Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic

BACKGROUND: This study assessed the international variation in surgical neuro-oncology practice and 30-day outcomes of patients who had surgery for an intracranial tumor during the COVID-19 pandemic./ METHODS: We prospectively included adults aged ≥18 years who underwent surgery for a malignant or benign intracranial tumor across 55 international hospitals from 26 countries. Each participating hospital recorded cases for 3 consecutive months from the start of the pandemic. We categorized patients’ location by World Bank income groups (high [HIC], upper-middle [UMIC], and low- and lower-middle [LLMIC]). Main outcomes were a change from routine management, SARS-CoV-2 infection, and 30-day mortality. We used a Bayesian multilevel logistic regression stratified by hospitals and adjusted for key confounders to estimate the association between income groups and mortality./ RESULTS: Among 1016 patients, the number of patients in each income group was 765 (75.3%) in HIC, 142 (14.0%) in UMIC, and 109 (10.7%) in LLMIC. The management of 200 (19.8%) patients changed from usual care, most commonly delayed surgery. Within 30 days after surgery, 14 (1.4%) patients had a COVID-19 diagnosis and 39 (3.8%) patients died. In the multivariable model, LLMIC was associated with increased mortality (odds ratio 2.83, 95% credible interval 1.37–5.74) compared to HIC./ CONCLUSIONS: The first wave of the pandemic had a significant impact on surgical decision-making. While the incidence of SARS-CoV-2 infection within 30 days after surgery was low, there was a disparity in mortality between countries and this warrants further examination to identify any modifiable factors

Telomere Shortening Impairs Regeneration of the Olfactory Epithelium in Response to Injury but Not Under Homeostatic Conditions

Atrophy of the olfactory epithelium (OE) associated with impaired olfaction and dry nose represents one of the most common phenotypes of human aging. Impairment in regeneration of a functional olfactory epithelium can also occur in response to injury due to infection or nasal surgery. These complications occur more frequently in aged patients. Although age is the most unifying risk factor for atrophic changes and functional decline of the olfactory epithelium, little is known about molecular mechanisms that could influence maintenance and repair of the olfactory epithelium. Here, we analyzed the influence of telomere shortening (a basic mechanism of cellular aging) on homeostasis and regenerative reserve in response to chemical induced injury of the OE in late generation telomere knockout mice (G3 mTerc−/−) with short telomeres compared to wild type mice (mTerc+/+) with long telomeres. The study revealed no significant influence of telomere shortening on homeostatic maintenance of the OE during mouse aging. In contrast, the regenerative response to chemical induced injury of the OE was significantly impaired in G3 mTerc−/− mice compared to mTerc+/+ mice. Seven days after chemical induced damage, G3 mTerc−/− mice exhibited significantly enlarged areas of persisting atrophy compared to mTerc+/+ mice (p = 0.031). Telomere dysfunction was associated with impairments in cell proliferation in the regenerating epithelium. Deletion of the cell cycle inhibitor, Cdkn1a (p21) rescued defects in OE regeneration in telomere dysfunctional mice. Together, these data indicate that telomere shortening impairs the regenerative capacity of the OE by impairing cell cycle progression in a p21-dependent manner. These findings could be relevant for the impairment in OE function in elderly people

Analysis methods for the first KATRIN neutrino-mass measurement

We report on the dataset, data handling, and detailed analysis techniques of the first neutrino-mass measurement by the Karlsruhe Tritium Neutrino (KATRIN) experiment, which probes the absolute neutrino-mass scale via the β-decay kinematics of molecular tritium. The source is highly pure, cryogenic T2 gas. The β electrons are guided along magnetic field lines toward a high-resolution, integrating spectrometer for energy analysis. A silicon detector counts β electrons above the energy threshold of the spectrometer, so that a scan of the thresholds produces a precise measurement of the high-energy spectral tail. After detailed theoretical studies, simulations, and commissioning measurements, extending from the molecular final-state distribution to inelastic scattering in the source to subtleties of the electromagnetic fields, our independent, blind analyses allow us to set an upper limit of 1.1 eV on the neutrino-mass scale at a 90% confidence level. This first result, based on a few weeks of running at a reduced source intensity and dominated by statistical uncertainty, improves on prior limits by nearly a factor of two. This result establishes an analysis framework for future KATRIN measurements, and provides important input to both particle theory and cosmology

Quantitative Long-Term Monitoring of the Circulating Gases in the KATRIN Experiment Using Raman Spectroscopy

The Karlsruhe Tritium Neutrino (KATRIN) experiment aims at measuring the effective electron neutrino mass with a sensitivity of 0.2 eV/c$^{2}$, i.e., improving on previous measurements by an order of magnitude. Neutrino mass data taking with KATRIN commenced in early 2019, and after only a few weeks of data recording, analysis of these data showed the success of KATRIN, improving on the known neutrino mass limit by a factor of about two. This success very much could be ascribed to the fact that most of the system components met, or even surpassed, the required specifications during long-term operation. Here, we report on the performance of the laser Raman (LARA) monitoring system which provides continuous high-precision information on the gas composition injected into the experiment’s windowless gaseous tritium source (WGTS), specifically on its isotopic purity of tritium—one of the key parameters required in the derivation of the electron neutrino mass. The concentrations c$_{x}$ for all six hydrogen isotopologues were monitored simultaneously, with a measurement precision for individual components of the order 10$^{-3}$ or better throughout the complete KATRIN data taking campaigns to date. From these, the tritium purity, εT, is derived with precision of <10$^{-3}$ and trueness of <3 × 10$^{-3}$, being within and surpassing the actual requirements for KATRIN, respectively

Precision measurement of the electron energy-loss function in tritium and deuterium gas for the KATRIN experiment

The KATRIN experiment is designed for a direct and model-independent determination of the effective electron anti-neutrino mass via a high-precision measurement of the tritium $\beta$-decay endpoint region with a sensitivity on $m_\nu$ of 0.2$\,$eV/c$^2$ (90% CL). For this purpose, the $\beta$-electrons from a high-luminosity windowless gaseous tritium source traversing an electrostatic retarding spectrometer are counted to obtain an integral spectrum around the endpoint energy of 18.6$\,$keV. A dominant systematic effect of the response of the experimental setup is the energy loss of $\beta$-electrons from elastic and inelastic scattering off tritium molecules within the source. We determined the \linebreak energy-loss function in-situ with a pulsed angular-selective and monoenergetic photoelectron source at various tritium-source densities. The data was recorded in integral and differential modes; the latter was achieved by using a novel time-of-flight technique. We developed a semi-empirical parametrization for the energy-loss function for the scattering of 18.6-keV electrons from hydrogen isotopologs. This model was fit to measurement data with a 95% T$_2$ gas mixture at 30$\,$K, as used in the first KATRIN neutrino mass analyses, as well as a D$_2$ gas mixture of 96% purity used in KATRIN commissioning runs. The achieved precision on the energy-loss function has abated the corresponding uncertainty of $\sigma(m_\nu^2)<10^{-2}\,\mathrm{eV}^2$ [arXiv:2101.05253] in the KATRIN neutrino-mass measurement to a subdominant level.Comment: 12 figures, 18 pages; to be submitted to EPJ

Improved eV-scale sterile-neutrino constraints from the second KATRIN measurement campaign

We present the results of the light sterile neutrino search from the second Karlsruhe Tritium Neutrino (KATRIN) measurement campaign in 2019. Approaching nominal activity, 3.76×106 tritium β-electrons are analyzed in an energy window extending down to 40 eV below the tritium end point at E0=18.57  keV. We consider the 3ν+1 framework with three active and one sterile neutrino flavors. The analysis is sensitive to a fourth mass eigenstate m24≲1600  eV2 and active-to-sterile mixing |Ue4|2≳6×10−3. As no sterile-neutrino signal was observed, we provide improved exclusion contours on m24 and |Ue4|2 at 95% C.L. Our results supersede the limits from the Mainz and Troitsk experiments. Furthermore, we are able to exclude the large Δm241 solutions of the reactor antineutrino and gallium anomalies to a great extent. The latter has recently been reaffirmed by the BEST Collaboration and could be explained by a sterile neutrino with large mixing. While the remaining solutions at small Δm241 are mostly excluded by short-baseline reactor experiments, KATRIN is the only ongoing laboratory experiment to be sensitive to relevant solutions at large Δm241 through a robust spectral shape analysis

New Constraint on the Local Relic Neutrino Background Overdensity with the First KATRIN Data Runs

We report on the direct cosmic relic neutrino background search from the first two science runs of the KATRIN experiment in 2019. Beta-decay electrons from a high-purity molecular tritium gas source are analyzed by a high-resolution MAC-E filter around the kinematic endpoint at 18.57 keV. The analysis is sensitive to a local relic neutrino overdensity of 9.7e10 (1.1e11) at a 90% (95%) confidence level. A fit of the integrated electron spectrum over a narrow interval around the kinematic endpoint accounting for relic neutrino captures in the Tritium source reveals no significant overdensity. This work improves the results obtained by the previous kinematic neutrino mass experiments at Los Alamos and Troitsk. We furthermore update the projected final sensitivity of the KATRIN experiment to <1e10 at 90% confidence level, by relying on updated operational conditions.Comment: 7 pages, 7 figure