Isothermal annealing of radiation defects in silicon bulk material of diodes from 8” silicon wafers

The high luminosity upgrade of the LHC will provide unique physics opportunities, such as the observation of rare processes and precision measurements. However, the accompanying harsh radiation environment will also pose unprecedented challenged to the detector performance and hardware. In this paper, we study the radiation induced damage and its macroscopic isothermal annealing behaviour of the bulk material from new 8" silicon wafers using diode test structures. The sensor properties are determined through measurements of the diode capacitance and leakage current for three thicknesses, two material types, and neutron fluences from 6.5 · 10$^{14}$ to 1 · 10$^{16}$ n$_{eq}$/cm$^2$

Efficacy and Safety of Rivaroxaban for Postoperative Thromboprophylaxis in Patients After Bariatric Surgery: A Randomized Clinical Trial.

IMPORTANCE Venous thromboembolism (VTE) is a leading cause of morbidity and mortality after bariatric surgery. Clinical end point studies on thromboprophylaxis with direct oral anticoagulants in patients undergoing bariatric surgery are lacking. OBJECTIVE To assess the efficacy and safety of a prophylactic dose of 10 mg/d of rivaroxaban for both 7 and 28 days after bariatric surgery. DESIGN, SETTING, AND PARTICIPANTS This assessor-blinded, phase 2, multicenter randomized clinical trial was conducted from July 1, 2018, through June 30, 2021, with participants from 3 academic and nonacademic hospitals in Switzerland. INTERVENTION Patients were randomized 1 day after bariatric surgery to 10 mg of oral rivaroxaban for either 7 days (short prophylaxis) or 28 days (long prophylaxis). MAIN OUTCOMES AND MEASURES The primary efficacy outcome was the composite of deep vein thrombosis (symptomatic or asymptomatic) and pulmonary embolism within 28 days after bariatric surgery. Main safety outcomes included major bleeding, clinically relevant nonmajor bleeding, and mortality. RESULTS Of 300 patients, 272 (mean [SD] age, 40.0 [12.1] years; 216 women [80.3%]; mean body mass index, 42.2) were randomized; 134 received a 7-day and 135 a 28-day VTE prophylaxis course with rivaroxaban. Only 1 thromboembolic event (0.4%) occurred (asymptomatic thrombosis in a patient undergoing sleeve gastrectomy with extended prophylaxis). Major or clinically relevant nonmajor bleeding events were observed in 5 patients (1.9%): 2 in the short prophylaxis group and 3 in the long prophylaxis group. Clinically nonsignificant bleeding events were observed in 10 patients (3.7%): 3 in the short prophylaxis arm and 7 in the long prophylaxis arm. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, once-daily VTE prophylaxis with 10 mg of rivaroxaban was effective and safe in the early postoperative phase after bariatric surgery in both the short and long prophylaxis groups. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03522259

Randomized, double-blind, placebo-controlled crossover trial of once daily empagliflozin 25 mg for the treatment of postprandial hypoglycaemia after Roux-en-Y gastric bypass.

Aims To investigate the effect of empagliflozin on glucose dynamics in individuals suffering from postbariatric hypoglycaemia (PBH) after Roux-en-Y gastric bypass (RYGB). Methods Twenty-two adults with PBH after RYGB were randomized to empagliflozin 25 mg or placebo once daily over 20 days in a randomized, double-blind, placebo-controlled, crossover trial. The primary efficacy outcome was the amplitude of plasma glucose excursion (peak to nadir) during a mixed meal tolerance test (MMTT). Outcomes of the outpatient period were assessed using continuous glucose monitoring (CGM) and an event-tracking app. Results The amplitude of glucose excursion during the MMTT was 8.1±2.4 mmol/L with empagliflozin vs 8.1±2.6 mmol/L with placebo (mean±SD, p=0.807). CGM-based mean amplitude of glucose excursion (MAGE) during the 20 day-period was lower with empagliflozin than placebo (4.8±1.3 vs 5.2±1.6. p=0.028). Empagliflozin reduced the time spent with CGM values >10.0 mmol/L (3.8±3.5 % vs. 4.7±3.8 %, p =0.009), but not the time spent with CGM values <3.0 mmol/L (1.7±1.6 % vs. 1.5±1.5 %, p=0.457). No significant difference was observed in the quantity and quality of recorded symptoms. Eleven adverse events occurred with empagliflozin (three drug-related) and six with placebo. Conclusions Empagliflozin 25 mg reduces glucose excursions but not hypoglycaemia in individuals with PBH

Randomized, Double-Blind, Placebo-Controlled Crossover Trial of Once Daily Empagliflozin 25 mg for the Treatment of Postprandial Hypoglycemia After Roux-en-Y Gastric Bypass

Aims: To investigate the effect of empagliflozin on glucose dynamics in individuals suffering from postbariatric hypoglycemia (PBH) after Roux-en-Y gastric bypass (RYGB). Methods: Twenty-two adults with PBH after RYGB were randomized to empagliflozin 25 mg or placebo once daily over 20 days in a randomized, double-blind, placebo-controlled, crossover trial. The primary efficacy outcome was the amplitude of plasma glucose excursion (peak to nadir) during a mixed-meal tolerance test (MMTT). Outcomes of the outpatient period were assessed using continuous glucose monitoring (CGM) and an event-tracking app. Results: The amplitude of glucose excursion during the MMTT was 8.1 ± 2.4 mmol/L with empagliflozin versus 8.1 ± 2.6 mmol/L with placebo (mean ± standard deviation, P = 0.807). CGM-based mean amplitude of glucose excursion during the 20-day period was lower with empagliflozin than placebo (4.8 ± 1.3 vs. 5.2 ± 1.6. P = 0.028). Empagliflozin reduced the time spent with CGM values >10.0 mmol/L (3.8 ± 3.5% vs. 4.7 ± 3.8%, P = 0.009), but not the time spent with CGM values <3.0 mmol/L (1.7 ± 1.6% vs. 1.5 ± 1.5%, P = 0.457). No significant difference was observed in the quantity and quality of recorded symptoms. Eleven adverse events occurred with empagliflozin (three drug-related) and six with placebo. Conclusions: Empagliflozin 25 mg reduces glucose excursions but not hypoglycemia in individuals with PBH

Counter-regulatory responses to postprandial hypoglycaemia in patients with post-bariatric hypoglycaemia vs surgical and non-surgical control individuals

Aims/hypothesis Post-bariatric hypoglycaemia is an increasingly recognised complication of bariatric surgery, manifesting particularly after Roux-en-Y gastric bypass. While hyperinsulinaemia is an established pathophysiological feature, the role of counter-regulation remains unclear. We aimed to assess counter-regulatory hormones and glucose fluxes during insulin-induced postprandial hypoglycaemia in patients with post-bariatric hypoglycaemia after Roux-en-Y gastric bypass vs surgical and non-surgical control individuals. Methods In this case–control study, 32 adults belonging to four groups with comparable age, sex and BMI (patients with post-bariatric hypoglycaemia, Roux-en-Y gastric bypass, sleeve gastrectomy and non-surgical control individuals) underwent a postprandial hypoglycaemic clamp in our clinical research unit to reach the glycaemic target of 2.5 mmol/l 150–170 min after ingesting 15 g of glucose. Glucose fluxes were assessed during the postprandial and hypoglycaemic period using a dual-tracer approach. The primary outcome was the incremental AUC of glucagon during hypoglycaemia. Catecholamines, cortisol, growth hormone, pancreatic polypeptide and endogenous glucose production were also analysed during hypoglycaemia. Results The rate of glucose appearance after oral administration, as well as the rates of total glucose appearance and glucose disappearance, were higher in both Roux-en-Y gastric bypass groups vs the non-surgical control group in the early postprandial period (all p<0.05). During hypoglycaemia, glucagon exposure was significantly lower in all surgical groups vs the non-surgical control group (all p<0.01). Pancreatic polypeptide levels were significantly lower in patients with post-bariatric hypoglycaemia vs the non-surgical control group (median [IQR]: 24.7 [10.9, 38.7] pmol/l vs 238.7 [186.3, 288.9] pmol/l) (p=0.005). Other hormonal responses to hypoglycaemia and endogenous glucose production did not significantly differ between the groups. Conclusions/interpretation The glucagon response to insulin-induced postprandial hypoglycaemia is lower in post-bariatric surgery individuals compared with non-surgical control individuals, irrespective of the surgical modality. No significant differences were found between patients with post-bariatric hypoglycaemia and surgical control individuals, suggesting that impaired counter-regulation is not a root cause of post-bariatric hypoglycaemia

Fostering physical activity-related health competence after bariatric surgery with a multimodal exercise programme: A randomised controlled trial.

Regular physical activity (PA) supports the long-term success of bariatric surgery. However, integrating health-enhancing physical activity in daily life requires specific competences. In this study, we evaluated a multimodal exercise programme to build these competences.Forty adults who underwent bariatric surgery were randomised to a multimodal exercise programme or control group. Primary outcomes were the facets of PA-related health competences, namely the control competence for physical training, PA-specific affect regulation, motivational competence and PA-specific self-control. Secondary outcomes were PA behaviour and subjective vitality. Outcomes were assessed before, directly after the intervention and at 3 months follow-up.Significant treatment effects were found for control competence for physical training and PA-specific self-control but not for PA-specific affect regulation and motivational competence. Significant treatment effects were further observed for self-reported exercise and subjective vitality, all in favour of the intervention group. In contrast, no treatment effect was found for device-based PA. Overall, this study provides a foundation for future research to optimise long-term post bariatric surgery outcomes

The impact of postbariatric hypoglycaemia on driving performance: A randomized, single-blind, two-period, crossover study in a driving simulator

Postbariatric hypoglycemia (PBH) is an increasingly recognized complication of bariatric surgery, but its effect on daily functioning remains unclear. In this randomized single-blind crossover trial we assessed driving performance in patients with PBH. Ten active drivers with PBH (8 females, age 38.2 ± 14.7 years, BMI 27.2 ± 4.6 kg/m2) received 75 g glucose to induce PBH in the late postprandial period and aspartame to leave glycemia unchanged, on two different occasions. A simulator was driven during 10 min before (D0) and 20 (D1), 80 (D2), 125 (D3) and 140 min (D4) after the glucose/aspartame ingestion, reflecting the expected blood glucose (BG) increase (D1), decrease (D2), and hypoglycemia (D3, D4). Seven driving features indicating impaired driving were integrated in a Bayesian hierarchical regression model to assess the difference in driving performance after glucose/aspartame ingestion. Mean ± standard deviation peak and nadir BG after glucose were 182 ± 24 and 47 ± 14 mg/dL, while BG was stable after aspartame (85 ± 4 mg/dL). Despite the lack of a difference in symptom perception, driving performance was significantly impaired after glucose vs. aspartame during D4 (posterior probability 98.2%). Our findings suggest that PBH negatively affects driving performance.ISSN:1462-8902ISSN:1463-132

BARiatric Basic Questionnairy for Traditional Chinese Medicine. Interest in complementary medicine in 789 obese patients from Austria, Switzerland and Germany

Aims: Obesity is the major multifactorial metabolic burden of the 21st century. Complementary and Alternative Medicine (CAM) including Traditional Chinese Medicine (TCM) add to the multidisciplinary treatment options. Aim of the study was to investigate the interest in TCM among bariatric patients. Methods: From April 2017, 789 patients from Germany (D: 265), Austria (A: 126) and Switzerland (CH: 398) answered the anonymous BARBQTCM questionnaires in the outpatient wards of the obesity centres. Age (median 46y), sex (female: 67.8%), Body Mass Index (BMI: median 37kg/m2; IQR: 30-44) and prior experience with CAM (414: 52.5%) were assessed. Results: 672 respondents (85.2%) had professional nutritional counselling, 602 underwent diverse dietary programs (76.3%). Nearly half of the Swiss tried out weight loss drugs (D-A-CH: 22.3% vs. 25.4% vs. 48.0%; p<0.05). 522 patients (66.2%) underwent bariatric surgery: gastric banding (61/522: 11.7%), sleeve gastrectomy (187/522: 35.8%), Y-Roux (227/522: 43.5%) and Omega-Loop (47/522: 9.0%) gastric bypass. 166 respondents (31.8%) reported weight regain (>10 kilograms) after bariatric surgery. 659 respondents (83.5%) were interested in TCM. Top-3 indications for TCM therapy included weight problems (505/659: 76.6%) followed by chronic fatigue (439/659: 66.6%) and joint complaints (399/659: 60.5%). Austrians were least interested in eastern therapies: TCM nutritional advices (D-A-CH: 53.4% vs. 41.3% vs. 53.0%; p<0.05), acupuncture (D-A-CH: 43.8% vs. 30.2% vs. 48.5%; p<0.05) and herbal therapy (D-A-CH: 31.3% vs. 30.2% vs. 35.7%; n.s.). Conclusions: TCM has developed as important option in the interest of obese people. Standardized programs have to be offered to face the therapeutic challenge, especially in Austria

pVHL is a regulator of glucose metabolism and insulin secretion in pancreatic β cells

Insulin secretion from pancreatic β cells is stimulated by glucose metabolism. However, the relative importance of metabolizing glucose via mitochondrial oxidative phosphorylation versus glycolysis for insulin secretion remains unclear. von Hippel-Lindau (VHL) tumor suppressor protein, pVHL, negatively regulates hypoxia-inducible factor HIF1α, a transcription factor implicated in promoting a glycolytic form of metabolism. Here we report a central role for the pVHL–HIF1α pathway in the control of β-cell glucose utilization, insulin secretion, and glucose homeostasis. Conditional inactivation of Vhlh in β cells promoted a diversion of glucose away from mitochondria into lactate production, causing cells to produce high levels of glycolytically derived ATP and to secrete elevated levels of insulin at low glucose concentrations. Vhlh-deficient mice exhibited diminished glucose-stimulated changes in cytoplasmic Ca2+ concentration, electrical activity, and insulin secretion, which culminate in impaired systemic glucose tolerance. Importantly, combined deletion of Vhlh and Hif1α rescued these phenotypes, implying that they are the result of HIF1α activation. Together, these results identify pVHL and HIF1α as key regulators of insulin secretion from pancreatic β cells. They further suggest that changes in the metabolic strategy of glucose metabolism in β cells have profound effects on whole-body glucose homeostasis

GNN-based end-to-end reconstruction in the CMS Phase 2 High-Granularity Calorimeter

We present the current stage of research progress towards a one-pass, completely Machine Learning (ML) based imaging calorimeter reconstruction. The model used is based on Graph Neural Networks (GNNs) and directly analyzes the hits in each HGCAL endcap. The ML algorithm is trained to predict clusters of hits originating from the same incident particle by labeling the hits with the same cluster index. We impose simple criteria to assess whether the hits associated as a cluster by the prediction are matched to those hits resulting from any particular individual incident particles. The algorithm is studied by simulating two tau leptons in each of the two HGCAL endcaps, where each tau may decay according to its measured standard model branching probabilities. The simulation includes the material interaction of the tau decay products which may create additional particles incident upon the calorimeter. Using this varied multiparticle environment we can investigate the application of this reconstruction technique and begin to characterize energy containment and performance.We present the current stage of research progress towards a one-pass, completely Machine Learning (ML) based imaging calorimeter reconstruction. The model used is based on Graph Neural Networks (GNNs) and directly analyzes the hits in each HGCAL endcap. The ML algorithm is trained to predict clusters of hits originating from the same incident particle by labeling the hits with the same cluster index. We impose simple criteria to assess whether the hits associated as a cluster by the prediction are matched to those hits resulting from any particular individual incident particles. The algorithm is studied by simulating two tau leptons in each of the two HGCAL endcaps, where each tau may decay according to its measured standard model branching probabilities. The simulation includes the material interaction of the tau decay products which may create additional particles incident upon the calorimeter. Using this varied multiparticle environment we can investigate the application of this reconstruction technique and begin to characterize energy containment and performance