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Objective: Nationwide data on the epidemiology, treatment characteristics, and long-term outcome of severe traumatic brain injury (TBI) in Germany is not yet existing. Neurosurgeons from the German Neurosurgery Society (DGNC) and traumatologists from the German Trauma Society (DGU), therefore, joined forces in 2016 to conceptualize a TBI module for the well-established Trauma Register of the DGU (TR-DGU). Here, we report how this “German National TBI registry (GNTR)” has been developed, implemented, and tested in a recently completed pilot period.
Methods: The conception and implementation process of the GNTR from August 2016 to February 2019 is described, and results of its 23-months long pilot period from February 2019 to December 2020 are presented. For the pilot period, TBI patients were prospectively enrolled at nine neurosurgical and traumatological hospitals across Germany. Inclusion criteria were treatment on the ICU ≥ 24h, or an ISS score ≥ 16. A variety of clinical, imaging, and laboratory parameters were collected, and the GOSE score was used to assess the outcome at discharge and 6- and 12 months follow-up.
Results: Details on the structure and dataset of the GNTR as well as milestones and pitfalls during its conception and implementation, are outlined. During the pilot period, a total of 264 TBI patients were enrolled. Their demographic characteristics, clinical, imaging, and radiological findings, and their early mortality and functional outcome are described. Furthermore, factors associated with an unfavorable outcome (GOSE 1-4) are assessed using uni- and multivariate regression analyses. Finally, problems and future directions of the GNTR are discussed.
Conclusion: The pilot period of the GNTR offers a first glance at the current epidemiology and treatment characteristics of TBI patients in Germany. More importantly, they show how a national TBI registry yielding high-quality prospective data can be developed, implemented, and tested within four years
Background: Dexamethasone (Dex) is the most common corticosteroid to treat edema in glioblastoma (GBM) patients. Recent studies identified the addition of Dex to radiation therapy (RT) to be associated with poor survival. Independently, Tumor Treating Fields (TTFields) provides a novel anti-cancer modality for patients with primary and recurrent GBM. Whether Dex influences the efficacy of TTFields, however, remains elusive.
Methods: Human GBM cell lines MZ54 and U251 were treated with RT or TTFields in combination with Dex and the effects on cell counts and cell death were determined via flow cytometry. We further performed a retrospective analysis of GBM patients with TTFields treatment +/- concomitant Dex and analysed its impact on progression-free (PFS) and overall survival (OS).
Results: The addition of Dex significantly reduced the efficacy of RT in U251 and MZ54 cells. TTFields (200 kHz/250 kHz) induced massive cell death in both cell lines. Concomitant treatment of TTFields and Dex did not reduce the overall efficacy of TTFields. Further, in our retrospective clinical analysis, we found that the addition of Dex to TTFields therapy did not influence PFS nor OS.
Conclusion: Our translational investigation indicates that the efficacy of TTFields therapy in patients with GBM and primary GBM cell lines is not affected by the addition of Dex.
Oral e-Poster Presentations - Booth 2: Spine 1 (Trauma&Misc), September 25, 2023, 10:00 AM - 10:40 AM
Background: Spondylodiscitis is a prevalent type of spinal infection, with pyogenic spondylodiscitis being the most common subtype. While antibiotic therapy is the standard treatment, some argue that early surgery can aid in infection clearance, improve survival rates, and prevent long-term complications such as deformities. However, others view early surgery as excessively risky. Due to the high mortality rate of up to 20%, it is crucial to determine the most effective treatment.
Methods: The primary objective of this study was to compare the mortality rate, relapse rate, and length of hospital stay for conservative and early surgical treatments of pyogenic spondylodiscitis, including determinants of outcomes. The study was registered on PROSPERO with the registration number CRD42022312573. The databases MEDLINE, Embase, Scopus, PubMed, and JSTOR were searched for original studies comparing conservative and early surgical treatments of pyogenic spondylodiscitis. The included studies were assessed using the ROBINS-1 tool, and eligible studies were evaluated using meta-analyses, influence, and regression analyses.
Results: The systematic review included 31 studies. The meta-analysis, which had a pooled sample size of 10,954 patients from 21 studies, found that the pooled mortality rate among patients treated with early surgery was 8%, while the rate was 13% for patients treated conservatively. The mean proportion of relapse/failure was 15% for patients treated with early surgery and 21% for those treated conservatively. Furthermore, the analysis concluded that early surgical treatment is associated with a 40% and 39% risk reduction in relapse/failure and mortality rates, respectively, when compared to conservative management. Additionally, early surgical treatment resulted in a 7.75-day reduction in length of hospital stay per patient (p<0.01). The most highly significant predictors of treatment outcome were found to be intravenous drug use, diabetes, the presence of an epidural abscess, positive cultures, location of infection, and age (p<0.001).
Conclusions: Overall, early surgical management was found to be consistently significantly more effective than conservative management in terms of relapse/failure and mortality rates when treating pyogenic spondylodiscitis, particularly for non-spinal epidural abscess spondylodiscitis.
The Ethics of Waiting lists and Rationing access to care (Ethics Parallel Session), September 26, 2023, 4:50 PM - 6:20 PM
Background: There has been a fivefold increase of neurosurgeons over the last three decades in Germany, despite a lesser increase in operations. Currently, there are approximately 1000 neurosurgical residents employed at training hospitals. Little is known about the overall training experience and career opportunities for these trainees.
Methods: In our role as resident representatives, we implemented a mailing list for interested German neurosurgical trainees. Thereafter, we created a survey including 25 items to assess the trainees’ satisfaction with their training and their perceived career prospects, which we then distributed through the mailing list. The survey was open from 1st April until 31st May 2021.
Results: 90 trainees were enrolled in the mailing list and we received 81 completed responses to our survey. Overall, 47% of trainees were very dissatisfied or dissatisfied with their training. 62% of trainees reported a lack of surgical training. 58% of trainees found it difficult to attend courses or classes and only 16% had consistent mentoring. There was an expressed desire for a more structured training programme and mentoring projects. In addition, 88% of trainees were willing to relocate for fellowships outside their current hospitals.
Conclusions: Half of the responders were dissatisfied with their neurosurgical training. There are various aspects that require improvement, such as the training curriculum, the lack of structured mentoring and the amount of administrative work. We propose the implementation of a modernized structured curriculum, which addresses the mentioned aspects, in order to improve neurosurgical training and, consecutively, patient care.
Introduction: The optimal treatment of patients with spinal infections remains a controversial topic. Within Europe, fundamentally different therapeutic concepts are found. Therefore, the aim of this study was to compare the outcome of patients who received surgical vs. antibiotic treatment alone for primary pyogenic spondylodiscitis in an international cohort analysis.
Materials and Methods: The retrospectively compiled databases of tertiary high-volume spine centers served as the baseline for this study. All documented cases of primary spondylodiscitis treated surgically and conservatively in the period of 2017-2022 were included and grouped according to the therapeutic concept: conservative vs. surgical treatment. Independent investigators collected the relevant clinical and radiological data. The primary endpoint of this study was mortality rate; secondary endpoints were relapse rate and persisting neurological deficit.
Results: A total of 392 patients were included in the analysis (155 females with a mean age of 68 years). Of these, 95 cases were treated conservatively (CoT) and 297 cases were treated surgically (SuT). There was no significant difference (p<0.01) related to patient’s disease characteristics: Lumbar was the main location (n=240, CoT 58/ SuT 182, p=0.97) followed by thoracic (n=70, CoT 24/ SuT 46, p=0,03) and cervical (n=47, CoT 7/ SuT 40, p=0.11) region. A multilocular spinal infection was present in 32 patients (CoT 3/ SuT 29, p=0.04). 181 cases (CoT 36/ SuT 145, p=0.06) presented with an epidural abscess. Neurological deficits were recorded in 100 cases (CoT 26/ SuT 74, p=0.63), and septic conditions in 88 cases (CoT 26/ SuT 62, p=0.19). Pre-existing conditions like Diabetes (p=0.57), renal failure (p= 0.97), hepatopathy (p= 0.15), malignoma (p=0.39) or i.v. drug abuse (p=0.93) did also not differ between the groups. The mortality rate of all conservatively treated was 24.2% (23 cases) and 6.7% (20 cases) in all surgically treated patients (p<0.001). A follow-up of ≥ 6 weeks was available in 289 cases (CoT 83, SuT 206 ). In this subset of patients relapse of infection occurred in six (7.2%) and 23 (11.2%) cases in the conservative and early surgical treatment group, respectively (p=0.69). Persisting neurological deficit was recorded in 21 (25.3%) of conservatively treated and 51 (24.8%) of surgically treated cases (p=0.92).
Conclusion: Whereas relapse rates and persisting neurological deficit were not found to differ significantly, the results of this international data analyses, with their respective limitations, clearly support the growing evidence of a significantly reduced mortality rate after surgical therapy for primary pyogenic spondylodiscitis when compared to conservative treatment regimen.
Spinal Tumors / Infections (Spine Parallel Session v.3), September 27, 2023, 8:30 AM - 10:00 AM
Background: The optimal treatment of patients with spinal infections remains a controversial topic. While there is some consensus regarding the indication for surgical intervention in infections with neurologic deficit, significant deformity or progressive disease, other situations remain controversial. Within Europe, fundamentally different therapeutic concepts are found. Therefore, the aim of this study was to compare the outcome of patients who received surgical vs. antibiotic treatment alone for primary pyogenic spondylodiscitis in an international cohort analysis.
Methods: The retrospectively compiled databases of tertiary high-volume spine centers served as the baseline for this study. All documented cases of primary spondylodiscitis treated surgically and conservatively in the period of 2017-2022 were included and grouped according to the therapeutic concept: conservative vs. surgical treatment. Independent investigators collected the relevant clinical and radiological data. The primary endpoint of this study was mortality rate; secondary endpoints were relapse rate and persisting neurological deficit.
Results: A total of 392 patients were included in the analysis (155 females and 237 males with a mean age of 68 years). Of these, 95 cases were treated conservatively (CoT) and 297 cases were treated surgically (SuT). Most of conservatively treated patients were treated in the United Kingdom (CoT 81/ SuT 7), while most of the surgically treated cases were treated in Germany (CoT 14/ SuT 290). There was no significant difference (p<0.01) related to patient’s disease characteristics:
Lumbar was the main location (n=240, CoT 58/ SuT 182, p=0.97) followed by thoracic (n=70, CoT 24/ SuT 46, p=0,03) and cervical (n=47, CoT 7/ SuT 40, p=0.11) region. A multilocular spinal infection was present in 32 patients (CoT 3/ SuT 29, p=0.04). 181 cases (CoT 36/ SuT 145, p=0.06) presented with an epidural abscess. Neurological deficits were recorded in 100 cases (CoT 26/ SuT 74, p=0.63), and septic conditions in 88 cases (CoT 26/ SuT 62, p=0.19). Pre-existing conditions like Diabetes (CoT 20/, SuT 71, p=0.57), renal failure (CoT 19/ SuT 60, p= 0.97), hepatopathy (CoT 4/ SuT 26, p= 0.15), malignoma (CoT 9/ SuT 38, p=0.39) or i.v. drug abuse (CoT 5/, SuT 15, p=0.93) did also not differ between the groups.
The mortality rate of all conservatively treated was 24.2% (23 cases) and 6.7% (20 cases) in all surgically treated patients (p<0.001). A follow-up of ≥ 6 weeks was available in 289 cases (CoT 83, SuT 206 ). In this subset of patients relapse of infection occurred in six (7.2%) and 23 (11.2%) cases in the conservative and early surgical treatment group, respectively (p=0.69). Persisting neurological deficit was recorded in 21 (25.3%) of conservatively treated and 51 (24.8%) of surgically treated cases (p=0.92).
Conclusions: Whereas relapse rates and persisting neurological deficit were not found to differ significantly, the results of this international data analyses, with their respective limitations, clearly support the growing evidence of a significantly reduced mortality rate after surgical therapy for primary pyogenic spondylodiscitis when compared to conservative treatment regimen.
Introduction: Spondylodiscitis is the commonest form of infectious disease of the spine and harbours a high mortality rate of up to 20%. Recent demographic trends in Germany, such as an aging population, immunosuppression, and intravenous drug use, suggest that the incidence of spondylodiscitis may be on the rise. However, the exact epidemiological development of the disease remains uncertain. This study aims to analyse the burden on the tertiary healthcare system in Germany using data from the Federal Statistical Office of Germany (FSOG) database.
Materials and Methods: All cases of spondylodiscitis diagnosed between 2005 and 2021 were identified from the FSOG database. The study characterised the mean duration of hospital stays, total and population-adjusted number of diagnoses made, age-stratified incidence, and outcomes of hospitalised patients.
Results: A total of 131,982 diagnoses for spondylodiscitis were identified between 2005 and 2021. The number of diagnoses for spondylodiscitis has doubled during this period, from 5.4/100,000 population in 2005 to 11/100,000 population in 2021. The highest increase in admissions was recorded for those aged 90 years and above (+1307%), 80-89 (+376%) and 70-79 (+99%). Hospital discharges to rehabilitation facilities have increased by 160%, and discharges against medical advice by 91%. On the other hand, during the analysed period, the in-hospital mortality rate has decreased by 52%.
Conclusion: The population-adjusted incidence of spondylodiscitis in Germany has more than doubled between 2005 and 2021, highlighting the clinical relevance of this disease. During the same period, in-hospital mortality dropped by half. These findings suggest the need for further investigation into optimal therapy, particularly the role and timing of surgical treatment.
Background: Epileptic seizures are common clinical features in patients with acute subdural hematoma (aSDH); however, diagnostic feasibility and therapeutic monitoring remain limited. Surface electroencephalography (EEG) is the major diagnostic tool for the detection of seizures but it might be not sensitive enough to detect all subclinical or nonconvulsive seizures or status epilepticus. Therefore, we have planned a clinical trial to evaluate a novel treatment modality by perioperatively implanting subdural EEG electrodes to diagnose seizures; we will then treat the seizures under therapeutic monitoring and analyze the clinical benefit.
Methods: In a prospective nonrandomized trial, we aim to include 110 patients with aSDH. Only patients undergoing surgical removal of aSDH will be included; one arm will be treated according to the guidelines of the Brain Trauma Foundation, while the other arm will additionally receive a subdural grid electrode. The study's primary outcome is the comparison of incidence of seizures and time-to-seizure between the interventional and control arms. Invasive therapeutic monitoring will guide treatment with antiseizure drugs (ASDs). The secondary outcome will be the functional outcome for both groups as assessed via the Glasgow Outcome Scale and modified Rankin Scale both at discharge and during 6 months of follow-up. The tertiary outcome will be the evaluation of chronic epilepsy within 2-4 years of follow-up.
Discussion: The implantation of a subdural EEG grid electrode in patients with aSDH is expected to be effective in diagnosing seizures in a timely manner, facilitating treatment with ASDs and monitoring of treatment success. Moreover, the occurrence of epileptiform discharges prior to the manifestation of seizure patterns could be evaluated in order to identify high-risk patients who might benefit from prophylactic treatment with ASDs.
Trial registration: ClinicalTrials.gov identifier no. NCT04211233.
Propranolol as a potentially novel treatment of arteriovenous malformations: from bench to bedside
(2022)
Background: Propranolol is a non-selective blocker of the β-adrenergic receptor and has been used for treatment of proliferative infantile hemangiomas. The vasoconstrictive and antiangiogenic effects of propranolol led us to explore its potential application for the treatment of AVMs.
Methods: AVM tissue was cultured after surgical resection in the presence of 100μM propranolol or solvent DMSO. After incubation for 72 hours, tissue was harvested for testing. The expression levels of SDF1α, CXCR4, VEGF and HIF-1 was measured by rt-PCR. Furthermore, data of patients in 2 vascular centres harboring AVM was retrospectively interrogated for a time period of 20 years. The database included information about hemorrhage, AVM size and antihypertensive medication. Descriptive analyses were performed, focusing on the risk of hemorrhage, size of the lesion at presentation and clinical follow-up in patients on β-blocker medication versus those who were not.
Results: Among 483 patients, 73 (15%) were under β-blocker-treatment. 48% AVMs presented with hemorrhage at diagnosis. Patients under β-blocker-treatment had a lower risk of hemorrhage at the time of diagnosis in a univariate analysis (p<0,0001;OR13). Patients under β-blocker-treatment showed a significant higher chance for a lower Spetzler-Martin-grade ≤III (p<0,0001;OR6,5) and a lower risk for the presence of an associated aneurysm (p<0,0001;OR3,6).
Multivariate analysis including Spetzler-Martin-Grading, young age ≤50, presence of associated aneurysm and β-blocker-treatment showed reduced risk for hemorrhage under β-blocker-treatment (p<0,01,OR0,2).
The expression of CXCR4 was suppressed by propranolol most likely through the HIF-1-pathways. The gene-expression of vasculogenesis factors was decreased in with propranolol incubated AVMs.
Conclusion: β-Blocker medication seems to be associated with a decreased risk of AVM-related hemorrhage and AVM-size at presentation or during follow-up. Propranolol inhibits SDF1α-induced vasculogenesis by suppressing the expression of CXCR4 most likely through the HIF-1-pathways. Therefore, SDF1α/CXCR4 axis plays an important role in the vasculogenesis and migration of inflammatory cells in AVM lesions.
Background: Following elective craniotomy patients routinely receive monitoring on ICU. However, the benefit of ICU monitoring in these patients is discussed controversially. Due to the current COVID-19 pandemic, there are further limitations of ICU capacities. This study aimed to compare this strategy with a standardized management of post-craniotomy patients on ICU.
Methods: Two postoperative strategies were compared in a matched-pair analysis: The first cohort included patients treated between May-August 2021 according to the “No ICU – unless” concept (NIU group), where patients were managed on the normal ward postoperatively. The second cohort contained patients routinely admitted to the ICU between February-April 2021 (control group). Outcome parameters contained complications, length of stay, duration to first postoperative mobilization, number of unplanned imaging, number/type of ICU interventions and pre- and postoperative mRS. Patient characteristics were analyzed using electronic medical records.
Results: The NIU group consisted of 96 patients, the control group of 75 patients. Complication rates were comparable in both cohorts (16% in NIU vs. 17% in control; p=0.123). Groups did not differ significantly in the number of imaging (10% in NIU vs. 13% in control; p=0.67), in the type of interventions on ICU (antihypertensive therapy 5% (NIU) vs. 6% (control); p=0.825) or in the time to first postoperative mobilization (average 1.1± 1.6 days vs. 0.9± 1.2 days; p=0.402). Length of hospital stay was shorter in the NIU group without reaching statistical significance (average 5.8 vs. 6.8 days; p=0.481). There was no significant change in the distribution of preoperative (p=0.960) and postoperative (p=0.425) mRS scores.
Conclusion: Postoperative ICU management does not reduce postoperative complications and has no effect on the surgical outcome of elective craniotomies. The majority of postoperative complications are detected after a 24-hour observation period. This approach may represent a potential strategy to prevent overutilization of ICU capacities while maintaining sufficient postoperative care for neurosurgical patients.
Introduction: Lumbosacral fixation is a common procedure in primary and revision spine surgery but leads to high biomechanical stress on adjacent segments and the SIJ, resulting in implant failure such as breakage and loosening and pain. This frequently results in further surgery. For patients showing clinical and radiological signs of SIJ affection/arthrosis who fail conservative therapy, transarticular lumbopelvic fusion via the SIJ may be considered. The Bedrock™ technique has been described as a new option for reinforced lumbopelvic fixation, fusing the SIJ with additional triangular titanium implants, thereby reducing biomechanical loads off the S2AI screws. We share our experiences with 19 patients treated with this technique since January 2019.
Materials and Methods: 19 patients suffering from persisting low back pain (LBP) with indication for reinforced lumbopelvic fixation and SIJ fusion were treated with reinforced lumboplevic fixation with S2AI screw and a triangular titanium implant. 14 cases were revisions. All surgeries were carried out by a single surgeon at a orthopedic university hospital. Data was gathered retrospectively.
Results: From 1/2019 - 9/2021 19 patients (11f, 8m) were treated with reinforced lumbopelvic fixation and SIJ fusion with a mean follow up of 18,2 months. Mean age 68 years (range 62-78y). Preop. walking distance was reduced to an average <100 m. Standard treatment involved S2AI screws and triangular titanium implants (SIBone, iFuse 3D™). 14 revision cases split into 5 low grade infections with screw loosening, 3 cases with rod breakage, 5 cases of painful lumbopelvic screw prominence, 7 cases with proximal junctional kyphosis, 2 cases with misplaced implants, 8 cases of poor bone mineral density. 5 patients without prior spine surgery. All patients were treated bilaterally using freehand technique. Average implant length was 65 mm. There were no intraoperative or implant associated adverse events (AE) or serious adverse events (SAE). Postoperative imaging demonstrated good implant positioning and function. All patients regained walking ability for distances > 1000 m and were satisfied with the result. All patients reported significant reduction of SIJ pain.
Conclusion: We report results of 19 patients with a reinforced lumbopelvic fixation and fusion by S2AI screws augmented by one parallelly placed triangular titanium implant fusing the SIJ bilaterally with a mean follow-up of 18.2 months. Intra- and postoperatively we experienced no implant associated adverse event. Patients regained significant walking ability and significant reduction of SIJ pain. Radiologically no signs of implant loosening or failure were detected at the end of follow-up. Our results demonstrate a safe and efficacious surgical technique for reinforced lumbopelvic fixation with fusion of SIJ with significant improvement of the health care related quality of life. Further studies need to be conducted in order to obtain additional evidence.
Background: During the COVID-19 pandemic, decreased volumes of acute stroke admissions were reported. We aimed to examine whether subarachnoid hemorrhage (SAH) volumes demonstrated similar declines in our department. Furthermore, the impact of pandemic on disease progression should be analyzed.
Methods: We conducted a retrospective study in neurosurgical department of university hospital Frankfurt including patients with the diagnosis of aneurysmal SAH during the first year of COVID-pandemic. One year cumulative volume for SAH hospitalization procedures were compared to the one-year period before (03/2020–02/2021 versus 03/2019–02/2020) and the last 5 pre-COVID-pandemic years (2015-2020). All relevant patient characteristics concerning family history, disease history, clinical condition at admission, active/past COVID-infection, treatment management, complications and outcome were analyzed.
Results: There was a decline in SAH hospitalizations, with 84 admissions in the year immediately before and 56 admissions during the pandemic, without reaching a significance. No significant difference in analyzed patient characteristics including clinical condition at onset, treatment, complications and outcome, between 56 SAH patients admitted during COVID pandemic and treated patients in the last 5 years in pre-COVID period were found. Using a multivariable analysis, we detected young age (p<0.05;OR4,2) and no existence of early hydrocephalus (p<0.05;OR0,13) as important factors for a favorable outcome (mRS≤0-2) after aSAH during the COVID-pandemic. A past COVID-infection was detected in young patients suffering from aSAH (Age< 50years, p<0.05;OR10,5) with increased rate of cerebral vasospasm after SAH onset (p<0.05;OR26). Nevertheless, past COVID-infection did not reach a significance as a high risk factor for unfavorable outcome.
Conclusion: There was a relative decrease in the volume of SAH during the COVID-19 pandemic. Despite of extremely different conditions of hospitalization, there was no impairing significant effect on treatment and outcome of admitted SAH patients. A past COVID-infection seemed not to be a relevant limiting factor concerning favorable outcome.
Background: Unruptured intracranial aneurysm (UIA) poses a therapeutic dilemma in which the risk-benefit analysis of invasive intervention has to be balanced against the natural history of the disease. To date, there is no medical treatment to prevent aneurysm development and subsequent progression to rupture. We explored the vitamin D system because of its known anti-inflammatory and anti-tissue-remodeling effect as a potential treatment for UIA.
Methods: 25-vitaminD3 levels tested between 2008-2016 and data of SAH patients admitted during the months with a peak versus nadir of VitD3-values were analyzed, retrospectively. We prospectively correlated VitD3 with size and number of aneurysms at the rupture time in patients admitted between 2017-2019. An experimental mice shear stress model and cell culture model were used to investigate the effect of 1,25-dihydroxy-vitaminD3 (1,25-VitD3) and acting mediators in this mechanism.
Results: Based on the retrospective analysis demonstrating an increased frequency of aneurysm rupture rate in patients during the low vitamin D period in winter, we started the prospective study evaluating plasma vitamin D levels at admission. VitD levels were inversely correlated with aneurysm size as well as number of aneurysms. Low number of aneurysms was significantly associated with sufficient plasma Vitamin D level as an independent factor in a multivariate analysis.
From bedside back to bench, active 1,25-VitD3 hormone attenuated the natural history of remodeling in mice basilar artery. Deletion of the vitamin-D-receptor in myeloid cells decreased the protective 1,25-VitD3 effect. Cell-culture of vascular fibroblasts confirmed the anti-tissue remodeling effect of 1,25-VitD3.
Conclusion: 1,25-VitD3 attenuates aneurysm development and subsequent progression to rupture. However, VitD-administration should be tested as optional treatment in management of patients with UIA.
Oral e-Poster Presentations - Booth 1: Vascular 3, September 27, 2023, 10:00 AM - 10:40 AM
Background: Despite current clinical guidelines recommending suboccipital decompressive craniectomy (SDC) in patients with space-occupying cerebellar infarction when neurological deterioration occurs, the precise definition of such deterioration remains unclear. The current study aimed at characterizing whether clinical outcomes can be predicted by the GCS score immediately prior to SDC, and whether higher GCS scores are associated with better clinical outcomes. We aimed to characterize whether clinical outcomes can be predicted by the GCS score immediately prior to SDC, and if higher GCS scores are associated with better clinical outcomes.
Methods: In a single-center, retrospective analysis of 51 patients treated with SDC for space-occupying cerebellar infarction clinical and imaging data were evaluated at the timepoints of symptom onset, hospital admission and preoperatively. Clinical outcome was measured by mRS at the last available follow-up. Preoperative GCS scores were stratified into three groups (GCS 3-8, 9-11 and 12-15). Univariate and multivariate Cox regression analyses were performed using clinical and radiological parameters as predictors of clinical outcome.
Results: In Cox-regression analysis using mRS of 1-2 as a positive clinical outcome we found a significant increase in the proportional hazard ratio (HR) of 6.581 [CI 1.839-36.414]; p=0.031 for GCS scores of 12-15 prior to SDC. Clinical outcomes (mRS 3-6) were associated with infarct volume above 6.0 cm3 (HR 2.473 [CI 1.209-5.057]; p=0.013), tonsillar herniation (HR: 0.279 [CI 0.083-0.933]; p=0.038), brainstem compression (HR 0.304 [CI 0.123-0.749]; p=0.010) and a preoperative GCS score of 3-8 (HR 2.386 [CI 1.160-4.906]; p=0.018).
Conclusions: SDC should be considered in patients with infarct volumes above 6.0 cm3 with GCS scores higher than previously described in the literature, as these patients may show better long-term outcome than those in which surgery is delayed until a GCS score of 11 or lower.
Background: Dysphagia is a common and severe symptom of traumatic brain injury (TBI) affecting up to 78% of patients. It is associated with pneumonia, increased morbidity and mortality. Although subdural hematoma (SDH) accounts for over 50% of TBI, the occurrence of dysphagia in this subtype has not been investigated. This study investigates the overall frequency, clinical predictors of dysphagia and functional outcome of patients with SDH associated dysphagia.
Methods: All patients presenting in author ́s institution between 2007 and 2020 with SDH were included in the study. Patients with SDH and clinical suspicion for dysphagia received a clinical swallowing assessment by a speech and language pathologist (SLP). Furthermore the severity of dysphagia was rated according to swallowing disorder scale.Functional outcome was evaluated by Glasgow outcome scale (GOS).
Results: Of 545 patients with SDH, 71 patients had dysphagia (13%). The prevalence of dysphagia was significantly lower in the surgical arm compared to the conservative arm (11.8% vs 21.8%; OR 0.23; p=0.02). Independent predictors for dysphagia were GCS <13 at admission (p<0.001; OR 4.17), cardiovascular disease (p=0.002; OR 2.29) and pneumonia (p=0.002; OR 2.88) whereas operation was a protective factor (p<0.001; OR 0.2). All patients with dysphagia improved significantly under SLP treatment from initial diagnosis to hospital discharge (p<0.01). However, patients with most severe grade of dysphagia showed no significant improvement during the clinical course. Patients with dysphagia had significantly worse outcome (GOS 1-3) compared to those without dysphagia (48.8% vs 26.4%; p<0.001).
Conclusion: Dysphagia is a frequent symptom in SDH and the early identification of dysphagia is crucial regarding initiation of treatment and functional outcome. Surgery is effective in preventing dysphagia and should be considered in high-risked patients.
Background: Research on chronic subdural hematoma (cSDH) management has primarily focused on potential recurrence after surgical evacuation. Herein, we present a novel postoperative/non-invasive treatment that includes a supervised Valsalva maneuver (SVM), which may serve to reduce SDH recurrence. Accordingly, the aims of the study were to investigate the effects of SVM on SDH recurrence rates and functional outcomes.
Methods: A prospective study was conducted from December 2016 until December 2019 at the Goethe University Hospital Frankfurt. Of the 204 adult patients with surgically treated cSDH who had subdural drains placed, 94 patients were assigned to the SVM group and 82 patients were assigned to the control group. The SVM was performed by having patients blow into a self-made SVM device at least two times/h for 12 h/day. The primary end-point was SDH recurrence rate, while secondary outcomes were morbidity and functional outcomes at 3 months of follow-up.
Results: SDH recurrence was observed in 16 of 94 patients (17%) in the SVM group, which was a significant reduction as compared with the control group, which had 24 of 82 patients (29.3%; p = 0.05) develop recurrent SDHs. Further, the infection rate (e.g., pneumonia) was significantly lower in the SVM group (1.1%) than in the control group (13.4%; p < 0.001; odds ratio [OR] 0.1). At the 3-month follow-up, 85 of 94 patients (90.4%) achieved favorable outcomes in the SVM group compared with 62 of 82 patients (75.6%) in the control group (p = 0.008; OR 3.0). Independent predictors for favorable outcome at follow-up were age (OR 0.9) and infection (OR 0.2).
Conclusion: SVM appears to be safe and effective in the post-operative management of cSDHs, reducing both recurrence rates and infections after surgical evacuation, thereby resulting in favorable outcomes at follow-up.
Background: The extent of preoperative peritumoral edema in glioblastoma (GBM) has been negatively correlated with patient outcome. As several ongoing studies are investigating T-cell based immunotherapy in GBM, we conducted this study to assess whether peritumoral edema with potentially increased intracranial pressure, disrupted tissue homeostasis and reduced local blood flow has influence on immune infiltration and affects survival.
Methods: A volumetric analysis of preoperative imaging (gadolinium enhanced T1 weighted MRI sequences for tumor size and T2 weighted sequences for extent of edema (including the infiltrative zone, gliosis etc.) was conducted in 144 patients using the BrainlabÒ software. Immunohistochemical staining was analyzed for lymphocytic- (CD 3+) and myeloid (CD15+) tumor infiltration. A retrospective analysis of patient-, surgical-, and molecular characteristics was performed using medical records.
Results: The edema to tumor ratio was neither associated with progression-free nor overall survival (p=0.90, p=0.74). However, GBM patients displaying IDH-1 wildtype had significantly higher edema to tumor ratio than patients displaying an IDH-1 mutation (p=0.01). Immunohistopathological analysis did not show significant differences in lymphocytic or myeloid tumor infiltration (p=0.78, p=0.74) between these groups.
Conclusion: In our cohort, edema to tumor ratio had no significant correlation with immune infiltration and outcome. However, patients with an IDH-1wildtype GBM had a significantly higher edema to tumor ratio compared to their IDH-1 mutated peer group. Further studies are necessary to elucidate the underlying mechanisms.
Introduction: Ferroptosis has recently been identified as a form of programmed cell death caused by an accumulation of lipid reactive oxygen species (ROS). However, little is yet known about the role in hepatocellular carcinoma (HCC) and its signalling mechanism as well the modulation of ROS.
Material and methods: Human HCC cell lines were treated with different concentrations of ROS modulators (Auranofin, Erastin, BSO). Cell death was determined by analysis of PI-stained nuclei using flow cytometry. ROS production and lipid peroxidation were analysed at early time points before cell death starts. For mechanistic studies we performed Western Blot and a Proteome array. Different inhibitors of cell death target proteins, ROS-scavengers as well as lipoxygenase inhibitors were used. To investigate the functional relevance of NAPDH oxidases (NOX) 1 and 4 for ROS modulation and ferroptosis we genetically silenced its genes using three distinct siRNAs and we used the NOX1/4-inhibitor GKT137831.
Results and discussions: Compared to the single treatment, Auranofin/BSO-cotreatment as well as Erastin/BSO-cotreatment acted in concert to trigger cell death and to reduce cell viability of HCC cells in a dose- and time-dependent manner. Furthermore, both cotreatments induce ROS production, lipid peroxidation and ferroptotic cell death, which could be inhibited by the use of Ferrostatin-1 (inhibitor of lipid peroxidation) and Liproxstatin-1 (specific inhibitor of ferroptosis). The broad-range caspase inhibitor zVAD.fmk failed to rescue cells from Auranofin/BSO- or Erastin/BSO-cotreatment induced cell death. No activation of caspases-3 could be seen in the proteome profiler apoptosis assay. Importantly, the selective lipoxygenase (LOX) inhibitor Baicalain and the pan-LOX inhibitor NDGA protect HCC cells from Auranofin/BSO- and Erastin/BSO-cotreatment stimulated lipid peroxidation, ROS generation and cell death, indication that the induction of ferroptosis may bypass apoptosis resistance of HCC cells. Mechanistic studies showed that Auranofin/BSO-cotreatment decreased TrxR-activity, led to Nrf2 accumulation and promoted the activation of HO-1. In contrast, NOX 1 and 4 were involved in Erastin/BSO-mediated cell death and the use of the NOX1/4-inhibitor GKT137831 rescued HCC cells from the Erastin/BSO-induced cell death.
Conclusion: By providing new insights into the molecular regulation of ROS and ferroptosis, our study contributes to the development of novel treatment strategies to reactivate programmed cell death in HCC cells.
Background: The most frequent therapy of hydrocephalus is the implantation of ventriculoperitoneal shunts for diverting cerebrospinal fluid from the ventricles into the peritoneum. We compared two adjustable valves, the proGAV and proGAV 2.0, for complications which resulted in revision operations.
Methods: Four hundred patients who underwent primary shunt implantation between 2014 and 2020 were analyzed for overall revision rate, one-year revision rate, revision free survival and overall survival observing patient age group, gender, etiology of hydrocephalus, implantation site, prior diversion of cerebrospinal fluid and cause of revision.
Results: All data were available of all 400 patients (female/male 208/192). Overall, 99 patients underwent revision surgery after primary implantation. ProGAV valve was implanted in 283 patients, proGAV 2.0 in 117 patients. There was no significant difference between the two shunt valves concerning revision rate (p=0.8069), one-year revision rate (p=0.9077), revision free survival (p=0.6921) and overall survival (p=0.3232). Furthermore, regarding one-year revision rate, we observed no significant difference between the two shunt valves in pediatric patients (40.7% vs 27.6%; p=0.2247). Revision operation had to be performed more frequently in pediatric patients (46.6% vs 24.8%; p=0.0093) with a significant higher number of total revisions with proGAV than proGAV 2.0 (55.9% vs. 27.6%; p=0.0110) most likely due to longer follow up in the proGAV -group.
Conclusion: According to the target variables we analyzed, aside from lifetime revision rate in pediatric patients there is no significant difference between the two shunt valves. From our subjective point of view, implantation of the newer proGAV 2.0 valve is preferable due to higher adjustment comfort for both patients and physicians.
Nosocomial infectious diseases (e.g. influenza, pertussis) are a threat particularly for immunocompromised and vulnerable patients. Although vaccination of healthcare workers (HCWs) constitutes the most convenient and effective means to prevent nosocomial transmissions, vaccine uptake among HCWs remains unacceptably low. Worldwide, numerous studies have demonstrated that nurses have lower vaccination rates than physicians and that there is a relationship between receipt of vaccination by HCWs and knowledge. Measures to improve vaccination rates need to be profession-sensitive as well as specific in their approach in order to achieve sustained success.
Health-care personnel (HCP) are exposed to infectious diseases throughout the course of their work. The concerns of pregnant HCP are considerable because certain otherwise mild infections may affect fetal development. We studied 424 pregnant HCP at the University Hospital Frankfurt / Germany between March 2007 and July 2011. Serological tests were carried out for varicella zoster virus (VZV), measles, mumps, rubella (MMR), cytomegalovirus (CMV) and parvovirus B19. Our overall seroprevalence data with regard to VZV, MMR, CMV and parvovirus B 19 corresponded to the general population. It was striking that, only 57.1% of the study population was immune against the four vaccine-preventable diseases (MMR, VZV). Our study suggests that a comprehensive approach to improving the vaccination status of said HCP before pregnancy is paramount.
Previous study showed that kaffir lime leaf contains alkaloid, flavonoid, terpenoid, tannin and saponin. The objective of this study was to examine the cytotoxic effect of kaffir lime leaf extract on cervical cancer and neuroblastoma cell lines. The method used for this research to determine cell viability was an 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Results showed that an ethyl acetate extract had an IC50 for HeLa cells, UKF-NB3, IMR-5 and SK-N-AS parental cells of 40.7 μg · mL–1, 28.4 μg · mL–1, 14.1 μg · mL–1, and 25.2 μg · mL–1 respectively. Furthermore, the IC50 of chloroform extracts for HeLa cells, UKF-NB3, IMR-5 and SK-N-AS parental were 17.6 μg · mL–1, 18.9 μg · mL–1, 6.4 μg · mL–1, and 9.4 μg · mL–1 respectively. These data showed that kaffir lime extract reduces the viability of cervical and neuroblastoma cell lines and may have potential as anti-cancer compounds.
ecently, pertussis has become a problem also in the adult population, with incidences even higher than in children. Pediatric health care workers (HCWs) are an important source of transmission, exposing very young and immunocompromised patients to an increased risk of potentially severe pertussis infections. Encouraging HCWs to get vaccinated can play a vital role in stopping the transmission of pertussis, thereby reducing institutional outbreaks.
In Germany, HCWs come up with all sorts of reasons for not getting pertussis vaccination. This study was meant to provide information in order to better understand the backgrounds of these attitudes.
A survey was conducted at the children's university hospital in Frankfurt, using an anonymous questionnaire. Survey results were used to design an intervention to increase the immunization rate of staff. Disappointingly, our efforts to increase the acceptance of the immunization program by providing information in advance were not yet satisfying.
Misconception about pertussis vaccination was prevalent especially among nursing staff. The main reasons for non-compliance included: unawareness of an own risk of infection, the belief that pertussis is not a serious illness, fear of side effects, the belief that the pertussis vaccine might trigger the pertussis disease itself, and skepticism about the efficacy of the pertussis vaccination.
Recently, pertussis has become a problem also in the adult population, with incidences even higher than in children. Pediatric health care workers (HCWs) are an important source of transmission, exposing very young and immunocompromised patients to an increased risk of potentially severe pertussis infections. Encouraging HCWs to get vaccinated can play a vital role in stopping the transmission of pertussis, thereby reducing institutional outbreaks.
In Germany, HCWs come up with all sorts of reasons for not getting pertussis vaccination. This study was meant to provide information in order to better understand the backgrounds of these attitudes.
A survey was conducted at the children's university hospital in Frankfurt, using an anonymous questionnaire. Survey results were used to design an intervention to increase the immunization rate of staff. Disappointingly, our efforts to increase the acceptance of the immunization program by providing information in advance were not yet satisfying.
Misconception about pertussis vaccination was prevalent especially among nursing staff. The main reasons for non-compliance included: unawareness of an own risk of infection, the belief that pertussis is not a serious illness, fear of side effects, the belief that the pertussis vaccine might trigger the pertussis disease itself, and skepticism about the efficacy of the pertussis vaccination.
Garnet xenocrysts from kimberlites provide unique insights into the composition, structure and evolution of the subcontinental lithospheric mantle (SCLM). For example, different metasomatic events in the SCLM are reflected in compositional differences between garnet xenocrysts. As mantle metasomatism largely controls the physical and chemical properties of the SCLM, it exerts first order control over the genesis of kimberlitic magmas and diamond formation. However, dating mantle lithologies and processes is complicated by high ambient temperatures that allow the equilibration of most isotopic systems up to the time of kimberlite eruption. As a consequence, the temporal connection between metasomatic events in the mantle and kimberlite genesis is commonly ambiguous.
In this study, we applied LA-ICPMS U-Pb dating to 43 harzburgitic, lherzolithic and megacrystic garnet xenocrysts from the ~376 Ma diamondiferous V. Grib kimberlite, Russia, in order to investigate the link between different types of mantle metasomatism and kimberlite genesis.
Our results indicate that, with two possible exceptions, only harzburgitic garnet overlaps in age with the kimberlite eruption, whereas lherzolitic and megacrystic garnet crystals are ~20 to 130 million years older. Furthermore, garnet U-Pb ages and Ni-in-garnet temperatures of ~820 to 1200 °C do not correlate. This, and the high closure temperature of U-Pb in garnet (≥900 °C) suggests that the garnet U-Pb ages indeed reflect metasomatic events in the SCLM. However, the U-Pb ages could also reflect cooling ages. In this case, the metasomatic events recorded in the garnet crystals must still have occurred up to ~130 million years prior to the eruption of the V. Grib kimberlite.
These findings have far-reaching implications for the genesis of (diamondiferous) kimberlites, as they clearly show that the time lag between metasomatic events in the SCLM, as recorded in kimberlitic garnet xenocrysts, and kimberlite eruption may extend to tens of millions of years.
The oxidation state of sulfur in slab fluids is controversial, with both dominantly oxidized and reduced species proposed. Here we use in situ X-ray absorption spectroscopy analysis of sulfur-in-apatite to monitor changes in the oxidation state of sulfur during high-P metasomatism by slab fluids in the subduction channel. Our samples include a 73 cm continuous transect of reaction zones between a metagabbroic eclogite block and serpentinite matrix from a mélange zone on the island of Syros, Greece. The block core consists of garnet, omphacite, phengite, paragonite, epidote-clinozoisite, and rutile. In this region, apatite is only observed as elongate inclusions in omphacite cores. From the core outwards micas are increasingly replaced by epidote-clinozoisite, garnets are smaller and more frequent, pyrite + bornite is observed as inclusions in recrystallized omphacite, and apatite is increasingly abundant in the matrix and inclusions in garnet. A major transition at 48 cm separates an assemblage of Ca-Na amphibole, omphacite, chlorite, pyrite, and apatite from the inner garnet-bearing eclogite assemblages. Omphacite disappears from the assemblage at ~56 cm and amphibole compositions sharply transition to tremolite at 59 cm. Finally, the assemblage tremolite + talc + pyrite is observed after ~70 cm.Apatites in the eclogite assemblages exclusively display S6+ peaks in their absorption spectra. This includes apatite inclusions in omphacite in the least altered lithology, as well as matrix apatite and isolated apatite inclusions in garnet in the outermost metasomatized eclogite zone. In the intermediate pyrite-rich (~1-5 vol %) amphibole + omphacite + chlorite zone, apatite displays a strong S1- absorption peak in most grains, with rare analyses showing mixed S1- and S6+. Finally, apatite in the outermost tremolite-bearing assemblages only displays a S6+ peak. The pyrite-rich zone at 48 cm occurs at the initial interface between the serpentinite matrix and eclogite block, characterized by a dramatic decrease in Na content and Mg#. Our data suggest that reduction of S6+ in infiltrating fluids to S1- in pyrite became focused as Fe diffused across the steep Mg# gradient, resulting in pyrite precipitation. In contrast, S reduction in the Mg-rich tremolite-dominant portions of the transect was limited by a lack of Fe, resulting in low modes of pyrite and fluid buffered S6+ in apatite. Finally, S6+-bearing apatite is also observed in reaction zone lithologies from elsewhere on Syros, suggesting our observations are not isolated.Two important conclusions are drawn from these data and observations: (1) In the case of Syros, slab fluids at eclogite-facies conditions carried oxidized S6+, and (2) The interaction of these fluids with eclogites composed of ferrous-Fe silicates resulted in extensive sulfide precipitation.
With respect to nosocomial influenza infections, the welfare of patients is best served by high rates of staff immunity against influenza. However, data from the Centers of Disease Control (CDC) in the USA and the Robert Koch-Institute (RKI) in Germany indicate that most of health care workers (HCWs) choose not to be vaccinated. Under voluntary influenza immunization standards, institutional influenza outbreaks occur every flu season. The question about the legality of implementation mandatory flu vaccination for HCWs is an ongoing debate, which covers several different positions.
To characterize the attitudes of German HCWs toward mandatory influenza immunization, an anonymous questionnaire was offered to HCWs of the University Hospital in Frankfurt/Main / Germany. Our study showed that almost 70% of the respondents would accept mandatory influenza vaccination.
In our opinion an annual influenza vaccination should be required for HCWs who care for immunocompromised patients and residents in long-term care if there will be a failure of voluntary vaccination programs. An informed declination should be obtained from employees who decline vaccination and these HCWs ought to work in uncritical areas of patient care.
Sulfur in the slab: a sulfur-isotopes and thermodynamic-modeling perspective from exhumed terranes
(2022)
Sulfur is a key element in the subduction zone-volcanic arc system; however, the mechanism(s) that recycle sulfur from the slab into the overlying volcanic arc are debated. Here we summarize recent advances in quantifying this component of the deep sulfur cycle. First, primary metamorphic or inherited sulfides in oceanic-type eclogites are only rarely observed as inclusions and are typically absent from the rock matrix. Additionally, sulfides are relatively common in rocks metasomatized at the slab-mantle interface by slab-derived fluids during exhumation. Combined, these two observations suggest that sulfur loss from subducted mafic crust is relatively efficient. Thermodynamic modeling in Perple_X using the Holland and Powell (2011) database combined with the Deep Earth Water model suggests that the efficiency and speciation of sulfur loss varies depending on the degree of seafloor alteration prior to subduction and the geothermal gradient of the slab. In relatively cold subduction zones, such as Honshu, slab-fluids derived from subducted mafic crust are predicted to exhibit elevated concentrations of HSO4-, SO42-, HSO3-, and CaSO4(aq), whereas hot subduction zones, such as Cascadia, are predicted to produce slab fluids enriched in HS- and H2S at lower pressures. The oxidation of sulfur expelled from subducted pyrite is balanced by the reduction of Fe3+ to Fe2+, consistent with the low Fe3+/SFe of exhumed eclogites relative to blueschists and altered oceanic crust. Where oxidized S-bearing fluids are produced, they are anticipated to interact with more reduced rocks at the slab-mantle interface and within the mantle wedge, resulting in sulfide precipitation and significant isotopic fractionation. The δ34S values of slab fluids are estimated to fall between -11 and +8 ‰. Rayleigh fractionation during progressive fluid-rock interaction results in fractionations of tens of per mil as oxidized species are depleted and sulfides are precipitated, resulting in δ34S values of sulfides that easily span the -21.7 to +13.9 ‰ range observed in metasomatic sulfides in exhumed high-pressure rocks. However, in subduction zones where reduced species prevail, the S isotopic signature of slab fluids is expected to reflect their source and will exhibit a narrower range in δ34S values. As a result, the δ34S values measured in arc magmas may not always be a reliable indicator of the contribution of different components of the slab, such as sediments vs. AOC. Additionally, the impact of S recycling on the oxygen fugacity of arc magmas is expected to vary both spatially and temporally throughout Earth history.
In the culture history of ancient Europe questions pertaining to its diverse relationships to advanced civilisations in the Mediterranean sphere look back upon a long tradition. Varyingly different single finds and groups of finds have repeatedly provided the prospect and scope for investigating the character and extent of contacts and influences as well as the consequences for cultural developments north of the Alps. In discussions on the genesis and significance of the Bronze Age in central and northern Europe, the perceived linkages between the eastern Mediterranean and the Carpathian Basin and via the Danube River as far as areas north of the Alps have played an important role. Without question, the Danube River represented a crucial axis of communication ever since the Neolithic period and in following times. Recent interdisciplinary studies, however, have broadened the scope and shown that further important communication routes existed along the Ionian-Adriatic Sea to Upper Italy and beyond the Alps, and via the Rhône valley and the West Alps to the North. Thereby, impulses of varying economic nature could be discerned, which were consequential for many aspects of the cultural development of the Early and Middle Bronze Age in Central Europe.
The STAR experiment provides a perfect machinery for studying strange matter for more than two decades. Recently, we developed the express procedure, which allows online monitoring of the collected physics data. The high quality of express calibration and reconstruction provides a unique possibility to run the express production and observe almost in real time strange particles including mesons, hyperons, resonances and even hypernuclei.
The STAR Beam Energy Scan II program, including fixed target Au+Au collisions taken in 2018–2021, is particularly suited to study hypernuclei. Light hypernuclei are expected to be abundantly produced in low energy heavy-ion collisions. Measurements of hypernuclei production and their properties will provide information on the hyperon-nucleon interactions, which are essential ingredients for understanding nuclear matter equation of state at high net-baryon densities, such as inside neutron stars.
With the heavy fragment trigger introduced for the 2021 data taking, we were able to run the express production at the STAR High Level Trigger farm. The collected data were suffcient to observe the decay process of Λ5He →4Hepπ− with more than 11σ significance, measure binding energy as a function of hypernuclei mass, and study hypernuclei decay properties with the Dalitz plot technique.
The interrelation between quantum anomalies and electromagnetic fields leads to a series of non-dissipative transport effects in QCD. In this work we study anomalous transport phenomena with lattice QCD simulations using improved staggered quarks in the presence of a background magnetic field. In particular, we calculate the conductivities both in the free case and in the interacting case, analysing the dependence of these coefficients with several parameters, such as the temperature and the quark mass.
Stabilized Wilson fermions are a reformulation of Wilson clover fermions that incorporates several numerical stabilizing techniques, but also a local change of the fermion action - the original clover term being replaced with an exponentiated version of it. We intend to apply the stabilized Wilson fermions toolbox to the thermodynamics of QCD, starting on the Nf=3 symmetric line on the Columbia plot, and to compare the results with those obtained with other fermion discretizations.
We compute potentials of two static antiquarks in the presence of two quarks qq of finite mass using lattice QCD. In a second step we solve the Schrödinger equation, to determine, whether the resulting potentials are sufficiently attractive to host a bound state, which would indicate the existence of a stable qqb¯b¯ tetraquark. We find a bound state for qq=(ud−du)/2–√ with corresponding quantum numbers I(JP)=0(1+) and evidence against the existence of bound states with isospin I=1 or qq∈{cc,ss}.
We present first results of a recently started lattice QCD investigation of antiheavy-antiheavy-light-light tetraquark systems including scattering interpolating operators in correlation functions both at the source and at the sink. In particular, we discuss the importance of such scattering interpolating operators for a precise computation of the low-lying energy levels. We focus on the b¯b¯ud four-quark system with quantum numbers I(JP)=0(1+), which has a ground state below the lowest meson-meson threshold. We carry out a scattering analysis using Lüscher's method to extrapolate the binding energy of the corresponding QCD-stable tetraquark to infinite spatial volume. Our calculation uses clover u, d valence quarks and NRQCD b valence quarks on gauge-link ensembles with HISQ sea quarks that were generated by the MILC collaboration.
Study of I = 0 bottomonium bound states and resonances based on lattice QCD static potentials
(2022)
We investigate I=0 bottomonium bound states and resonances in S, P, D and F waves using lattice QCD static-static-light-light potentials. We consider five coupled channels, one confined quarkonium and four open B(∗)B¯(∗) and B(∗)sB¯(∗)s meson-meson channels and use the Born-Oppenheimer approximation and the emergent wave method to compute poles of the T matrix. We discuss results for masses and decay widths and compare them to existing experimental results. Moreover, we determine the quarkonium and meson-meson composition of these states to clarify, whether they are ordinary quarkonium or should rather be interpreted as tetraquarks.
In this work we study the 3+1-dimensional Nambu-Jona-Lasinio (NJL) model in the mean field-approximation. We carry out calculations using five different regularization schemes (two continuum and three lattice regularization schemes) with particular focus on inhomogeneous phases and condensates. The regularization schemes lead to drastically different inhomogeneous regions. We provide evidence that inhomogeneous condensates appear for all regularization schemes almost exclusively at values of the chemical potential and with wave numbers, which are of the order of or even larger than the corresponding regulators. This can be interpreted as indication that inhomogeneous phases in the 3+1-dimensional NJL model are rather artifacts of the regularization and not a consequence of the NJL Lagrangian and its symmetries.
In this contribution we report the status and plans of the open lattice initiative to generate and share new gauge ensembles using the stabilised Wilson fermion framework. The production strategy is presented in terms of a three stage plan alongside summaries of the data management as well as access policies. Current progress in completing the first stage of generating ensembles at four lattice spacings at the flavor symmetric point is given.
The OpenLat initiative presents its results of lattice QCD simulations using Stabilized Wilson Fermions (SWF) using 2+1 quark flavors. Focusing on the SU(3) flavor symmetric point mπ=mK=412 MeV, four different lattice spacings (a=0.064,0.077,0.094,0.12 fm) are used to perform the continuum limit to study cutoff effects. We present results on light hadron masses; for the determination we use a Bayesian analysis framework with constraints and model averaging to minimize the bias in the analysis.
We present SU(3) lattice Yang-Mills data for hybrid static potentials from five ensembles with different small lattice spacings and the corresponding parametrizations for quark-antiquark separations 0.08fm≤r≤1.12fm. We remove lattice discretization errors at tree level of perturbation theory and partly at order a2 as well as the a-dependent self energy. In particular the tree-level improvement of static potentials is discussed in detail and two methods are compared. The resulting parametrizations are expected to represent continuum limit results for hybrid static potentials within statistical errors.
Gravitational-wave cosmology with dark sirens: state of the art and perspectives for 3G detectors
(2022)
A joint fit of the mass and redshift distributions of the population of Binary Black Holes detected with Gravitational-Wave observations can be used to obtain constraints on the Hubble parameter and on deviations from General Relativity in the propagation of Gravitational Waves. We first present applications of this technique to the latest catalog of Gravitational-Wave events, focusing on the comparison of different parametrizations for the source-frame mass distribution of Black Hole Binaries. We find that models with more than one feature are favourite by the data, as suggested by population studies, even when varying the cosmology. Then, we discuss perspectives for the use of this technique with third generation Gravitational-Wave detectors, exploiting the recently developed Fisher information matrix Python code GWFAST.
Computation of masses of quarkonium bound states using heavy quark potentials from lattice QCD
(2022)
We compute masses of bottomonium and charmonium bound states using a Schrödinger equation with a heavy quark-antiquark potential including 1/m and 1/m2 corrections previously derived in potential Non-Relativistic QCD and computed with lattice QCD. This is a preparatory step for a future project, where we plan to take into account similar corrections to study quarkonium resonances and tetraquarks above the lowest meson-meson thresholds.
The thermodynamics of QCD with sufficiently heavy dynamical quarks can be described by a three-dimensional Polyakov loop effective theory, obtained after a truncated character and hopping expansion. We investigate the resulting phase diagram for low temperatures by mean field methods. Taking into account chemical potentials for both baryon number and isospin, we obtain clear signals for a liquid-gas type transition to baryon matter at μI=0 and a Bose-Einstein condensation transition at μB=0, as well as for their connection when both chemical potentials are non-zero.
The magnetic fields generated in non-central heavy-ion collisions are among the strongest fields produced in the Universe, reaching magnitudes comparable to the scale of the strong interactions. Backed by model simulations, the resulting field is expected to be spatially modulated, deviating significantly from the commonly considered uniform profile. To improve our understanding of the physics of quarks and gluons under such extreme conditions, we use lattice QCD simulations with 2+1 staggered fermion flavors with physical quark masses and an inhomogeneous magnetic background for a range of temperatures covering the QCD phase transition. We assume a 1/cosh2 function to model the field profile and vary its strength to analyze the impact on the computed observables and on the transition. We calculate local chiral condensates, local Polyakov loops and estimate the size of lattice artifacts. We find that both observables show non-trivial spatial features due to the interplay between the sea and the valence effects.
We discuss results for the Roberge Weiss (RW) phase transition at nonzero imaginary baryon and isospin chemical potentials, in the plane of temperature and quark masses. Our study focuses on the light tricritical endpoint which has already been used as a starting point for extrapolations aiming at the chiral limit at vanishing chemical potentials. In particular, we are interested in determining how imaginary isospin chemical potential shifts the tricritical mass with respect to earlier studies at zero imaginary isospin chemical potential. A positive shift might allow one to perform the chiral extrapolations from larger quark mass values, therefore making them less computationally expensive. We also present results for the dynamics of Polyakov loop clusters across the RW phase transition.
We compute the equation of state of isospin asymmetric QCD at zero and non-zero temperatures using direct simulations of lattice QCD with three dynamical flavors at physical quark masses. In addition to the pressure and the trace anomaly and their behavior towards the continuum limit, we will particularly discuss the extraction of the speed of sound. Furthermore, we discuss first steps towards the extension of the EoS to small non-zero baryon chemical potentials via Taylor expansion.
In QCD at large enough isospin chemical potential Bose-Einstein Condensation (BEC) takes place, separated from the normal phase by a phase transition. From previous studies the location of the BEC line at the physical point is known. In the chiral limit the condensation happens already at infinitesimally small isospin chemical potential for zero temperature according to chiral perturbation theory. The thermal chiral transition at zero density might then be affected, depending on the shape of the BEC boundary, by its proximity. As a first step towards the chiral limit, we perform simulations of 2+1 flavors QCD at half the physical quark masses. The position of the BEC transition is then extracted and compared with the results at physical masses.
We refine our previous study of a udb¯b¯ tetraquark resonance with quantum numbers I(JP)=0(1−), which is based on antiheavy-antiheavy lattice QCD potentials, by including heavy quark spin effects via the mass difference of the B and the B∗ meson. This leads to a coupled channel Schrödinger equation, where the two channels correspond to BB and B∗B∗, respectively. We search for T matrix poles in the complex energy plane, but do not find any indication for the existence of a tetraquark resonance in this refined coupled channel approach. We also vary the antiheavy-antiheavy potentials as well as the b quark mass to further understand the dynamics of this four-quark system.
We consider a dual representation of an effective three-dimensional Polyakov loop model for the SU(3) theory at nonzero real chemical potential. This representation is free of the sign problem and can be used for numeric Monte-Carlo simulations. These simulations allow us to locate the line of second order phase transitions, that separates the region of first order phase transition from the crossover one. The behavior of local observables in different phases of the model is studied numerically and compared with predictions of the mean-field analysis. Our dual formulation allows us to study also Polyakov loop correlation functions. From these results, we extract the screening masses and compare them with large-N predictions.