Hypothermic Machine Perfusion as a National Standard Preservation Method for Deceased Donor Kidneys.

BACKGROUND: Recently, continuous nonoxygenated hypothermic machine perfusion (HMP) has been implemented as standard preservation method for deceased donor kidneys in the Netherlands. This study was designed to assess the effect of the implementation of HMP on early outcomes after transplantation. METHODS: Kidneys donated in the Netherlands in 2016 and 2017 were intended to be preserved by HMP. A historical cohort (2010-2014) preserved by static cold storage was chosen as the control group. Primary outcome was delayed graft function (DGF). Additional analyses were performed on safety, graft function, and survival up until 2 y after transplantation. RESULTS: Data were collected on 2493 kidneys. Analyses showed significantly more donation after circulatory death, preemptive transplantation, and retransplants in the project cohort. Of the 681 kidneys that were transplanted during the project, 81% were preserved by HMP. No kidneys were discarded due to HMP-related complications. DGF occurred in 38.2% of the project cohort versus 43.7% of the historical cohort (P < 0.001), with a significantly shorter duration within the project cohort (7 versus 9 d, P = 0.003). Multivariate regression analysis showed an odds ratio of 0.69 (95% confidence interval, 0.553-0.855) for the risk of DGF when using HMP compared with cold storage (P = 0.001). There was no significant difference in kidney function, graft survival, and recipient survival up until 2 y posttransplantation. CONCLUSIONS: This study showed that HMP as a standard preservation method for deceased donor kidneys is safe and feasible. HMP was associated with a significant reduction of DGF.

Establishing a core outcome set for treatment of uncomplicated appendicitis in children: study protocol for an international Delphi survey.

INTRODUCTION: Appendicitis is a global disease affecting roughly 1 in every 12 people in the world, with the highest incidence between ages 10 and 19 years. To date, a wide variety of health outcomes have been reported in randomised controlled trials and meta-analyses evaluating treatments for appendicitis. This is especially the case in studies comparing non-operative treatment with operative treatment. A set of standard outcomes, to be reported in all future trials, is needed to allow for adequate comparison and interpretation of clinical trial results and to make data pooling possible. This protocol describes the development of such a global core outcome set (COS) to allow unified reporting of treatment interventions in children with acute uncomplicated appendicitis. METHODS AND ANALYSIS: We use current international standard methodology for the development and reporting of this COS. Its development consists of three phases: (1) an update of the most recent systematic review on outcomes reported in uncomplicated paediatric appendicitis research to identify additional outcomes, (2) a three-step global Delphi study to identify a set of core outcomes for which there is consensus between parents and (paediatric) surgeons and (3) an expert meeting to finalise the COS and its definitions. Children and young people will be involved through their parents during phase 2 and will be engaged directly using a customised face-to-face approach. ETHICS AND DISSEMINATION: The medical research ethics committee of the Academic Medical Center Amsterdam has approved the study. Each participating country/research group will ascertain ethics board approval. Electronic informed consent will be obtained from all participants. Results will be presented in peer-reviewed academic journals and at (international) conferences. TRIAL REGISTRATION NUMBER: COMET registration: 1119.

Initial non-operative management of uncomplicated appendicitis in children: a protocol for a multicentre randomised controlled trial (APAC trial).

INTRODUCTION: Based on epidemiological, immunological and pathology data, the idea that appendicitis is not necessarily a progressive disease is gaining ground. Two types are distinguished: simple and complicated appendicitis. Non-operative treatment (NOT) of children with simple appendicitis has been investigated in several small studies. So far, it is deemed safe. However, its effectiveness and effect on quality of life (QoL) have yet to be established in an adequately powered randomised trial. In this article, we provide the study protocol for the APAC (Antibiotics versus Primary Appendectomy in Children) trial. METHODS AND ANALYSIS: This multicentre, non-inferiority, randomised controlled trial randomises children aged 7-17 years with imaging-confirmed simple appendicitis between appendectomy and NOT. Patients are recruited in 15 hospitals. The intended sample size, based on the primary outcome, rate of complications and a non-inferiority margin of 5%, is 334 patients.NOT consists of intravenous antibiotics for 48-72 hours, daily blood tests and ultrasound follow-up. If the patient meets the predefined discharge criteria, antibiotic treatment is continued orally at home. Primary outcome is the rate of complications at 1-year follow-up. An independent adjudication committee will assess all complications and their relation to the allocated treatment. Secondary outcomes include, but are not limited to, delayed appendectomies, QoL, pain and (in)direct costs.The primary outcome will be analysed both according to the intention-to-treat principle and the per-protocol principle, and is presented with a one-sided 97.5% CI. We will use multiple logistic and linear regression for binary and continuous outcomes, respectively, to adjust for stratification factors. ETHICS AND DISSEMINATION: The protocol has been approved by the Medical Ethics Review Committee of the Academic Medical Center, Amsterdam. Data monitoring is performed by an independent institute and a Data Safety Monitoring Board has been assigned. Results will be presented in peer-reviewed academic journals and at (international) conferences. TRIAL REGISTRATION NUMBER: NCT02848820; NTR5977; Pre-results.

Surface Structure of Bi(111) from Helium Atom Scattering Measurements. Inelastic Close-Coupling Formalism.

Elastic and inelastic close-coupling (CC) calculations have been used to extract information about the corrugation amplitude and the surface vibrational atomic displacement by fitting to several experimental diffraction patterns. To model the three-dimensional interaction between the He atom and the Bi(111) surface under investigation, a corrugated Morse potential has been assumed. Two different types of calculations are used to obtain theoretical diffraction intensities at three surface temperatures along the two symmetry directions. Type one consists of solving the elastic CC (eCC) and attenuating the corresponding diffraction intensities by a global Debye-Waller (DW) factor. The second one, within a unitary theory, is derived from merely solving the inelastic CC (iCC) equations, where no DW factor is necessary to include. While both methods arrive at similar predictions for the peak-to-peak corrugation value, the variance of the value obtained by the iCC method is much better. Furthermore, the more extensive calculation is better suited to model the temperature induced signal asymmetries and renders the inclusion for a second Debye temperature for the diffraction peaks futile.

Helium atom scattering investigation of the Sb(111) surface.

The Sb(111) surface was studied with helium atom scattering (HAS). Elastic HAS at different energies of the incident helium beam (15.3, 21.9, 28.4 meV) was applied for structural investigations. The lattice constants derived from the positions of the observed diffraction peaks up to third order were found to be in perfect agreement with previous structure determinations of Sb(111). The observed diffraction patterns with clear peaks up to second order were used to model the electronic surface corrugation with the GR method. As an estimation for the attractive part of the interaction potential a well depth of (4.0 ± 0.5) meV was found. Best fit results were obtained with a corrugation height of 12-13% of the lattice constant, which is rather large compared to other surfaces with metallic character. Intensity measurements of the specular peak as a function of incident energy were analysed to determine the distribution of terraces on the surface. The results show a quite flat Sb(111) surface and a step height of 3.81 Å of the remaining terraces.

Vibrational dynamics and surface structure of Bi(111) from helium atom scattering measurements.

The Bi(111) surface was studied by elastic scattering of helium atoms at temperatures between 118 and 423 K. The observed diffraction patterns with clear peaks up to third order were used to model the surface corrugation using the eikonal approximation as well as the GR method. Best fit results were obtained with a rather large corrugation height compared to other surfaces with metallic character. The corrugation shows a slight enhancement of the surface electron density in between the positions of the surface atoms. The vibrational dynamics of Bi(111) were investigated by measurements of the Debye-Waller attenuation of the elastic diffraction peaks and a surface Debye temperature of (84 ± 8) K was determined. A decrease of the surface Debye temperature at higher temperatures that was recently observed on Bi nanofilms could not be confirmed in the case of our single-crystal measurements.

Spectroscopy of nS, nP, and nD Rydberg series of Cs atoms on helium nanodroplets.

The preparation of an artificial superatom consisting of a positive charge inside a superfluid helium nanodroplet and an electron in an orbital surrounding the droplet is of fundamental interest and represents an experimental challenge. In this work, nanodroplets of several thousand helium atoms are doped with single caesium (Cs) atoms. While on the droplet, the Cs valence electron is excited in two steps through an intermediate state into nS, nP, and nD states. The excitation is monitored by laser induced fluorescence or, for high principal quantum numbers, by resonant three-photon-ionization. On-droplet Rydberg excitations are resolved up to about n = 20. The energies are compared with those of free Cs atom Rydberg states and quantum defects as well as the on-droplet ionization threshold are derived.

Reinvestigation of the Rb2 (2)3Pi(g)-a 3Sigma(u)+ band on helium nanodroplets.

It is well known that alkali-metal molecules are preferentially observed in the weak van der Waals-bound high spin states by helium droplet isolation spectroscopy. In [F. R. Brühl et al., J. Chem. Phys. 115, 10275 (2001)] the Rb(2) (2)(3)Pi(g)-a (3)Sigma(u)(+) band on He droplets was investigated by laser-induced fluorescence and dispersed emission spectroscopy. At that time no information on the magnitude of spin-orbit coupling was available for the (2)(3)Pi(g) state which connects to the atomic 5s+4d asymptote and it was neglected. In this work we reinvestigate the observed spectra. The dispersed emission spectra, which resulted from free molecules, are consistent with state-of-the-art nonrelativistic potential energy surfaces and effective spin-orbit coupling matrix elements obtained from resonance-enhanced multiphoton ionization spectroscopy of cold Rb dimers [J. Lozeille et al., Eur. Phys. J. D 39, 261 (2006)]. Having validated the theoretical description of the free molecule state, we use the laser-induced fluorescence spectrum to discuss the influence of the He droplet on the excitation band.

Elastic and inelastic scattering of He atoms from Bi(111).

Elastic and inelastic scattering of helium atoms has been used to study the Bi(111) surface. Sharp diffraction peaks are found with results in excellent agreement with previous structure determinations of the Bi(111) surface. The rather large first order peaks with respect to the zero order peak indicate a stronger surface corrugation than observed in helium scattering from other metallic surfaces. Time-of-flight spectra of scattered He atoms clearly reveal two inelastic scattering maxima, which allow a first report on phonon creation and annihilation events on the Bi(111) surface. An estimate of the group velocity shows that the phonon creation peak is likely to correspond to a Rayleigh mode.

Observation of relativistic E x e vibronic coupling in Rb3 and K3 quartet states on helium droplets.

Spectroscopy of alkali-metal complexes on helium droplets (He(N), N=1000-10 000) provides the unique opportunity to observe high-spin species, which exhibit prominent spin-orbit (SO) effects. In this work we present laser-induced-fluorescence and magnetic-circular-dichroism (MCD) spectra of the (2)(4)E(')<--(1)(4)A(2) (') band of Rb(3) and K(3) on He(N). For Rb(3) we find a progression of four SO split bands, weakly perturbed by linear vibronic [Jahn-Teller (JT)] coupling. The K(3) transition was previously observed and interpreted in terms of linear and quadratic JT effects in the (2)(4)E(') state [J. H. Reho et al., J. Chem. Phys. 115, 10265 (2001)]. The structure of the MCD spectrum, however, clearly reveals the importance of SO coupling also for the K(3) transition and suggests a different assignment with weak linear JT and nonsignificant quadratic JT coupling. The observed strong C-type MCD spectra arise from different populations of the ground-state Zeeman sublevels. Thus a quantitative analysis allows a determination of the spin temperature, and since alkali-metal complexes are situated on the surface of the helium droplet this corresponds to a determination of the surface temperature. Our results from the trimer spectra are consistent with the value of approximately 0.4 K, which is found in the interior of a droplet and which we already confirmed for the surface from the spectra of triplet-state alkali-metal dimers in a previous work.

Anomalous phonon behavior: blueshift of the surface boson peak in silica glass with increasing temperature.

We present helium atom scattering measurements of the boson peak at the surface of vitreous silica between 127.0 and 368.5 K. The most probable energy shows a strong temperature dependence and increases linearly with temperature in the measured range. The observed blueshift of the surface boson peak (shift rate 0.008+/-0.002 meV/K) is a factor of 4 to 10 times stronger than shift rates measured in the bulk by inelastic neutron and Raman scattering. We suggest that the anomalous shift direction of the boson peak to higher energies with increasing temperature has the same origin as the unusual temperature dependence of the bulk modulus of silica glass.

Imaging with neutral atoms: a new matter-wave microscope.

Matter-wave microscopy can be dated back to 1932 when Max Knoll and Ernst Ruska published the first image obtained with a beam of focussed electrons. In this paper a new step in the development of matter-wave microscopy is presented. We have created an instrument where a focussed beam of neutral, ground-state atoms (helium) is used to image a sample. We present the first 2D images obtained using this new technique. The imaged sample is a free-standing hexagonal copper grating (with a period of about 36 microm and rod thickness of about 8 microm). The images were obtained in transmission mode by scanning the focussed beam, which had a minimum spot size of about 2.0 microm in diameter (full width at half maximum) across the sample. The smallest focus achieved was 1.9 +/- 0.1 microm. The resolution for this experiment was limited by the speed ratio of the atomic beam through the chromatic aberrations of the zone plate that was used to focus. Ultimately the theoretical resolution limit is set by the wavelength of the probing particle. In praxis, the resolution is limited by the source and the focussing optics.

Observation of the boson peak at the surface of vitreous silica.

The boson peak is an excess in the phonon density of states compared to the Debye model that appears in almost all glasses. It has been repeatedly measured in the bulk by a variety of methods, but its origin is still highly debated. Here we present first experimental evidence of the boson peak on the v-SiO2 surface. The measurements were obtained by helium atom scattering. The boson peak appears as a dispersionless mode of approximately 4 meV in the recorded time-of-flight spectra. It is clearly identified as an excess contribution to the low energy Debye-like region in the surface phonon spectral density which is extracted from the time-of-flight spectra using a straightforward theoretical model.

Cesium dimer spectroscopy on helium droplets.

Visible absorption spectra of cesium-doped helium nanodroplets between 14,500 and 17,600 cm(-1) were probed by laser-induced fluorescence. A strong absorption band peaking around 16,700 cm(-1) is identified as Cs2 1(a) 3Sigmau+-3 3Sigmag+ transition. A broad unstructured band near 17,520 cm(-1) is assigned as the Cs2 1(X) 1Sigmag+-2 1Sigmau+ transition. Explanations of the observations are discussed on the basis of ab initio potential curves calculated by Spies and Meyer [(unpublished)]. All spectra have been modeled using narrow Frank-Condon windows around the equilibrium internuclear distance of the lowest singlet and triplet states. Many observed absorption peaks of smaller intensities could be identified, some of which may be due to transitions of cesium trimers formed on the droplets.

Computer controlled cw laser spectrometer.

A computer controlled cw UV-visible dye laser source for spectroscopic use has been developed. Computer control facilitates both continuous single-frequency scanning and data acquisition. With 4 W of Ar-ion laser pump power, such a spectrometer can generate in excess of 1 W of cw single-frequency power in the visible and up to 1 mW in the UV by using extracavity nonlinear optical mixing. The laser spectrometer has been tested by performing high-resolution measurements of the fluorescence spectrum of I(2) in the visible and of the absorption spectrum of SO(2) in the UV.