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The past two decades have seen an unprecedented trend towards de-escalation of surgical therapy in the setting of early BC, the most prominent examples being the reduction of re-excision rates for close surgical margins after breast-conserving surgery and replacing axillary lymph node dissection by less radical procedures such as sentinel lymph node biopsy (SLNB). Numerous studies confirmed that reducing the extent of surgery in the upfront surgery setting does not impact locoregional recurrences and overall outcome. In the setting of primary systemic treatment, there is an increased use of less invasive staging strategies reaching from SLNB and targeted lymph node biopsy (TLNB) to targeted axillary dissection (TAD). Omission of any axillary surgery in the presence of pathological complete response in the breast is currently being investigated in clinical trials. On the other hand, concerns have been raised that surgical de-escalation might induce an escalation of other treatment modalities such as radiation therapy. Since most trials on surgical de-escalation did not include standardized protocols for adjuvant radiotherapy, it remains unclear, whether the effect of surgical de-escalation was valid in itself or if radiotherapy compensated for the decreased surgical extent. Uncertainties in scientific evidence may therefore lead to escalation of radiotherapy in some settings of surgical de-escalation. Further, the increasing rate of mastectomies including contralateral procedures in patients without genetic risk is alarming. Future studies of locoregional treatment strategies need to include an interdisciplinary approach to integrate de-escalation approaches combining surgery and radiotherapy in a way that promotes optimal quality of life and shared decision-making.

A series of novel CoFe2O4 – xBaTiO3 (x = 0.6–0.9) phosphate-bonded multifunctional ceramic composites were synthesized and studied both in ‘Salisbury screen’ geometry and as free-standing films in the frequency range of 25–54 GHz and temperature interval of 120–500 K. Experiments prove that the studied system is prospective for shielding applications in both modes providing total transmission losses of the free-standing sample layer of 40 dB for x = 0.9 dominated by absorption and more than 40 dB of reflection losses at resonant conditions in the Salisbury screen geometry. It was demonstrated that the electromagnetic response of multiferroic composite ceramics in microwaves is very sensitive to the temperature changes in the application's significant temperature range, i.e. 150 – 400 K. Notably, a small, i.e. 5 – 10 K, temperature variation drastically changes the shielding efficiency of the Salisbury screen (SER). In particular, SER ≥ 40 dB is achieved in the range of 302–309 K for the sample with x = 0.9, outside of the range SE rapidly decreases to 10–15 dB. The impact of temperature has to be considered for the efficient use of shielding materials in Ka and V bands for different applications.

We demonstrate a proof of principle of a simple all-solid-state post-compression setup for low-energy, high-repetition-rate laser pulses, where spectral broadening was performed using a combination of highly nonlinear bulk materials in a simple single-pass geometry. The 75 fs, 210 nJ pulses from an amplified 76 MHz, 15.7 W Yb:KGW oscillator after sequential spectral broadening in ZnS and YAG samples of 2 mm and 15 mm thickness, respectively, were compressed to 37 fs by means of Gires–Tournois interferometric mirrors. The post-compressed pulses with an average power of 11.47 W demonstrated reasonable spatial-spectral homogeneity of the beam with the spectral overlap parameter V>83% and good beam quality with Mx2=1.28 and My2=1.14.

In this paper enrolment and study problems in the faculty of Mathematics and informatics of Vilnius Pedagogical university are discussed.

Bismuth ferrite-barium titanate (BF-BT) solid solutions are lead-free ferroelectrics that show great promise as the basis for high temperature piezoelectric transducers. This article investigates the dielectric properties of such materials using broadband dielectric spectroscopy. The study focuses on the re-entrant relaxor ferroelectric behaviour of Nb-doped BF-BT ceramics, exploring a wide frequency range from approximately 20 Hz to 30 GHz and temperature from 200 to 500 K. The results reveal the presence of thermally induced transitions between ordered and disordered states. Quantitative analysis of the dielectric dispersion is accomplished using the Cole-Cole model, modified to account for the contribution from conduction losses at low frequencies/high temperatures. This analysis revealed that the freezing temperature of the polar nanoregions is around 158 K, with an activation energy of 0.194 eV. The findings contribute to understanding the dielectric relaxation mechanisms and thermal evolution of functional properties in BiFeO _3 -BaTiO _3 ceramics.

Background: von Willebrand factor (VWF) multimers (VWF:MM) methodologies are technically difficult, laborious, time consuming, non-standardized and results vary between laboratories. A new semi automated VWF:MM assay is available for routine use (Sebia). Due to lack of reference values for VWF:MM fractions, results interpretation can be challenging in some cases. The aim of this study was to determine reference intervals for low molecular weight (LMWM), intermediate molecular weight (IMWM) and high molecular weight (HMWM) multimers. Methods: By the international cooperation initiated between 4 countries (Estonia, Latvia, France, and USA) 131 samples of relatively healthy individuals were analyzed for VWF:MM (in total 51 males and 80 non-pregnant females aged 17-69 years). Reference intervals were calculated according to CLSI C28-A3 standard. Results: The proposed reference intervals for VWF:MM were calculated for LMWM 10.4-22.5%, IMWM 22.6-37.6%, HMWM 45.6-66.6%. Age related differences were seen in IMWM and HMWM (p

In this paper, the full-wave analysis of the direct scattering problem in the rectangular waveguide is derived. The numerical calculation results of the scattering characteristics are presented. To show the advantage of our proposed model, we compared direct problem results with three-dimensional simulation software Ansys HFSS calculations. An excellent agreement is observed when compared these two approaches.

Objectives Acquired von Willebrand syndrome (AVWS) is a rare and frequently underdiagnosed bleeding disorder with an unknown prevalence. The diagnosis of AVWS is made based on laboratory investigations and the presence of clinical symptoms. Evaluation and management of affected patients are complex due to the need for multiple laboratory assays. Materials and Methods Here, we describe the clinical and laboratory data of seven patients with a diagnosis of AVWS. All patients met the criteria for AVWS based on laboratory findings, bleeding symptoms, and the absence of any previous history of a bleeding disorder. Results In all cases, the laboratory findings, lack of bleeding anamnesis, and family history suggested the presence of AVWS. Von Willebrand factor multimeric analysis showed decreased high-molecular weight (HMW) multimers in six cases. Patients with lower HMW multimers experienced more severe bleeding complications. Conclusions The diagnosis of AVWS is complex and requires extensive laboratory evaluation. Interdisciplinary collaboration and complex laboratory evaluations are of paramount importance for the early recognition of AVWS and optimal AVWS diagnosis as well as successful clinical management.

Ground radar stations observing specific regions of interest nowadays provide detections in the form of point-clouds. This article focuses on a framework that consists of an elliptical multitarget tracker, referred to as Principal-Axes based Kalman Filter (PAKF)-based Joint Probabilistic Data Association (JPDA) (PAKF-JPDA), to enable maritime traffic monitoring. The framework touches on two major stages, target detection and target tracking. For the former, we employed a clustering approach and for the latter, we presented a data-association-based version of the PAKF tracker with an automatic track management functionality. The framework’s benefits are demonstrated when it is applied to the radar streaming in a harbor setting based on a homogeneous multisensor tracking system by comparing our results against their corresponding reference data with visualizations, including performance measures.

Background: Accurate diagnosis and classification of von Willebrand disease (VWD) are essential for optimal management. The von Willebrand factor multimers analysis (VWF:MM) is an integral part of the diagnostic process in the phenotypic classification, especially in discrepant cases. The aim of this study was to evaluate the performance of a new Hydragel 11VWF multimer assay (H11VW). Methods: Analytical performance characteristics such as repeatability (intra-assay variability, in gel between track variation), reproducibility (inter-assay variability, between gel variation), sensitivity, EQA performance and differences between two commercially available VWF:MM kits (H5VW and H11VW) were analysed in healthy volunteers' plasmas using in-house prepared reference plasma. Results: Repeatability and reproducibility results of H11VW demonstrated acceptable and equivalent performance with previously verified H5VW. Participation in EQA was successful. No statistically significant difference was detected between H5VW and H11VW kits for different fractions of multimers: LMWM p=0.807; IMWM p=0.183; HMWM p=0.774. Conclusions: H11VW demonstrated acceptable analytical performance characteristics. H11VW kit conveniently offers a more significant number of samples on a single gel. H5VW and H11VW kits can be used in daily practice interchangeably.

Understanding the underlying physics and improving the performance of mixed lead halide perovskite materials remains a challenge. Here, the authors present experimental and theoretical study of structural phases, phase transitions, and dipolar dynamics in the mixed cation MA1-xDMAxPbBr3 perovskites.

Domain walls in van der Waals layered ferrielectric CuInP2Se6 exhibit piezoelectric response. This striking departure from traditional ferroelectric behavior is ascribed to a partially polarized antiferroelectric state, where the domain wall separates coexisting regions of ferrielectric and antiferroelectric phases.

Measuring direct oral anticoagulant (DOAC) concentrations might be necessary in certain clinical situations but is not routinely performed. The DOAC Dipstick is a new rapid test for detecting DOACs in urine. The aim of this study was to evaluate the possible uses and limitations of the DOAC Dipstick and to compare visual analysis and DOASENSE Reader analysis of DOAC Dipstick pads. Plasma and urine samples were collected from 23 patients taking DOACs. DOAC concentrations in plasma and urine were measured by chromogenic substrate assays and in urine also by the DOAC Dipstick. Plasma concentrations were dichotomized at a threshold of ≥30 ng/mL. Patient samples were compared with samples from control individuals not using anticoagulants (n = 10) and with DOASENSE control urines. The Combur-10 test was used to measure parameters that may affect urine color and hence the interpretation of the DOAC Dipstick result. DOAC Dipstick test results were positive in 21/23 patient urine samples at a plasma DOAC concentration of ≥30 ng/mL and in 2/23 patient urine samples at a plasma DOAC concentration of

At low temperature, methyl groups act as hindered quantum rotors exhibiting rotational quantum tunneling, which is highly sensitive to a local methyl group environment. Recently, we observed this effect using pulsed electron paramagnetic resonance (EPR) in two dimethylammonium-containing hybrid perovskites doped with paramagnetic Mn2+ ions. Here, we investigate the feasibility of using an alternative fast-relaxing Co2+ paramagnetic center to study the methyl group tunneling, and, as a model compound, we use dimethylammonium zinc formate [(CH3)2NH2][Zn(HCOO)3] hybrid perovskite. Our multifrequency (X-, Q- and W-band) EPR experiments reveal a high-spin state of the incorporated Co2+ center, which exhibits fast spin-lattice relaxation and electron spin decoherence. Our pulsed EPR experiments reveal magnetic field independent electron spin echo envelope modulation (ESEEM) signals, which are assigned to the methyl group tunneling. We use density operator simulations to extract the tunnel frequency of 1.84 MHz from the experimental data, which is then used to calculate the rotational barrier of the methyl groups. We compare our results with the previously reported Mn2+ case showing that our approach can detect very small changes in the local methyl group environment in hybrid perovskites and related materials.

Abstract Background The prognostic relevance of circulating tumour cells (CTCs) in metastatic breast cancer (MBC) patients has been confirmed by several clinical trials. However, predictive blood-based biomarkers for stratification of patients for targeted therapy are still lacking. The DETECT studies explore the utility of CTC phenotype for treatment decisions in patients with HER2 negative MBC. Associated with this concept is a plethora of translational projects aiming to identify potential predictive biomarkers. The androgen receptor (AR) is expressed in over 70% of hormone receptor-positive and up-to 45% of triple-negative tumours. Studies has indicated the promising nature of AR as a new therapy target with a clinical benefit rate for anti-AR treatment in MBC patients up to 25% The aim of this analysis was the characterization of CTCs regarding the expression of the AR using immunofluorescence. Methods MBC patients were screened for the HER2-status of CTCs in the DETECT studies. In a subset of CTC-positive patients (n = 67) an additional blood sample was used for immunomagnetic enrichment of CTCs using the CellSearch® Profile Kit prior to transfer of the cells onto cytospin slides. Establishment of immunofluorescence staining for the AR was performed using prostate cancer cell lines LNCaP and DU145 as positive and negative control, respectively. Staining of DAPI, pan-cytokeratin (CK) and CD45 was applied to identify nucleated epithelial cells as CTCs and to exclude leucocytes. Results Co-staining of the AR, CK and CD45 according to the above mentioned workflow has been successfully established using cell lines with known AR expression spiked into the blood samples from healthy donors. For this translational project, samples were analysed from 67 patients participating in the DETECT studies. At least one CTC was detected in 37 out of 67 patients (56%). In 16 of these 37 patients (43%) AR-positive CTCs were detected. In eight out of 25 patients (32%) with more than one CTC, AR-positive and AR-negative CTCs were observed. Conclusion In 43% of the analysed CTC samples from patients with MBC the AR expression has been detected. The predictive value of AR expression in CTCs remains to be evaluated in further trials.

Ferromagnetic-ferroelectric composite materials on the base of Pb0.85Zr0.53Ti0.47O3-Sr2FeMoO6-δ (PZT-SFMO) compound have been prepared by a complex ceramic technology and the citrate-gel synthesis. It was determined that the dielectric permittivity of a sample with a content of PZT of 55 wt. % and SFMO of 45 wt. % increases with temperature due to the rise of electrical conductivity and an influence of the dielectric dispersion caused by the Maxwell-Wagner relaxation. The electrical conductivity of the sample with a content of PZT of 35 wt. % and a content of SFMO of 65 wt. % possesses a clearly expressed frequency dependence, at temperature lower than 600 K, whereas at higher temperatures the electrical conductivity almost does not depends on frequency in the range 20 Hz-1 MHz. This is concerned with a considerable decrease of critical frequency at higher temperatures. At frequencies higher than 100 kHz and temperature lower than 600 K, the electrical conductivity increases by a power law.

Abstract Background Over 1 billion people suffer from chronic respiratory diseases such as asthma, COPD, rhinitis and rhinosinusitis. They cause an enormous burden and are considered as major non-communicable diseases. Many patients are still uncontrolled and the cost of inaction is unacceptable. A meeting was held in Vilnius, Lithuania (March 23, 2018) under the patronage of the Ministry of Health and several scientific societies to propose multisectoral care pathways embedding guided self-management, mHealth and air pollution in selected chronic respiratory diseases (rhinitis, chronic rhinosinusitis, asthma and COPD). The meeting resulted in the Vilnius Declaration that was developed by the participants of the EU Summit on chronic respiratory diseases under the leadership of Euforea. Conclusion The Vilnius Declaration represents an important step for the fight against air pollution in chronic respiratory diseases globally and has a clear strategic relevance with regard to the EU Health Strategy as it will bring added value to the existing public health knowledge.

The broadband electrical properties of Ag1−xLixNbO3 (ALNx) ceramics (x ≤ 0.1) together with AgNbO3 (AN) crystals were studied over a wide temperature interval of 20–800 K. For ALNx with x ≤ 0.05, a very diffused ferroelectric phase transition was observed. The position of the dielectric permittivity maximum in this phase transition is strongly frequency-dependent and is described well by the Vogel–Fulcher law. The freezing temperature decreases when the lithium concentration increases. Below the ferroelectric phase transition temperature, the dielectric dispersion is mainly caused by ferroelectric domain dynamics. Moreover, for ALN3 and ALN5 ceramics at very low temperatures (below 100 K), behavior typical of dipolar glasses is observed. At higher temperatures (above 650 K for ALN5), electrical conductivity effects become important. The DC conductivity increases with temperature according to the Arhenius law and the activation energy is highest in the antiferroelectric phase. Moreover, the activation energy is strongly dependent on the lithium concentration and it is greatest when x = 0.02.

Dielectric permittivity (ε′), magnetic permeability (µ′) and dielectric and magnetic loss (tan δε and tan δµ, respectively) of magneto-dielectric cobalt ferrite-titania (CFO-TO) ceramic composites are determined from 200 to 300 MHz. The four different combinations of phases - that can be produced in the sintered composite, according to the starting CFO/TO molar ratio - allow to tune the macroscopic permittivity and permeability. For the first time impedance, miniaturization and magneto-dielectric loss of the four classes of composites are calculated and discussed. The displayed miniaturization factors between 4.4 and 8.2 in the very-high frequency (VHF) range corroborate their potential application as magneto-dielectric substrate materials for antennas. Remarkably, the ceramic composites characterized by 2 vol.% and 3 vol.% of CFO and TO, respectively, dispersed in Fe2CoTi3O10 (FCTO) matrix display a magneto-dielectric loss lower than 0.07 and a miniaturization factor of 4.8.

Abstract Background An important component of the RAS signalling pathway, the RAS p21 oncogene, is frequently hyperactivated in breast cancer. Its expression in tumor tissue has been linked to poor clinical outcome. This study was designed to evaluate the clinical relevance of RAS p21 levels in peripheral blood in a large cohort of metastatic breast cancer patients. Methods Two hundred fifty-one patients with metastatic breast cancer were enrolled in this prospective, multicentre, open-label, non-randomized study. Blood samples were collected before start of first-line or later-line treatment. RAS p21 was determined using a sandwich-type ELISA immunoassay. For the determination of the cutoff, blood samples from age-matched healthy controls were analyzed. A value above 452 pg/ml was regarded as elevated (mean + 2 x SD). In the univariate survival analysis, two other cutoffs were considered as well (50th and 75th percentile of patients, i.e. 229 pg/ml and 320 pg/ml). Circulating tumor cells (CTCs) were detected using the CellSearch system. Results 29 of 251 (12%) patients had RAS p21 levels above the cut-off level of 452 pg/ml. Clinical-pathological parameters, such as hormone receptor and HER2 status, line of therapy and CTC status, did not correlate with RAS p21 levels. Elevated RAS p21 was significantly associated with shorter progression-free and overall survival in the univariate analysis (median PFS: 3.9 months [95%-CI: 1.8–6.0] for patients with elevated RAS p21 levels versus 8.5 months [95%-CI: 7.4–9.5] with non-elevated levels [p = 0.01]; median OS: 7.1 months [95%-CI: 0.3–14.2] versus not reached [p = 0.002], respectively). When RAS p21 cutoffs other than 452 pg/ml were considered, elevated RAS p21 was significantly associated with OS but not with PFS. Classical clinical-pathological factors were included into a multivariate Cox regression analysis. In addition, factors previously shown to influence survival in a univariate analysis, such as serum HER2, CAIX and TIMP1, were included as well. In the multivariate analysis, RAS p21, presence of ≥5 CTCs per 7.5 ml blood, higher grading and higher line of therapy remained independent predictors of shorter OS. Conclusions Metastatic breast cancer patients with elevated levels of circulating RAS p21 have significantly worse clinical outcome. Hypothetically, these patients might benefit from therapeutic strategies targeting RAS pathway. Trial registration Current Controlled Trials ISRCTN59722891 (DETECT); trial registration date: April, 17th 2010; the trial was registered retrospectively.

Background and Objectives: Kidney transplant recipients represent a unique population with metabolic abnormalities, altered nutritional and immune status, as well as an imbalanced regulation of adipocytokine metabolism. Leptin is a hormonally active protein mainly produced by fat tissue that modulates appetite, satiety, and influences growth, energy, and bone metabolism. There has been great interest in the role of this hormone in chronic kidney disease-related protein energy wasting; thus, a positive leptin correlation with body mass index and fat mass was confirmed. This study was designed to determine the association of pre and post-kidney transplant leptin concentration with nutritional status and body composition. Materials and Methods: We studied 65 kidney transplant recipients. Nutritional status was evaluated before kidney transplantation and 6 months later using three different malnutrition screening tools (Subjective Global Assessment Scale (SGA), Malnutrition Inflammation Score (MIS), and Geriatric Nutritional Risk Index (GNRI)), anthropometric measurements, and body composition (bioelectrical impedance analysis (BIA)). Demographic profile, serum leptin levels, and other biochemical nutritional markers were collected. Statistical analysis was performed with R software. Results: Median age of the studied patients was 45 years, 42% were females, and 12% had diabetes. Leptin change was associated with body weight (p < 0.001), waist circumference (p < 0.001), fat mass (p < 0.001) and body fat percentage (p < 0.001), decrease in parathyroid hormone (PTH) (p < 0.001) transferrin (p < 0.001), diabetes mellitus (p = 0.010), and residual renal function (p = 0.039), but not dependent on dialysis vintage, estimated glomerular filtration rate (eGFR), or delayed graft function at any time during the study. After adjustment for age and sex, body mass index (BMI) (p < 0.001), fat mass (p < 0.001), and body fat percentage (p < 0.001) were independent variables significantly associated with post-transplant leptin change. Lower leptin values were found both before and after kidney transplantation in the SGA B group. GNRI as a nutritional status tool was strongly positively related to changes in leptin within the 6-month follow-up period. Conclusions: Kidney transplant recipients experience change in leptin concentration mainly due to an increase in fat mass and loss of muscle mass. GNRI score as compared to SGA or MIS score identifies patients in whom leptin concentration is increasing alongside an accumulation of fat and decreasing muscle mass. Leptin concentration evaluation in combination with BIA, handgrip strength measurement, and GNRI assessment are tools of importance in defining nutrition status in the early post-kidney transplant period.

Collision avoidance is one of the high-level safety objectives and requires a complete and reliable description of the maritime traffic situation. The radar is specified by the IMO as the primary sensor for collision avoidance. In this paper we study the performance of multi-target tracking based on radar imagery to refine the maritime traffic situation awareness. In order to achieve this we simulate synthetic radar images and evaluate the tracking performance of different Bayesian multi-target trackers (MTTs), such as particle and JPDA filters. For the simulated tracks, the target state estimates in position, speed and course over ground will be compared to the reference data. The performance of the MTTs will be assessed via the OSPA metric by comparing the estimated multi-object state vector to the reference. This approach allows a fair performance analysis of different tracking algorithms based on radar images for a simulated maritime scenario.

Ferrimagnetic-ferroelectric composite materials on the base of Pb0.85Zr0.53Ti0.47O3– Sr2FeMoO6–δ (PZT-SFMO) compounds have been prepared by a complex ceramic technology and a modified sol-gel synthesis. The dielectric properties of the PZT-SFMO composites with the PZT concentrations of 55 wt% and less, as well as of pure SFMO, are caused by the Maxwell-Wagner relaxation and a huge electrical conductivity. In contrast, in pure PZT the ferroelectric phase transition is clearly expressed in the static dielectric permittivity anomaly. Moreover, in all investigated composites, similarly to pure SFMO, the electrical conductivity anomaly is observed in the range from 560–540 K. This indicates that the composites with PZT concentrations of 55 wt% and higher are above the electrical and magnetic percolation threshold, in a good agreement with the excluded volume theory. In PZT-SFMO composites the DC electrical conductivity increases with SFMO concentration almost in a power law fashion, while the activation energy of the DC conductivity decreases under certain conditions.

The dielectric/electric properties of the Ni@C (carbon-coated Ni)/epoxy composites and Ni@C/MWCNTs (multi-walled carbon nanotubes)/epoxy composites loaded with fixed MWCNTs amount just below the percolation threshold (0.09 vol.%) and Ni@C at different concentrations up to 1 vol.% were investigated in broad frequency (20 Hz–40 GHz) and temperature (30 K–500 K) regions. In composites with the only Ni@C nanoparticles, the electrical percolation threshold was determined between 10 and 15 vol.%. Above the percolation threshold the dielectric permittivity (ε’) and the electrical conductivity (σ) of the composites loaded with Ni@C only are high enough, i.e., ε’ = 105 and σ = 0.6 S/m at 100 Hz for composites with 30 vol.% Ni@C, to be used for electromagnetic shielding applications. The annealing to 500 K was proved to be an effective and simple tool to decrease the percolation threshold in epoxy/Ni@C composites. For hybrid composites series an optimal concentration of Ni@C (0.2 vol.%) was determined, leading to the conductivity absolute values several orders of magnitude higher than that of a composite filled with MWCNTs only. The synergy effects of using both fillers have been discussed. Below room temperature the electrical transport is mainly governed by epoxy resin compression in all composites, while the electron tunnelling was observed only in hybrid composites below 200 K. At higher temperatures (above 400 K), in addition to the nanoparticles redistribution effects, the electrical conductivity of epoxy resin makes a significant contribution to the total composite conductivity. The dielectric relaxation spectroscopy allows estimating the nanoparticles distributions in polymer matrix and could be used as the non-destructive and fast alternate to microscopy techniques for general polymer composite fabrication control.