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Shi Chen,1,* Jiaqi Qiang,1,2,* Bin Zhao,3 Ran Tian,4 Tao Yuan,1 Ming Li,1 Mei Li,1 Zhaoqi Gu,5 Liping Yang,6 Huijuan Zhu,1 Hui Pan,1,7 Yan Tang,3 Yuxiu Li1 1Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China; 2Eight-Year Program of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China; 3Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China; 4Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China; 5Department of Radiotherapy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China; 6Department of Pharmacy, Handan First Hospital, Handan, Hebei Province, People’s Republic of China; 7State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuxiu Li, Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, People’s Republic of China, Email liyuxiu@medmail.com.cn Yan Tang, Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, People’s Republic of China, Email tangyan@pumch.cnAbstract: The sulfhydryl group of clopidogrel metabolite could induce insulin autoimmune syndrome (IAS) with hypoglycemia as the major symptom. For patients with cardiovascular disease taking clopidogrel for vascular protection, this adverse event hypoglycemia increases the risk of cardiovascular events. However, discontinuing clopidogrel leaves patients without appropriate antiplatelet therapy. Treating IAS with glucocorticoids is also risky for these patients’ primary cardiovascular diseases. Early recognition and appropriate treatment of clopidogrel-induced IAS (CIAS) would be beneficial for patients. This research aimed to discover the clinical features and investigate optimal therapeutic management of CIAS. We systematically searched for cases of CIAS in PubMed and Embase and performed data mining in Food and Drug Administration Adverse Event Reporting System (FAERS). In the CIAS series, clinical features were summarized and compared to 287 IAS cases, including demographic information, HLA alleles, onset, and symptoms. The therapeutic effect of glucocorticoids was compared between the receiving group and the not-receiving group. The possibilities of common antiplatelet drugs to induce hypoglycemia/IAS were investigated with chemical structure and FAERS reports. A CIAS series of 51 patients was established. CIAS had an onset age of 74.8± 8.6 years old, 92.2% male, and a balanced proportion of East Asians and non-East Asians. Confusion occurred more frequently in CIAS than in IAS from various causes, while the other symptoms and hypoglycemia types were similar. The recovery time was approximately the same whether using glucocorticoids/immunotherapy in CIAS or not. Among common antiplatelet drugs, ticagrelor and rivaroxaban were unlikely to induce hypoglycemia/IAS. Clopidogrel is a distinctive cause of IAS featuring an elderly male presenting confusion as the symptom of hypoglycemia. Glucocorticoids/immunotherapy might not be necessary for the long-term recovery of CIAS. To balance the risks of hypoglycemia and cardiovascular events, substituting clopidogrel with ticagrelor and rivaroxaban might be considered.Keywords: autoimmune hypoglycemia, antiplatelet therapy, glucocorticoids, cardiovascular diseases, ticagrelor

The ever increasing demands placed upon machine performance have resulted in the need for more comprehensive particle accelerator modeling. Computer simulations are key to the success of particle accelerators. Many aspects of particle accelerators rely on computer modeling at some point, sometimes requiring complex simulation tools and massively parallel supercomputing. Examples include the modeling of beams at extreme intensities and densities (toward the quantum degeneracy limit), and with ultra-fine control (down to the level of individual particles). In the future, adaptively tuned models might also be relied upon to provide beam measurements beyond the resolution of existing diagnostics. Much time and effort has been put into creating accelerator software tools, some of which are highly successful. However, there are also shortcomings such as the general inability of existing software to be easily modified to meet changing simulation needs. In this paper possible mitigating strategies are discussed for issues faced by the accelerator community as it endeavors to produce better and more comprehensive modeling tools. This includes lack of coordination between code developers, lack of standards to make codes portable and/or reusable, lack of documentation, among others.

Superconducting (SC) magnets for accelerator concepts are often synthesized by numerically optimizing magnetic field waveforms, a process that requires a subsequent solution of a constrained inverse problem to identify suitable SC magnet windings. When the desired field distribution is intuitive, the inverse process is facilitated by seeding preconceived coil distributions into design optimization methods for refinement. With more complex magnetic field distributions, an initial design may be unknown, and topology optimization tools are required to synthesize current distributions without a priori guidance from a subject matter expert. In this work, we develop a constrained inverse Biot-Savart topology optimization methodology that synthesizes optimal distributions of current density in racetrack-like SC coils. The problem structure is exploited through a computationally efficient quadratic programming formulation, and the method is applied to recently published magnetic field waveforms for a recirculating proton phase shifter, a proton therapy gantry, and dipole magnets with sharp field transitions. The method and results herein identify novel winding configurations that can help magnet designers bring accelerator concepts to fruition.

Crab crossing scheme is an essential collision scheme to achieve high luminosity for the future colliders with large crossing angles. However, when bunch length of one or both colliding beams is comparable with the wavelength of the crab cavity voltage, the nonlinear dependence of the crabbing kick may present a challenge to the beam dynamics of the colliding beams and impact the beam quality and the luminosity lifetime. In this paper, the results of nonlinear dynamics in the crab crossing scheme are presented, using both analytical and numerical approaches. The result indicates that higher-order synchrobetatron resonances may be excited in the crab crossing scheme with large crossing angle, which causes the beam quality deterioration and luminosity degradation. The studies also reveal possible countermeasures to suppress the synchrobeta resonance, hence mitigate the degradation of beam quality and luminosity.

The multi-pass recirculating proton linac can significantly improve the usage efficiency of rf superconducting cavities by accelerating the proton beam through the same cavity multiple times. However, in order to achieve acceleration for different energy proton beams, longitudinal phase synchronous conditions among these beams have to be satisfied. In this paper, we propose a fixed field phase shifter system based on two superconducting bending magnets with an optimized field distribution to meet the synchronous conditions. Such a phase shifter provides both longitudinal phase delay and transverse focusing of multiple energy beams. Self-consistent macroparticle simulations including space-charge effects through the system show that the proton beam emittances can be well preserved after the phase shifter for multiple energy beams.

The nonlinear space-charge effects are an important topic in high intensity accelerator beam dynamics and have been extensively studied using macroparticle tracking simulations. In this paper, we report on recent advances in the simulation of space-charge effects using a symplectic multiparticle space-charge model. The transverse space-charge limit was explored for a periodic focusing and defocusing lattice. The artificial numerical emittance growth in the macroparticle space-charge simulation was analyzed using a one-dimensional model.

The microbunching instability seeded by small initial density modulation and driven by collective effects can cause significant electron beam quality degradation in next generation x-ray free electron lasers. A method exploiting longitudinal mixing derived from the natural transverse spread of the electron beam through a dispersive bending magnet was proposed to suppress this instability several years ago [Phys. Rev. Lett. 111, 054801 (2013)PRLTAO0031-900710.1103/PhysRevLett.111.054801]. Instead of using bending magnets to introduce the transverse-to-longitudinal coupling, which will lead to an inconvenient deflection of the downstream beam line, in this paper, we propose a scheme to mitigate the microbunching instability by inserting a quadrupole magnet inside a bunch compressor of the accelerator. This results in transverse-to-longitudinal phase space mixing and large slice energy spread that can efficiently mitigate the growth of the microbunching instability through the major accelerator section. Finally, at the exit of the accelerator, a dogleg section is used to restore the emittance and slice energy spread before entering the undulator radiation section. Multiparticle simulations show that the transverse space charge, structure wakefield, and the coherent synchrotron radiation effects will have a relatively small impact on this scheme.

High brightness electron beams play an important role in accelerator-based applications such as driving X-ray free electron laser (FEL) radiation. In this paper, we report on advances in global beam dynamics optimization of an accelerator design using start-to-end simulations and a new parallel multi-objective differential evolution optimization method. The global optimization results in significant improvement of the final electron beam brightness.

In Refs. Qiang (2019) and Kesting (2015), the authors showed that the emittance growth rate due to the force error of macroparticle sampling will be proportional to the step size of simulation. In this note, we show that for the random force error, the emittance growth rate will be independent of the step size, which is consistent with the simulation observation.

Space-charge effects play an important role in high intensity accelerators. These effects can be studied self-consistently by solving the Poisson equation with the dynamically evolved charge density distribution subject to appropriate boundary conditions. In this paper, two computationally efficient methods are proposed to solve the Poisson equation inside an elliptical perfectly conducting pipe. One method uses a spectral method and the other uses a spectral finite difference method. The former method has a high accuracy and the latter one has a computational complexity of O(Nlog(N)), where N is the total number of unknowns. These methods implemented in a beam dynamics tracking code enable the fast simulation of space-charge effects in an accelerator with an elliptical conducting pipe.

A high peak current, flat longitudinal phase space electron beam is desirable for efficient X-ray free electron laser (FEL) radiation in next generation light sources. To attain such a beam requires the extensive design of the linear accelerator (linac) including both linear and nonlinear effects. In this paper, we propose a lumped longitudinal beam dynamics model for fast optimization of the electron beam longitudinal phase space through the accelerator. This model is much faster than available tracking programs and also shows good agreement with the fully three-dimensional element-by-element multiparticle simulations. We applied this model in a parallel multiobjective differential evolution optimization program to an existing LCLS-II superconducting linac design and obtained an optimal solution with significantly higher core peak current than the original design.

The long-term macroparticle tracking simulation is computationally challenging but needed in order to study space-charge effects in high intensity circular accelerators. To address the challenge, in this paper, we proposed using a fully symplectic particle-in-cell model for the long-term space-charge simulation. We analyzed the artificial numerical emittance growth in the simulation and suggested using threshold numerical filtering in frequency domain to mitigate the emittance growth in the simulation. We also explored alternative frozen space-charge simulations and observed qualitative agreement with the self-consistent simulations.

High-intensity beams of composite ions are susceptible to particle interactions that do not affect single ions, such as stripping of electrons and charge exchange. Beam dynamics simulation techniques used in accelerator design do not often include these particle interactions, and so the transmission of the real beam can be significantly different from the design simulations. We have modified the IMPACT-T code to include particle interactions as part of the beam dynamics simulations, including space-charge effects and beam losses. We have carried out validation simulations of interactions in a molecular hydrogen ion beam through an existing high-intensity deuteron RFQ design, as beam commissioning is often carried out using molecular hydrogen beams, to avoid deuteron-deuteron interactions in the accelerator leading to neutron activation. The new code framework successfully models the interactions within the beam, tracks the different source and product ions through the accelerator, and calculates the collective effects such as space charge from all particles together. We also discuss other simulation codes that could be modified to include similar interaction effects, and possible applications to other types of accelerators.

Advances in numerical methods for free-electron-laser (FEL) simulation under wiggler period averaging (WPA) are presented. First, WPA is generalized using the perturbative Lie map method. The conventional WPA is identified as the leading order contribution. Next, the shot-noise model under WPA is improved along with a particle migration scheme across the numerical mesh. The artificial shot noise arising from particle migration is suppressed. The improved model also allows using arbitrary mesh size, slippage resolution, and integration step size. These advances will improve modeling of longitudinal beam profile evolution for fast FEL simulation.

The space-charge driven envelope instability can be of great danger in high intensity accelerators. Linear accelerators were designed to avoid this instability by keeping the zero current phase advance per lattice period below 90 degrees. In this paper, we studied the acceleration effects on the instability in a periodic solenoid and radio-frequency (rf) focusing channel and a periodic quadrupole and rf focusing channel using a three-dimensional envelope model and self-consistent macroparticle simulations. Our results suggest that the envelope instability might be dramatically mitigated with a reasonable accelerating gradient in both channels. This suggests that the zero current phase advance without acceleration might be above 90 degrees in linear accelerators where the accelerating gradient is sufficiently high.

The crab cavities are a critical component in the high luminosity LHC upgrade project to compensate the luminosity loss from large crossing angle collision. However, these crab cavities will not be perfect in the real accelerator. In this paper, we studied the effects of crab cavity imperfections on colliding beam luminosity lifetime degradation for the LHC upgrade through detailed numerical simulations. Our simulation results suggest that the white noise jitter in the crab cavity RF phase and voltage rms amplitudes should be kept below a few 10−5 for a good luminosity lifetime, while with frequency-dependent jitter, the amplitudes should be kept below a few 10−4 for a good lifetime. The RF multipole errors in the current crab cavity designs are small enough and would not cause extra luminosity degradation.

Space-charge effects play an important role in high intensity particle accelerators and were studied using a variety of macroparticle tracking models. In this paper, we propose a symplectic particle-in-cell (PIC) model and compare this model with a recently published symplectic gridless particle model and a conventional nonsymplectic PIC model for long-term space-charge simulation of a coasting beam. Using the same step size and the same number of modes for the space-charge Poisson solver, all three models show qualitatively similar emittance growth evolutions and final phase space shapes in the benchmark examples. Quantitatively, the symplectic PIC and the symplectic gridless particle models agree with each other very well, while the nonsymplectic PIC model yields different emittance growth value. Using finer step size, the emittance growth from the nonsymplectic PIC converges towards that from the symplectic PIC model.

A symplectic multi-particle tracking model is implemented on the Graphic Processing Units (GPUs) using the Compute Unified Device Architecture (CUDA) language. The symplectic tracking model can preserve phase space structure and reduce non-physical effects in long term simulation, which is important for beam property evaluation in particle accelerators. Though this model is computationally expensive, it is very suitable for parallelization and can be accelerated significantly by using GPUs. In this paper, we optimized the implementation of the symplectic tracking model on both single GPU and multiple GPUs. Using a single GPU processor, the code achieves a factor of 2–10 speedup for a range of problem sizes compared with the time on a single state-of-the-art Central Processing Unit (CPU) node with similar power consumption and semiconductor technology. It also shows good scalability on a multi-GPU cluster at Oak Ridge Leadership Computing Facility. In an application to beam dynamics simulation, the GPU implementation helps save more than a factor of two total computing time in comparison to the CPU implementation.

The space-charge driven envelope instability can be of great danger in high intensity accelerators and was studied using a two-dimensional (2D) envelope model and three-dimensional (3D) macroparticle simulations before. In this paper, we study the instability for a bunched beam using a three-dimensional envelope model in a periodic solenoid and radio-frequency (rf) focusing channel and a periodic quadrupole and rf focusing channel. This study shows that when the transverse zero current phase advance is below 90°, the beam envelope can still become unstable if the longitudinal zero current phase advance is beyond 90°. For the transverse zero current phase advance beyond 90°, the instability stopband width becomes larger with the increase of the longitudinal focusing strength and even shows different structure from the 2D case when the longitudinal zero current phase advance is beyond 90°. Breaking the symmetry of two longitudinal focusing rf cavities and the symmetry between the horizontal focusing and the vertical focusing in the transverse plane in the periodic quadrupole and rf channel makes the instability stopband broader. This suggests that a more symmetric accelerator lattice design might help reduce the range of the envelope instability in parameter space.

The recirculating superconducting proton linac has the advantage of reducing the number of cavities in the accelerator and the corresponding construction and operational costs. Beam dynamics simulations were done recently in a double-pass recirculating proton linac using a single proton beam bunch. For continuous wave (cw) operation, the high-energy proton bunch during the second pass through the linac will overtake and collide with the low-energy bunch during the first pass at a number of locations of the linac. These collisions might cause proton bunch emittance growth and beam quality degradation. In this paper, we study the collisional effects due to Coulomb space-charge forces between the high-energy bunch and the low-energy bunch. Our results suggest that these effects on the proton beam quality would be small and might not cause significant emittance growth or beam blowup through the linac. A 10 mA, 500 MeV cw double-pass proton linac is feasible without using extra hardware for phase synchronization.

A three-dimensional (3D) Poisson solver with longitudinal periodic and transverse open boundary conditions can have important applications in beam physics of particle accelerators. In this paper, we present a fast efficient method to solve the Poisson equation using a spectral finite-difference method. This method uses a computational domain that contains the charged particle beam only and has a computational complexity of O(Nu(logNmode)), where Nu is the total number of unknowns and Nmode is the maximum number of longitudinal or azimuthal modes. This saves both the computational time and the memory usage of using an artificial boundary condition in a large extended computational domain. The new 3D Poisson solver is parallelized using a message passing interface (MPI) on multi-processor computers and shows a reasonable parallel performance up to hundreds of processor cores.

In this paper, we report on a fast second-order numerical integrator to solve the Lorentz force equations of a relativistic charged particle in electromagnetic fields. This numerical integrator shows less numerical error than the popular Boris algorithm in tracking the relativistic particle subject to electric and magnetic space-charge fields and requires less number of operations than another recently proposed relativistic integrator.

Crab crossing scheme is essential collision scheme to achieve high luminosity for the future electron-ion collider (EIC). Since the ion beam is long when cooling is not present, the nonlinear dependence of the crabbing kick may present a challenge to the beam dynamics of the ion beam, hence a impact to the luminosity lifetime. In this paper, we present the initial result of the weak-strong and strong-strong beam-beam tracking with the crab crossing scheme. The result provides beam dynamics guidance in choosing the proper frequency the crab cavity for the future EIC.

The shot-noise driven microbunching instability can significantly degrade electron beam quality in x-ray free electron laser light sources. Experiments were carried out at the Linac Coherent Light Source (LCLS) to study this instability. In this paper, we present start-to-end simulations of the shot-noise driven microbunching instability experiment at the LCLS using the real number of electrons. The simulation results reproduce the measurements quite well. A microbunching self-heating mechanism is also illustrated in the simulation, which helps explain the experimental observation.

A recirculating superconducting linear accelerator with the advantage of both straight and circular accelerator has been demonstrated with relativistic electron beams. The acceleration concept of a recirculating proton beam was recently proposed [J. Qiang, Nucl. Instrum. Methods Phys. Res., Sect. A 795, 77 (2015NIMAER0168-900210.1016/j.nima.2015.05.056)] and is currently under study. In order to further support the concept, the beam dynamics study on a recirculating proton linear accelerator has to be carried out. In this paper, we study the feasibility of a two-pass recirculating proton linear accelerator through the direct numerical beam dynamics design optimization and the start-to-end simulation. This study shows that the two-pass simultaneous focusing without particle losses is attainable including fully 3D space-charge effects through the entire accelerator system.

There is a great interest in generating high-power hard X-ray Free Electron Laser (FEL) in the terawatt (TW) level that can enable coherent diffraction imaging of complex molecules like proteins and probe fundamental high-field physics. A feasibility study of producing such X-ray pulses was carried out employing a configuration beginning with a Self-Amplified Spontaneous Emission FEL, followed by a “self-seeding” crystal monochromator generating a fully coherent seed, and finishing with a long tapered undulator where the coherent seed recombines with the electron bunch and is amplified to high power. The undulator tapering profile, the phase advance in the undulator break sections, the quadrupole focusing strength, etc. are parameters to be optimized. A Genetic Algorithm (GA) is adopted for this multi-dimensional optimization. Concrete examples are given for LINAC Coherent Light Source (LCLS) and LCLS-II-type systems. Analytical estimate is also developed to cross check the simulation and optimization results as a quick and complimentary tool.

Symplectic tracking is important in accelerator beam dynamics simulation. So far, to the best of our knowledge, there is no self-consistent symplectic space-charge tracking model available in the accelerator community. In this paper, we present a two-dimensional and a three-dimensional symplectic multiparticle spectral model for space-charge tracking simulation. This model includes both the effect from external fields and the effect of self-consistent space-charge fields using a split-operator method. Such a model preserves the phase space structure and shows much less numerical emittance growth than the particle-in-cell model in the illustrative examples.

The need to operate an rf-gun-based electron photoinjector with a beam emitted away from the cathode center can occur under various circumstances. First, in some cases the cathode can be affected by ion back-bombardment that progressively reduces the quantum efficiency (QE) in its center, making off-axis operation mandatory; second, in some cases the drive laser intensity can be sufficiently high to generate QE depletion in the cathode area illuminated by the laser, forcing off-axis operation; last, in cathodes with nonuniform QE distribution it could be convenient to operate off axis to exploit a better QE. However, operation in this mode may lead to growth of the projected transverse beam emittances due to correlations between the transverse and longitudinal degrees of freedom that are introduced within the gun and downstream rf cavities. A strategy is described to mitigate this emittance growth by allowing the beam to propagate along a carefully tuned off-axis trajectory in downstream rf cavities to remove the time-dependent rf kicks introduced in the gun. Along this trajectory, short range wakefields do not degrade the emittance, and long range wakefields degrade the emittance for very high repetition rate only.

Three-dimensional (3D) Poisson solver plays an important role in the study of space-charge effects on charged particle beam dynamics in particle accelerators. In this paper, we propose three new 3D Poisson solvers for a charged particle beam in an open rectangular conducting pipe. These three solvers include a spectral integrated Green function (IGF) solver, a 3D spectral solver, and a 3D integrated Green function solver. These solvers effectively handle the longitudinal open boundary condition using a finite computational domain that contains the beam itself. This saves the computational cost of using an extra larger longitudinal domain in order to set up an appropriate finite boundary condition. Using an integrated Green function also avoids the need to resolve rapid variation of the Green function inside the beam. The numerical operational cost of the spectral IGF solver and the 3D IGF solver scales as O(Nlog(N)), where N is the number of grid points. The cost of the 3D spectral solver scales as O(NnN), where Nn is the maximum longitudinal mode number. We compare these three solvers using several numerical examples and discuss the advantageous regime of each solver in the physical application.

The Rare isotope Accelerator Of Newness (RAON) at the Rare Isotope Science Project (RISP) is being designed to simultaneously accelerate beams with multiple charge states. It includes a driver superconducting (SC) linac for producing 200 MeV/u and 400 kW continuous wave (CW) heavy ion beams from protons to uranium. The RAON consists of a few electron cyclotron resonance ion sources, a low-energy beam transport (LEBT) system, a CW 81.25 MHz, 500 keV/u radio frequency quadrupole (RFQ) accelerator, a medium-energy beam transport system, the SC linac, and a charge-stripper system. The LEBT system for the RISP accelerator facility consists of a high-voltage platform, two 90° dipoles, a multi-harmonic buncher (MHB), solenoids, electrostatic quadrupoles, a velocity equalizer, and a diagnostic system. The ECR ion sources are located on a high-voltage platform to reach an initial beam energy of 10 keV/u. After extraction, the ion beam is transported through the LEBT system to the RFQ accelerator. The generated charge states are selected by an achromatic bending system and then bunched by the MHB in the LEBT system. The MHB is used to achieve a small longitudinal emittance in the RFQ by generating a sawtooth wave with three harmonics. In this paper, we present the results and issues of the beam dynamics of the LEBT system.

Chunmei Jin,1 Rong Shi,1 Xue Jiang,1 Fuxian Zhou,1 Jixiang Qiang,1 Changshan An2 1Department of Clinical Laboratory, Yanbian University Hospital, Yanji, People’s Republic of China; 2Department of Respiratory Medicine, Yanbian University Hospital, Yanji, People’s Republic of ChinaCorrespondence: Changshan An Tel +86-433-2660064Email cs_an2003@aliyun.comIntroduction: Carbapenem-resistant Enterobacteriaceae (CRE) pose a serious threat to clinical patient management and public health, as they are generally resistant to most antibiotics and cause infections with high mortality rates. Klebsiella pneumoniae ranks second among Enterobacteriaceae species that cause nosocomial infections. In this study, we investigated the epidemic characteristics of carbapenem-resistant K. pneumoniae (CRKP) in the pediatric intensive care unit (PICU) of Yanbian University Hospital.Materials and Methods: A total of 14 non-duplicate CRKP strains, collected from March 2015 to November 2019, were subjected to automated microbial identification and antimicrobial susceptibility tests using the Phoenix-100 ID/AST system. The strains were also subjected to genotypic resistance testing, polymerase chain reaction assays to detect genes encoding carbapenemases and other β-lactamases, multi-locus sequence typing (MLST), and pulsed-field gel electrophoresis (PFGE)-based homology analysis.Results: Two carbapenemase genes, KPC-2 and NDM-1 (in eight and six strains, respectively), were detected. MLST enabled the division of the strains into two sequence types, ST11 and ST1224 (containing eight and six strains, respectively). PFGE results classified the 14 strains into clonotypes A–D, of which clonotypes A and B belonged to ST11, while clonotypes C and D belonged to ST1224.Conclusion: Our study reveals that epidemics of the KPC-2-ST11 and NDM-1-ST1224 strains occurred in the PICU of Yanbian University Hospital. Surveillance and strict implementation of prevention and control measures are crucial to prevent the occurrence and rapid spread of nosocomial infections.Keywords: Klebsiella pneumoniae, carbapenemase, sequence type 1224, pediatric intensive care unit

Chunmei Jin,1 Fuxian Zhou,1 Qingsong Cui,2 Jixiang Qiang,1 Changshan An3 1Department of Clinical Laboratory, Yanbian University Hospital, Yanji, People’s Republic of China; 2Department of Intensive Care Unit, Yanbian University Hospital, Yanji, People’s Republic of China; 3Department of Respiratory Medicine, Yanbian University Hospital, Yanji, People’s Republic of ChinaCorrespondence: Changshan An Tel +86-0433-2660064Email cs_an2003@aliyun.comBackground: Infections caused by the carbapenem-resistant Enterobacter cloacae (CREC) bring great challenges to the clinical treatment and pose a serious threat to public health. In this study, we investigated the molecular characteristics of CREC in a tertiary hospital.Materials and Methods: A total of 12 non-duplicate CREC strains isolated during the period of November 2016 to July 2019 were subjected to automated microbial identification and antimicrobial susceptibility testing (AST) using the BD Phoenix-100 identification and antimicrobial susceptibility testing (ID/AST) system. The strains were also subjected to phenotypic screening for the detection of antibiotic resistance genes such as the carbapenemase and other β-lactamase genes, with the use of the polymerase chain reaction assay (PCR). Finally, multi-locus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE)-based homology analysis were applied.Results: Four types of carbapenemases namely IMP-26, NDM-5, NDM-1, and KPC-2 were identified in 12 CREC strains. IMP-26 was the most prevalent type (6/12 strains, 50 %), followed by NDM-5 (3/12 strains, 25 %). The results of MLST revealed that these 12 strains could be divided into five sequence types (STs) among which ST544 was the dominant type (6/12 strains, 50 %). The PFGE results divided the 12 strains into four clusters.Conclusion: Our study indicated that the epidemics of the IMP-26-producing E. cloacae ST544 strain did occur in the intensive care unit (ICU) of a tertiary hospital. Therefore, early surveillance and strict implementation of control measures are crucial for the prevention of nosocomial infections and transmissions in hospitals.Keywords: Enterobacter cloacae, carbapenemase, IMP-26, ST544

The NGLS collaboration is developing design concepts for a multi-beamline soft x-ray FEL array powered by a superconducting linear accelerator, operating with a high bunch repetition rate of approximately 1 MHz. The CW superconducting linear accelerator design is based on developments of TESLA and ILC technology, and is supplied by an injector based on a high-brightness, highrepetition- rate photocathode electron gun. Electron bunches from the linac are distributed by RF deflecting cavities to the array of independently configurable FEL beamlines with nominal bunch rates of ∼100 kHz in each FEL, with uniform pulse spacing, and some FELs capable of operating at the full linac bunch rate. Individual FELs may be configured for different modes of operation, including self-seeded and external-laser-seeded, and each may produce high peak and average brightness x-rays with a flexible pulse format, and with pulse durations ranging from femtoseconds and shorter, to hundreds of femtoseconds. In this paper we describe current design concepts, and progress in RandD activities. Copyright © 2013 CC-BY-3.0 and by the respective authors.