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Background: Overall inferior vena cava filter (IVCF) utilization has decreased in the United States since the 2010 US Food and Drug Administration (FDA) safety communication. The FDA renewed this safety warning in 2014 with additional mandates on reporting IVCF-related adverse events. We evaluated the impact of the FDA recommendations on IVCF placements for different indications from 2010 to 2019 and further assessed utilization trends by region and hospital teaching status.Methods: Inferior vena cava filter placements between 2010 and 2019 were identified in the Nationwide Inpatient Sample database using the associated International Classification of Diseases, Ninth Revision, Clinical Modification, and Tenth Revision codes. Inferior vena cava filter placements were categorized by indication for venous thromboembolism (VTE) “treatment” in patients with VTE diagnosis and contraindication to anticoagulation and “prophylaxis” in patients without VTE. Generalized linear regression was used to analyze utilization trends.Results: A total of 823 717 IVCFs were placed over the study period, of which 644 663 (78.3%) were for VTE treatment and 179 054 (21.7%) were for prophylaxis indications. The median age for both categories of patients was 68 years. The total number of IVCFs placed for all indications decreased from 129 616 in 2010 to 58 465 in 2019, with an aggregate decline rate of −8.4%. The decline rate was higher between 2014 and 2019 than between 2010 and 2014 (−11.6% vs −7.2%). From 2010 to 2019, IVCF placement for VTE treatment and prophylaxis trended downward at rates of −7.9% and −10.2%, respectively. Urban nonteaching hospitals saw the highest decline for both VTE treatment (−17.2%) and prophylactic indications (−18.0%). Hospitals located in the Northeast region had the highest decline rates for VTE treatment (−10.3%) and prophylactic indications (−12.5%).Conclusion: The higher decline rate in IVCF placements between 2014 and 2019 compared with 2010 and 2014 suggests an additional impact of the renewed 2014 FDA safety indications on national IVCF utilization. Variations in IVCF use for VTE treatment and prophylactic indications existed across hospital teaching types, locations, and regions.Clinical Impact Inferior vena cava filters (IVCF) are associated with medical complications. The 2010 and 2014 FDA safety warnings appeared to have synergistically contributed to a significant decline in IVCF utilization rates from 2010 – 2019 in the US. IVC filter placements in patients without venous thromboembolism (VTE) declined at a higher rate than VTE. However, IVCF utilization varied across hospitals and geographical locations, likely due to the absence of universally accepted clinical guidelines on IVCF indications and use. Harmonization of IVCF placement guidelines is needed to standardize clinical practice, thereby reducing the observed regional and hospital variations and potential IVC filter overutilization.

Median arcuate ligament syndrome (MALS) is a rarely diagnosed and treated etiology of abdominal pain with no established diagnostic approach. The effectiveness of our institutional protocol in identifying these patients was investigated by analyzing their surgical outcomes.

To explore the association of estimated plasma volume (ePV) and plasma volume status (PVS) as surrogates of volume status with new-onset AKI and in-hospital mortality among hospitalized COVID-19 patients.

This review is devoted to the development of a technique for the fabrication of tubular samples based on needleless electrospinning. Such materials have the potential for use in a wide range of tissue engineering applications including glaucoma drainage devices, vascular grafts, peripheral nerves, and the repair of the urethra. Since needle electrospinning is a time-consuming method, concerning which it is difficult to regulate the ambient conditions, Nanospider technology was employed for the fabrication of the tubular-shaped samples. A special device was constructed and inserted into the electrospinning chamber of the Nanospider machine. The feasibility of the use of the device was proven via electrospinning of polycaprolactone. The testing of the productivity of the needle and the needleless methods proved that needleless technology is four to five times more efficient than the needle electrospinning approach.

The reaction of iodoferrocene (FcI) with tert-butyl or benzyl carbazate gives the protected ferrocenylhydrazines tert-butyl-1-ferrocenylhydrazine-1-carboxylate (1) and benzyl-1-ferrocenylhydrazine-1-carboxylate (2). Air-stable 2was converted to ferrocenylhydrazine (3) by Pd-catalyzed hydrogenolysis under mild conditions in yields of up to 70% (based on the starting FcI). The applicability of 3in the synthesis of heterocycles bearing a Fc–N–N fragment was demonstrated by the preparation of (3,5-dimethylpyrazol-1-yl) ferrrocene (4), (3-trifluoromethyl-5-phenyl-pyrazol-1-yl) ferrrocene (5), (1,2,4-diazaphosphol-1-yl) ferrrocene (6), (1,2,4-diazarsol-1-yl) ferrrocene (7), and 1-ferrocenyl-4,5-dichloro-pyridazin-6-one (8). Condensation of 3with FcCH═O yielded bimetallic ferrocene carboxaldehyde ferrocenylhydrazone (9). Electrochemical studies on this series of ferrocenylated compounds showed that both the hydrazine and protected hydrazine function serve as electron donors, whereas N-bonded heterocycles possess weak electron-withdrawing properties. All compounds studied have been fully characterized by spectroscopic methods and their molecular structures are reported.

Microaggressions are statements or actions taken in a discriminatory manner. Microaggressions can be subtle or explicit, intentional or unintentional, but regardless of the type of microaggressions, it is important to identify and address them, as they are linked to physician burnout and add to levels of depression, anxiety, and stress. In this study, we evaluated the prevalence, quality, and impacts of gender-based microaggressions on surgeons and surgical trainees using simulation-based education. Further, we plan to iteratively develop more simulation sessions based on the findings of this study.

Surgical simulation has come to the forefront to enhance the training of residents. The aim of our scoping review is to analyze the available simulation-based carotid revascularization techniques, including carotid endarterectomy (CEA) and carotid artery stenting (CAS) and suggest critical steps for evaluating competency in a standardized fashion.

Previous studies suggest a coprevalence of intracranial aneurysms (IA) in patients with infrarenal abdominal aortic aneurysms (AAA). We reviewed our multicenter experience in the detection/treatment of IAs in patients with ascending thoracic aortic aneurysms (ATAA) relative to patients without ATAA.

Der freie Gewebetransfer gehört heute zu den Regeleingriffen an allen mund-, kiefer- und gesichtschirurgischen Kliniken mit Schwerpunkt Tumorchirurgie. Die seit Aufkommen dieser Technik erworbene hohe Expertise in der Lappenhebung und mikrovaskulären Anastomosierung führt regelmäßig zu hohen Erfolgsraten und ermöglicht selbst umfangreiche Resektionen mit vorhersagbaren funktionell und ästhetisch zufriedenstellenden Ergebnissen. Besonders bei der Rekonstruktion der Mandibula konnten durch die heute weit verbreiteten virtuellen, patientenspezifischen Planungsmethoden Abläufe und Ergebnisse nochmals verbessert werden. Während somit prinzipiell bei operativ belastbaren Patienten nahezu jeder resektable Tumor chirurgisch angegangen werden kann, bestehen, unabhängig von der onkologischen Gesamtsituation, jedoch weiterhin Herausforderungen, wenn bereits Eingriffe und Bestrahlungen stattgefunden haben. Bei diesen Patienten kann aufgrund eingeschränkter oder fehlender Verfügbarkeit von Anschlussgefäßen ein freier Gewebetransfer methodisch schwierig oder sogar unmöglich sein. In diesem Beitrag werden die wichtigsten Standardlappen sowie Techniken dargestellt, die keinen Routinecharakter haben. Hiermit soll auch die Notwendigkeit der fortwährenden wissenschaftlichen Beschäftigung mit diesem für unser Fachgebiet existenziell wichtigen Thema unterstrichen werden.

The aim of the present study was to assess the current strategies of endovascular and laparoscopic extravascular stenting for symptomatic compression of the left renal vein (LRV), most frequently between the aorta and superior mesenteric artery (nutcracker syndrome [NCS]).

BackgroundThis study aims to define the proportion of Medicare neuroendovascular procedures performed by different specialists from 2013 to 2019, map the geographic distribution of these specialists, and trend reimbursement for these procedures.MethodsThe Medicare Provider Utilization Database was queried for recognized neuroendovascular procedures. Data on specialists and their geographic distribution were tabulated. Reimbursement data were gathered using the Physician Fee Schedule Look-Up Tool and adjusted for inflation using the United States Bureau of Labor Statistics’ Consumer Price Index Inflation calculator.ResultsThe neuroendovascular workforce in 2013 and 2019, respectively, was as follows: radiologists (46% vs 44%), neurosurgeons (45% vs 35%), and neurologists (9% vs 21%). Neurologists increased proportionally (p=0.03). Overall procedure numbers increased across each specialty: radiology (360%; p=0.02), neurosurgery (270%; p<0.01), and neurology (1070%; p=0.03). Neuroendovascular revascularization (CPT 61645) increased in all fields: radiology (170%; p<0.01), neurosurgery (280%; p<0.01), neurology (240%; p<0.01); central nervous system (CNS) permanent occlusion/embolization (CPT61624) in neurosurgery (67%; p=0.03); endovascular temporary balloon artery occlusion (CPT61623) in neurology (29%; p=0.04). In 2019, radiologists were the most common neuroendovascular specialists everywhere except in the Northeast where neurosurgeons predominated. Inflation adjusted reimbursement decreased for endovascular temporary balloon occlusion (CPT61623, −13%; p=0.01), CNS transcatheter permanent occlusion or embolization (CPT61624, −13%; p=0.02), non-CNS transcatheter permanent occlusion or embolization (CPT61626, −12%; p<0.01), and intracranial stent placement (CPT61635, −12%; p=0.05).ConclusionsThe number of neuroendovascular procedures and specialists increased, with neurologists becoming more predominant. Reimbursement decreased. Coordination among neuroendovascular specialists in terms of training and practice location may maximize access to acute care.

BackgroundTransvenous embolization is emerging as a promising treatment for cerebrospinal fluid-venous fistulas (CVF) associated with spontaneous intracranial hypotension (SIH).ObjectiveTo perform an independent validation of the efficacy and safety of the procedure and describe the procedural techniques used at our institution.MethodsA retrospective review was performed including consecutive patients with SIH who had undergone CVF embolization with 3-month clinical and imaging follow-up. Clinical evaluation included the Patient Global Impression of Change (PGIC) Scale and six-item Headache Impact Test (HIT-6). Bern SIH score was used for imaging evaluation on brain MRI. Post-treatment changes in scores were assessed by Wilcoxon signed rank test. Procedural technical details, including use of upper-extremity access and dual-microcatheter pressure cooker technique, were recorded.Results18 patients (13 female, median age 60 years) were included. 17 (94%) procedures were performed with upper-extremity access and 12 (67%) using dual-microcatheter pressure cooker technique. After embolization, 16 (89%) patients reported much or very much improved at follow-up PGIC; median (IQR) HIT-6 score improved from 68 (62–72) to 36 (36–38) and Bern SIH score improved from 8 (6–8) to 3 (1.5–3.5), pvalues <0.001. Side effects were transient embolization site back pain in 15 (83%) and rebound intracranial hypertension requiring medical management in 9 (50%) patients. HIT-6 and Bern SIH score changes were similar between conventional and pressure cooker techniques (pvalues >0.05).ConclusionTransvenous embolization is independently validated as a highly effective and safe treatment for CVF and is feasible using upper-extremity venous access. Dual-microcatheter and balloon/coil pressure cooker techniques may be used to optimize distribution of embolic material and potentially, treatment efficacy.

•Mortality rate in patients with hematologic malignancy with breakthrough COVID-19 is ∼9%, lower than in the prevaccination era.•Patients who received monoclonal antibodies, alone or combined with antivirals, showed a better clinical outcome.

To evaluate and describe the radiographic imaging findings in a series of patients who underwent reintervention after radiation induced carotid artery stenting (RICAS).

Contrast-enhanced US has high accuracy for evaluation of the abdominal aorta after endovascular stent repair of aneurysms, and radiologists should be familiar with how to perform this examination, diagnose endoleaks, and recognize technical challenges.

Abdominal aortic aneurysms account for nearly 9000 deaths annually, with ruptured abdominal aortic aneurysms being the thirteenth leading cause of death in the United States. Abdominal aortic aneurysms can be detected by screening, but a majority are detected incidentally. Visceral artery aneurysms are often discovered incidentally, and treatment is guided by symptoms, etiology, and size. A timely diagnosis and referral to a vascular specialist are essential for timely open or endovascular repair and to ensure successful patient outcomes.

Background and Purpose: To describe the neurological and cerebrovascular findings in patients who tested positive for SARS-CoV-2 and underwent head imaging in ambulatory and inpatient settings.Methods: Consecutive patients aged ≥18 years with SARS-CoV-2 infection diagnosed or treated at Mayo Clinic sites from 3/11/2020 to 7/23/2020 with head CT or brain MRI within 30 days of SARS-CoV-2 diagnosis were included. Demographics, medical history, indication for SARS-CoV-2 testing, neurologic symptoms, indication for brain imaging, neuroimaging findings, etiology of cerebrovascular events, and hospital course were abstracted from medical records.Results: Of 8,675 patients with SARS-CoV-2, 180 (2.07%) had head imaging. Mean age of the entire cohort was 42 ± 18 years, whereas mean age of those with head imaging was 62 ± 19 years. Common indications for imaging were headache (34.4%), encephalopathy (33.4%), focal neurologic symptom (16.7%), and trauma (13.9%). While 86.1% of patients who underwent head imaging had normal exams, cerebrovascular events occurred in 18 patients (0.21% of the total cohort). Of patients with cerebrovascular events, 8 (44.5%) had acute infarct; 6 (33.3%), acute intracranial hemorrhage; 5 (2.8%), subacute infarct; and 1 (0.6%) posterior reversible encephalopathy syndrome. In the thirteen patients with ischemic stroke, 6 (46.2%) had cryptogenic stroke; 3 (23.1%), other defined causes; 2 (15.4%), small vessel stroke; 1 (7.7%), large vessel stroke; and 1 (7.7%) cardioembolic stroke.Conclusion: In ambulatory and hospitalized patients with SARS-CoV-2 infection, the rate of head imaging is low, with common indications of encephalopathy and headache. Cerebrovascular events occurred rarely, and cryptogenic stroke was the most common stroke mechanism.

A growing interest in the circular economy concept has pushed the discourse in various management-related disciplines beyond established boundaries, with calls to better address how such a model may be developed in a world of global value chains. Still, the conventional linear economy model continues to dominate business, society, and research. While the concept of better connecting physical output and input flows at multiple production or consumption levels is becoming more accepted, it remains unclear how to make this happen while ensuring that sustainability targets are met or exceeded. Multiple scientific communities contribute different perspectives to this discourse, with promising opportunities for research. Circular economy and sustainability from business and economics perspectives are multifaceted. The existing body of knowledge needs to be advanced to assist private individuals, business managers, investors, or policymakers in making informed decisions. In this article for the inaugural issue, we provide a snapshot of the discourses among those who have studied the circular economy and its related topics. We outline conceptual inroads and potential research questions to encourage further circular economy and sustainability research and discourse from business or economics perspectives as well as from the broader transdisciplinary angle. We propose three research pathways: (1) connecting output with input needs in a global circular economy; (2) beyond today’s business logic for a global circular economy; and (3) inclusion of the Global South in North-dominated circular economies. For each, we propose concepts, theories, or methodological approaches and offer various perspectives from the micro, macro, and meso levels.

This study aimed to review short- and long-term outcomes of all carotid artery stenting (CAS) in patients with radiation-induced (RI) internal carotid artery (ICA) stenosis compared with patients with atherosclerotic stenosis (AS).

Scientific evidence in medicine is based on data generated from research. Recently, the number of scientifically active physicians has decreased, which has led to the development of the Clinician Scientist Programs. To better structure and focus the research of young physicians, we aimed to investigate the impact of collaborations and other factors on the quality and output of scientific publications.

Experimental and cross-linguistic studies have shown that vocal iconicityis prevalent in words that carry meanings related to sizeand shape. Although these studies demonstrate the importance of vocal iconicity and reveal the cognitive biases underpinning it, there is less work demonstrating how these biases lead to the evolution of a sound symbolic lexicon in the first place. In this study, we show how words can be shaped by cognitive biases through cultural evolution. Using a simple experimental setup resembling the game telephone, we examined how a single word form changed as it was passed from one participant to the next by a process of immediate iterated learning. About 1,500 naïve participants were recruited online and divided into five condition groups. The participants in the control-group received no information about the meaning of the word they were about to hear, while the participants in the remaining four groups were informed that the word meant either bigor small(with the meaning being presented in text), or roundor pointy(with the meaning being presented as a picture). The first participant in a transmission chain was presented with a phonetically diverse word and asked to repeat it. Thereafter, the recording of the repeated word was played for the next participant in the same chain. The sounds of the audio recordings were then transcribed and categorized according to six binary sound parameters. By modelling the proportion of vowels or consonants for each sound parameter, the small-condition showed increases of front unroundedvowels and the pointy-condition increases of acuteconsonants. The results show that linguistic transmission is sufficient for vocal iconicity to emerge, which demonstrates the role non-arbitrary associations play in the evolution of language.

The adverse gender disparities for women after open abdominal aortic aneurysm (AAA) repair have been well documented. The purpose of this study is to review whether these disparities extend to elective endovascular aneurysm repair (EVAR).

To review the sex differences among symptomatic and asymptomatic patients treated with carotid endarterectomy (CEA) and carotid artery stenting (CAS) in the Southeastern Vascular Study Group (SEVSG), a regional quality group of the Vascular Quality Initiative (VQI).

Poly-ε-caprolactone nanofibrous polymer has been used as an alternative to restricted access media for extraction of protein-containing biological samples and direct transfer in the chromatographic system. Three commercial cartridges differing in length and internal diameter have been manually packed with the composite material prepared from poly-ε-caprolactone nanofibers coated on poly-ε-caprolactone microfibrous scaffold and connected to the column-switching chromatographic system. Bovine milk and human serum (25 μL) spiked with a mixture of methyl-, ethyl-, propyl-, and butylparaben in a concentration range of 1–100 μg mL–1were online extracted using the cartridge-containing fibers. Then, 5 and 20% (v/v) aqueous methanol was applied as the washing mobile phase. While the ballast protein macromolecules were quantitatively eluted from the nano/microfibrous composite sorbent, the parabens were retained. After the mobile phase was switched to a stronger one, these compounds were then eluted from the extraction sorbent, directed in the analytical column, and finally separated. An extraction efficiency of 86–101% for all parabens achieved using the optimum-sized cartridge and a repeatability of the extraction procedure of 0.06–1.95% RSD were obtained.

A magnetic stirring device allowing semidispersive solid phase extraction of eight bisphenols (A, AF, AP, C, BP, G, M, and Z) from river waters using polymer nano- and microfibers followed by HPLC with spectrophotometric detection has been developed and applied. About 50 mg of fibers was placed in a round, cage-like housing consisting of two identical 3D printed pieces that were locked together by a magnetic stirring bar. Magnetic stirring action of the cage devices enabled highly efficient interaction of the fibers housed inside with the aqueous samples and analyte transfer without risking fiber compaction and/or damaging. Polypropylene was found to be the best-suited filament material for the cage 3D printing, and polycaprolactone fibers appeared the most efficient sorbent out of eight tested polymers. Experimental design revealed that analytes extraction from 100 mL aqueous samples was completed within 50 min and stripping in methanol required less than 35 min. Cage housing enabled simple and robust handling of the fibrous sorbent that could be used repeatedly up to at least 5 times. Procedural repeatability was less than 5% RSD, and limits of detection and quantitation were 0.1–2.1 and 0.4–7.0 μg L–1, respectively. Analyte recoveries at 50 μg L–1level ranged from 87.1% to 106.5% in the analysis of two spiked river and two lake waters.

Multiple studies have demonstrated the benefits of creating arteriovenous fistulas (AVFs) under regional anesthesia. This is most likely because of the avoidance of hemodynamic instability and stress response of general anesthesia, as well as the sympathectomy associated with brachial plexus blockade. As vein diameter is the major limiting factor for primary AVF creation and maturation, our aim is to investigate if the vasodilation that accompanies regional anesthesia leads to improved patency and maturation rate of autologous AVF and improved patency of arteriovenous graft (AVG) compared with those placed under general anesthesia.

Nutcracker syndrome (NCS) describes the symptomatic compression of the left renal vein between the aorta and superior mesenteric artery. Whereas asymptomatic compression is a common radiological finding, patients with NCS can report a range of symptoms. There are no specific diagnostic criteria and interventions include a range of open surgical and endovascular procedures. Therefore, we wished to develop an international consensus document covering aspects of diagnosis, management, and follow-up for patients with NCS.

The simultaneous evaluation of the PES and valence synchrotron photoionization studies complemented by the results of quantum chemical calculations offers unusually detailed insights into the valence ionization processes of small covalent molecules. Thus, methyl thiochloroformate, ClC(O)SCH3, has been investigated by using results from both photoelectron spectroscopy (PES) and synchrotron radiation in the valence energy range. In an additional series of experiments, total ion yield (TIY) and photoelectron−photoion coincidence (PEPICO) spectra have been recorded. Furthermore, the relative yields for ionic fragments have been determined as a function of the photon energy. Vibronic structure has been observed in the TIY spectrum recorded in the synchrotron experiments. The photodissociation behavior of ClC(O)SCH3can be divided into two well-defined energy regions.

Pure methoxycarbonylsulfenyl cyanide, CH3OC(O)SCN (I), and methoxycarbonylsulfenyl thiocyanate, CH3OC(O)SSCN (II), were prepared by reacting liquid CH3OC(O)SCl with either AgCN or AgSCN, respectively. Compounds I and II were characterized by 1H NMR, CG−MS, and vibrational (FTIR and FT-Raman) techniques. The conformational properties have been studied by using vibrational spectroscopy [infrared (gaseous, liquid, and Ar matrix isolated), Raman (liquid) spectroscopy] together with quantum chemical calculations at the B3LYP and MP2 methods with the extended 6-311++G** and aug-cc-pVTZ basis sets. Compound I exhibits a conformational equilibrium at room temperature having the most stable form Cssymmetry with a synperiplanar (syn) orientation of the carbonyl double bond (CO) with respect to both the CH3O− and −SCN groups (syn−syn). Several bands assigned to a second conformer have been observed in the IR matrix spectra. This rotamer presents an antiperiplanar orientation of the thiocyanate group (syn−anti). Evaluating the equilibrium compositions at different temperatures by quenching the gas phase mixtures as Ar matrices allowed us to determine the conformational enthalpy difference ΔH0= H0(syn−anti)− H0(syn−syn)= 0.80(18) kcal mol−1. A similar conformational behavior has been determined for compound II. Thermodynamic properties were also computed at the high-level G2MP2 and G3 model chemistry methods. The importance of mesomeric (resonance) and anomeric (hyperconjugation) electronic interaction in the conformational behavior is evaluated by using the NBO approach for both species.

Both photoelectron spectroscopy (PES) data and PhotoElectron-PhotoIon-Coincidence (PEPICO) spectra obtained from a synchrotron facility have been used to examine the electronic structure and the dissociative ionization of halomethyl thiocyantes in the valence and shallow-core S 2p and Cl 2p regions. Two simple and closely related molecules, namely, CCl3SCN and CCl2FSCN, have been analyzed to assess the role of halogen substitution in the electronic properties of thiocyanates. The assignment of the He(I) photoelectron spectra has been achieved with the help of quantum chemical calculations at the outer-valence Green’s function (OVGF) level of approximation. The first ionization energies observed at 10.55 and 10.78 eV for CCl3SCN and CCl2FSCN, respectively, are assigned to ionization processes from the sulfur lone pair orbital [n(S)]. When these molecules are compared with CX3SCN (X = H, Cl, F) species, a linear relationship between the vertical first ionization energy and electronegativity of CX3group is observed. Irradiation of CCl3SCN and CCl2FSCN with photons in the valence energy regions leads to the formation of CCl2X+and CClXSCN+ions (X = Cl or F). Additionally, the achievement of the fragmentation patterns and the total ion yield spectra obtained from the PEPICO data in the S 2p and Cl 2p regions and several dissociation channels can be inferred for the core-excited species by using the triple coincidence PEPIPICO (PhotoElectron-PhotoIon-PhotoIon-Coincidence) spectra.

Ergonomic microbreaks such as the OR-Stretch can address work-related musculoskeletal pain among surgeons and potentially alleviate burnout and early retirement. Fifteen surgeons at a single institution completed two operative cases using the OR-Stretch, once using the Scheduled (every 45 min) timing strategy and once using the Self-Determined (between 30 and 60 min based on surgeon preference) strategy. Eight surgeons preferred the Scheduled timing strategy, and seven preferred Self-Determined (p= .80). The stretch was skipped 16% of the time using the Scheduled strategy and 6% with the Self-Determined strategy (p= .18). Personal interest, improved mental focus, and ease of remembering were cited as the most influential factors for continued usage, while the most influential factor for not continuing was forgetting to use it. Self-determined intervals for intraoperative microbreaks represent a valid and potentially preferable implementation approach. Efforts to promote long-term adoption of microbreaks should focus on reminding surgeons to use them during operations.

ABSTRACTPD-L1 status assessed by immunohistochemistry (IHC) has failed to reliably predict outcomes for patients with metastatic urothelial carcinoma (mUC) on immune checkpoint blockade (ICB). PD-L1promoter methylation is an epigenetic mechanism that has been shown to regulate PD-L1mRNA expression in various malignancies. The aim of our present study was to evaluate the predictive potential of PD-L1promoter methylation status (mPD-L1) in ICB-treated mUC compared to conventional IHC-based PD-L1 assessment. We quantified mPD-L1in formalin-fixed and paraffin-embedded tissue sections using an established quantitative methylation-specific PCR assay (qMSP) in a well-characterized multicenter ICB-treated cohort comprising N = 107 patients with mUC. Additionally, PD-L1 protein expression in tumor tissues was assessed using regulatory approved IHC protocols. The effect of pharmacological hypomethylation by the DNA methyltransferase inhibitor decitabine in combination with interferon-γ stimulation in urothelial carcinoma cell lines was investigated by IHC and FACS. mPD-L1hypomethylation predicted objective response rate at the first staging on ICB. Patients with tumors categorized as PD-L1hypomethylated (lower quartile) showed significantly prolonged progression-free (PFS) and overall survival (OS) after ICB initiation. In contrast, PD-L1 protein expression status neither correlated with response nor survival. In multivariable Cox regression analyses, PD-L1promoter hypermethylation remained an independent predictor of unfavorable PFS and OS. In urothelial carcinoma cell lines, pharmacological demethylation led to an upregulation of membranous PD-L1 expression and an enhanced inducibility of PD-L1 expression by interferon γ. Hypomethylation of the PD-L1promoter is a promising predictive biomarker for response to ICB in patients with mUC.

Graphical Abstract:

Training and assessment outside of the operating room is crucial for minimally invasive surgery due to steep learning curves. Thus, we have developed and validated the sensor- and expert model-based laparoscopic training system, the iSurgeon. Participants of different experience levels (novice, intermediate, expert) performed four standardized laparoscopic knots. Instruments and surgeons’ joint motions were tracked with an NDI Polaris camera and Microsoft Kinect v1. With frame-by-frame image analysis, the key steps of suturing and knot tying were identified and registered with motion data. Construct validity, concurrent validity, and test–retest reliability were analyzed. The Objective Structured Assessment of Technical Skills (OSATS) was used as the gold standard for concurrent validity. The system showed construct validity by discrimination between experience levels by parameters such as time (novice = 442.9 ± 238.5 s; intermediate = 190.1 ± 50.3 s; expert = 115.1 ± 29.1 s; p< 0.001), total path length (novice = 18,817 ± 10318 mm; intermediate = 9995 ± 3286 mm; expert = 7265 ± 2232 mm; p< 0.001), average speed (novice = 42.9 ± 8.3 mm/s; intermediate = 52.7 ± 11.2 mm/s; expert = 63.6 ± 12.9 mm/s; p< 0.001), angular path (novice = 20,573 ± 12,611°; intermediate = 8652 ± 2692°; expert = 5654 ± 1746°; p< 0.001), number of movements (novice = 2197 ± 1405; intermediate = 987 ± 367; expert = 743 ± 238; p< 0.001), number of movements per second (novice = 5.0 ± 1.4; intermediate = 5.2 ± 1.5; expert = 6.6 ± 1.6; p= 0.025), and joint angle range (for different axes and joints all p< 0.001). Concurrent validity of OSATS and iSurgeon parameters was established. Test–retest reliability was given for 7 out of 8 parameters. The key steps “wrapping the thread around the instrument” and “needle positioning” were most difficult to learn. Validity and reliability of the self-developed sensor-and expert model-based laparoscopic training system “iSurgeon” were established. Using multiple parameters proved more reliable than single metric parameters. Wrapping of the needle around the thread and needle positioning were identified as difficult key steps for laparoscopic suturing and knot tying. The iSurgeon could generate automated real-time feedback based on expert models which may result in shorter learning curves for laparoscopic tasks. Our next steps will be the implementation and evaluation of full procedural training in an experimental model.

The authors studied Staticenames derived from the Tournefortianum “Limonium Lusitanicum, Auriculae Ursi folio”. The name S. auriculaeursifolia, basionym of the accepted Limonium auriculaeursifolium, is typified by a specimen in Lamarck's herbarium in Paris. The controversial name S. auriculifolia, often regarded as a synonym of L. auriculaeursifolium, corresponds instead to L. nydeggeri, employed for a narrowly endemic plant of Portugal, and has priority over that name. Statice auriculifoliais lectotypified by a specimen in Tournefort's herbarium. In addition, the related names S. lychnidifolia, S. willdenovii(both illegitimate and synonyms of L. auriculaeursifolium), and S. ovalifoliumare discussed. Finally, the taxon to which the invalid name “L. ovalifoliumsubsp. gallicum” has been applied, has a legitimate name at the specific rank: L. gallicumDomina. This latter name, however, is a taxonomic synonym of L. ovalifolium.

Synchrotron-based total ion yield and photoelectron–photoion-coincidence spectra have been applied to investigate the electronic structure and the dissociative ionization of gaseous O,S-dimethyl xanthate, CH3OC(S)SCH3, in the shallow-core S 2p region. The spectral assignment and the electronic structure are interpreted in terms of the most stable synperiplanar conformer in the Cssymmetry point group. The use of tunable synchrotron radiation allows for a selective excitation of sulfur atoms at different photon energy values, including resonance transitions and ionization around the S 2p level. The fragmentation patterns show that the title molecule is well suited as a laboratory precursor of ionic species found in the interstellar medium, especially formyl and thioformyl cations, HCO+and HCS+, respectively.

Sex-related differences in outcomes have been identified in patients with peripheral artery disease (PAD). We hypothesized that women with PAD would have equivalent inpatient mortality with men after vascular intervention.

The observation of quantum light emission from atomically thin transition metal dichalcogenides has opened a new field of applications for these material systems. The corresponding excited charge-carrier localization has been linked to defects and strain, while open questions remain regarding the microscopic origin. We demonstrate that the bending rigidity of these materials leads to wrinkling of the two-dimensional layer. The resulting strain field facilitates strong carrier localization due to its pronounced influence on the band gap. Additionally, we consider charge carrier confinement due to local changes of the dielectric environment and show that both effects contribute to modified electronic states and optical properties. The interplay of surface wrinkling, strain-induced confinement, and local changes of the dielectric environment is demonstrated for the example of nanobubbles that form when monolayers are deposited on substrates or other two-dimensional materials.