Psychiatric presentations and admissions during the first wave of Covid-19 compared to 2019 in a psychiatric emergency department in Berlin, Germany: a retrospective chart review.

BACKGROUND: Most studies agree that the Covid-19 pandemic and the subsequent lockdown had a negative impact on mental health. On the other hand, international studies have shown that psychiatric emergency departments (pED) experienced a decrease in presentations and admissions. METHODS: Retrospective chart review of all pED presentations and admissions during the first wave of Covid-19 pandemic in Germany (Covid-19 period: 3/2/20 to 05/24/20) in a psychiatric hospital in Berlin compared to 1 year earlier (pre-Covid-19 period). Descriptive statistics and logistic regression were performed. RESULTS: We observed no statistical significant changes in overall pED presentations and overall hospital admissions during the Covid-19 period compared to the pre-Covid-19 period (813 vs. 894, - 9.1%, p = 0.064 and (363 vs. 437, - 16.9%, p = 0.080 respectively). In the subgroup analysis, less patients with depressive disorders (p = 0.035) and with personality disorders (p = 0.002) presented to the pED, a larger number of presentations with schizophrenia was observed (p = 0.020). In the Covid-19 period, less patients with substance use disorder and paranoid schizophrenia were admitted to the hospital via the pED than in the pre-Covid-19 period (p = 0.035 and p = 0.006, respectively). Bed capacity was reduced in the Covid-19 period by - 32.8% (p <  0.001). Presentations in police custody were 13.7% (p = 0.029) higher during the Covid-19 compared to pre-Covid-19 period, with higher rates in female presentations (p = 0.008) and suicide attempts (p = 0.012) and less hospital admissions (p = 0.048). Logistic regression analyses revealed that positive predictors for pED presentation during Covid-19 period were police custody (p <  0.001), being redirected from another hospital (p <  0.001), suicide attempt (p = 0.038), suicidal thoughts (p = 0.004), presentation with paranoid schizophrenia (p = 0.001) and bipolar and manic disorders (p = 0.004), negative predictors were hospital admission (p <  0.001), depressive disorders (p = 0.021) and personality disorders (p <  0.001). CONCLUSIONS: A larger number of presentations in police custody during the Covid-19 period may represent untreated medical needs. This was seen predominantly in female patients, suggesting this subgroup might have suffered particularly under lockdown measures. Patients with paranoid schizophrenia were the only subgroup, which increased in absolute numbers, also suggesting a particular lockdown effect. Reduced bed capacity due to infection curbing measures is suggestive to have played an important role in augmenting the threshold for hospital admissions.

International round-robin experiment for angle-resolved light scattering measurement.

An international round-robin experiment has been conducted to test procedures and methods for the measurement of angle-resolved light scattering. ASTM E2387-05 has been used as the main guide, while the experience gained should also contribute to the new ISO standard of angle-resolved scattering currently under development (ISO/WD 19986:2016). Seven laboratories from Europe and the United States measured the angle-resolved scattering from Al/SiO2-coated substrates, transparent substrates, volume diffusors, quasi-volume diffusors, white calibration standards, and grating samples at laser wavelengths in the UV, VIS, and NIR spectra. Results were sent to Fraunhofer IOF, which coordinated the experiments and analyzed the data, while ESA-ESTEC, as the project donor, defined conditions and parameters. Depending mainly on the sample type, overall good to reasonable agreements were observed, with largest deviations at scattering angles very close to the specular beam. Volume diffusor characterization unexpectedly turned out to be challenging. Not all participants provided measurement uncertainty ranges according to the Guide to the Expression of Uncertainty in Measurement; often, a single general scatterometer-related measurement uncertainty value was stated. Although relative instrument measurement uncertainties close to 1% are sometimes claimed, the comparison results did not support these claims for specular scattering samples as mirrors, substrates, or gratings.

Conductance Spectroscopy of Exfoliated Thin Flakes of Nb xBi2Se3.

We study unconventional superconductivity in exfoliated single crystals of a promising three-dimensional (3D) topological superconductor candidate, Nb-doped Bi2Se3 through differential conductance spectroscopy and magneto-transport. The strong anisotropy of the critical field along the out-of-plane direction suggests that the thin exfoliated flakes are in the quasi-2D limit. Normal metal-superconductor (NS) contacts with either high or low transparencies made by depositing gold leads onto Nb-doped Bi2Se3 flakes both show significant enhancement in zero bias conductance and coherence dips at the superconducting energy gap. Such behavior is inconsistent with conventional Blonder-Tinkham-Klapwijk theory. Instead, we discuss how our results are consistent with p-wave pairing symmetry, supporting the possibility of topological superconductivity in Nb-doped Bi2Se3. Finally, we observe signatures of multiple superconducting energy gaps, which could originate from multiple Fermi surfaces reported earlier in bulk crystals.

Long-term survival of sorafenib-treated FLT3-ITD-positive acute myeloid leukaemia patients relapsing after allogeneic stem cell transplantation.

BACKGROUND: Fms-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD)-positive acute myeloid leukaemia (AML) relapsing after allogeneic stem cell transplantation (allo-SCT) has a dismal prognosis with limited therapeutic options. FLT3-ITD kinase inhibition is a reasonable but palliative experimental treatment alternative in this situation. Information on long-term outcome is not available. METHODS: We performed a long-term follow-up analysis of a previously reported cohort of 29 FLT3-ITD-positive AML patients, which were treated in relapse after allo-SCT with sorafenib monotherapy. FINDINGS: With a median follow-up of 7.5 years, 6 of 29 patients (21%) are still alive. Excluding one patient who received a second allo-SCT, five patients (17%) achieved sustained complete remissions with sorafenib. Four of these patients are in treatment-free remission for a median of 4.4 years. INTERPRETATION: Sorafenib may enable cure of a proportion of very poor risk FLT3-ITD-positive AML relapsing after allo-SCT.

Evidence for an anomalous current-phase relation in topological insulator Josephson junctions.

Josephson junctions with topological insulator weak links can host low-energy Andreev-bound states giving rise to a current-phase relation that deviates from sinusoidal behaviour. Of particular interest are zero-energy Majorana-bound states that form at a phase difference of π. Here we report on interferometry studies of Josephson junctions and superconducting quantum interference devices (SQUIDs) incorporating topological insulator weak links. We find that the nodes in single-junction diffraction patterns and SQUID oscillations are lifted and independent of chemical potential. At high temperatures, the SQUID oscillations revert to conventional behaviour, ruling out asymmetry. The node-lifting of the SQUID oscillations is consistent with low-energy Andreev-bound states exhibiting a nonsinusoidal current-phase relation, co-existing with states possessing a conventional sinusoidal current-phase relation. However, the finite nodal currents in the single-junction diffraction pattern suggest an anomalous contribution to the supercurrent possibly carried by Majorana-bound states, although we also consider the possibility of inhomogeneity.

Parallelized multichannel BSDF measurements.

The intensity of scattered light is extremely sensitive to even small changes of illumination wavelength, incident angle, polarization states, or even the measurement position. To obtain light scattering distributions with varied parameters, time-consuming sequential measurement procedures are typically employed. Here, we propose a concept for the measurement of multiple properties at the same time. This is achieved by tailoring orthogonal frequency division multiplexing (OFDM) for light scattering measurement techniques to the required low inter-channel crosstalk performance. The concept is used for a highly-robust roughness and contamination characterization, to derive one-shot roughness information, as well as to characterize color and appearance.

Anomalous modulation of a zero-bias peak in a hybrid nanowire-superconductor device.

We report on transport measurements of an InAs nanowire coupled to niobium nitride leads at high magnetic fields. We observe a zero-bias anomaly (ZBA) in the differential conductance of the nanowire for certain ranges of magnetic field and chemical potential. The ZBA can oscillate in width with either the magnetic field or chemical potential; it can even split and re-form. We discuss how our results relate to recent predictions of hybridizing Majorana fermions in semiconducting nanowires, while considering more mundane explanations.

Exciton condensation and perfect Coulomb drag.

Coulomb drag is a process whereby the repulsive interactions between electrons in spatially separated conductors enable a current flowing in one of the conductors to induce a voltage drop in the other. If the second conductor is part of a closed circuit, a net current will flow in that circuit. The drag current is typically much smaller than the drive current owing to the heavy screening of the Coulomb interaction. There are, however, rare situations in which strong electronic correlations exist between the two conductors. For example, double quantum well systems can support exciton condensates, which consist of electrons in one well tightly bound to holes in the other. 'Perfect' drag is therefore expected; a steady transport current of electrons driven through one quantum well should be accompanied by an equal current of holes in the other. Here we demonstrate this effect, taking care to ensure that the electron-hole pairs dominate the transport and that tunnelling of charge between the quantum wells, which can readily compromise drag measurements, is negligible. We note that, from an electrical engineering perspective, perfect Coulomb drag is analogous to an electrical transformer that functions at zero frequency.

High activity of sorafenib in FLT3-ITD-positive acute myeloid leukemia synergizes with allo-immune effects to induce sustained responses.

Preliminary evidence suggests that the multikinase inhibitor sorafenib has clinical activity in FLT3-ITD-positive (FLT3-ITD) acute myeloid leukemia (AML). However, the quality and sustainability of achievable remissions and clinical variables that influence the outcome of sorafenib monotherapy are largely undefined. To address these questions, we evaluated sorafenib monotherapy in 65 FLT3-ITD AML patients treated at 23 centers. All but two patients had relapsed or were chemotherapy-refractory after a median of three prior chemotherapy cycles. Twenty-nine patients (45%) had undergone prior allogeneic stem cell transplantation (allo-SCT). The documented best responses were: hematological remission in 24 patients (37%), bone marrow remission in 5 patients (8%), complete remission (with and without normalization of peripheral blood counts) in 15 patients (23%) and molecular remission with undetectable FLT3-ITD mRNA in 10 patients (15%), respectively. Seventeen of the patients without prior allo-SCT (47%) developed sorafenib resistance after a median treatment duration of 136 days (range, 56-270 days). In contrast, allo-SCT patients developed sorafenib resistance less frequently (38%) and significantly later (197 days, range 38-225 days; P=0.03). Sustained remissions were seen exclusively in the allo-SCT cohort. Thus, sorafenib monotherapy has significant activity in FLT3-ITD AML and may synergize with allogeneic immune effects to induce durable remissions.

Exciton transport and Andreev reflection in a bilayer quantum Hall system.

We demonstrate that counterflowing electrical currents can move through the bulk of the excitonic quantized Hall phase found in bilayer two-dimensional electron systems (2DES) even as charged excitations cannot. These counterflowing currents are transported by neutral excitons which are emitted and absorbed at the inner and outer boundaries of an annular 2DES via Andreev reflection.

Delayed selective cerebral hypothermia decreases infarct volume after reperfused stroke in baboons.

BACKGROUND: Hypothermia is known to provide neuroprotection from focal ischemia. However, lethal cardiovascular complications resulting from total body cooling have greatly restricted hypothermia as a therapy for stroke. This study determined whether selective cerebral cooling induced after reversible cerebral artery occlusion would decrease the infarct volume. METHODS: Under general anesthesia, 8 baboons were subjected to 1-hour simultaneous occlusion of the left internal carotid artery and anterior cerebral arteries by transorbital surgical approach. Four animals were treated with selective cerebral hypothermia to 25°C, initiated 2.5 hours after placement of cerebral artery clips. Selective cerebral hypothermia was achieved, after heparinization, by continuous withdrawal of femoral arterial blood into an extracorporeal closed-circuit pump system, cooling by water bath and perfusion into the right internal carotid artery. Pump flow was adjusted to maintain right internal carotid artery pressure near systemic blood pressure. Cerebral cortical temperature was maintained below 27°C for 12 hours, whereas systemic temperature was preserved near normal by convective air mattresses and warm water blankets. Four control animals were maintained at 36°C. Blood pressure, pH, and blood gases were maintained at normal values for both groups. Forty-eight to 72 hours after cerebral artery occlusion, magnetic resonance imaging brain scans were obtained and infarct volume measured. RESULTS: Normothermic baboons had infarction of 35.4±4.4% (mean±SD) of the left cerebral hemisphere compared with 0.5±1% for baboons treated with cerebral hypothermia (P<0.01). In brain-cooled animals, esophageal temperature was maintained greater than 34°C, despite cerebral temperature less than 27°C. CONCLUSION: Selective brain cooling initiated 2.5 hours after onset of focal ischemia resulted in marked reduction in infarct volume, without cardiovascular derangement.

LIGHT (TNFSF14) inhibits adipose differentiation without affecting adipocyte metabolism.

OBJECTIVE: The member of the tumor necrosis factor family LIGHT (lymphotoxin-like inducible protein that competes with glycoprotein D for herpesvirus entry on T cells; TNFSF14 (tumor necrosis factor super family protein 14) is primarily expressed in lymphocytes, in which it induces the expression of pro-inflammatory cytokines and alterations of lipid homeostasis. Recently, the protein was shown to be upregulated in obesity and to induce cytokine secretion from adipocytes. RESEARCH METHODS AND PROCEDURES: Using an automated complementary DNA (cDNA) screen, LIGHT was identified to inhibit adipose differentiation. As cellular models for adipogenesis mouse 3T3-L1, human SGBS (Simpson-Golabi-Behmel syndrome) and primary human preadipocytes differentiated in vitro were used as well as primary human adipocytes to study adipocyte functions. Analysis of lipid deposition by Oil Red O staining, mRNA expression by quantitative reverse transcriptase-PCR, nuclear factor (NF)-κB activation as well as protein secretion by enzyme linked immunosorbent assay and Luminex technology was performed. RESULTS: LIGHT was found to inhibit lipid accumulation in the three models of preadipocytes in a dose-dependent manner without cytotoxic effects. This inhibition of differentiation was probably because of interference at early steps of adipogenesis, as early exposure during differentiation showed the strongest effect, as assessed by decreased peroxisome proliferator-activated receptor-γ (PPARγ) and CCAAT/enhancer-binding protein-α (C/EBPα) mRNA expression. In contrast to TNFα, basal and insulin-stimulated glucose uptake and lipolysis of terminally differentiated mature adipocytes were not altered in the presence of LIGHT. At a concentration sufficient to inhibit differentiation, secretion of proinflammatory cytokines was not significantly induced and NF-κB activity was only modestly induced compared with TNFα. CONCLUSION: LIGHT is a novel inhibitor of human adipocyte differentiation without adversely influencing central metabolic pathways in adipocytes.

Quantum Hall exciton condensation at full spin polarization.

Using Coulomb drag as a probe, we explore the excitonic phase transition in quantum Hall bilayers at nu(T) = 1 as a function of Zeeman energy E(Z). The critical layer separation (d/l)(c) for exciton condensation initially increases rapidly with E(Z), but then reaches a maximum and begins a gentle decline. At high E(Z), where both the excitonic phase at small d/l and the compressible phase at large d/l are fully spin polarized, we find that the width of the transition, as a function of d/l, is much larger than at small E(Z) and persists in the limit of zero temperature. We discuss these results in the context of two models in which the system contains a mixture of the two fluids.

Dexmedetomidine may impair cognitive testing during endovascular embolization of cerebral arteriovenous malformations: a retrospective case report series.

After the reported successful use of dexmedetomidine to sedate patients in the intensive care unit without respiratory depression, we began to use dexmedetomidine for interventional neuroradiologic procedures. We report on five patients who had dexmedetomidine administered for sedation during embolization of cerebral arteriovenous malformations. All patients were comfortably sedated and breathing spontaneously. However, although patients were awake and following simple commands 10 minutes after the discontinuation of the infusion of dexmedetomidine, they were nevertheless unable to undergo cognitive testing. They were still unable to undergo cognitive testing 45 minutes after the infusion was stopped. In contrast, 10 minutes after the discontinuation of the infusion of propofol, all patients were awake, alert, cooperative, and able to undergo cognitive testing without difficulty. In conclusion, on examination of five non-randomly selected case records, we found that dexmedetomidine significantly prevented neurologic and cognitive testing.

Selective cerebral hypothermia by means of transfemoral internal carotid artery catheterization.

Global cerebral hypothermia of 24 degrees C was induced without systemic cooling by means of selective hypothermic perfusion of a single internal carotid artery in four baboons. With a closed-circuit pump system, blood was withdrawn from the femoral artery, cooled in a water bath, and infused through an internal carotid artery catheter, which was positioned with fluoroscopic guidance. This endovascular technique may have applications in the treatment of neurologic disease in humans.

Isolated cerebral hypothermia by single carotid artery perfusion of extracorporeally cooled blood in baboons.

OBJECTIVE: Hypothermia has been demonstrated to protect the brain from ischemic or traumatic injury. Previous efforts to induce cerebral hypothermia have relied on techniques requiring total body cooling that have resulted in serious cardiovascular derangements. A technique to selectively cool the brain, without systemic hypothermia, may have applications for the treatment of neurological disease. METHODS: After induction of general anesthesia in 12 baboons, the right common carotid artery and ipsilateral femoral artery were each occlusively cannulated and joined to a centrifugal pump. In a closed-circuit system, blood was continually withdrawn from the femoral artery, cooled by water bath, and infused through the common carotid artery with its external branches occluded. Pump flow was varied so that right carotid pressure approximated systemic blood pressure. In six animals, perfusate was cooled to decrease right cerebral temperature to < 19 degrees C for 30 minutes. In six animals, right cerebral temperature was decreased to < 25 degrees C for 3 hours. In those six animals, 133Xe was injected into the right carotid artery before, during, and after hypothermia. Peak radioactivity and washout curves were recorded from bilateral cranial detectors. Systemic warming was accomplished by convective air and warm water blankets. Esophageal, rectal, and bilateral cerebral temperatures were continuously recorded. RESULTS: In animals cooled to < 19 degrees C, right cerebral temperature decreased from 34 degrees C to 18.5 +/- 1.1 degrees C (mean +/- standard deviation), P < 0.01, in 26 +/- 13 minutes. Simultaneously, left cerebral temperature decreased to 20.7 +/- 1.6 degrees C. During 30 minutes of stable cerebral hypothermia, esophageal temperature decreased from 35.1 +/- 2.3 degrees C to 34.2 +/- 2.2 degrees C, P < 0.05. In animals cooled to < 25 degrees C, right cerebral temperature decreased from 34 degrees C to 24.5 +/- 0.6 degrees C in 12.0 +/- 6.0 minutes, P < 0.01. Simultaneously, left cerebral temperature decreased to 26.3 +/- 4.8 degrees C. After 3 hours of stable cerebral hypothermia, esophageal temperature was 34.4 +/- 0.5 degrees C, P < 0.05. Right hemispheric cerebral blood flow decreased during hypothermia (26 +/- 16 ml/min/100 g) compared to values before and after hypothermia (63 +/- 29 and 51 +/- 34 ml/min/100 g, respectively; P < 0.05). Furthermore, hypothermic perfusion resulted in a proportionally increased radioactivity peak detected in the left cerebral hemisphere after right carotid artery injection of 133Xe (0.8 +/- 0.2:1, left:right) compared to normothermia before and after hypothermia (0.3 +/- 2 and 0.3 +/- 1, respectively; P < 0.05). Normal heart rhythm, systemic arterial blood pressure, and arterial blood gas values were preserved during hypothermia in all animals. CONCLUSION: Bilateral cerebral deep or moderate hypothermia can be induced by selective perfusion of a single internal carotid artery, with minimal systemic cooling and without cardiovascular instability. This global brain hypothermia results from profoundly altered collateral cerebral circulation during artificial hypothermic perfusion. This technique may have clinical applications for neurosurgery, stroke, or traumatic brain injury.

Cardiovascular responses to beta-blockade and 5 degrees C cold air stress.

To determine the cardiovascular responses to beta-blockade and cold air stress, six males were randomly exposed at rest to three drug conditions (placebo, nonselective beta-blockade (propranolol), and selective beta-blockade (atenolol)) in each of two environments (5 and 25 degrees C) for 1 h. Cardiac output was lower on beta-blockade than on the placebo in both the 25 and 5 degrees C environments. Cardiac output on propranolol (4.2 +/- 0.3 L.min-1) at 5 degrees C was lower than on atenolol (4.7 +/- 0.4 L.min-1, p < 0.05). Mean arterial pressure was greater (p < 0.05) at 5 than 25 degrees C for each drug condition. There was no drug effect on total peripheral resistance at 25 degrees C. At 5 degrees C, total peripheral resistance on both beta-blockers (propranolol 1942.7 +/- 169.9 dyn.s.cm-5 (1 dyn = 10 microN); atenolol 1706.7 +/- 160.0 dyn.s.cm-5) was higher (p < 0.05) than on the placebo (1485.3 +/- 111.8 dyn.s.cm-5). Total peripheral resistance was also higher on propranolol than atenolol (p < 0.05). In conclusion, cold air stress interacts with beta-blockade to elevate total peripheral resistance by decreasing cardiac output while having little effect on mean arterial pressure. These effects are greater on nonselective than on selective blockade.

Nitrous oxide selectively releases Met5-enkephalin and Met5-enkephalin-Arg6-Phe7 into canine third ventricular cerebrospinal fluid.

The role of the opioid receptor-endogenous opioid peptide system in mediating analgesia induced by nitrous oxide has been a controversial subject. Most previous studies provided only indirect evidence either to support or refute the involvement of opioid receptors and/or endogenous opioid peptides. To provide more direct evidence, we measured concentrations of five naturally occurring endogenous opioid peptides in third ventricular cerebrospinal fluid from eight acclimated dogs with chronically implanted ventricular catheters. Paired samples of cerebrospinal fluid were obtained from each animal when breathing room air or 66-75 vol% nitrous oxide in oxygen through a face mask. Endogenous opioid peptides were physically separated using reversed phase high-performance liquid chromatography and quantified using radioimmunoassays. Nitrous oxide inhalation increased cerebrospinal fluid concentrations of met5-enkephalin from a control value of 0.30 +/- 0.07 (mean +/- SEM, n = 8) to 42.4 +/- 8.1 pmol/mL (P = 0.0006). Increases ranged from 28 to more than 400 times the control value. Met5-enkephalin-arg6-phe7 concentrations also increased from 14.5 +/- 2.5 to 57.6 +/- 17.8 pmol/mL (P = 0.018). No significant changes were noted in concentrations of dynorphin A, dynorphin B, or beta-endorphin. These results directly support the hypothesis that nitrous-oxide-induced analgesia involves the proenkephalin-derived family of endogenous opioid peptides.