a microwave to optical transducer.

Observation of Intensity Squeezing in Resonance Fluorescence from a Solid-State Device.

Intensity squeezing-i.e., photon number fluctuations below the shot-noise limit-is a fundamental aspect of quantum optics and has wide applications in quantum metrology. It was predicted in 1979 that intensity squeezing could be observed in resonance fluorescence from a two-level quantum system. However, its experimental observation in solid states was hindered by inefficiencies in generating, collecting, and detecting resonance fluorescence. Here, we report the intensity squeezing in a single-mode fiber-coupled resonance fluorescence single-photon source based on a quantum dot-micropillar system. We detect pulsed single-photon streams with 22.6% system efficiency, which show sub-shot-noise intensity fluctuation with an intensity squeezing of 0.59 dB. We estimate a corrected squeezing of 3.29 dB at the first lens. The observed intensity squeezing provides the last piece of the fundamental picture of resonance fluorescence, which can be used as a new standard for optical radiation and in scalable quantum metrology with indistinguishable single photons.

Risk factors associated with progressive lacunar strokes and benefit from dual antiplatelet therapy.

BACKGROUND AND PURPOSE: Early neurological deterioration (END) occurs in 20%-30% of patients with lacunar stroke and challenges their clinical management. This retrospective cohort study analyzed clinical and neuroimaging risk factors predicting the occurrence of END, the functional outcome after END and potential benefit from dual antiplatelet therapy (DAPT) in patients with lacunar strokes. METHODS: Factors associated with END and benefit from DAPT were retrospectively analyzed in 308 patients with lacunar stroke symptoms and detected lacunar infarction by magnetic resonance imaging. END was defined by deterioration of ≥3 total National Institutes of Health Stroke Scale (NIHSS) points, ≥2 NIHSS points for limb paresis or documented deterioration within 5 days after admission. Patients were treated with DAPT according to in-house standards. The primary efficacy end-point for functional outcome was fulfilled if NIHSS at discharge improved after END at least to the score at admission. RESULTS: Male gender [odds ratio (OR) 2.08; 95% confidence interval (CI) 1.09-4.00], higher age (OR = 1.65 per 10 years; 95% CI 1.18-2.31), motor paresis (OR = 18.89, 95% CI 4.66-76.57) and infarction of the internal capsule or basal ganglia (OR = 3.58, 95% CI 1.26-10.14) were associated with an increased risk for END. A larger diameter of infarction (OR = 0.85, 95% CI 0.76-0.95), more microangiopathic lesions (OR = 0.75, 95% CI 0.57-0.99) and pontine localization (OR = 0.29, 95% CI 0.12-0.65) were factors associated with unfavorable functional outcome after END occurred. Localization in the internal capsule or basal ganglia was identified as a significant predictive factor for a benefit from DAPT after END. CONCLUSIONS: Identified clinical and neuroimaging factors predicting END occurrence, functional outcome after END and potential benefit from DAPT might improve the clinical management of patients with lacunar strokes.

Trimethylamine-N-oxide is elevated in the acute phase after ischaemic stroke and decreases within the first days.

BACKGROUND AND PURPOSE: Trimethylamine-N-oxide (TMAO) is a biomarker of the gut microbiome and correlates with the risk of cardiovascular diseases. However, conflicting data exist on the specific role of TMAO in ischaemic stroke patients. We aimed to analyze the time course of TMAO levels in stroke patients compared with controls. METHODS: In this prospective, case-control study, patients suffering from ischaemic stroke (onset <24 h) and control patients with less than two cardiovascular risk factors were enrolled. Plasma TMAO levels were analyzed on admission, after 48 h and after 3 months. The primary endpoint was the difference in TMAO levels on admission between stroke patients and controls. RESULTS: A total of 196 patients with ischaemic stroke and 100 controls were included between February 2018 and April 2019. Plasma TMAO levels on admission were significantly higher in stroke patients than in controls [median value 4.09 (2.87-6.49) vs. 3.16 (2.08-5.16) µmol/L, P = 0.001]. There was a significant decrease in TMAO levels in stroke patients after 48 h [median at 48 h, 3.49 (2.30-5.39) µmol/L, P = 0.027]. TMAO levels increased again 3 months after stroke [median 4.23 (2.92-8.13) µmol/L, P = 0.047]. In controls, TMAO levels did not change between admission and after 48 h [median at 48 h, 3.14 (1.63-4.61) µmol/L, P = 0.11]. An inverse correlation between TMAO values and kidney function was found (Spearman rho -0.334, P < 0.001). CONCLUSIONS: Our study emphasizes the importance of the time course of TMAO levels after ischaemic stroke. Future studies should define the time point of TMAO analysis, preferably in the acute phase (<24 h).

Comparison of manual and semi-automatic registration in augmented reality image-guided liver surgery: a clinical feasibility study.

BACKGROUND: The laparoscopic approach to liver resection may reduce morbidity and hospital stay. However, uptake has been slow due to concerns about patient safety and oncological radicality. Image guidance systems may improve patient safety by enabling 3D visualisation of critical intra- and extrahepatic structures. Current systems suffer from non-intuitive visualisation and a complicated setup process. A novel image guidance system (SmartLiver), offering augmented reality visualisation and semi-automatic registration has been developed to address these issues. A clinical feasibility study evaluated the performance and usability of SmartLiver with either manual or semi-automatic registration. METHODS: Intraoperative image guidance data were recorded and analysed in patients undergoing laparoscopic liver resection or cancer staging. Stereoscopic surface reconstruction and iterative closest point matching facilitated semi-automatic registration. The primary endpoint was defined as successful registration as determined by the operating surgeon. Secondary endpoints were system usability as assessed by a surgeon questionnaire and comparison of manual vs. semi-automatic registration accuracy. Since SmartLiver is still in development no attempt was made to evaluate its impact on perioperative outcomes. RESULTS: The primary endpoint was achieved in 16 out of 18 patients. Initially semi-automatic registration failed because the IGS could not distinguish the liver surface from surrounding structures. Implementation of a deep learning algorithm enabled the IGS to overcome this issue and facilitate semi-automatic registration. Mean registration accuracy was 10.9 ± 4.2 mm (manual) vs. 13.9 ± 4.4 mm (semi-automatic) (Mean difference - 3 mm; p = 0.158). Surgeon feedback was positive about IGS handling and improved intraoperative orientation but also highlighted the need for a simpler setup process and better integration with laparoscopic ultrasound. CONCLUSION: The technical feasibility of using SmartLiver intraoperatively has been demonstrated. With further improvements semi-automatic registration may enhance user friendliness and workflow of SmartLiver. Manual and semi-automatic registration accuracy were comparable but evaluation on a larger patient cohort is required to confirm these findings.

Tracking Dark Excitons with Exciton Polaritons in Semiconductor Microcavities.

Dark excitons are of fundamental importance for a wide variety of processes in semiconductors but are difficult to investigate using optical techniques due to their weak interaction with light fields. We reveal and characterize dark excitons nonresonantly injected into a semiconductor microcavity structure containing InGaAs/GaAs quantum wells by a gated train of eight 100 fs pulses separated by 13 ns by monitoring their interactions with the bright lower polariton mode. We find a surprisingly long dark exciton lifetime of more than 20 ns, which is longer than the time delay between two consecutive pulses. This creates a memory effect that we clearly observe through the variation of the time-resolved transmission signal. We propose a rate equation model that provides a quantitative agreement with the experimental data.