Visualizing broken symmetry and topological defects in a quantum Hall ferromagnet

The interaction between electrons in graphene under high magnetic fields drives the formation of a rich set of quantum Hall ferromagnetic (QHFM) phases with broken spin or valley symmetry. Visualizing atomic-scale electronic wave functions with scanning tunneling spectroscopy (STS), we resolved microscopic signatures of valley ordering in QHFM phases and spectral features of fractional quantum Hall phases of graphene. At charge neutrality, we observed a field-tuned continuous quantum phase transition from a valley-polarized state to an intervalley coherent state, with a Kekulé distortion of its electronic density. Mapping the valley texture extracted from STS measurements of the Kekulé phase, we could visualize valley skyrmion excitations localized near charged defects. Our techniques can be applied to examine valley-ordered phases and their topological excitations in a wide range of materials

Broken symmetries and excitation spectra of interacting electrons in partially filled Landau levels

Interacting electrons in flat bands give rise to a variety of quantum phases. One fundamental aspect of such states is the ordering of the various flavours -such as spin or valley - that the electrons can undergo and the excitation spectrum of the broken symmetry states that they form. These properties cannot be probed directly with electrical transport measurements. The zeroth Landau level of monolayer graphene with four-fold spin-valley degeneracy is a model system for such investigations, but the nature of its broken symmetry states -particularly at partial fillings - is still not understood. Here we demonstrate a non-invasive spectroscopic technique with a scanning tunneling microscope and use it to perform measurements of the valley polarization of the electronic wave functions and their excitation spectrum in the partially filled zeroth Landau level of graphene. We can extract information such as the strength of Haldane pseudopotentials that characterize the repulsive interactions underlying the fractional quantum states. Our experiments also demonstrate that fractional quantum Hall phases are built upon broken symmetry states that persist at partial filling. Our experimental approach quantifies the valley phase diagram of the partially filled Landau level as a model flat band platform which is applicable to other graphene-based electronic systems

Broken symmetries and excitation spectra of interacting electrons in partially filled Landau levels

Interacting electrons in flat bands give rise to a variety of quantum phases. One fundamental aspect of such states is the ordering of the various flavours—such as spin or valley—that the electrons can possess and the excitation spectrum of the broken-symmetry states that they form. These properties cannot be probed directly with electrical transport measurements. The zeroth Landau level of monolayer graphene with fourfold spin–valley degeneracy is a model system for such investigations, but the nature of its broken-symmetry states—particularly at partial fillings—is still not understood. Here we demonstrate a non-invasive spectroscopic technique with a scanning tunnelling microscope and use it to perform measurements of the valley polarization of the electronic wavefunctions and their excitation spectrum in the partially filled zeroth Landau level of graphene. We can extract information such as the strength of the Haldane pseudopotentials that characterize the repulsive interactions underlying the fractional quantum states. Our experiments also demonstrate that fractional quantum Hall phases are built upon broken-symmetry states that persist at partial filling. Our experimental approach quantifies the valley phase diagram of the partially filled Landau level as a model flat-band platform, which is applicable to other graphene-based electronic systems

Toxicity and Clinical Results after Proton Therapy for Pediatric Medulloblastoma: A Multi-Centric Retrospective Study

Medulloblastoma is the most common malignant brain tumor in children. Even if current treatment dramatically improves the prognosis, survivors often develop long-term treatment-related sequelae. The current radiotherapy standard for medulloblastoma is craniospinal irradiation with a boost to the primary tumor site and to any metastatic sites. Proton therapy (PT) has similar efficacy compared to traditional photon-based radiotherapy but might achieve lower toxicity rates. We report on our multi-centric experience with 43 children with medulloblastoma (median age at diagnosis 8.7 years, IQR 6.6, M/F 23/20; 26 high-risk, 14 standard-risk, 3 ex-infant), who received active scanning PT between 2015 and 2021, with a focus on PT-related acute-subacute toxicity, as well as some preliminary data on late toxicity. Most acute toxicities were mild and manageable with supportive therapy. Hematological toxicity was limited, even among HR patients who underwent hematopoietic stem-cell transplantation before PT. Preliminary data on late sequelae were also encouraging, although a longer follow-up is needed

Surrogate-free machine learning-based organ dose reconstruction for pediatric abdominal radiotherapy

To study radiotherapy-related adverse effects, detailed dose information (3D distribution) is needed for accurate dose-effect modeling. For childhood cancer survivors who underwent radiotherapy in the pre-CT era, only 2D radiographs were acquired, thus 3D dose distributions must be reconstructed. State-of-the-art methods achieve this by using 3D surrogate anatomies. These can however lack personalization and lead to coarse reconstructions. We present and validate a surrogate-free dose reconstruction method based on Machine Learning (ML). Abdominal planning CTs (n=142) of recently-treated childhood cancer patients were gathered, their organs at risk were segmented, and 300 artificial Wilms' tumor plans were sampled automatically. Each artificial plan was automatically emulated on the 142 CTs, resulting in 42,600 3D dose distributions from which dose-volume metrics were derived. Anatomical features were extracted from digitally reconstructed radiographs simulated from the CTs to resemble historical radiographs. Further, patient and radiotherapy plan features typically available from historical treatment records were collected. An evolutionary ML algorithm was then used to link features to dose-volume metrics. Besides 5-fold cross validation, a further evaluation was done on an independent dataset of five CTs each associated with two clinical plans. Cross-validation resulted in mean absolute errors ≤0.6 Gy for organs completely inside or outside the field. For organs positioned at the edge of the field, mean absolute errors ≤1.7 Gy for Dmean, ≤2.9 Gy for D2cc, and ≤13% for V5Gy and V10Gy, were obtained, without systematic bias. Similar results were found for the independent dataset. To conclude, our novel organ dose reconstruction method is not only accurate, but also efficient, as the setup of a surrogate is no longer needed

Risk Factors for Heart Failure Among Pan-European Childhood Cancer Survivors: A PanCareSurFup and ProCardio Cohort and Nested Case-Control Study.

PURPOSE Heart failure (HF) is a potentially life-threatening complication of treatment for childhood cancer. We evaluated the risk and risk factors for HF in a large European study of long-term survivors. Little is known of the effects of low doses of treatment, which is needed to improve current treatment protocols and surveillance guidelines. METHODS This study includes the PanCareSurFup and ProCardio cohort of ≥ 5-year childhood cancer survivors diagnosed between 1940 and 2009 in seven European countries (N = 42,361). We calculated the cumulative incidence of HF and conducted a nested case-control study to evaluate detailed treatment-related risk factors. RESULTS The cumulative incidence of HF was 2% (95% CI, 1.7 to 2.2) by age 50 years. The case-control study (n = 1,000) showed that survivors who received a mean heart radiation therapy (RT) dose of 5 to < 15 Gy have an increased risk of HF (odds ratio, 5.5; 95% CI, 2.5 to 12.3), when compared with no heart RT. The risk associated with doses 5 to < 15 Gy increased with exposure of a larger heart volume. In addition, the HF risk increased in a linear fashion with higher mean heart RT doses. Regarding total cumulative anthracycline dose, survivors who received ≥ 100 mg/m2 had a substantially increased risk of HF and survivors treated with a lower dose showed no significantly increased risk of HF. The dose-response relationship appeared quadratic with higher anthracycline doses. CONCLUSION Survivors who received a mean heart RT dose of ≥ 5 Gy have an increased risk of HF. The risk associated with RT increases with larger volumes exposed. Survivors treated with < 100 mg/m2 total cumulative anthracycline dose have no significantly increased risk of HF. These new findings might have consequences for new treatment protocols for children with cancer and for cardiomyopathy surveillance guidelines

Obesity prevalence from a European perspective: a systematic review

<p>Abstract</p> <p>Background</p> <p>Obesity has been recognised as an important contributing factor in the development of various diseases, but comparative data on this condition are limited. We therefore aimed to identify and discuss current epidemiological data on the prevalence of obesity in European countries.</p> <p>Methods</p> <p>We identified relevant published studies by means of a MEDLINE search (1990–2008) supplemented by information obtained from regulatory agencies. We only included surveys that used direct measures of weight and height and were representative of each country's overall population.</p> <p>Results</p> <p>In Europe, the prevalence of obesity (body mass index ≥ 30 kg/m²) in men ranged from 4.0% to 28.3% and in women from 6.2% to 36.5%. We observed considerable geographic variation, with prevalence rates in Central, Eastern, and Southern Europe being higher than those in Western and Northern Europe.</p> <p>Conclusion</p> <p>In Europe, obesity has reached epidemic proportions. The data presented in our review emphasise the need for effective therapeutic and preventive strategies.</p

Risk of Subsequent Bone Cancers Among 69 460 Five-Year Survivors of Childhood and Adolescent Cancer in Europe

Introduction: We investigate the risks of subsequent primary bone cancers after childhood and adolescent cancer in 12 European countries. For the first time, we satisfactorily address the risks beyond 40 years from diagnosis and beyond 40 years of age among all survivors. Methods: This largest-ever assembled cohort comprises 69 460 five-year survivors of cancer diagnosed before age 20 years. Standardized incidence ratios, absolute excess risks, and multivariable-adjusted relative risks and relative excess risks were calculated. All statistical tests were two-sided. Results: Overall, survivors were 21.65 times (95% confidence interval ¼ 18.97 to 24.60 times) more likely to be diagnosed with a subsequent primary bone cancer than expected from the general population. The greatest excess numbers of bone cancers were observed after retinoblastoma, bone sarcoma, and soft tissue sarcoma. The excess number of bone cancers declined linearly with both years since diagnosis and attained age (all P < .05). Beyond 40years from diagnosis and age 40 years, there were at most 0.45 excess bone cancers among all survivors per 10000 person-years at risk; beyond 30years from diagnosis and age 30 years, there were at most 5.02 excess bone cancers after each of retinoblastoma, bone sarcoma, and soft tissue sarcoma, per 10000 person-years at risk. Conclusions: For all survivors combined and the cancer groups with the greatest excess number of bone cancers, the excess numbers observed declined with both age and years from diagnosis. These results provide novel, reliable, and unbiased information about risks and risk factors among long-term survivors of childhood and adolescent cancer.</p