Efficient termination of cardiac arrhythmias using optogenetic resonant feedback pacing.

Malignant cardiac tachyarrhythmias are associated with complex spatiotemporal excitation of the heart. The termination of these life-threatening arrhythmias requires high-energy electrical shocks that have significant side effects, including tissue damage, excruciating pain, and worsening prognosis. This significant medical need has motivated the search for alternative approaches that mitigate the side effects, based on a comprehensive understanding of the nonlinear dynamics of the heart. Cardiac optogenetics enables the manipulation of cellular function using light, enhancing our understanding of nonlinear cardiac function and control. Here, we investigate the efficacy of optically resonant feedback pacing (ORFP) to terminate ventricular tachyarrhythmias using numerical simulations and experiments in transgenic Langendorff-perfused mouse hearts. We show that ORFP outperforms the termination efficacy of the optical single-pulse (OSP) approach. When using ORFP, the total energy required for arrhythmia termination, i.e., the energy summed over all pulses in the sequence, is 1 mJ. With a success rate of 50%, the energy per pulse is 40 times lower than with OSP with a pulse duration of 10 ms. We demonstrate that even at light intensities below the excitation threshold, ORFP enables the termination of arrhythmias by spatiotemporal modulation of excitability inducing spiral wave drift.

Ångstrom-Depth Resolution with Chemical Specificity at the Liquid-Vapor Interface.

The determination of depth profiles across interfaces is of primary importance in many scientific and technological areas. Photoemission spectroscopy is in principle well suited for this purpose, yet a quantitative implementation for investigations of liquid-vapor interfaces is hindered by the lack of understanding of electron-scattering processes in liquids. Previous studies have shown, however, that core-level photoelectron angular distributions (PADs) are altered by depth-dependent elastic electron scattering and can, thus, reveal information on the depth distribution of species across the interface. Here, we explore this concept further and show that the experimental anisotropy parameter characterizing the PAD scales linearly with the average distance of atoms along the surface normal obtained by molecular dynamics simulations. This behavior can be accounted for in the low-collision-number regime. We also show that results for different atomic species can be compared on the same length scale. We demonstrate that atoms separated by about 1 Å along the surface normal can be clearly distinguished with this method, achieving excellent depth resolution.

[Vasoactive drugs in the treatment of septic shock]. / Fármacos vasoactivos en el tratamiento del shock séptico.

Septic shock is a high mortality complication frequently associated with sepsis. Early initiation of vasopressor treatment, even before completion of initial fluid resuscitation, is a determining factor in prognosis. In this sense, norepinephrine continues to be the drug of first choice, although there is increasing evidence of benefit combining it with other non-adrenergic drugs, such as vasopressin, instead of escalating norepinephrine doses. The pathophysiology of septic shock is multifactorial, and sometimes is associated with a situation of myocardial dysfunction that contributes to hemodynamic instability. It is essential to identify this situation since it worsens the prognosis and may benefit from combined treatment with inotropic drugs. There are novel vasoactive agents under study, more selective than the classic ones that in a next future could help to design more individualized and precise treatments. In the present work, the current knowledge about vasoactive drugs and their use in the management of septic shock is summarized according to the most recent scientific evidence.

Photon-electron coincidence experiments at synchrotron radiation facilities with arbitrary bunch modes.

We report the adaptation of an electron-photon coincidence detection scheme to the multibunch hybrid mode of the synchrotron radiation source BESSY II (Helmholtz-Zentrum Berlin). Single-event-based data acquisition and evaluation, combined with the use of relative detection times between the coincident particles, enable the acquisition of proper coincidence signals from a quasi-continuous excitation pattern. The background signal produced by accidental coincidences in the time difference representation is modeled using the non-coincident electron and photon spectra. We validate the method by reproducing previously published results, which were obtained in the single bunch mode, and illustrate its usability for the multibunch hybrid mode by investigating the photoionization of CO2 into CO2 + B satellite states, followed by subsequent photon emission. The radiative lifetime obtained and the electron binding energy are in good agreement with earlier publications. We expect this method to be a useful tool to extend the versatility of coincident particle detection to arbitrary operation modes of synchrotron radiation facilities and other excitation sources without the need for additional experimental adjustments.

NMR-based Fragment Screening in a Minimum Sample but Maximum Automation Mode.

Fragment-based screening (FBS) is a well-validated and accepted concept within the drug discovery process both in academia and industry. The greatest advantage of NMR-based fragment screening is its ability not only to detect binders over 7-8 orders of magnitude of affinity but also to monitor purity and chemical quality of the fragments and thus to produce high quality hits and minimal false positives or false negatives. A prerequisite within the FBS is to perform initial and periodic quality control of the fragment library, determining solubility and chemical integrity of the fragments in relevant buffers, and establishing multiple libraries to cover diverse scaffolds to accommodate various macromolecule target classes (proteins/RNA/DNA). Further, an extensive NMR-based screening protocol optimization with respect to sample quantities, speed of acquisition and analysis at the level of biological construct/fragment-space, in condition-space (buffer, additives, ions, pH, and temperature) and in ligand-space (ligand analogues, ligand concentration) is required. At least in academia, these screening efforts have so far been undertaken manually in a very limited fashion, leading to limited availability of screening infrastructure not only in the drug development process but also in the context of chemical probe development. In order to meet the requirements economically, advanced workflows are presented. They take advantage of the latest state-of-the-art advanced hardware, with which the liquid sample collection can be filled in a temperature-controlled fashion into the NMR-tubes in an automated manner. 1H/19F NMR ligand-based spectra are then collected at a given temperature. High-throughput sample changer (HT sample changer) can handle more than 500 samples in temperature-controlled blocks. This together with advanced software tools speeds up data acquisition and analysis. Further, application of screening routines on protein and RNA samples are described to make aware of the established protocols for a broad user base in biomacromolecular research.

Impact ionization-induced bistability in CMOS transistors at cryogenic temperatures for capacitorless memory applications.

Cryogenic operation of complementary metal oxide semiconductor (CMOS) silicon transistors is crucial for quantum information science, but it brings deviations from standard transistor operation. Here, we report on sharp current jumps and stable hysteretic loops in the drain current as a function of gate voltage V G for both n- and p-type commercial-foundry 180-nm-process CMOS transistors when operated at voltages exceeding 1.3 V at cryogenic temperatures. The physical mechanism responsible for the device bistability is impact ionization charging of the transistor body, which leads to effective back-gating of the inversion channel. This mechanism is verified by independent measurements of the body potential. The hysteretic loops, which have a >107 ratio of high to low drain current states at the same V G, can be used for a compact capacitorless single-transistor memory at cryogenic temperatures with long retention times.

1H, 13C, and 15N backbone chemical shift assignments of coronavirus-2 non-structural protein Nsp10.

The international Covid19-NMR consortium aims at the comprehensive spectroscopic characterization of SARS-CoV-2 RNA elements and proteins and will provide NMR chemical shift assignments of the molecular components of this virus. The SARS-CoV-2 genome encodes approximately 30 different proteins. Four of these proteins are involved in forming the viral envelope or in the packaging of the RNA genome and are therefore called structural proteins. The other proteins fulfill a variety of functions during the viral life cycle and comprise the so-called non-structural proteins (nsps). Here, we report the near-complete NMR resonance assignment for the backbone chemical shifts of the non-structural protein 10 (nsp10). Nsp10 is part of the viral replication-transcription complex (RTC). It aids in synthesizing and modifying the genomic and subgenomic RNAs. Via its interaction with nsp14, it ensures transcriptional fidelity of the RNA-dependent RNA polymerase, and through its stimulation of the methyltransferase activity of nsp16, it aids in synthesizing the RNA cap structures which protect the viral RNAs from being recognized by the innate immune system. Both of these functions can be potentially targeted by drugs. Our data will aid in performing additional NMR-based characterizations, and provide a basis for the identification of possible small molecule ligands interfering with nsp10 exerting its essential role in viral replication.

1H, 13C, and 15N backbone chemical shift assignments of the apo and the ADP-ribose bound forms of the macrodomain of SARS-CoV-2 non-structural protein 3b.

The SARS-CoV-2 genome encodes for approximately 30 proteins. Within the international project COVID19-NMR, we distribute the spectroscopic analysis of the viral proteins and RNA. Here, we report NMR chemical shift assignments for the protein Nsp3b, a domain of Nsp3. The 217-kDa large Nsp3 protein contains multiple structurally independent, yet functionally related domains including the viral papain-like protease and Nsp3b, a macrodomain (MD). In general, the MDs of SARS-CoV and MERS-CoV were suggested to play a key role in viral replication by modulating the immune response of the host. The MDs are structurally conserved. They most likely remove ADP-ribose, a common posttranslational modification, from protein side chains. This de-ADP ribosylating function has potentially evolved to protect the virus from the anti-viral ADP-ribosylation catalyzed by poly-ADP-ribose polymerases (PARPs), which in turn are triggered by pathogen-associated sensing of the host immune system. This renders the SARS-CoV-2 Nsp3b a highly relevant drug target in the viral replication process. We here report the near-complete NMR backbone resonance assignment (1H, 13C, 15N) of the putative Nsp3b MD in its apo form and in complex with ADP-ribose. Furthermore, we derive the secondary structure of Nsp3b in solution. In addition, 15N-relaxation data suggest an ordered, rigid core of the MD structure. These data will provide a basis for NMR investigations targeted at obtaining small-molecule inhibitors interfering with the catalytic activity of Nsp3b.

Photoisomerization dynamics of trans-trans, cis-trans, and cis-cis diphenylbutadiene from broadband transient absorption spectroscopy and calculations.

The photoisomerization path and dynamics of trans-trans (ttD), cis-trans (ctD), and cis-cis (ccD) 1,4-diphenyl-1,3-butadiene (DPB) in solution are studied with broadband transient absorption (TA) spectroscopy and quantum chemical calculations. For ttD in n-hexane, 2-photon-excited TA spectra indicate that the 2Ag state is located above 1-photon allowed 1Bu (S1) by ∼1000 cm-1. Following S0 → S1 optical excitation, the isomerization occurs via torsion about a butadiene double bond to perpendicular molecular configuration P. The P-state is detected in ccD with an excited-state absorption band at 390 nm. This P-band develops during S1 → P half-torsion with time of 0.15 ps, followed further by P → S0 half-torsion and simultaneous decay with 1.6 ps in acetonitrile and 5 ps in n-hexane. In addition, two oscillation cycles between P and S1 population are observed before equilibration in n-hexane. For ctD, an indication of rising and decaying P is found in acetonitrile. The vast majority of ctD species photoisomerizes to ttD and not to ccD, in agreement a with calculated low torsional barrier about the cis double bond and high barrier about the trans double bond. Photoisomerization yield Y and time τi depend drastically on the solvent polarity. Thus, in n-hexane, the isomerization ttD → ctD has yield Ytt,ct = 0.1 and time τi = 829 ps, while in acetonitrile, Ytt,ct = 0.4 and τi = 27 ps. The 30-fold acceleration of the isomerization in acetonitrile clearly reflects a highly polar character of P, consistent with a dipole moment µP > 9.6 D. The results for DPB are discussed in comparison to stilbene.

Transient Rotamerism and Photoisomerization Dynamics of trans- and cis-Naphthylstilbene.

The rotamerism and photoisomerization of trans- and cis-1,2-di-(2-naphthyl)ethylene (tN and cN) are studied with stationary and transient absorption spectroscopies assisted by quantum chemical calculations. Absorption and emission spectra of rotamers (rotational isomers) tN-S (C2h-symmetric), tN-A (C1), and tN-S' (C2) are derived with a 53:47 ratio of tN-S to tN-A. Upon photoexcitation, the equilibration of the rotamers in S0 (rotamerization) is observed in the bleach region with characteristic time τrotamer ≈ 0.5 ns. With excitation at 364 nm, the S0 equilibrium shifts because, mainly, tN-A is bleached and the rotamerization becomes traceable, whereas with excitation at 345 nm, the equilibrium is preserved and the bleach spectrum remains unchanged. It is just long-lived (∼2 ns) S1 that allows for monitoring the rotamer dynamics in S0. Replacement of the stilbene phenyl rings with larger naphthyls increases the S1 → P torsional barrier E1act toward perpendicular configuration P both from cis and trans configurations. In tN, the radiative relaxation with τR ≈ 3.7 ns becomes the main deactivation channel, and accordingly, the measured decays show nearly no dependence on the solvent viscosity. The cis-to-trans photoisomerization occurs via two paths: adiabatic cS1 → P → tS1 (20%) and more common nonadiabatic cS1 → P → S0 (80%). The barrier cS1 → P in the cis-isomer is reduced in polar solvents because of a zwitterionic character of P. The P-state is directly detected with the cN isomer in acetonitrile by an excited-state absorption band at 400 nm developing with 0.7 ps and decaying with 1.6 ps. Two dihydrophenanthrene (DHP)-like products result from photoexcited cN. The metastable DHP-A builds up transiently from cN-A, and its spectrum at about 550 nm matches the published DHP absorption. The stable DHP-S' accumulates under stationary illumination and is formed either from excited cN-S' or metastable DHP-A.

The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high-risk intensive care unit patients: a randomized controlled parallel-group trial.

BACKGROUND: There is a high incidence of pressure ulcers in high-risk settings such as intensive care. There is emerging evidence that the application of dressings to pressure ulcer predilection areas (sacrum and heels) improves prevention strategies. OBJECTIVES: To determine whether preventive dressings, applied to the sacrum and heels of high-risk patients in intensive care units, in addition to standard prevention, reduces the incidence of pressure ulcers. METHODS: Between June 2015 and July 2018, a randomized, controlled, two-arm, superiority pragmatic study was performed with a concealed 1 : 1 allocation to the intervention and control group. Patients assigned to the intervention group had dressings applied to the sacrum and heels. RESULTS: In total, 7575 patients were screened for eligibility and 475 patients were included and allocated to both groups. Finally, 212 patients in the intervention group and 210 in the control group were analysed. The mean age was 63·5 years and the majority of patients were male (65·4%). The cumulative pressure ulcer incidence category II and above was 2·8% in the intervention, and 10·5% in the control group (P = 0·001). Compared with the control group, the relative risk in the intervention group was 0·26 [95% confidence interval (CI) 0·11-0·62] and the absolute risk reduction was 0·08 (95% CI 0·03-0·13). CONCLUSIONS: The results indicate that the application of dressings, in addition to standard prevention, in high-risk intensive care unit patients is effective in preventing pressure ulcers at the heels and sacrum. What's already known about this topic? Pressure ulcers are severe soft tissue injuries and wounds, which occur worldwide in all healthcare settings. Despite preventive interventions, pressure ulcers still develop. There is emerging evidence that dressings help to prevent pressure ulcers. What does this study add? The incidence of pressure ulcers in intensive care units among high-risk patients remains high. The application of dressings to the sacrum and heels, in addition to standard preventive measures, reduces the relative and absolute risks for the development of pressure ulcers. The application of preventive dressings at the heels and sacrum seems to be feasible in intensive care settings.

The effects of rehabilitation on the biomechanics of patients with athletic groin pain.

This study sought to investigate the kinematic and kinetic variables that change in patients with athletic groin pain (AGP) after a successful exercise intervention. The kinematic and kinetic measures of subjects with AGP (n = 65) that completed a lateral hurdle hop, pre and post an exercise rehabilitation program were compared to a control group of matched uninjured individuals (n = 50). Analysis of Characterising Phases was used to identify differences in kinematic and kinetic measures between the groups. AGP subjects returned to pain-free participation in sport in a median time of 9.14 weeks (5.14-29.0). In total 18 different biomechanical variables were significantly different between the AGP group and the uninjured group pre-rehabilitation. Of these, seven variables were no longer significantly different between the AGP group post-rehabilitation and the uninjured group. These seven variables may represent the factors most related to return to play in this cohort and are potential targets for rehabilitation.

Setup for multicoincidence experiments of photons in the extreme ultraviolet to visible spectral range and charged particles-The solid angle maximization approach.

The coincident detection of particles is a powerful method in experimental physics, enabling the investigation of a variety of projectile-target interactions. The vast majority of coincidence experiments is performed with charged particles, as they can be guided by electric or magnetic fields to yield large detection probabilities. When a neutral species or a photon is one of the particles recorded in coincidence, its detection probability typically suffers from small solid angles. Here, we present two optical assemblies considerably enhancing the solid angle for photon detection in the extreme ultraviolet to visible spectral range. The efficiency and versatility of these assemblies are demonstrated for electron-photon coincidence detection, where electrons and photons emerge from fundamental processes after photoexcitation of gaseous samples by synchrotron radiation.

A comparison of anterior cruciate ligament - Return to sports after injury (ACL-RSI) scores of male athletes nine-months Post-ACL reconstruction with matched uninjured controls.

OBJECTIVES: To report ACL-RSI scores in healthy athletes with no history of ACL injury. To measure ACL-RSI scores at nine-months post-ACL reconstruction and to assess the difference between healthy athlete and patient responses. DESIGN: Cross-sectional study. SETTING: Private sports clinic. PARTICIPANTS: 499 ACL reconstruction athletes completed the scale as they returned for their nine-month post-operative review appointment. A matched control group of 103 healthy athletes were selected for comparison. MAIN OUTCOME MEASURES: ACL-RSI for participants with controls completing a study-specific modified scale. RESULTS: The median response to the ACL-RSI for the control group was higher (80.0) (Interquartile Range (IRQ) 66.7-88.3) than that of the ACL reconstruction group (74.17) (IRQ 59.2-86.0), however the effect size was small (0.1). CONCLUSION: This study reports normative values for uninjured athletes using the ACL-RSI questionnaire giving a benchmark for recovery after ACLR but also reflecting awareness of injury risk in uninjured athletes. ACL-RSI scores nine-months post-operatively had not yet returned to levels seen in matched uninjured controls.

Log file-based dose reconstruction and accumulation for 4D adaptive pencil beam scanned proton therapy in a clinical treatment planning system: Implementation and proof-of-concept.

BACKGROUND AND PURPOSE: Motion-induced uncertainties hamper the clinical implementation of pencil beam scanning proton therapy (PBS-PT). Prospective pretreatment evaluations only provide multiscenario predictions without giving a clear conclusion for the actual treatment. Therefore, in this proof-of-concept study we present a methodology for a fraction-wise retrospective four-dimensional (4D) dose reconstruction and accumulation aiming at the evaluation of treatment quality during and after treatment. MATERIAL AND METHODS: We implemented an easy-to-use, script-based 4D dose assessment of PBS-PT for patients with moving tumors in a commercially available treatment planning system. This 4D dose accumulation uses treatment delivery log files and breathing pattern records of each fraction as well as weekly repeated 4D-CT scans acquired during the treatment course. The approach was validated experimentally and was executed for an exemplary dataset of a lung cancer patient. RESULTS: The script-based 4D dose reconstruction and accumulation was implemented successfully, requiring minimal user input and a reasonable processing time (around 10 min for a fraction dose assessment). An experimental validation using a dynamic CIRS thorax phantom confirmed the precision of the 4D dose reconstruction methodology. In a proof-of-concept study, the accumulation of 33 reconstructed fraction doses showed a linear increase of D98 values. Projected treatment course D98 values revealed a CTV underdosage after fraction 25. This loss of target coverage was confirmed in a dose volume histogram comparison of the nominal, the projected (after 16 fractions) and the accumulated (after 33 fractions) dose distribution. CONCLUSIONS: The presented method allows for the assessment of the conformity between planned and delivered dose as the treatment course progresses. The implemented approach considers the influence of changing patient anatomy and variations in the breathing pattern. This facilitates treatment quality evaluation and supports decisions regarding plan adaptation. In a next step, this approach will be applied to a larger patient cohort to investigate its capability as 4D quality control and decision support tool for treatment adaptation.

Uncovering the (un-)occupied electronic structure of a buried hybrid interface.

The energy level alignment at organic/inorganic (o/i) semiconductor interfaces is crucial for any light-emitting or -harvesting functionality. Essential is the access to both occupied and unoccupied electronic states directly at the interface, which is often deeply buried underneath thick organic films and challenging to characterize. We use several complementary experimental techniques to determine the electronic structure of p -quinquephenyl pyridine (5P-Py) adsorbed on ZnO(1 0 -1 0). The parent anchoring group, pyridine, significantly lowers the work function by up to 2.9 eV and causes an occupied in-gap state (IGS) directly below the Fermi level E F. Adsorption of upright-standing 5P-Py also leads to a strong work function reduction of up to 2.1 eV and to a similar IGS. The latter is then used as an initial state for the transient population of three normally unoccupied molecular levels through optical excitation and, due to its localization right at the o/i interface, provides interfacial sensitivity, even for thick 5P-Py films. We observe two final states above the vacuum level and one bound state at around 2 eV above E F, which we attribute to the 5P-Py LUMO. By the separate study of anchoring group and organic dye combined with the exploitation of the occupied IGS for selective interfacial photoexcitation, this work provides a new pathway for characterizing the electronic structure at buried o/i interfaces.

Use of quantum effects as potential qualifying metrics for "quantum grade silicon".

Across solid state quantum information, materials deficiencies limit performance through enhanced relaxation, charge defect motion or isotopic spin noise. While classical measurements of device performance provide cursory guidance, specific qualifying metrics and measurements applicable to quantum devices are needed. For quantum applications, new materials metrics, e.g., enrichment, are needed, while existing, classical metrics like mobility might be relaxed compared to conventional electronics. In this work, we examine locally grown silicon superior in enrichment, but inferior in chemical purity compared to commercial-silicon, as part of an effort to underpin the materials standards needed for quantum grade silicon and establish a standard approach for intercomparison of these materials. We use a custom, mass-selected ion beam deposition technique, which has produced isotopic enrichment levels up to 99.99998 % 28Si, to isotopically enrich 28Si, but with chemical purity > 99.97% due the MBE techniques used. From this epitaxial silicon, we fabricate top-gated Hall bar devices simultaneously on the 28Si and on the adjacent natural abundance Si substrate for intercomparison. Using standard-methods, we measure maximum mobilities of ≈(1740±2)cm2/(V⋅s) at an electron density of (2.7×1012±3×108) cm-2 and ≈(6040±3)cm2/(V⋅s) at an electron density of (1.2×1012±5×108) cm-2 at T=1.9 K for devices fabricated on 28Si and natSi, respectively. For magnetic fields B>2 T, both devices demonstrate well developed Shubnikov-de Haas (SdH) oscillations in the longitudinal magnetoresistance. This provides transport characteristics of isotopically enriched 28Si, and will serve as a benchmark for classical transport of 28Si at its current state, and low temperature, epitaxially grown Si for quantum devices more generally.