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Objectives: To compare clinical success, procedure time, and complication rates between MRI-guided and CT-guided real-time biopsies of small focal liver lesions (FLL) < 20 mm. Methods: A comparison of a prospectively collected MRI-guided cohort (n = 30) to a retrospectively collected CT-guided cohort (n = 147) was performed, in which patients underwent real-time biopsies of small FLL < 20 mm in a freehand technique. In both groups, clinical and periprocedural data, including clinical success, procedure time, and complication rates (classified according to CIRSE guidelines), were analyzed. Wilcoxon rank sum test, Pearson's chi-squared test, and Fisher's exact test were used for statistical analysis. Additionally, propensity score matching (PSM) was performed using the following criteria for direct matching: age, gender, presence of liver cirrhosis, liver lobe, lesion diameter, and skin-to-target distance. Results: The median FLL diameter in the MRI-guided cohort was significantly smaller compared to CT guidance (p < 0.001; 11.0 mm vs. 16.3 mm), while the skin-to-target distance was significantly longer (p < 0.001; 90.0 mm vs. 74.0 mm). MRI-guided procedures revealed significantly higher clinical success compared to CT guidance (p = 0.021; 97% vs. 79%) as well as lower complication rates (p = 0.047; 0% vs. 13%). Total procedure time was significantly longer in the MRI-guided cohort (p < 0.001; 38 min vs. 28 min). After PSM (n = 24/n = 38), MRI-guided procedures still revealed significantly higher clinical success compared to CT guidance (p = 0.039; 96% vs. 74%). Conclusion: Despite the longer procedure time, freehand biopsy of small FLL < 20 mm under MR guidance can be considered superior to CT guidance because of its high clinical success and low complication rates. Clinical relevance statement: Biopsy of small liver lesions is challenging due to the size and conspicuity of the lesions on native images. MRI offers higher soft tissue contrast, which translates into a higher success of obtaining enough tissue material with MRI compared to CT-guided biopsies. Key Points: • Image-guided biopsy of small focal liver lesions (FLL) is challenging due to inadequate visualization, leading to sampling errors and false-negative biopsies. • MRI-guided real-time biopsy of FLL < 20 mm revealed significantly higher clinical success (p = 0.021; 97% vs. 79%) and lower complication rates (p = 0.047; 0% vs. 13%) compared to CT guidance. • Although the procedure time is longer, MRI-guided biopsy can be considered superior for small FLL < 20 mm. [ABSTRACT FROM AUTHOR]

To prepare very-long-chain fatty acids and alkenes (VLCFAs and VLC alkenes) that are known pollinator attractants for sexually deceptive orchids, and biosynthetic precursors thereof, we applied a methodology allowing us to prepare monounsaturated VLCFAs with chain lengths up to 28 carbons and VLC alkenes up to 31 carbons. We implemented a coupling reaction between commercially available terminal alkynes and bromoalkanoic acids to prepare VLCFAs, allowing the products to be formed in two steps. For VLC alkenes, with many alkyltriphenylphosphonium bromides commercially available, we applied a Wittig reaction approach to prepare (Z)-configured monoenes in a single step. Using practical methods not requiring special reagents or equipment, we obtained 11 VLCFAs in > 90% isomeric purity, and 17 VLC alkenes in > 97% isomeric purity. Such general and accessible synthetic methods are essential for chemical ecology and biochemistry research to aid researchers in unambiguously identifying isolated semiochemicals and their precursors. [ABSTRACT FROM AUTHOR]

The prone position is an immediately available and easily implemented procedure that was introduced more than 50 years ago as a method for improvement of gas exchange in patients with acute respiratory distress syndrome (ARDS). In the meantime, a survival advantage could also be shown in patients with severe ARDS, which led to the recommendation of the prone position for treatment of severe ARDS by expert consensus and specialist society guidelines. The continuing coronavirus disease 2019 (COVID-19) pandemic moved the prone position to the forefront of medicine, including the widespread implementation of the prone position for awake, spontaneously breathing nonintubated patients with acute hypoxemic respiratory insufficiency. The survival advantage is possible due to a reduction of the ventilator-associated lung damage. In this article, the physiological effects, data on clinical results, practical considerations and open questions with respect to the prone position are discussed. [ABSTRACT FROM AUTHOR]

Pollinator-driven evolution of floral traits is thought to be a major driver of angiosperm speciation and diversification. Ophrys orchids mimic female insects to lure male pollinators into pseudocopulation. This strategy, called sexual deception, is species-specific, thereby providing strong premating reproductive isolation. Identifying the genomic architecture underlying pollinator adaptation and speciation may shed light on the mechanisms of angiosperm diversification. Here, we report the 5.2 Gb chromosome-scale genome sequence of Ophrys sphegodes. We find evidence for transposable element expansion that preceded the radiation of the O. sphegodes group, and for gene duplication having contributed to the evolution of chemical mimicry. We report a highly differentiated genomic candidate region for pollinator-mediated evolution on chromosome 2. The Ophrys genome will prove useful for investigations into the repeated evolution of sexual deception, pollinator adaptation and the genomic architectures that facilitate evolutionary radiations. Pollinator-driven evolution of floral traits is thought to be a major driver of angiosperm speciation and diversification. Here, the authors assemble the chromosome-scale genome of the sexually deceptive orchid Ophrys sphegodes and reveal insights into sexual deception and pollinator adaptation. [ABSTRACT FROM AUTHOR]

Objectives: While the impact of treatment with 5-alpha Reductase Inhibitors (5-ARI) on the risk of cancer-related mortality in men with prostate cancer (PC) has been extensively studied, little is known about the impact of preoperative 5-ARI use on patient-reported outcomes (PROs) following radical prostatectomy (RP). Methods: Within our prospectively maintained institutional database of 5899 patients treated with RP for PC (2008– 2021), 99 patients with preoperative 5-ARI therapy were identified. A 1:4 propensity-score matched analysis of 442 men (n = 90 5-ARI, n = 352 no 5-ARI) was conducted. Primary endpoint was continence recovery using daily pad usage and ICIQ-SF. Health-related quality of life (HRQOL) was assessed using the validated EORTC QLQ-C30 and PR25 questionnaires. Multivariable Cox-regression-models tested the effect of preoperative 5-ARI treatment on continence-recovery (p < 0.05). Results: Patients were followed up perioperatively, followed by annual assessments up to 60mo postoperatively. Preoperative mean ICIQ-SF score (2.2 vs. 0.9) was significantly higher in the 5-ARI cohort (p = 0.006). 24mo postoperatively, 68.6% (no 5-ARI) vs. 55.7% (5-ARI) had full continence recovery (p = 0.002). Multivariable Cox regression analysis, revealed preoperative 5-ARI treatment as an independent predictor for impaired continence recovery (HR 0.50, 95% CI 0.27–0.94, p = 0.03) In line, general HRQOL was significantly higher for patients without 5-ARI only up to 24mo postoperatively (70.6 vs. 61.2, p = 0.045). There was no significant impact of preoperative 5-ARI treatment on erectile function, biochemical recurrence-free survival and metastasis-free survival. Conclusions: Pre-RP 5-ARI treatment was associated with impaired continence outcomes starting 24mo postoperatively, suggesting that preoperative 5-ARI treatment can impair the long-term urinary function recovery following RP. [ABSTRACT FROM AUTHOR]

Objectives: To determine a data-based optimal annual radical cystectomy (RC) hospital volume threshold and evaluate its clinical significance regarding perioperative mortality, complications, length of hospital stay, and hospital revenues. Material and methods: We used the German Nationwide inpatient Data, provided by the Research Data Center of the Federal Bureau of Statistics (2005–2020). 95,841 patients undergoing RC were included. Based on ROC analyses, the optimal RC threshold to reduce mortality, ileus, sepsis, transfusion, hospital stay, and costs is 54, 50, 44, 44, 71 and 76 cases/year, respectively. Therefore, we defined an optimal annual hospital threshold of 50 RCs/year, and we also used the threshold of 20 RCs/year proposed by the EAU guidelines to perform multiple patient-level analyses. Results: 28,291 (29.5%) patients were operated in low- (< 20 RC/year), 49,616 (51.8%) in intermediate- (20–49 RC/year), and 17,934 (18.7%) in high-volume (≥ 50 RC/year) centers. After adjusting for major risk factors, high-volume centers were associated with lower inpatient mortality (OR 0.72, 95% CI 0.64–0.8, p < 0.001), shorter length of hospital stay (2.7 days, 95% CI 2.4–2.9, p < 0.001) and lower costs (457 Euros, 95% CI 207–707, p < 0.001) compared to low-volume centers. Patients operated in low-volume centers developed more perioperative complications such as transfusion, sepsis, and ileus. Conclusions: Centralization of RC not only improves inpatient morbidity and mortality but also reduces hospital stay and costs. We propose a threshold of 50 RCs/year for optimal outcomes. [ABSTRACT FROM AUTHOR]

The naked mole rat (NMR), Heterocephalus glaber, the longest-living rodent, provides a unique opportunity to explore how evolution has shaped adult stem cell (ASC) activity and tissue function with increasing lifespan. Using cumulative BrdU labelling and a quantitative imaging approach to track intestinal ASCs (Lgr5+) in their native in vivo state, we find an expanded pool of Lgr5+ cells in NMRs, and these cells specifically at the crypt base (Lgr5+CBC) exhibit slower division rates compared to those in short-lived mice but have a similar turnover as human LGR5+CBC cells. Instead of entering quiescence (G0), NMR Lgr5+CBC cells reduce their division rates by prolonging arrest in the G1 and/or G2 phases of the cell cycle. Moreover, we also observe a higher proportion of differentiated cells in NMRs that confer enhanced protection and function to the intestinal mucosa which is able to detect any chemical imbalance in the luminal environment efficiently, triggering a robust pro-apoptotic, anti-proliferative response within the stem/progenitor cell zone. Authors report that long-term intestinal tissue maintenance in naked mole rats is achieved by having an expanded pool of slow-dividing adult stem cells while a higher proportion of differentiated cells confer enhanced function and protection to the intestinal mucosa. [ABSTRACT FROM AUTHOR]

Battery fast charging is pivotal for broader acceptance of electric mobility. While demonstrated for lithium titanate (Li 4 Ti 5 O 12 , LTO) anodes, the underlying mechanisms are still poorly understood. Recently, NMR T 1 relaxation time constants of 7 Li in the bulk of LTO were found to change if the surrounding electrolyte was altered. It was explained by interdiffusion of mobile lithium ions between the two phases, facilitated by unpinning of polarons from surface defects and leading to a pseudocapacitive effect that potentially influences fast charging. This effect is explored further by systematically varying the lithium salt concentration in an aprotic electrolyte in contact with LTO. Spectrally resolved 7 Li T 1 NMR relaxation times were used as a measure for bulk concentration changes of paramagnetic polaronic charges in LTO. Correlation of electrolyte concentration and 7 Li T 1 showed qualitatively different behavior above and below a salt concentration of about 5 mM, leading to a relaxation dispersion maximum in the LTO bulk. At intermediate concentrations, relaxation was consistent with a 7 Li exchange equilibrium between LTO and electrolyte. Upon contact of the two phases, yet without insertion into an electrochemical cell or applying an external potential, lithium ions redistributed between LTO bulk and liquid electrolyte. The results can be understood analogously to the distribution of mobile lithium ions between two phases separated by a Li + permeable membrane. This is the first demonstration of such an equilibrium for non-faradaic lithium exchange at an interface between a solid ceramic electrode and a liquid electrolyte outside an electrochemical cell, substantiating our previous hypothesis of a polaron-supported mechanism. This study provides a basis for more quantitative (surface)-defect engineering, which is key to optimize battery fast-charging properties. [ABSTRACT FROM AUTHOR]

Transmission electron microscopy (TEM) is essential for determining atomic scale structures in structural biology and materials science. In structural biology, three-dimensional structures of proteins are routinely determined from thousands of identical particles using phase-contrast TEM. In materials science, three-dimensional atomic structures of complex nanomaterials have been determined using atomic electron tomography (AET). However, neither of these methods can determine the three-dimensional atomic structure of heterogeneous nanomaterials containing light elements. Here, we perform ptychographic electron tomography from 34.5 million diffraction patterns to reconstruct an atomic resolution tilt series of a double wall-carbon nanotube (DW-CNT) encapsulating a complex ZrTe sandwich structure. Class averaging the resulting tilt series images and subpixel localization of the atomic peaks reveals a Zr11Te50 structure containing a previously unobserved ZrTe2 phase in the core. The experimental realization of atomic resolution ptychographic electron tomography will allow for the structural determination of a wide range of beam-sensitive nanomaterials containing light elements. Transmission electron microscopy is essential for three-dimensional atomic structure determination, but solving complex heterogeneous structures containing light elements remains challenging. Here, authors solve a complex nanostructure using atomic resolution ptychographic electron tomography. [ABSTRACT FROM AUTHOR]

Objective and background: Catheter-based treatment of patients with ventricular arrhythmias (VA) reduces VA and mortality in selected patients. With regard to potential risks of catheter ablation, a benefit–risk assessment should be carried out. This can be performed with risk scores such as the recently published "Risk in Ventricular Ablation (RIVA) Score". We sought to validate this score and to test for possible additional predictors in a large database of VT ablations. Methods and results: We analyzed 1964 catheter ablations for VA in patients with (1069; 54.4%) and without (893, 45.6%) structural heart disease (SHD) and observed an overall major adverse event rate of 4.0% with an in-hospital mortality of 1.3% with significantly less complications occurring in patients without structural heart disease (6.5% vs. 1.1%; p ≤ 0.01). The RIVA Score demonstrated to be a valid predictive tool for major in-hospital complications (OR 1.18; 95% CI 1.12, 1.25; p ≤ 0.001). NYHA Class ≥ III (OR 2.5; 95% CI 1.5, 4.2; p < 0.001) and age (OR 1.04; 95% CI 1.02, 1.07; p ≤ 0.001) proved to be additional predictive parameters. Hence, a modified RIVA Score (mRIVA) model was analyzed with a subset of established predictors (SHD, eGFR, epicardial puncture) as well as new predictive parameters (age, NYHA Class ≥ III), that achieved a higher predictive value for major complications compared with the model based on all RIVA variables. Conclusion: Adding age and functional heart failure status (NYHA class) as simple clinical parameters to the recently published RIVA Score increases the predictive value for ablation-associated complications in a large VT ablations registry. [ABSTRACT FROM AUTHOR]

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Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: For transjugular intrahepatic portosystemic shunt (TIPS) creation, ultrasound guidance for portal vein puncture is strongly recommended. However, outside regular hours of service, a skilled sonographer might be lacking. Hybrid intervention suites combine CT imaging with conventional angiography allowing to project 3D information into the conventional 2D imaging and further CT-fluoroscopic puncture of the portal vein. The purpose of this study was to assess whether TIPS using angio-CT facilitates the procedure for a single interventional radiologist. Methods: All TIPS procedures from 2021 and 2022 which took place outside regular working hours were included (n = 20). Ten TIPS procedures were performed with just fluoroscopy guidance and ten procedures using angio-CT. For the angio-CT TIPS, a contrast-enhanced CT was performed on the angiography table. From the CT, a 3D volume was created using virtual rendering technique (VRT). The VRT was blended with the conventional angiography image onto the live monitor and used as guidance for the TIPS needle. Fluoroscopy time, area dose product, and interventional time were assessed. Results: Hybrid intervention with angio-CT did lead to a significantly shorter fluoroscopy time and interventional time (p = 0.034 for both). Mean radiation exposure was significantly reduced, too (p = 0.04). Furthermore, the mortality rate was lower in patients who underwent the hybrid TIPS (0% vs 33%). Conclusion: TIPS procedure in angio-CT performed by only one interventional radiologist is quicker and reduces radiation exposure for the interventionalist compared to mere fluoroscopy guidance. The results further indicate increased safety using angio-CT. Clinical relevance statement: This study aimed to evaluate the feasibility of using angio-CT in TIPS procedures during non-standard working hours. Results indicated that the use of angio-CT significantly reduced fluoroscopy time, interventional time, and radiation exposure, while also leading to improved patient outcomes. Key Points: • Image guiding such as ultrasound is recommended for transjugular intrahepatic portosystemic shunt creation but might be not available for emergency cases outside of regular working hours. • Transjugular intrahepatic portosystemic shunt creation using an angio-CT with image fusion is feasible for only one physician under emergency settings and results in lower radiation exposure and faster procedures. • Transjugular intrahepatic portosystemic shunt creation using an angio-CT with image fusion seems to be safer than using mere fluoroscopy guidance. [ABSTRACT FROM AUTHOR]

Copyright of Innere Medizin (2731-7080) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Cardiohepatic syndrome (CHS) has been identified as an important but underrecognized survival predictor in multiple cardiovascular disease entities. The objectives of this study were to evaluate the prevalence and prognostic value of CHS in patients undergoing TAVR for severe aortic stenosis (AS). Methods: The study included patients with available laboratory parameters of hepatic function who underwent TAVR from July 2013 until December 2019 at our center. CHS was defined as an elevation of at least two of three laboratory cholestasis parameters above the upper limit of normal (bilirubin, alkaline phosphatase, and gamma glutamyl transferase). Study endpoints were three-year survival, technical and device failure (VARC 3), as well as New York Heart Association (NYHA) functional class at follow-up. Results: Among a total of 953 analyzed patients (47.6% females, median age 80.0 [76.0–85.0] years) CHS was present in 212 patients (22.4%). In patients with vs. without CHS, rates of technical (6.1% vs. 8.4%, p = 0.29) and device failure (18.9% vs. 17.3%, p = 0.59) were comparable. NYHA functional class at baseline and follow-up was more severe in patients with CHS. Nevertheless, heart failure symptoms improved from baseline to follow-up irrespective of hepatic function. Three-year survival rates were significantly lower in patients with CHS (49.4 vs. 65.4%, p < 0.001). The predictive value of CHS persisted after adjustment in a multivariable analysis (hazard ratio 1.58, p < 0.01). Conclusion: In patients undergoing TAVR, CHS is prevalent in 22% of patients and is associated with increased postinterventional mortality. Thus, CHS should be included in the decision-making process within the TAVR heart team. Cardiohepatic syndrome (CHS) as defined by an elevation of at least two of three laboratory cholestasis parameters above the upper limit of normal was prevalent in 22% of patients undergoing TAVR for severe AS. The presence of CHS was associated with more severe heart failure symptoms and worse three-year survival. [ABSTRACT FROM AUTHOR]

Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this paper, we present the first comprehensive survey of window types for stream processing systems which have been presented in research and commercial systems. We cover publications from the most relevant conferences, journals, and system whitepapers on stream processing, windowing, and window aggregation which have been published over the last 20 years. For each window type, we provide detailed specifications, formal notations, synonyms, and use-case examples. We classify each window type according to categories that have been proposed in literature and describe the out-of-order processing. In addition, we examine academic, commercial, and open-source systems with respect to the window types that they support. Our survey offers a comprehensive overview that may serve as a guideline for the development of stream processing systems, window aggregation techniques, and frameworks that support a variety of window types. [ABSTRACT FROM AUTHOR]

Objectives: Mindfulness-based interventions (MBIs) have been successfully applied to persons with dementia (PwD) and their caregivers and may yield beneficial effects on depression and quality of life. However, due to inconsistent results, it may be beneficial to re-examine mindfulness in PwD cross-sectionally to identify further potential therapeutic target variables. Rumination, the maladaptive disposition to excessively think about causes and consequences of symptoms and negative mood, may represent such a target. The current study sought to confirm the validity of trait rumination and the antagonistic relationship between mindfulness, rumination, and depression in PwD and their caregivers, as this may qualify rumination as a potential process and outcome variable in future MBIs. Method: Forty patients with mild dementia completed a neuropsychological examination and provided self-report data on trait mindfulness, depression, and rumination. Self-report measures were also obtained from 30 caregivers. Regression analyses were used to examine the relation between mindfulness, depression, and rumination. We used clinical cutoffs for depression and rumination to estimate the practical implications of the opposing relationships between these variables. Results: For PwD, mindfulness was significantly negatively correlated with depression and rumination, explaining 37% and 25% of variance, respectively. In PwD with low mindfulness scores, clinical depression and rumination syndromes occurred more frequently than in those with high mindfulness. Caregiver results were compatible. Conclusion: Mindfulness shows an antagonistic relationship with clinically relevant rumination in PwD. Rumination may represent a relevant clinical outcome variable for future MBIs that can be reliably measured in PwD through validated self-report measures. Preregistration: This study is not preregistered. [ABSTRACT FROM AUTHOR]

It is of general interest to combine the faradaic processes based high energy density of a battery with the non-faradaic processes based high power density of a capacitor in one cell. Surface area and functional groups of electrode materials strongly affect these properties. For the anode material Li4Ti5O12 (LTO), we suggest a polaron based mechanism that influences Li ion uptake and mobility. Here we show electrolytes containing a lithium salt induce an observable change in the bulk NMR relaxation properties of LTO nano particles. The longitudinal 7Li NMR relaxation time of bulk LTO can change by almost an order of magnitude and, therefore, reacts very sensitively to the cation and its concentration in the surrounding electrolyte. The reversible effect is largely independent of the used anions and of potential anion decomposition products. It is concluded that lithium salt containing electrolytes increase the mobility of surface polarons. These polarons and additional lithium cations from the electrolyte can now diffuse through the bulk, induce the observed enhanced relaxation rate and enable the non-faradaic process. This picture of a Li+ ion equilibrium between electrolyte and solid may help with improving the charging properties of electrode materials. The surface chemistries of electrode materials strongly influence their faradaic and non-faradaic properties. Here, the anode material Li4Ti5O12 is probed in the presence of different electrolytes, and surface polarons are suggested to enable a Li ion equilibrium between the bulk and the electrolyte, explaining the role of defects for intercalative pseudocapacity and fast charging properties in this material. [ABSTRACT FROM AUTHOR]

We systematically review the effectiveness of police presence. In doing so, we investigate concepts of police presence and differences between reported effects. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and protocols, we systematically identify and review eligible studies on police presence. Further, quality assessment and findings synthesis are used to map limitations of current research as well as grounds for future avenues. The systematic search strategies yielded 49 studies focusing on testing the effects of police presence or evaluating its measurement. We find evidence that police presence has mostly crime reduction effects on crimes related to motor theft, property, violence and guns. Police presence also reduces calls for service and improves traffic behaviour. Police presence focused on specific areas, times and types of crime achieves maximum effectiveness. The reviewed studies show a high degree of heterogeneity in reporting which limits comparability of findings across studies. Research on police presence presents evidence for significant crime preventative effects of focused police actions and shows strongest effects when focused on certain areas, times, or types of crimes. We encourage future research to focus on police presence en route and its effects, including crime prevention, traffic regulation and fear of crime. [ABSTRACT FROM AUTHOR]

Copyright of Notfall & Rettungsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: The aim of this study was to analyse the predictive value of CTA-determined tricuspid annular dilatation (TAD) on the persistence of tricuspid regurgitation (TR) in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) and concomitant at least moderate TR. Methods and results: 288 consecutive patients treated with TAVR due to severe AS and concomitant at least moderate TR at baseline were included in the analysis. As cutoff for TAD, the median value of the CTA-determined, to the body surface area-normalized tricuspid annulus diameter (25.2 mm/m2) was used. TAD had no impact on procedural characteristics or outcomes, including procedural death and technical or device failure according to the Valve Academic Research Consortium 3 criteria. However, the primary outcome of the study—TR persistence after TAVR was significantly more frequent in patients with compared to patients without TAD (odds ratio 2.60, 95% confidence interval 1.33–5.16, p < 0.01). Multivariable logistic regression analysis, adjusting for clinical and echocardiographic baseline characteristics, which are known to influence aetiology or severity of TR, confirmed TAD as an independent predictor of TR persistence after TAVR (adjusted odds ratio 2.30, 95% confidence interval 1.20–4.46, p = 0.01). Moreover, 2 year all-cause mortality was significantly higher in patients with persistence or without change of TR compared to patients with TR improvement (log-rank p < 0.01). Conclusion: In patients undergoing TAVR for severe AS and concomitant at least moderate TR at baseline, TAD is a predictor of TR persistence, which is associated with increased 2-year all-cause mortality. [ABSTRACT FROM AUTHOR]

Background: Besides other factors, complication rate of transarterial interventions depends on the size of the vascular access. Therefore, the vascular access is mostly chosen as small as possible while still allowing all planned parts of the intervention. This retrospective analysis is to evaluate the safety and feasibility of sheathless arterial interventions for a broad spectrum of interventions in daily practice. Methods: All sheathless interventions using a 4 F main catheter between May 2018 and September 2021 were included in the evaluation. Additionally, intervention parameters such as type of catheter, use of microcatheter and required change of main catheters were assessed. Information about the use about sheathless approach and catheters were obtained from the material registration system. All catheters were braided. Results: 503 sheathless interventions with 4 F catheters from the groin were documented. The spectrum comprised bleeding embolization, diagnostic angiographies, arterial DOTA-TATE-therapy, uterine fibroid embolization, transarterial chemotherapy, transarterial radioembolization and others. In 31 cases (6 %) a change of the main catheter was required. In 381 cases (76 %) a microcatheter was utilized. No clinically relevant adverse events were observed (grade 2 or higher [CIRSE AE-classification]). None of the cases later required conversion to a sheath-based intervention. Conclusions: Sheathless interventions with a 4 F braided catheter from the groin are safe and feasible. It allows for a broad spectrum of interventions in daily practice. [ABSTRACT FROM AUTHOR]

Letter to the Editor [ABSTRACT FROM AUTHOR]

The Oman upwelling zone (OUZ) creates an unfavorable environment and a major biogeographic barrier for many coral reef species, such as giant clams, thus promoting and maintaining faunal differences among reefs on the east and west side of the Arabian Peninsula. We record the former existence of Tridacna in the Gulf of Oman and review its stratigraphic distribution in the Persian Gulf to provide new insights on the connectivity of coral reef habitats around southern Arabia under changing climate and ocean conditions. Fossil shells were carbon-14 dated and employed as sclerochronological proxy archives. This reveals that the Omani population represents a last glacial colonization event during the Marine Isotope Stage 3 interstadial under colder-than-present temperatures and variable upwelling intensity linked to Dansgaard-Oeschger climate oscillations. It was favored by temperatures just above the lower threshold for the habitat-forming reef coral communities and instability of the upwelling barrier. We conclude that the distribution of Tridacna in the northern Arabian Sea is generally limited by either strong upwelling or cool sea surface temperature under gradually changing climate conditions at the interglacial-glacial scale. Opportunities for dispersal and temporary colonization existed only when there was a simultaneous attenuation of both limiting factors due to high-frequency climate variability. The OUZ will unlikely become a future climate change refuge for giant clams because they will be exposed either to thermal stress by rapid anthropogenic Indian Ocean warming or to unfavorable upwelling conditions. [ABSTRACT FROM AUTHOR]

The assumption that economic resources are equally shared within households has been found to be untenable for income but is still often upheld for wealth. In this introduction to the special issue "Wealth in Couples", we argue that within-household inequality in wealth is a pertinent and under-researched area that is ripe for development. To this end, we outline the relevance of wealth for demographic research, making the distinction between individual and household wealth. Drawing on a life-course perspective, we discuss individual wealth accumulation within couples and its links to family-demographic processes, the institutional context, and norms on pooling and sharing. We conclude with a brief summary of the main findings from the special issue and highlight implications for demographic research and for future research in this field. [ABSTRACT FROM AUTHOR]

This study examines the money-subjective well-being nexus by studying the link between changes in jointly and solely (i.e. respondents' own and their partner's own) held gross wealth and changes in married individuals' subjective well-being. Joint assets reflect norms of sharing responsibilities and resources. Solely held assets, in contrast, offer individual economic independence. Using wealth data from the German Socio-Economic Panel Study (SOEP; 2002, 2007, 2012, 2017), we estimate individual fixed effects regressions. Although coefficients for all three wealth measures are positive, our results highlight that only increases in jointly held wealth are associated with statistically significant increases in spouses' life satisfaction in Germany. Despite expectations about a stronger relevance of joint wealth for men compared to women in line with men's role as a financial provider for the family, we do not find substantial gender differences in the positive association between increases in joint wealth and life satisfaction. In light of the individualisation of marriages, our results highlight that the personal benefits associated with marital sharing of wealth seem to trump those of economic independence and financial autonomy. [ABSTRACT FROM AUTHOR]

Metal-organic layers (MOLs) are highly attractive for application in catalysis, separation, sensing and biomedicine, owing to their tunable framework structure. However, it is challenging to obtain comprehensive information about the formation and local structures of MOLs using standard electron microscopy methods due to serious damage under electron beam irradiation. Here, we investigate the growth processes and local structures of MOLs utilizing a combination of liquid-phase transmission electron microscopy, cryogenic electron microscopy and electron ptychography. Our results show a multistep formation process, where precursor clusters first form in solution, then they are complexed with ligands to form non-crystalline solids, followed by the arrangement of the cluster-ligand complex into crystalline sheets, with additional possible growth by the addition of clusters to surface edges. Moreover, high-resolution imaging allows us to identify missing clusters, dislocations, loop and flat surface terminations and ligand connectors in the MOLs. Our observations provide insights into controllable MOL crystal morphology, defect engineering, and surface modification, thus assisting novel MOL design and synthesis. Obtaining information about the structure of metal-organic layers (MOLs) using standard electron microscopy methods is challenging due to damage under electron beam irradiation. Here, the authors reveal a multistep formation process of MOLs and identify missing clusters, dislocations, loop and flat surface terminations and ligand connector of MOLs via complementary electron microscopy techniques. [ABSTRACT FROM AUTHOR]

Rod-shaped bacteria typically elongate and divide by transverse fission. However, several bacterial species can form rod-shaped cells that divide longitudinally. Here, we study the evolution of cell shape and division mode within the family Neisseriaceae, which includes Gram-negative coccoid and rod-shaped species. In particular, bacteria of the genera Alysiella, Simonsiella and Conchiformibius, which can be found in the oral cavity of mammals, are multicellular and divide longitudinally. We use comparative genomics and ultrastructural microscopy to infer that longitudinal division within Neisseriaceae evolved from a rod-shaped ancestor. In multicellular longitudinally-dividing species, neighbouring cells within multicellular filaments are attached by their lateral peptidoglycan. In these bacteria, peptidoglycan insertion does not appear concentric, i.e. from the cell periphery to its centre, but as a medial sheet guillotining each cell. Finally, we identify genes and alleles associated with multicellularity and longitudinal division, including the acquisition of amidase-encoding gene amiC2, and amino acid changes in proteins including MreB and FtsA. Introduction of amiC2 and allelic substitution of mreB in a rod-shaped species that divides by transverse fission results in shorter cells with longer septa. Our work sheds light on the evolution of multicellularity and longitudinal division in bacteria, and suggests that members of the Neisseriaceae family may be good models to study these processes due to their morphological plasticity and genetic tractability. Rod-shaped bacteria typically elongate and divide by transverse fission, but a few species are known to divide longitudinally. Here, the authors use genomic, phylogenetic and microscopy techniques to shed light on the evolution of cell shape, multicellularity and division mode within the family Neisseriaceae. [ABSTRACT FROM AUTHOR]

In model-based systems engineering projects, engineers from multiple domains collaborate by establishing a common system model. Multi-level modeling is a technique that can be used to model the development from abstract ideas to concrete implementations. However, current multi-level modeling approaches are not adequate for processes with multiple modeling phases that might have to be rearranged later. In this paper, we introduce multi-phase modeling that utilizes concepts of multi-level modeling by considering a description of the expected phase ordering per domain. Constraints aware of this context can express that certain elements are only valid in specific phases without having to determine a concrete phase ordering for a particular model. This enables using multi-phase modeling in flexible workflows, adapting to changing requirements and the definition of access rules in domain notation. We show feasibility of this multi-phase modeling by applying it to multiple real-life systems engineering projects of the aerospace domain. [ABSTRACT FROM AUTHOR]

This study examines the prevalence of marital contracts across marriage cohorts (1990–2019) in Germany. We further investigate the characteristics of spouses who signed a marital contract. Using cross-sectional data from the German Family Panel (pairfam, 2018/19), we employ complementary log–log and multinomial logistic regression models to predict the prevalence and the type of marital contracts. The results show that 5% of all married couples opt out of the default matrimonial property regime by signing a contract in Germany. Differentiating between contract types, most couples either specify a separation of property (40%) or modify the default community of accrued gains (31%). We find an increase in the prevalence of marital contracts across marriage cohorts. The decision to opt out of the default is strongly positively associated with self-employment that often requires the customisation of asset ownership structures within marriage. Married individuals with prior divorce experiences are more likely to opt for the separation of property, indicating that the awareness of the economic consequences of divorce promotes the individualisation of marriage. Our results are in line with the cross-national trend towards customised marriages, although the trend in Germany is less pronounced than in other countries. [ABSTRACT FROM AUTHOR]

Window aggregations and windowed joins are central operators of modern real-time analytic workloads and significantly impact the performance of stream processing systems. This paper gives an overview of state-of-the-art research in this area conducted by the Berlin Institute for the Foundations of Learning and Data (BIFOLD) and the Technische Universität Berlin. To this end, we present different algorithms for efficiently processing windowed operators and discuss techniques for distributed stream processing. Recently, several approaches have leveraged modern hardware for windowed stream processing, which we will also include in this overview. Additionally, we describe the integration of windowed operators into various stream processing systems and diverse applications that use specialized window operations. [ABSTRACT FROM AUTHOR]

The Internet of Things (IoT) presents a novel computing architecture for data management: a distributed, highly dynamic, and heterogeneous environment of massive scale. Applications for the IoT introduce new challenges for integrating the concepts of fog and cloud computing as well as sensor networks in one unified environment. In this paper, we present early approaches that address parts of the overall problem space. All approaches are incorporated into NebulaStream (NES), our novel data processing platform that addresses the heterogeneity, unreliability, and scalability challenges of the IoT and thus provides efficient data management for future applications. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the differentiation of premalignant from benign colorectal polyps detected by CT colonography using deep learning. Methods: In this retrospective analysis of an average risk colorectal cancer screening sample, polyps of all size categories and morphologies were manually segmented on supine and prone CT colonography images and classified as premalignant (adenoma) or benign (hyperplastic polyp or regular mucosa) according to histopathology. Two deep learning models SEG and noSEG were trained on 3D CT colonography image subvolumes to predict polyp class, and model SEG was additionally trained with polyp segmentation masks. Diagnostic performance was validated in an independent external multicentre test sample. Predictions were analysed with the visualisation technique Grad-CAM++. Results: The training set consisted of 107 colorectal polyps in 63 patients (mean age: 63 ± 8 years, 40 men) comprising 169 polyp segmentations. The external test set included 77 polyps in 59 patients comprising 118 polyp segmentations. Model SEG achieved a ROC-AUC of 0.83 and 80% sensitivity at 69% specificity for differentiating premalignant from benign polyps. Model noSEG yielded a ROC-AUC of 0.75, 80% sensitivity at 44% specificity, and an average Grad-CAM++ heatmap score of ≥ 0.25 in 90% of polyp tissue. Conclusions: In this proof-of-concept study, deep learning enabled the differentiation of premalignant from benign colorectal polyps detected with CT colonography and the visualisation of image regions important for predictions. The approach did not require polyp segmentation and thus has the potential to facilitate the identification of high-risk polyps as an automated second reader. Key Points: • Non-invasive deep learning image analysis may differentiate premalignant from benign colorectal polyps found in CT colonography scans. • Deep learning autonomously learned to focus on polyp tissue for predictions without the need for prior polyp segmentation by experts. • Deep learning potentially improves the diagnostic accuracy of CT colonography in colorectal cancer screening by allowing for a more precise selection of patients who would benefit from endoscopic polypectomy, especially for patients with polyps of 6–9 mm size. [ABSTRACT FROM AUTHOR]

The formation of strongly correlated fermion pairs is fundamental for the emergence of fermionic superfluidity and superconductivity1. For instance, Cooper pairs made of two electrons of opposite spin and momentum at the Fermi surface of the system are a key ingredient of Bardeen–Cooper–Schrieffer (BCS) theory—the microscopic explanation of the emergence of conventional superconductivity2. Understanding the mechanism behind pair formation is an ongoing challenge in the study of many strongly correlated fermionic systems3. Controllable many-body systems that host Cooper pairs would thus be desirable. Here we directly observe Cooper pairs in a mesoscopic two-dimensional Fermi gas. We apply an imaging scheme that enables us to extract the full in situ momentum distribution of a strongly interacting Fermi gas with single-particle and spin resolution4. Our ultracold gas enables us to freely tune between a completely non-interacting, unpaired system and weak attractions, where we find Cooper pair correlations at the Fermi surface. When increasing the attractive interactions even further, the pairs gradually turn into deeply bound molecules that break up the Fermi surface. Our mesoscopic system is closely related to the physics of nuclei, superconducting grains or quantum dots5–7. With the precise control over the interactions, particle number and potential landscape in our experiment, the observables we establish in this work provide an approach for answering longstanding questions concerning not only such mesoscopic systems but also their connection to the macroscopic world.Precise control over the quantum state of a two-dimensional Fermi gas together with single-particle-resolved fluorescence imaging enables the direct observation of the formation of Cooper pairs at the Fermi surface. [ABSTRACT FROM AUTHOR]

Clinical and laboratory data on newly described staphylococcal species is rare, which hampers decision-making when such pathogens are detected in clinical specimens. Here, we describe Staphylococcus massiliensis detected in three patients at a university hospital in southwest Germany. We report the discrepancy of microbiological findings between matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, 16S-rRNA polymerase chain reaction, and whole-genome sequencing for all three isolates. Our findings highlight the diagnostic pitfalls pertinent to novel and non-model organisms in daily microbiological practice, in whom the correct identification is dependent on database accuracy. [ABSTRACT FROM AUTHOR]

To meet the modern demands for lightweight construction and energy efficiency, hard-to-machine materials such as ceramics, superalloys, and fiber-reinforced plastics are being used progressively. These materials can only be machined with great effort using conventional machining processes due to the high cutting forces, poor surface qualities, and the associated tool wear. Vibration-assisted machining has already proven to be an adequate solution in order to achieve extended tool lives, better surface qualities, and reduced cutting forces. This paper presents an analytical force model for longitudinal-torsional vibration-assisted milling (LT-VAM), which can predict cutting forces under intermittent and non-intermittent cutting conditions. Under intermittent cutting conditions, the relative contact ratio between the rake face and the sliding chip is utilized for modelling the shearing forces. Ploughing forces and shearing forces under non-intermittent cutting conditions are calculated by using an extended macroscopic friction reduction model, which can predict the reduced frictional forces under parallel and perpendicular vibration superimposition. The force model was implemented in MATLAB and can predict cutting forces without using any experimental vibration-assisted milling (VAM) data input. [ABSTRACT FROM AUTHOR]

Purpose: Liposarcoma (LPS) represent the largest group of malignant soft tissue tumours comprising a heterogeneous group of subtypes in which the degrees of chemoresistance and radiosensitivity strongly vary. Consequently, it is of utmost interest to establish novel therapeutic regimens based on molecular targets. Methods: Immunohistochemical staining of survivin was performed in tissue microarrays comprising 49 primary LPS specimens. LPS cell lines were treated with survivin antagonist YM155 and doxorubicin or etoposide alone as well as in combination. Changes in cell viability were investigated and the synergistic effect of a combined therapy analysed. Results: Immunohistochemistry revealed an abundant expression of survivin in LPS that significantly concurred with less-differentiated tumour subtypes and grading. In vitro, we demonstrated the impact of the survivin inhibitor YM155 on dedifferentiated LPS (DDLPS) and, even more imposing, pleomorphic LPS (PLS) tumour cell viability with a strong induction of apoptosis. A combined treatment of doxorubicin or etoposide with YM155 augmented the cytotoxic effects on DDLPS and PLS cells. Conclusion: These findings support the significant role of survivin in the oncogenesis and progression of LPS subtypes providing a rationale to target survivin in eligible in-vivo models and to pioneer clinical applications of survivin-specific substances unfolding their therapeutic potential in LPS patients prospectively. [ABSTRACT FROM AUTHOR]

Purpose: The question of whether cancer patients with severe respiratory failure benefit from veno-venous extracorporeal membrane oxygenation (vv-ECMO) remains unanswered. We, therefore, analyzed clinical characteristics and outcomes of a large cohort of cancer patients treated with vv-ECMO with the aim to identify prognostic factors. Methods: 297 cancer patients from 19 German and Austrian hospitals who underwent vv-ECMO between 2009 and 2019 were retrospectively analyzed. A multivariable cox proportional hazards analysis for overall survival was performed. In addition, a propensity score-matched analysis and a latent class analysis were conducted. Results: Patients had a median age of 56 (IQR 44–65) years and 214 (72%) were males. 159 (54%) had a solid tumor and 138 (47%) a hematologic malignancy. The 60-day overall survival rate was 26.8% (95% CI 22.1–32.4%). Low platelet count (HR 0.997, 95% CI 0.996–0.999; p = 0.0001 per 1000 platelets/µl), elevated lactate levels (HR 1.048, 95% CI 1.012–1.084; p = 0.0077), and disease status (progressive disease [HR 1.871, 95% CI 1.081–3.238; p = 0.0253], newly diagnosed [HR 1.571, 95% CI 1.044–2.364; p = 0.0304]) were independent adverse prognostic factors for overall survival. A propensity score-matched analysis with patients who did not receive ECMO treatment showed no significant survival advantage for treatment with ECMO. Conclusion: The overall survival of cancer patients who require vv-ECMO is poor. This study shows that the value of vv-ECMO in cancer patients with respiratory failure is still unclear and further research is needed. The risk factors identified in the present analysis may help to better select patients who may benefit from vv-ECMO. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the cost-effectiveness of supplemental short-protocol brain MRI after negative non-contrast CT for the detection of minor strokes in emergency patients with mild and unspecific neurological symptoms. Methods: The economic evaluation was centered around a prospective single-center diagnostic accuracy study validating the use of short-protocol brain MRI in the emergency setting. A decision-analytic Markov model distinguished the strategies "no additional imaging" and "additional short-protocol MRI" for evaluation. Minor stroke was assumed to be missed in the initial evaluation in 40% of patients without short-protocol MRI. Specialized post-stroke care with immediate secondary prophylaxis was assumed for patients with detected minor stroke. Utilities and quality-of-life measures were estimated as quality-adjusted life years (QALYs). Input parameters were obtained from the literature. The Markov model simulated a follow-up period of up to 30 years. Willingness to pay was set to $100,000 per QALY. Cost-effectiveness was calculated and deterministic and probabilistic sensitivity analysis was performed. Results: Additional short-protocol MRI was the dominant strategy with overall costs of $26,304 (CT only: $27,109). Cumulative calculated effectiveness in the CT-only group was 14.25 QALYs (short-protocol MRI group: 14.31 QALYs). In the deterministic sensitivity analysis, additional short-protocol MRI remained the dominant strategy in all investigated ranges. Probabilistic sensitivity analysis results from the base case analysis were confirmed, and additional short-protocol MRI resulted in lower costs and higher effectiveness. Conclusion: Additional short-protocol MRI in emergency patients with mild and unspecific neurological symptoms enables timely secondary prophylaxis through detection of minor strokes, resulting in lower costs and higher cumulative QALYs. Key Points: • Short-protocol brain MRI after negative head CT in selected emergency patients with mild and unspecific neurological symptoms allows for timely detection of minor strokes. • This strategy supports clinical decision-making with regard to immediate initiation of secondary prophylactic treatment, potentially preventing subsequent major strokes with associated high costs and reduced QALY. • According to the Markov model, additional short-protocol MRI remained the dominant strategy over wide variations of input parameters, even when assuming disproportionally high costs of the supplemental MRI scan. [ABSTRACT FROM AUTHOR]

Despite the widespread use of anilines, synthetic challenges to these targets still exist. Selectivity is often an issue, when using the traditional nitration-reduction sequence or more modern approaches, including arene C–H aminations catalyzed by transition metals, photosensitizers, or electrodes. Accordingly, there is still a need for general methods to rapidly, directly access specific isomers of substituted anilines. Here, we report a simple route towards the synthesis of such motifs starting from benzyl alcohols, which are converted to anilines by the use of arylsulfonyl hydroxylamines, via an aza-Hock rearrangement. Good to excellent yields are observed. The method is applicable to various benzyl alcohol surrogates (such as ethers, esters, and halides) as well as simple alkylarenes. Functionalizations of pharmaceutically relevant structures are feasible under the reaction conditions. Over ten amination reagents can be used, which facilitates the rapid assembly of a vast set of compounds. Syntheses of anilines occur through a variety of methods, most requiring transition metals or multiple steps. Here the authors disclose a protocol to form anilines from benzyl alcohols via an aza-Hock rearrangement that uses only a sulfonyl hydroxylamine and solvent. [ABSTRACT FROM AUTHOR]

Purpose: Roux-en-Y gastric bypass (RYGB) surgery is currently the most efficient treatment to achieve long-term weight loss in individuals with severe obesity. This is largely attributed to marked reductions in food intake mediated in part by changes in gut-brain communication. Here, we investigated for the first time whether weight loss after RYGB is associated with alterations in central noradrenaline (NA) neurotransmission. Materials and Methods: We longitudinally studied 10 individuals with severe obesity (8 females; age 43.9 ± 13.1 years; body mass index (BMI) 46.5 ± 4.8 kg/m2) using (S,S)-[11C]O-methylreboxetine and positron emission tomography to estimate NA transporter (NAT) availability before and 6 months after surgery. NAT distribution volume ratios (DVR) were calculated by volume-of-interest analysis and the two-parameter multilinear reference tissue model (reference region: occipital cortex). Results: The participants responded to RYGB surgery with a reduction in BMI of 12.0 ± 3.5 kg/m2 (p < 0.001) from baseline. This was paralleled by a significant reduction in DVR in the dorsolateral prefrontal cortex (pre-surgery 1.12 ± 0.04 vs. post-surgery 1.07 ± 0.04; p = 0.019) and a general tendency towards reduced DVR throughout the brain. Furthermore, we found a strong positive correlation between pre-surgery DVR in hypothalamus and the change in BMI (r = 0.78; p = 0.01). Conclusion: Reductions in BMI after RYGB surgery are associated with NAT availability in brain regions responsible for decision-making and homeostasis. However, these results need further validation in larger cohorts, to assess whether brain NAT availability could prognosticate the outcome of RYGB on BMI. [ABSTRACT FROM AUTHOR]

This trial evaluates whether nocturnal oxygen therapy (NOT) during a stay at 2048 m improves altitude-induced exercise intolerance in lowlanders with chronic obstructive pulmonary disease (COPD). 32 lowlanders with moderate to severe COPD, mean ± SD forced expiratory volume in the first second of expiration (FEV1) 54 ± 13% predicted, stayed for 2 days at 2048 m twice, once with NOT, once with placebo according to a randomized, crossover trial with a 2-week washout period at < 800 m in-between. Semi-supine, constant-load cycle exercise to exhaustion at 60% of maximal work-rate was performed at 490 m and after the first night at 2048 m. Endurance time was the primary outcome. Additional outcomes were cerebral tissue oxygenation (CTO), arterial blood gases and breath-by-breath measurements (http://www.ClinicalTrials.gov NCT02150590). Mean ± SE endurance time at 490 m was 602 ± 65 s, at 2048 m after placebo 345 ± 62 s and at 2048 m after NOT 293 ± 60 s, respectively (P < 0.001 vs. 490 m). Mean difference (95%CI) NOT versus placebo was − 52 s (− 174 to 70), P = 0.401. End-exercise pulse oximetry (SpO2), CTO and minute ventilation ( V ˙ E ) at 490 m were: SpO2 92 ± 1%, CTO 65 ± 1%, V ˙ E 37.7 ± 2.0 L/min; at 2048 m with placebo: SpO2 85 ± 1%, CTO 61 ± 1%, V ˙ E 40.6 ± 2.0 L/min and with NOT: SpO2 84 ± 1%; CTO 61 ± 1%; V ˙ E 40.6 ± 2.0 L/min (P < 0.05, SpO2, CTO at 2048 m with placebo vs. 490 m; P = NS, NOT vs. placebo). Altitude-related hypoxemia and cerebral hypoxia impaired exercise endurance in patients with moderate to severe COPD and were not prevented by NOT. [ABSTRACT FROM AUTHOR]

Purpose: In this retrospective study, we compared inhaled sedation with isoflurane to intravenous propofol in invasively ventilated COVID-19 patients with ARDS (Acute Respiratory Distress Syndrome). Methods: Charts of all 20 patients with COVID-19 ARDS admitted to the ICU of a German University Hospital during the first wave of the pandemic between 22/03/2020 and 21/04/2020 were reviewed. Among screened 333 days, isoflurane was used in 97 days, while in 187 days, propofol was used for 12 h or more. The effect and dose of these two sedatives were compared. Mixed sedation days were excluded. Results: Patients' age (median [interquartile range]) was 64 (60–68) years. They were invasively ventilated for 36 [21–50] days. End-tidal isoflurane concentrations were high (0.96 ± 0.41 Vol %); multiple linear regression yielded the ratio (isoflurane infusion rate)/(minute ventilation) as the single best predictor. Infusion rates were decreased under ECMO (3.5 ± 1.4 versus 7.1 ± 3.2 ml∙h−1; p < 0.001). In five patients, the maximum recommended dose of propofol of 4 mg∙hour−1∙kg−1ABW was exceeded on several days. On isoflurane compared to propofol days, neuro-muscular blocking agents (NMBAs) were used less frequently (11% versus 21%; p < 0.05), as were co-sedatives (7% versus 31%, p < 0.001); daily opioid doses were lower (720 [720–960] versus 1080 [720–1620] mg morphine equivalents, p < 0.001); and RASS scores indicated deeper levels of sedation (− 4.0 [− 4.0 to − 3.0] versus − 3.0 [− 3.6 to − 2.5]; p < 0.01). Conclusion: Isoflurane provided sufficient sedation with less NMBAs, less polypharmacy and lower opioid doses compared to propofol. High doses of both drugs were needed in severely ill COVID-19 patients. [ABSTRACT FROM AUTHOR]

COVID-19 impacts the daily lives of millions of people. This radical change in our daily activities affected many aspects of life, but acted as well as a natural experiment for research into the spatial distribution of 911 calls. We analyse the impact of the COVID-19 measures on the spatial pattern of police interventions. Crime is not uniformly distributed across street segments, but how does COVID-19 affect these spatial patterns? To this end, Gini coefficients are calculated and a proportion differences spatial point pattern test is applied to compare the similarity of the patterns of incidents before, during, and after the first lockdown in Antwerp, Belgium. With only essential mobility being allowed, the emergency call pattern has not significantly changed before, during or after this lockdown, however, a qualitative shift in police officer's daily work may have had an effect on the daily operation of the Antwerp police force. [ABSTRACT FROM AUTHOR]

Background: Despite numerous advances in the identification of risk factors for the development of severe coronavirus disease 2019 (COVID-19), factors that promote recovery from COVID-19 remain unknown. Natural killer (NK) cells provide innate immune defense against viral infections and are known to be activated during moderate and severe COVID-19. Killer immunoglobulin-like receptors (KIR) mediate NK cell cytotoxicity through recognition of an altered MHC-I expression on infected target cells. However, the influence of KIR genotype on outcome of patients with COVID-19 has not been investigated so far. We retrospectively analyzed the outcome associations of NK cell count and KIR genotype of patients with COVID-19 related severe ARDS treated on our tertiary intensive care unit (ICU) between February and June 2020 and validated our findings in an independent validation cohort of patients with moderate COVID-19 admitted to our tertiary medical center. Results: Median age of all patients in the discovery cohort (n = 16) was 61 years (range 50–71 years). All patients received invasive mechanical ventilation; 11 patients (68%) required extracorporeal membrane oxygenation (ECMO). Patients who recovered from COVID-19 had significantly higher median NK cell counts during the whole observational period compared to patients who died (121 cells/µL, range 16–602 cells/µL vs 81 cells/µL, range 6–227 cells/µL, p-value = 0.01). KIR2DS5 positivity was significantly associated with shorter time to recovery (21.6 ± 2.8 days vs. 44.6 ± 2.2 days, p-value = 0.01). KIR2DS5 positivity was significantly associated with freedom from transfer to ICU (0% vs 9%, p-value = 0.04) in the validation cohort which consisted of 65 patients with moderate COVID-19. Conclusion: NK cells and KIR genotype might have an impact on recovery from COVID-19. [ABSTRACT FROM AUTHOR]

Purpose: A multidisciplinary expert panel convened to formulate state-of-the-art recommendations for optimisation of selective internal radiation therapy (SIRT) with yttrium-90 (90Y)-resin microspheres. Methods: A steering committee of 23 international experts representing all participating specialties formulated recommendations for SIRT with 90Y-resin microspheres activity prescription and post-treatment dosimetry, based on literature searches and the responses to a 61-question survey that was completed by 43 leading experts (including the steering committee members). The survey was validated by the steering committee and completed anonymously. In a face-to-face meeting, the results of the survey were presented and discussed. Recommendations were derived and level of agreement defined (strong agreement ≥ 80%, moderate agreement 50%–79%, no agreement ≤ 49%). Results: Forty-seven recommendations were established, including guidance such as a multidisciplinary team should define treatment strategy and therapeutic intent (strong agreement); 3D imaging with CT and an angiography with cone-beam-CT, if available, and 99mTc-MAA SPECT/CT are recommended for extrahepatic/intrahepatic deposition assessment, treatment field definition and calculation of the 90Y-resin microspheres activity needed (moderate/strong agreement). A personalised approach, using dosimetry (partition model and/or voxel-based) is recommended for activity prescription, when either whole liver or selective, non-ablative or ablative SIRT is planned (strong agreement). A mean absorbed dose to non-tumoural liver of 40 Gy or less is considered safe (strong agreement). A minimum mean target-absorbed dose to tumour of 100–120 Gy is recommended for hepatocellular carcinoma, liver metastatic colorectal cancer and cholangiocarcinoma (moderate/strong agreement). Post-SIRT imaging for treatment verification with 90Y-PET/CT is recommended (strong agreement). Post-SIRT dosimetry is also recommended (strong agreement). Conclusion: Practitioners are encouraged to work towards adoption of these recommendations. [ABSTRACT FROM AUTHOR]