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The monogermanide LuGe is obtained via high‐pressure high‐temperature synthesis (5–15 GPa, 1023–1423 K). The crystal structure is solved from single‐crystal X‐ray diffraction data (structure type FeB, space group Pnma, a=7.660(2) Å, b=3.875(1) Å, and c=5.715(2) Å, RF=0.036 for 206 symmetry independent reflections). The analysis of chemical bonding applying quantum‐chemical techniques in position space was performed. It revealed—beside the expected 2c‐Ge‐Ge bonds in the germanium polyanion—rather unexpected four‐atomic bonds between lutetium atoms indicating the formation of a polycation by the excess electrons in the system Lu3+(2b)Ge2−×1 e−. Despite the reduced VEC of 3.5, lutetium monogermanide is following the extended 8‐N rule with the trend to form lutetium‐lutetium bonds utilizing the electrons left after satisfying the bonding needs in the anionic Ge‐Ge zigzag chain., The germanium monogermanide is prepared by high‐pressure, high‐temperature synthesis. Chemical bonding in LuGe is described as covalently bonded zigzag chains of Ge atoms with the counterpart Lu4 polycations formed using excess electrons in sense of the Zintl count Lu3+(2b)Ge2−×1 e−. The homonuclear bonding in polycation in Lu4Ge4, which makes use of the electrons not required in the polyanion, resembles the situation in Ga2Se2.

There is an increasing demand for transient materials with a predefined lifetime like self-erasing temporary electronic circuits or transient biomedical implants. Chemically fueled materials are an example of such materials; they emerge in response to chemical fuel, and autonomously decay as they deplete it. However, these materials suffer from a slow, typically first order decay profile. That means that over the course of the material's lifetime, its properties continuously change until it is fully decayed. Materials that have a sharp on–off response are self-immolative ones. These degrade rapidly after an external trigger through a self-amplifying decay mechanism. However, self-immolative materials are not autonomous; they require a trigger. We introduce here materials with the best of both, i.e., materials based on chemically fueled emulsions that are also self-immolative. The material has a lifetime that can be predefined, after which it autonomously and rapidly degrades. We showcase the new material class with self-expiring labels and drug-delivery platforms with a controllable burst-release., We describe a design strategy for transient materials with a predefined lifetime and a fast on–off-response.

The clathrate-I borosilicide K8−xBySi46−y (0.8 ≤ x ≤ 1.2 and 6.4 ≤ y ≤ 7.2; space group Pmn) was prepared in sealed tantalum ampoules between 900 °C and 1000 °C. By high-pressure preparation at 8 GPa and 1000 °C, a higher boron content is achieved (x = 0.2, y = 7.8). Crystal structure and composition were established from X-ray diffraction data, chemical analysis, WDX spectroscopy, and confirmed by 11B and 29Si NMR, and magnetic susceptibility measurements. The compositions are electron-balanced according to the Zintl rule within one estimated standard deviation. The lattice parameter varies with composition from a = 9.905 A for K7.85(2)B7.8(1)Si38.2(1) to a = 9.968(1) A for K6.80(2)B6.4(5)Si39.6(5).

Purpose Breast cancer-related lymphedema (BCRL) represents a significant concern for patients following breast cancer treatment, and assessment for BCRL represents a key component of survivorship efforts. Growing data has demonstrated the benefits of early detection and treatment of BCRL. Traditional diagnostic modalities are less able to detect reversible subclinical BCRL while newer techniques such as bioimpedance spectroscopy (BIS) have shown the ability to detect subclinical BCRL, allowing for early intervention and low rates of chronic BCRL with level I evidence. We present updated clinical practice guidelines for BIS utilization to assess for BCRL. Methods and Results Review of the literature identified a randomized controlled trial and other published data which form the basis for the recommendations made. The final results of the PREVENT trial, with 3-year follow-up, demonstrated an absolute reduction of 11.3% and relative reduction of 59% in chronic BCRL (through utilization of compression garment therapy) with BIS as compared to tape measurement. This is in keeping with real-world data demonstrating the effectiveness of BIS in a prospective surveillance model. For optimal outcomes patients should receive an initial pre-treatment measurement and subsequently be followed at a minimum quarterly for first 3 years then biannually for years 4–5, then annually as appropriate, consistent with previous guidelines; the target for intervention has been changed from a change in L-Dex of 10 to 6.5. The lack of pre-operative measure does not preclude inclusion in the prospective surveillance model of care. Conclusion The updated clinical practice guidelines present a standardized approach for a prospective model of care using BIS for BCRL assessment and supported by evidence from a randomized controlled trial as well as real-world data.

Fomepizole inhibits formation of toxic acetaminophen (APAP) metabolites and may prevent or reverse mitochondrial toxicity. Given these mechanisms, it may be beneficial in patients with severe APAP toxicity. Current patterns of use for this indication are not well-studied.This is a secondary analysis of patients enrolled in the Toxicology Investigators Consortium (ToxIC) database from January 2015 to July 2020. We queried cases in which APAP was listed as an ingested agent and fomepizole was also administered. We excluded cases in which APAP was not the primary agent, N-acetylcysteine (NAC) was not administered, or fomepizole was explicitly administered for another indication. Additionally, we sent a survey to each ToxIC site that administered fomepizole for APAP toxicity to better understand when, why, and how they were using it for this indication.Twenty-five cases of fomepizole administration following an APAP ingestion met our inclusion criteria. There were one to four cases per year between 2015 and 2019 and eight cases in 2020. Seventeen of 25 (68%) cases were for a known acute ingestion. Eighteen of 25 (72%) patients developed hepatotoxicity (AST or ALT1000 IU/L) and 10 of 25 (40%) developed coagulopathy (PT15s). This was an ill patient population, with 18 of 25 (72%) developing metabolic acidosis (pH7.20), 12 of 25 (48%) were intubated, 9 of 25 (36%) receiving vasopressors, and 6 of 25 (24%) receiving continuous renal replacement therapy. Overall, mortality was 24%.The use of fomepizole is increasing in frequency in a small subset of critically ill and acutely APAP-poisoned patients.

Patient-reported outcomes are the primary measurement of breast reconstruction success, but results may be affected by nontechnical factors such as socioemotional determinants. Third-party observers provide an independent assessment of aesthetic outcomes. Factors associated with disparity between patient and observer perceptions of outcomes are not well understood.One hundred forty-seven patients underwent breast reconstruction at the authors' institution between 2009 and 2011, completed the BREAST-Q, and had photographs graded by a diverse panel using the Validated Breast Aesthetic Scale. Patient satisfaction with breasts scores that aligned with observer scores were categorized as group 2; patient satisfaction that exceeded observer scores were group 1; and those lower than observer scores were group 3. Statistical analysis was performed using SPSS, with values of p0.05 considered statistically significant.Twenty-eight patients (19 percent) were categorized as group 1, 93 (63 percent) in group 2, and 26 (18 percent) in group 3. Median overall appearance was highest in group 3 (median, 4.0; interquartile range, 4 to 4) and lowest in group 1 (median, 3.0; interquartile range, 2 to 3) ( p0.001). Psychosocial, sexual, and physical well-being were significantly associated with disparity (group 1 or 3 status) ( p0.01). Satisfaction with outcomes, nipples, abdomen, and breasts were significantly associated with disparity. Factors not significantly associated with disparity include age, body mass index, autologous or implant-based, adjuvant therapies, and timing of reconstruction.Incongruously high patient satisfaction with breast reconstruction aesthetics relative to third-party perception of aesthetic outcomes is associated with high quality-of-life scores. Incongruously low patient satisfaction with breast cosmesis compared with higher third-party perceptions was associated with low quality-of-life scores.Risk, II.

► Nausea ►Paresthesia ► Cold allodynia.

Malaria-causing parasites proliferate within erythrocytes through schizogony, forming multinucleated stages before cellularization. Nuclear multiplication does not follow a strict geometric 2 n progression, and each proliferative cycle produces a variable number of progeny. Here, by tracking nuclei and DNA replication, we show that individual nuclei replicate their DNA at different times, despite residing in a shared cytoplasm. Extrapolating from experimental data using mathematical modeling, we provide strong indication that a limiting factor exists, which slows down the nuclear multiplication rate. Consistent with this prediction, our data show that temporally overlapping DNA replication events were significantly slower than partially overlapping or nonoverlapping events. Our findings suggest the existence of evolutionary pressure that selects for asynchronous DNA replication, balancing available resources with rapid pathogen proliferation.

Gut parasites of plant-eating insects are exposed to antimicrobial phytochemicals that can reduce infection. Trypanosomatid gut parasites infect insects of diverse nutritional ecologies as well as mammals and plants, raising the question of how host diet-associated phytochemicals shape parasite evolution and host specificity. To test the hypothesis that phytochemical tolerance of trypanosomatids reflects the chemical ecology of their hosts, we compared related parasites from honey bees and mosquitoes--hosts that differ in phytochemical consumption--and contrasted our results with previous studies on phylogenetically related, human-parasitic Leishmania. We identified one bacterial and ten plant-derived substances with known antileishmanial activity that also inhibited honey bee parasites associated with colony collapse. Bee parasites exhibited greater tolerance of chrysin--a flavonoid found in nectar, pollen, and plant resin-derived propolis. In contrast, mosquito parasites were more tolerant of cinnamic acid--a product of lignin decomposition present in woody debris-rich larval habitats. Parasites from both hosts tolerated many compounds that inhibit Leishmania, hinting at possible trade-offs between phytochemical tolerance and mammalian infection. Our results implicate the phytochemistry of host diets as a potential driver of insect-trypanosomatid associations, and identify compounds that could be incorporated into colony diets or floral landscapes to ameliorate infection in bees. ORIGINALITY AND SIGNIFICANCETrypanosomatid parasites of insects pose threats to beneficial insects, crop plants, and human health. Elucidation of the environmental factors that determine host-parasite specificity and transmission of trypanosomatids is essential to predict the spread and spillover potential of trypanosomatids in wild and agricultural ecosystems. Our comparisons between trypanosomatids of bees and mosquitoes implicate the phytochemical composition of host diets as a potential determinant of insect-trypanosomatid associations. To our knowledge, this is the first comparative study of phytochemical tolerance in insect trypanosomatids. As the first characterization of phytochemical tolerance among honey bee-associated trypanosomatids, our results also identify compounds that could ameliorate infection of managed bees with parasites of concern to wild pollinators and associated with colony collapse.

Background Patients with opioid use disorder (OUD) are frequently admitted for invasive infections. Medications for OUD (MOUD) may improve outcomes in hospitalized patients. Methods In this retrospective cohort of 220 admissions to a tertiary care center for invasive infections due to OUD, we compared 4 MOUD treatment strategies: methadone, buprenorphine, methadone taper for detoxification, and no medication to determine whether there were differences in parenteral antibiotic completion and readmission rates. Results The MOUDs were associated with increased completion of parenteral antimicrobial therapy (64.08% vs 46.15%; odds ratio [OR] = 2.08; 95% CI, 1.23–3.61). On multivariate analysis, use of MOUD maintenance with either buprenorphine (OR = 0.38; 95% CI, .17–.85) or methadone maintenance (OR = 0.43; 95% CI, .20–.94) and continuation of MOUD on discharge (OR = 0.35; 95% CI, .18–.67) was associated with lower 90-day readmissions. In contrast, use of methadone for detoxification followed by tapering of the medication without continuation on discharge was not associated with decreased readmissions (OR = 1.87; 95% CI, .62–5.10). Conclusions Long-term MOUDs, regardless of selection, are an integral component of care in patients hospitalized with OUD-related infections. Patients with OUD should have arrangements made for MOUDs to be continued after discharge, and MOUDs should not be discontinued before discharge.

As companies engage in business model (BM) innovation, they increasingly turn to BM tools, such as the Business Model Canvas, the STOF framework, or e3-value ontology. The main advantages associated with these tools are that they establish a standard lexicon, or common language, within an organization. Despite the increasing scholarly interest in BM tools, we still lack theoretical foundations and empirical evidence for understanding their roles and uses in BM innovation. In this article, we argue for conceptualizing BM tools (i.e. models, methods, and IT support), as boundary objects that must have the capacities to overcome the knowledge boundaries between different communities of practice. Based on empirical insights from six case studies and an in-depth field study, we make three contributions: First, we identify five typical communities of practice involved in BM innovation in large organizations. Second, we analyze the knowledge boundaries between them. Third, we discuss implications for BM tool design as boundary objects with syntactic, semantic, and pragmatic capacities.

In this article, we report on recent advancements in reconstructive care of the breast cancer patient. New developments in sensate breast reconstruction to help address the problem of numbness after mastectomy have emerged and show promise. Methods to restore lymphatic physiologic flow after axillary lymphadenectomy using supermicrosurgical techniques have begun to show benefit by reducing the short-term incidence of breast cancer related lymphedema (BRCL). Breast implant safety has received significant recent attention and we explore the emergence of BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) and its implications for the breast cancer patient and their multidisciplinary care team.

Lymphedema prevention surgery (LPS), which identifies, preserves, and restores lymphatic flow via lymphaticovenous bypasses (LVB), has demonstrated potential to decrease lymphedema in breast cancer patients requiring axillary lymph node dissection. Implementing this new operating technique requires additional operating room (OR) time and coordination. This study sought to evaluate the improvement of LPS technique and OR duration over time. A prospective database of patients who underwent LPS at our institution from 2016 to 2019 was queried. Type of breast and reconstruction surgery, number of LVB performed, and OR times were collected. LPS details were compared by surgical group and year performed. Ninety-four patients underwent LPS, and 88 had complete OR time data available for analysis. Average age was 51 years, body mass index of 28, with an average of 15 lymph nodes removed. Reconstructive treatment groups included prosthetic reconstruction 56% (49), oncoplastic reduction 10% (9), and no reconstruction 34% (30). The number of patients undergoing LPS increased significantly from 2016 to 2019, and average number of LVB per patient doubled. In patients without reconstruction, the average time for LPS improved significantly from 212 to 87 min from 2016 to 2019 (p = 0.015) and similarly in patients undergoing LPS with prosthetic reconstruction from 238 to 160 min (p = 0.022). LVB is an emerging surgical lymphedema prevention technique. While requiring additional surgical time, our results show that with refinement of technique, over 4 years, we were able to perform double the number of LVB per patient in half the OR time.

Background Investigating the mechanical properties of biological and biocompatible hydrogels is important in tissue engineering and biofabrication. Atomic force microscopy (AFM) and compression testing are routinely used to determine mechanical properties of tissue and tissue constructs. However, these techniques are slow and require mechanical contact with the sample, rendering in situ measurements difficult. Objective We therefore aim at a fast and contactless method for determining the mechanical properties of biological hydrogels and investigate if an optical method, like Laser-Doppler vibrometry (LDV), can accomplish this task. Methods LDV is a fast contactless method for mechanical analysis. Nonetheless, LDV setups operating in the visible range of the optical spectrum are difficult to use for transparent materials, such as biological hydrogels, because LDV relies on reflected or back-scattered light from the sample. We therefore use a near-infrared (NIR) scanning LDV to determine the vibration spectra of cylindrical gelatin discs of different gelatin concentration and compare the results to AFM data and unconfined compression testing. Results We show that the gelatin test structures can be analyzed, using a NIR LDV, and the Young’s moduli can be deduced from the resonance frequencies of the first normal (0,1) mode of these structures. As expected, the frequency of this mode increases with the square root of the Young’s modulus and the damping constant increases exponentially with gelatin concentration, which underpins the validity of our approach. Conclusions Our results demonstrate that NIR wavelengths are suitable for a fast, contactless vibrational analysis of transparent hydrogel structures.

The binary strontium germanide SrGe6 was synthesized at high-pressure high-temperature conditions of approximately 10 GPa and typically 1400 K before quenching to ambient conditions. At ambient pressure, SrGe6 decomposes in a monotropic fashion at T = 680(10) K into SrGe2 and Ge, indicating its metastable character. Single-crystal X-ray diffraction data indicate that the compound SrGe6 adopts a new monoclinic structure type comprising a unique three-dimensional framework of germanium atoms with unusual cages hosting the strontium cations. Quantum chemical analysis of the chemical bonding shows that the framework consists of three- and four- bonded germanium atoms yielding the precise electron count Sr[(4bGe0]4[(3b)Ge−]2 in accordance with the 8 − N rule and the Zintl concept. Conflicting with that, a pseudo-gap in the electronic density of states appears clearly below the Fermi level, and elaborate bonding analysis reveals additional Sr–Ge interactions in the concave coordination polyhedron of the strontium atoms.

In the years following its discovery and characterization, the CRISPR-Cas system has been modified and converted into a multitude of applications for eukaryotes and bacteria, such as genome editing and gene regulation. Since no such method has been available for archaea, we developed a tool for gene repression in the haloarchaeon Haloferax volcanii by repurposing its endogenous type I-B CRISPR-Cas system. Here, we present the two possible approaches for gene repression as well as our workflow to achieve and assess gene knockdown, offer recommendations on protospacer selection and give some examples of genes we have successfully silenced.

Acetaminophen (paracetamol) remains the leading pharmaceutical agent in overdoses in North America. The three-bag Prescott protocol for intravenous (IV) acetylcysteine is complex and prone to error...

Most of the literature surrounding face transplantation focuses on technique, immunology, and psychology. Dental and skeletal outcomes remain persistently underreported. This study critically examined the worldwide face transplant experience to evaluate such outcomes.A systematic review of all composite allografts containing midface and/or mandible was performed. Dental and skeletal complications were recorded. Formal imaging and photographs available in the literature were analyzed using skeletal measurements, soft-tissue cephalometrics, and the Angle classification. Outcomes of our face transplant patients, including condylar assessment and airway volume measurements, is also presented.Twenty-five patients received allografts containing midface (n = 7) or mandible (n = 2), whereas 16 contained a double-jaw. All midface-only transplants developed skeletal deformity; 57 percent developed a palatal fistula. Both partial and full arch transplantation patients developed skeletal deformity. Among double-jaw transplants, 69 percent developed palatal fistula or floor-of-mouth dehiscence, 66 percent developed malocclusion, 50 percent developed trismus, and 31 percent required corrective orthognathic surgery. In 40 percent of patients, malocclusion recurred after corrective orthognathic surgery. Forty percent of all patients developed dental cavities or periodontal disease. All of our patients received midface and/or mandible. One patient required corrective orthognathic surgery. Midfacial segments showed clockwise rotation. Airway volumes decreased over time.Skeletal and dental complications remain extremely common after facial allotransplantation involving either single- or double-jaw composites. Corrective orthognathic surgery and dental extraction is often necessitated. These data will aid face transplant teams during surgical planning and preoperative counseling.Therapeutic, V.

We performed a Penning trap mass measurement of $^{61}{\rm Zn}$ at the National Superconducting Cyclotron Laboratory and NuShellX calculations of the $^{61}{\rm Zn}$ and $^{62}{\rm Ga}$ structure using the GXPF1A Hamiltonian to obtain improved estimates of the $^{61}{\rm Zn}(p,\gamma)^{62}{\rm Ga}$ and $^{60}{\rm Cu}(p,\gamma)^{61}{\rm Zn}$ reaction rates. Surveying astrophysical conditions for type-I X-ray bursts with the code MESA, implementing our improved reaction rates, and taking into account updated nuclear masses for $^{61}{\rm V}$ and $^{61}{\rm Cr}$ from the recent literature, we refine the neutrino luminosity from the important mass number $A=61$ urca cooling source in accreted neutron star crusts. This improves our understanding of the thermal barrier between deep heating in the crust and the shallow depths where extra heat is needed to explain X-ray superbursts, as well as the expected signature of crust urca neutrino emission in light curves of cooling transients., Comment: Submitted

BackgroundPersons who inject drugs (PWID) are frequently admitted for serious injection-related infections (SIRIs). Outcomes and adherence to oral antibiotics for PWID with patient-directed discharge (PDD) remain understudied.MethodsWe conducted a prospective multicenter bundled quality improvement project of PWID with SIRI at 3 hospitals in Missouri. All PWID with SIRI were offered multidisciplinary care while inpatient, including the option of addiction medicine consultation and medications for opioid use disorder (MOUD). All patients were offered oral antibiotics in the event of a PDD either at discharge or immediately after discharge through an infectious diseases telemedicine clinic. Additional support services included health coaches, a therapist, a case manager, free clinic follow-up, and medications in an outpatient bridge program. Patient demographics, comorbidities, 90-day readmissions, and substance use disorder clinic follow-up were compared between PWID with PDD on oral antibiotics and those who completed intravenous (IV) antibiotics using an as-treated approach.ResultsOf 166 PWID with SIRI, 61 completed IV antibiotics inpatient (37%), while 105 had a PDD on oral antibiotics (63%). There was no significant difference in 90-day readmission rates between groups (P = .819). For PWID with a PDD on oral antibiotics, 7.6% had documented nonadherence to antibiotics, 67% had documented adherence, and 23% were lost to follow-up. Factors protective against readmission included antibiotic and MOUD adherence, engagement with support team, and clinic follow-up.ConclusionsPWID with SIRI who experience a PDD should be provided with oral antibiotics. Multidisciplinary outpatient support services are needed for PWID with PDD on oral antibiotics.

While previous research on zoonotic transmission of community-acquired Clostridioides difficile infection (CA-CDI) focused on food-producing animals, the present study aimed to investigate whether dogs are carriers of resistant and/or virulent C. difficile strains. Rectal swabs were collected from 323 dogs and 38 C. difficile isolates (11.8%) were obtained. Isolates were characterized by antimicrobial susceptibility testing, whole-genome sequencing (WGS) and a DNA hybridization assay. Multilocus sequence typing (MLST), core genome MLST (cgMLST) and screening for virulence and antimicrobial resistance genes were performed based on WGS. Minimum inhibitory concentrations for erythromycin, clindamycin, tetracycline, vancomycin and metronidazole were determined by E-test. Out of 38 C. difficile isolates, 28 (73.7%) carried genes for toxins. The majority of isolates belonged to MLST sequence types (STs) of clade I and one to clade V. Several isolates belonged to STs previously associated with human CA-CDI. However, cgMLST showed low genetic relatedness between the isolates of this study and C. difficile strains isolated from humans in Austria for which genome sequences were publicly available. Four isolates (10.5%) displayed resistance to three of the tested antimicrobial agents. Isolates exhibited resistance to erythromycin, clindamycin, tetracycline and metronidazole. These phenotypic resistances were supported by the presence of the resistance genes erm(B), cfr(C) and tet(M). All isolates were susceptible to vancomycin. Our results indicate that dogs may carry virulent and antimicrobial-resistant C. difficile strains. 1 Introduction 2 Methods 2.1 Sampling and ethics 2.2 Isolation and identification of Clostridioides difficile 2.3 Antimicrobial susceptibility testing 2.4 Whole-genome sequencing and comparative genomic analysis 2.5 Statistical analysis 3 Results 3.1 Prevalence of Clostridioides difficile and risk factors for shedding 3.2 Antimicrobial susceptibility testing and detection of antimicrobial resistance determinants 3.3 Genomic characterization of canine Clostridioides difficile 3.4 Genome annotation and comparison 4 Discussion

Traction force microscopy (TFM) is the main method used in mechanobiology to measure cell forces. Commonly this is being used for cells adhering to flat soft substrates that deform under cell traction (2D-TFM). TFM relies on the use of linear elastic materials, such as polydimethylsiloxane (PDMS) or polyacrylamide (PA). For 2D-TFM on PA, the difficulty in achieving high throughput results mainly from the large variability of cell shapes and tractions, calling for standardization. We present a protocol to rapidly and efficiently fabricate micropatterned PA hydrogels for 2D-TFM studies. The micropatterns are first created by maskless photolithography using near-UV light where extracellular matrix proteins bind only to the micropatterned regions, while the rest of the surface remains non-adhesive for cells. The micropatterning of extracellular matrix proteins is due to the presence of active aldehyde groups, resulting in adhesive regions of different shapes to accommodate either single cells or groups of cells. For TFM measurements, we use PA hydrogels of different elasticity by varying the amounts of acrylamide and bis-acrylamide and tracking the displacement of embedded fluorescent beads to reconstruct cell traction fields with regularized Fourier Transform Traction Cytometry (FTTC). To further achieve precise recording of cell forces, we describe the use of a controlled dose of patterned light to release cell tractions in defined regions for single cells or groups of cells. We call this method local UV illumination traction force microscopy (LUVI-TFM). With enzymatic treatment, all cells are detached from the sample simultaneously, whereas with LUVI-TFM traction forces of cells in different regions of the sample can be recorded in sequence. We demonstrate the applicability of this protocol (i) to study cell traction forces as a function of controlled adhesion to the substrate, and (ii) to achieve a greater number of experimental observations from the same sample.

The clathrate I superconductor Sr8 Si46 is obtained under high-pressure high-temperature conditions, at 5 GPa and temperatures in the range of 1273 to 1373 K. At ambient pressure, the compound decomposes upon heating at T=796(5) K into Si and SrSi2 . The crystal structure of the clathrate is isotypic to that of Na8 Si46 . Chemical bonding analysis reveals conventional covalent bonding within the silicon network as well as additional multi-atomic interactions between Sr and Si within the framework cages. Physical measurements indicate a bulk BCS type II superconducting state below Tc =3.8(3) K.

Neurotization during the breast reconstruction process can improve patient quality-of-life and satisfaction with reconstructive outcomes. One concern with neurotization is increased total operative time due to the need for additional dissection and nerve coaptation. The purpose of this study was to compare total operative time between neurotized and non-neurotized abdominal-based, free flap breast reconstruction.A retrospective review was conducted of consecutive patients who underwent unilateral, abdominal-based, free flap breast reconstruction between 2016 and 2018 at a single tertiary care center. Data were collected on patient demographics, surgical techniques, and length of surgery. Data analysis was performed using chi-square test, independent t-test, and multivariate linear regression analysis. A p-value ≤0.05 was considered statistically significant.Seventy-three patients were included in this study. Twenty-three patients (31.50%) underwent flap neurotization (N group) and 50 (68.49%) underwent standard breast reconstruction without neurotization (NO group). The groups were similar in age, BMI, smoking status, and ASA class. No difference was found between the two groups in timing of reconstruction (p = 0.388). Average operative times were 467.73 ± 145.52 minutes and 455.28 ± 111.19 minutes for the N and NO groups, respectively, with no significant difference between the two groups (two-tailed p-value = 0.72).Seamless integration of neurotization in abdominal-based, free flap breast reconstruction is possible without significant prolongation of total operative time.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Discovering mechanisms governing organelle assembly is a fundamental pursuit in biology. The centriole is an evolutionarily conserved organelle with a signature 9-fold symmetrical chiral arrangement of microtubules imparted onto the cilium it templates. The first structure in nascent centrioles is a cartwheel, which comprises stacked 9-fold symmetrical SAS-6 ring polymers emerging orthogonal to a surface surrounding each resident centriole. The mechanisms through which SAS-6 polymerization ensures centriole organelle architecture remain elusive. We deploy photothermally-actuated off-resonance tapping high-speed atomic force microscopy to decipher surface SAS-6 self-assembly mechanisms. We show that the surface shifts the reaction equilibrium by ~104 compared to solution. Moreover, coarse-grained molecular dynamics and atomic force microscopy reveal that the surface converts the inherent helical propensity of SAS-6 polymers into 9-fold rings with residual asymmetry, which may guide ring stacking and impart chiral features to centrioles and cilia. Overall, our work reveals fundamental design principles governing centriole assembly., The centriole exhibits an evolutionarily conserved 9-fold radial symmetry that stems from a cartwheel containing vertically stacked ring polymers that harbor 9 homodimers of the protein SAS-6. Here the authors show how dual properties inherent to surface-guided SAS-6 self-assembly possess spatial information that dictates correct scaffolding of centriole architecture.

Psoriasis (Pso) and atopic dermatitis (AD) are chronic skin diseases that result in significant physical and psychological impairment, financial burden, and loss of quality of life. According to previous data, there are regional differences in healthcare.The aim was to analyse the epidemiology as well as the treatment of insured people with Pso and AD in Germany in a regional comparison.Data of the insurance company Techniker Krankenkasse for the year 2019 regarding treatment prevalences as well as drug prescriptions on the regional level for all physicians were examined.In 2019 the overall prevalence of Pso was 2.5% (about 2 million insured people in Germany) and AD was 4.2% (about 3.6 million insured people). In Pso, new guideline-compliant drugs were frequently utilised, yet systemic glucocorticosteroids (GCS) were still disproportionally prescribed. Regionally, there were pronounced disparities with higher prescription rates of the new drugs in the north and east. Insured people with AD most frequently received topical GCS (approx. 88%), of which most were class III (66%), and significantly less frequently calcineurin inhibitors ( 10%), which also conform to guidelines. Systemically, GCS were by far most commonly used (about 25% of all insured people with drug prescriptions). Dupilumab, the only long-term drug approved in 2019, was very rarely prescribed, accounting for less than 1%. Again, large regional differences similar to Pso were found.Pso and AD show relevant disparities and gaps in drug care in the regional comparison despite uniform national guidelines and patient needs. The barriers to appropriate modern pharmaceuticals need to be clarified and mitigated.HINTERGRUND: Psoriasis (Pso) und atopische Dermatitis (AD) sind chronische Hauterkrankungen, die zu erheblichen physischen und psychischen Beeinträchtigungen, finanziellen Belastungen und Einbußen an Lebensqualität führen. Nach früheren Daten weist die Versorgung regionale Unterschiede auf.Ziel war die Analyse der Epidemiologie sowie der Versorgungssituation von Versicherten (VS) mit Pso und AD in Deutschland (D) im regionalen Vergleich.Untersucht wurden Daten der Techniker Krankenkasse für das Jahr 2019 hinsichtlich der Behandlungsprävalenzen sowie der Arzneimittel(AM)-Versorgung auf Ebene der Regionen aller kassenärztlichen Vereinigungen.Die Gesamtprävalenz der Pso lag 2019 bei 2,5 % (ca. 2 Mio. VS in D), die der AD bei 4,2 % (ca. 3,6 Mio. VS). Bei Pso wurden vielfach leitliniengerechte AM-Innovationen, jedoch immer noch im Übermaß systemische Glukokortikosteroide (GKS) eingesetzt. Regional zeigten sich ausgeprägte Disparitäten mit höheren Verordnungsquoten der Innovationen im Norden und Osten. Versicherte mit AD erhielten topisch am häufigsten GKS (ca. 88 %), davon meist der Klasse III (66 %), und deutlich seltener die ebenfalls leitlinienkonformen Calcineurininhibitoren ( 10 %). Systemisch wurden mit Abstand am häufigsten GKS eingesetzt (ca. 25 % aller VS mit AM-Verordnungen). Dupilumab als einziges bislang zugelassenes Langzeit-AM wurde mit einem Anteil von unter 1 % sehr selten verordnet. Auch hier fanden sich große regionale Unterschiede ähnlich wie bei Pso.Pso und AD weisen trotz bundeseinheitlicher Leitlinien und Patientenbedarfe relevante Disparitäten und Versorgungslücken bei AM im Regionalvergleich auf. Die Barrieren einer sachgerechten modernen AM-Versorgung gilt es zu klären und zu mindern.