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To evaluate the safety and utility of an investigational robotic-assisted cochlear implant insertion system.Prospective, single-arm, open-label study under abbreviated Investigational Device Exemption requirements.All procedures were performed, and all data were collected, at a single tertiary referral center.Twenty-one postlingually deafened adult subjects that met Food and Drug Administration indication criteria for cochlear implantation.All patients underwent standard-of-care surgery for unilateral cochlear implantation with the addition of a single-use robotic-assisted insertion device during cochlear electrode insertion.Successful insertion of cochlear implant electrode array, electrode array insertion time, postoperative implant function.Successful robotic-assisted insertion of lateral wall cochlear implant electrode arrays was achieved in 20 (95.2%) of 21 patients. One insertion was unable to be achieved by either robotic-assisted or manual insertion methods, and the patient was retrospectively found to have a preexisting cochlear fracture. Mean intracochlear electrode array insertion time was 3 minutes 15 seconds. All implants with successful robotic-assisted electrode array insertion (n = 20) had normal impedance and neural response telemetry measures for up to 6 months after surgery.Here we report the first human trial of a single-use robotic-assisted surgical device for cochlear implant electrode array insertion. This device successfully and safely inserted lateral wall cochlear implant electrode arrays from the three device manufacturers with devices approved but he Food and Drug Administration.

Purpose: Men with metastatic castration-resistant prostate cancer (mCRPC) frequently develop resistance to androgen receptor signaling inhibitor (ARSI) treatment; therefore, new therapies are needed. Trophoblastic cell-surface antigen (TROP-2) is a transmembrane protein identified in prostate cancer and overexpressed in multiple malignancies. TROP-2 is a therapeutic target for antibody–drug conjugates (ADC). Experimental Design: TROP-2 gene (TACSTD2) expression and markers of treatment resistance from prostate biopsies were analyzed using data from four previously curated cohorts of mCRPC (n = 634) and the PROMOTE study (dbGaP accession phs001141.v1.p1, n = 88). EPCAM or TROP-2–positive circulating tumor cells (CTC) were captured from peripheral blood for comparison of protein (n = 15) and gene expression signatures of treatment resistance (n = 40). We assessed the efficacy of TROP-2–targeting agents in a mouse xenograft model generated from prostate cancer cell lines. Results: We demonstrated that TACSTD2 is expressed in mCRPC from luminal and basal tumors but at lower levels in patients with neuroendocrine prostate cancer. Patients previously treated with ARSI showed no significant difference in TACSTD2 expression, whereas patients with detectable AR-V7 expression showed increased expression. We observed that TROP-2 can serve as a cell surface target for isolating CTCs, which may serve as a predictive biomarker for ADCs. We also demonstrated that prostate cancer cell line xenografts can be targeted specifically by labeled anti–TROP-2 agents in vivo. Conclusions: These results support further studies on TROP-2 as a therapeutic and diagnostic target for mCRPC.

Anthropogenic alteration of physical habitat structure in streams and rivers is increasingly recognized as a major cause of impairment worldwide. As part of their assessment of the status and trends in the condition of rivers and streams in the U.S., the U.S. Environmental Protection Agency's (USEPA) National Aquatic Resource Surveys (NARS) quantify and monitor channel size and slope, substrate size and stability, instream habitat complexity and cover, riparian vegetation cover and structure, anthropogenic disturbance activities, and channel-riparian interaction. Like biological assemblages and water chemistry, physical habitat is strongly controlled by natural geoclimatic factors that can obscure or amplify the influence of human activities. We developed a systematic approach to estimate the deviation of observed river and stream physical habitat from that expected in least-disturbed reference conditions. We applied this approach to calculate indices of anthropogenic alteration of three aspects of physical habitat condition in the conterminous U.S. (CONUS): streambed sediment size and stability, riparian vegetation cover, and instream habitat complexity. The precision and responsiveness of these indices led the USEPA to use them to evaluate physical habitat condition in CONUS rivers and streams. The scores of these indices systematically decreased with greater anthropogenic disturbance at river and stream sites in the CONUS and within ecoregions, which we interpret as a response of these physical habitat indices to anthropogenic influences. Although anthropogenic activities negatively influenced all three physical habitat indices in the least-disturbed sites within most ecoregions, natural geoclimatic and geomorphic factors were the dominant influences. For sites over the full range of anthropogenic disturbance, analyses of observed/expected sediment characteristics showed augmented flood flows and basin and riparian agriculture to be the leading predictors of streambed instability and excess fine sediments. Similarly, basin and riparian agriculture and non-agricultural riparian land uses were the leading predictors of reduced riparian vegetation cover complexity in the CONUS and within ecoregions. In turn, these reductions in riparian vegetation cover and complexity, combined with reduced summer low flows, were the leading predictors of instream habitat simplification. We conclude that quantitative measures of physical habitat structure are useful and important indicators of the impacts of human activities on stream and river condition.

Taxonomic inconsistency in species-level identifications has constrained use of diatoms as biological indicators in aquatic assessments. We addressed this problem by developing diatom multimetric indices (MMIs) of ecological condition using genus-level taxonomy and trait-based autecological information. The MMIs were designed to assess river and stream chemical, physical and biological condition across the conterminous United States. Trait-based approaches have the advantage of using both species-level and genus-level data, which require less effort and expense to acquire than traditional species-based approaches and eliminate the persistent taxonomic biases introduced over vast geographic extents. For large-extent assessment programs that require multiple taxonomic laboratories to process samples, such as the United States Environmental Protection Agency's (U.S. EPA's) National Rivers and Streams Assessment (NRSA), the trait approach can eliminate discrepancies in species-level identification or nomenclature that hinder diatom data interpretation. We developed trait-based MMIs using NRSA data for each of the three large ecoregions across the U.S. - the East, Plains, and West. All three MMIs performed well in discriminating least-disturbed from most-disturbed sites. The MMI for the East had the greatest discrimination ability, followed by MMIs for the Plains and West, respectively. The performance of the MMIs was comparable to that observed in existing NRSA fish and macroinvertebrate MMIs. Our research shows that trait-based diatom indices constructed on genus-level taxonomy can be effective for large-scale assessments, and may also allow programs such as NRSA to assess trends in freshwater condition retrospectively, by revisiting older diatom datasets. Moreover, our genus-based approach facilitates including of diatoms into other assessment programs that have limited monitoring resources.

SARS-CoV-2 has massively changed the care situation in hospitals worldwide. Although tumour care should not be affected, initial reports from European countries were suggestive for a decrease in skin cancer during the first pandemic wave and only limited data are available thereafter.The aim of this study was to investigate skin cancer cases and surgeries in a nationwide inpatient dataset in Germany.Comparative analyses were performed in a prepandemic (18 March 2019 until 17 March 2020) and a pandemic cohort (18 March 2020 until 17 March 2021). Cases were identified and analysed using the WHO international classification of diseases codes (ICDs) and process key codes (OPSs).Comparing the first year of the pandemic with the same period 1 year before, a persistent decrease of 14% in skin cancer cases (n = 19 063) was observed. The largest decrease of 24% was seen in non-invasive in situ tumours (n = 1665), followed by non-melanoma skin cancer (NMSC) with a decrease of 16% (n = 15 310) and malignant melanoma (MM) with a reduction of 7% (n = 2088). Subgroup analysis showed significant differences in the distribution of sex, age, hospital carrier type and hospital volume. There was a decrease of 17% in surgical procedures (n = 22 548), which was more pronounced in minor surgical procedures with a decrease of 24.6% compared to extended skin surgery including micrographic surgery with a decrease of 15.9%.Hospital admissions and surgical procedures decreased persistently since the beginning of the pandemic in Germany for skin cancer patients. The higher decrease in NMSC cases compared to MM might reflect a prioritization effect. Further evidence from tumour registries is needed to investigate the consequences of the therapy delay and identify the upcoming challenges in skin cancer care.

Figure S1. Correlation of TACSTD2 with Prostate Cancer Cell Surface Markers.

Purpose:Men with metastatic castration-resistant prostate cancer (mCRPC) frequently develop resistance to androgen receptor signaling inhibitor (ARSI) treatment; therefore, new therapies are needed. Trophoblastic cell-surface antigen (TROP-2) is a transmembrane protein identified in prostate cancer and overexpressed in multiple malignancies. TROP-2 is a therapeutic target for antibody–drug conjugates (ADC).Experimental Design:TROP-2 gene (TACSTD2) expression and markers of treatment resistance from prostate biopsies were analyzed using data from four previously curated cohorts of mCRPC (n = 634) and the PROMOTE study (dbGaP accession phs001141.v1.p1, n = 88). EPCAM or TROP-2–positive circulating tumor cells (CTC) were captured from peripheral blood for comparison of protein (n = 15) and gene expression signatures of treatment resistance (n = 40). We assessed the efficacy of TROP-2–targeting agents in a mouse xenograft model generated from prostate cancer cell lines.Results:We demonstrated that TACSTD2 is expressed in mCRPC from luminal and basal tumors but at lower levels in patients with neuroendocrine prostate cancer. Patients previously treated with ARSI showed no significant difference in TACSTD2 expression, whereas patients with detectable AR-V7 expression showed increased expression. We observed that TROP-2 can serve as a cell surface target for isolating CTCs, which may serve as a predictive biomarker for ADCs. We also demonstrated that prostate cancer cell line xenografts can be targeted specifically by labeled anti–TROP-2 agents in vivo.Conclusions:These results support further studies on TROP-2 as a therapeutic and diagnostic target for mCRPC.

The objective of our study was to evaluate the efficacy of treatment options for the most frequently reported complications of acute mastoiditis in the English literature. PubMed, EMBASE, and The Cochrane Library were searched from database inception through March 29, 2019.Two independent reviewers (M.R.K., K.S.) evaluated search results for study inclusion. References cited in publications meeting inclusion criteria were reviewed. Twenty-three included studies were published from 1998 through 2018. Treatment efficacy was determined by comparing the change in number of complication subtypes in each treatment subgroup (medical, conservative, or surgical) from admission to discharge (range: 5-30 days) or postdischarge follow-up (range: 1-27.5 months) with a random effects model.Among 733 identified articles, 23 met inclusion criteria. Of the 883 included patients, 203 were managed medically (23%), 300 conservatively (34%) and 380 surgically (43%). Conservative patients had more extracranial complications (ECC, P = 0.04) and intratemporal complications (IT, P = 0.04) at follow-up compared with medical patients. Medical patients had more total number of complications (TNC, P = 0.03), ECC (P = 0.02), and IT (P = 0.01) at discharge compared with surgical patients. Conservative patients had more of all complications except intracranial/extracranial abscess and "other" at discharge and follow-up compared with surgical patients.There were larger reductions in TNC, ECC, and IT at discharge and follow-up among surgical patients compared with medical and conservative patients. There were greater reductions in TNC, ECC, IT, intracranial complications, subperiosteal abscess and lateral sinus thrombosis at discharge and follow-up among surgical patients compared with conservative patients.

Three-dimensional (3D) printing of vascular structures is of special interest for procedure simulations in Interventional Radiology, but remains due to the complexity of the vascular system and the lack of biological tissue mimicking 3D printing materials a technical challenge. In this study, the technical feasibility, accuracy, and usability of a recently introduced silicone-like resin were evaluated for endovascular procedure simulations and technically compared to a commonly used standard clear resin. Fifty-four vascular models based on twenty-seven consecutive embolization cases were fabricated from preinterventional CT scans and each model was checked for printing success and accuracy by CT-scanning and digital comparison to its original CT data. Median deltas (Δ) of luminal diameters were 0.35 mm for clear and 0.32 mm for flexible resin (216 measurements in total) with no significant differences (p > 0.05). Printing success was 85.2% for standard clear and 81.5% for the novel flexible resin. In conclusion, vascular 3D printing with silicone-like flexible resin was technically feasible and highly accurate. This is the first and largest consecutive case series of 3D-printed embolizations with a novel biological tissue mimicking material and is a promising next step in patient-specific procedure simulations in Interventional Radiology.

Robotics-assisted cochlear implant (CI) insertions will result in reduced intracochlear trauma when compared with manual, across multiple users.Whether intracochlear trauma and translocations are two factors that may contribute to significant variability in CI outcomes remains to be seen. To address this issue, we have developed a robotics-assisted insertion system designed to aid the surgeon in inserting electrode arrays with consistent speeds and reduced variability. This study evaluated the effect of robotics-assisted insertions on the intracochlear trauma as compared with manual insertions in cadaveric cochleae in a simulated operative environment.Twelve neurotologists performed bilateral electrode insertions into cochleae of full cadaveric heads using both the robotics-assisted system and manual hand insertion. Lateral wall electrodes from three different manufacturers (n = 24) were used and randomized between surgeons. Insertion angle of the electrode and trauma scoring were evaluated using high-resolution three-dimensional x-ray microscopy and compared between robotics-assisted and manual insertions.Three-dimensional x-ray microscopy provided excellent resolution to characterize the in situ trauma and insertion angle. Robotics-assisted insertions significantly decreased insertional intracochlear trauma as measured by reduced trauma scores compared with manual insertions (average: 1.3 versus 2.2, device versus manual, respectively; p0.05). There was no significant difference between insertion angles observed for manual and robotics-assisted techniques (311 ± 131° versus 307 ± 96°, device versus manual, respectively).Robotics-assisted insertion systems enable standardized electrode insertions across individual surgeons and experience levels. Clinical trials are necessary to investigate whether insertion techniques that reduce insertional variability and the likelihood of intracochlear trauma also improve CI auditory outcomes.

Lake water levels are integral to lake function, but hydrologic changes from land and water management may alter lake fluctuations beyond natural ranges. We constructed a conceptual model of multifaceted drivers of lake water-levels and evaporation-to-inflow ratio (Evap:Inflow). Using a structural equation modeling framework, we tested our model on 1) a national subset of lakes in the conterminous United States with minimal water management to describe natural drivers of lake hydrology and 2) five ecoregional subsets of lakes to explore regional variation in water management effects. Our model fit the national and ecoregional datasets and explained up to 47% of variation in Evap:Inflow, 38% of vertical water-level decline, and 79% of horizontal water-level decline (littoral exposure). For lakes with minimal water management, Evap:Inflow was related to lake depth (β = −0.31) and surface inflow (β = −0.44); vertical decline was related to annual climate (e.g., precipitation β = −0.18) and water management (β = −0.21); and horizontal decline was largely related to vertical decline (β = 0.73) and lake morphometry (e.g., depth β = −0.18). Anthropogenic effects varied by ecoregion and likely reflect differences in regional water management and climate. In the West, water management indicators were related to greater vertical decline (β = 0.38), whereas in the Midwest, these indicators were related to more stable and full lake levels (β = −0.22) even during drought conditions. National analyses show how human water use interacts with regional climate resulting in contrasting impacts to lake hydrologic variation in the US.

PurposeA significant body of research has now been accumulated in the intercultural service encounter (ICSE) literature. However, no study to date has provided scholars and practitioners with a systematic review to map and better understand the ICSE domain.Design/methodology/approachTo fill this gap, the authors systematically review and critically examine the state of academic research on ICSE.FindingsBased on a systematic review of 31 journal articles published over the last two decades, the results illustrate that ICSE research is a vibrant and rapidly growing stream of the broader international business domain, and it is topically and methodologically diverse. This review also identifies significant knowledge gaps related to the adoption of different theoretical orientations by researchers examining ICSE at different levels of analysis, a lack of contextual positioning, as well as poor methodological rigor.Originality/valueBased on the findings, the authors introduce a multilevel and multidisciplinary conceptual framework that integrates the concepts of emotional intelligence (EI) and intercultural communication competence (ICC) as the key variables that explain trust development during the interaction between two key culturally different stakeholders: service providers (employees) and service receivers (customers). Finally, the authors discuss the contributions and implications for both academics and practitioners.

Objective The role of anticoagulation (AC) in the management of otogenic cerebral venous sinus thrombosis (OCVST) remains controversial. Our study aims to better define when AC is used in OCVST. Methods MEDLINE, EMBASE, and The Cochrane Library were searched from inception to February 14, 2019 for English and English-translated articles. References cited in publications meeting search criteria were searched. Titles and abstracts were screened and identified in the literature search, assessing baseline risk of bias on extracted data with the methodological index for nonrandomized studies (MINORS) scale. Random effects meta-regression followed by random forest machine learning analysis across 16 moderator variables between AC and nonanticoagulated (NAC) cohorts was conducted. Results A total of 92% of treated patients were free of neurologic symptoms at the last follow-up (mean 29.64 months). Four percent of AC and 14% of NAC patients remained symptomatic (mean 18.72 and 47.10 months). 3.5% of AC patients experienced postoperative wound hematomas. AC and NAC recanalization rates were 81% (34/42) and 63% (five-eights), respectively. OCVST was correlated with cholesteatoma and intracranial abscess. Among the analyzed covariates, intracranial abscess was most predictive of AC and cholesteatoma was most predictive of NAC. Comorbid intracranial abscess and cholesteatoma were predictive of AC. Conclusion The present study is the first to utilize machine learning algorithms in approaching OCVST. Our findings support the therapeutic use of AC in the management of OCVST when complicated by thrombophilia, intracranial abscess, and cholesteatoma. Patients with intracranial abscess and cholesteatoma may benefit from AC and surgery. Patients with cholesteatoma can be managed with NAC and surgery.

Background: The objective of this study was to assess whether a zinc-impregnated polypropylene mesh (ZnMesh) has better antibacterial properties in a contaminated environment compared with a regular polypropylene mesh. Materials and methods: Thirty-eight Wistar Han rats underwent cecal ligation and puncture to induce peritonitis 24 h before implantation of an intraperitoneal ZnMesh or a regular polypropylene mesh. Primary outcome was the number of colony forming units (CFU) per sample (mesh and abdominal wall). Secondary outcomes were macroscopic (incorporation of mesh, abscesses, and adhesions on mesh surface) and histological (inflammatory cell reaction, mesh-specific parameters, and collagen deposition) parameters. All outcomes were evaluated after 30 and 90 d. Results: After 30 d, no significant difference in CFU per sample was present between the ZnMesh and control groups. After 90 d, a lower number of CFU per sample was present in the ZnMesh group compared with the control group (trypticase soy agar with 5% sheep blood: 0 log10 CFU/sample IQR: 0-1.40 versus 1.58 log10 CFU/sample IQR: 0-4.30, P = 0.012; MacConkey: 0 log10 CFU/sample IQR: 0-2.65 versus 1.18 log10 CFU/sample IQR: 0-4.04, P = 0.438). After 90 d, the percentage of adhesions on mesh surface was significantly higher in the ZnMesh group (95% IQR: 60%-100% versus 50% IQR: 23%-75%, P = 0.029). No differences were seen in other macroscopic outcomes or histology. Conclusions: A significantly lower number of CFU per sample was found in the ZnMesh group after 90 d. After 30 d, no statistically significant differences in CFU per sample were seen. This result suggests that the ZnMesh group has better antibacterial properties in a contaminated environment. However, this is at the cost of a significantly higher percentage of adhesions.

Establishing baseline hydrologic characteristics for lakes in the U.S. is critical to evaluate changes to lake hydrology. We used the U.S. EPA National Lakes Assessment 2007 and 2012 surveys to assess hydrologic characteristics of a population of ~45,000 lakes in the conterminous U.S. based on probability samples of ~1,000 lakes/yr distributed across nine ecoregions. Lake hydrologic study variables include water-level drawdown (i.e., vertical decline and horizontal littoral exposure) and two water stable isotope-derived parameters: evaporation-to-inflow (E:I) and water residence time. We present 1) national and regional distributions of the study variables for both natural and man-made lakes and 2) differences in these characteristics between 2007 and 2012. In 2007, 59% of the population of U.S. lakes had Greater than normal or Excessive drawdown relative to water levels in ecoregional reference lakes with minimal human disturbances; while in 2012, only 20% of lakes were significantly drawn down beyond normal ranges. Water isotope-derived variables did not differ significantly between survey years in contrast to drawdown. Median E:I was 20% indicating that flow-through processes dominated lake water regimes. For 75% of U.S. lakes, water residence time was < 1 year and was longer in natural vs. man-made lakes. Our study provides baseline ranges to assess local and regional lake hydrologic status and inform management decisions in changing environmental conditions.

Restoring degraded rivers requires initial assessment of the fluvial landscape to identify stressors and riverine features that can be enhanced. We associated local-scale river habitat data collected using standardized national monitoring tools with modeled regional water temperature and flow data on mid-sized northwest U.S. rivers (30–60 m wide). We grouped these rivers according to quartiles of their modeled mean August water temperature and examined their physical habitat structure and flow. We then used principal components analysis to summarize the variation in several dimensions of physical habitat. We also compared local conditions in the Priest River, a river targeted for restoration of native salmonid habitat in northern Idaho, with those in other rivers of the region to infer potential drivers controlling water temperature. The warmest rivers had physical structure and fluvial characteristics typical of thermally degraded rivers, whereas the coldest rivers had higher mean summer flows and greater channel planform complexity. The Priest River sites had approximately twice as many deep residual pools (>50, >75, and >100 cm) and incision that averaged approximately twice that in the coldest rivers. Percentage fines and natural cover in the Priest were also more typical of the higher-temperature river groups. We found generally low instream cover and low levels of large wood both across the region and within the Priest River. Our approach enabled us to consider the local habitat conditions of a river in the context of other similarly sized rivers in the surrounding region. Understanding this context is important for identifying potential influences on river water temperature within the focal basin and for defining attainable goals for management and restoration of thermal and habitat conditions.

Purpose Knowledge of postoperative behavior of mesh implants used for hernia repair is generally limited to cases of recurrence, local complications or return to the previous operative field in other pathological conditions. Previous studies with MRI-visible mesh implants in different parts of the abdominal wall have led to variable findings with regard to mesh properties and mostly described a reduction in size over time with subsequently limited mesh overlap over hernia defects which could contribute to recurrence. We aimed to evaluate implant properties in a mechanically stable anatomical region after TAPP repair of primary unilateral inguinal hernias in men with clinical and MRI examinations 4 weeks and 1 year after surgery. Methods From 11/2015 to 01/2019, 23 men with primary, unilateral, inguinal hernias underwent TAPP repair with iron particle-loaded, MRI-visible mesh implants in a prospective cohort study. In 16 patients the operative outcome could be evaluated 4 weeks and 12 months after surgery by clinical examination and MRI evaluation with regard to postoperative course, possible adverse outcomes and radiological findings related to implant behavior—namely MRI-identifiability, mesh dislocation or reduction in surface area. Results All included patients had an uneventful postoperative clinical course. MRI after 4 weeks revealed one postoperative seroma, which resolved spontaneously. No recurrence was detected. Mesh implants could be accurately delineated in DIXON-IN studies and showed neither clinically nor statistically significant changes in size or position. Conclusion 4 weeks and 1 year after a standardized TAPP procedure the mesh implant used in this study showed no tendency towards dislocation or reduction in size in this anatomical position. Its MRI visibility allows accurate delineation during the postoperative course by experienced radiologists in appropriate MRI protocols. Larger patient series are desirable to further support these findings. Shrinkage of implants in the groin as a reason for early recurrence may be overestimated.

Background The use of synthetic mesh in potentially contaminated and contaminated incisional hernias may lead to a higher morbidity and mortality. Biological meshes may provide a solution, but since these meshes are rarely used, little is known about long-term results. The aim of this cohort study was to evaluate the long-term clinical efficacy and patient satisfaction following Permacol™ in complex abdominal wall hernia repair (CAWHR) patients in a cross-sectional fashion. Materials and methods All patients were operated for CAWHR with Permacol™ in the Netherlands between 2009 and 2012. The design was a multicenter cross-sectional cohort study. The STROCSS statement was followed. Patients were interviewed, underwent abdominal examination, and completed quality-of-life questionnaires. ClinicalTrials.gov Identifier NCT02166112 . Research Registry Identifier researchregistry4713. Results Seventy-seven patients were seen in the outpatient clinic. Their hernias were classified as potentially contaminated in 25 patients (32.5%) and infected in 52 patients (67.5%). The mean follow-up was 22.2 ± 12.6 months. The most frequent postoperative complication was wound infection (n = 21; 27.3%), meshes had to be removed in five patients (6.5%). By the time of their visit to the outpatient clinic, 22 patients (28.6%) had a recurrence of whom ten (13%) had undergone reoperation. Thirty-nine patients (50.6%) had bulging of the abdominal wall. Quality-of-life questionnaires revealed that patients graded their health status with a mean 6.8 (± 1.8) out of 10 points. Conclusion Bulging and recurrence are frequently observed in patients treated with Permacol™ for CAWHR. Considering both recurrence and bulging as undesirable outcomes of treatment, a total of 46 patients (59.7%) had an unfavorable outcome. Infection rates were high, but comparable with similar patient cohorts. Quality-of-life questionnaires revealed that patients were satisfied with their general health, but scored significantly lower on most quality-of-life modalities of the Short Form-36 questionnaire.

Background. In laparoscopic incisional hernia repair, direct contact between the prosthesis and abdominal viscera is inevitable and may lead to adhesions. Despite the large variety of mesh prosthesis, little is known about their in vivo behavior. Biological meshes are considered to have many advantages, but due to their price they are rarely used. A rat model was used to assess biological and conventional synthetic meshes on their in vivo characteristics. Design. One-hundred twenty male Wistar rats were randomized into five groups of 24 rats. A mesh was implanted intraperitoneally and fixated with nonresorbable sutures. The following five meshes were implanted: Parietene (polypropylene), Permacol (cross-linked porcine acellular dermal matrix), Strattice (non-cross-linked porcine acellular dermal matrix), XCM Biologic (non-cross-linked porcine acellular dermal matrix), and Omyra Mesh (condensed polytetrafluoroethylene). The rats were sacrificed after 30, 90, or 180 days. Incorporation, shrinkage, adhesions, abscess formation, and histology were assessed for all meshes. Results. All animals thrived postoperatively. After 180 days, Permacol, Parietene, and Omyra Mesh had a significantly better incorporation than Strattice ( P = .001, P = .019, and P = .037 respectively). After 180 days, Strattice had significantly fewer adhesions on the surface of the mesh than Parietene ( P < .001), Omyra Mesh ( P = .011), and Permacol ( P = .027). After 30 days, Permacol had significantly stronger adhesions than Strattice ( P = .030). However, this difference was not significant anymore after 180 days. After 180 days, there was significantly less shrinkage in Permacol than in Strattice ( P = .001) and Omyra Mesh ( P = .050). Conclusion. Based on incorporation, adhesions, mesh shrinkage, and histologic parameters, Strattice performed best in this experimental rat model.

Lakes face multiple anthropogenic pressures that can substantially alter their hydrology. Dams and land use in the watershed (e.g., irrigated agriculture) can modify lake water regimes beyond natural ranges, and changing climate may exacerbate anthropogenic stresses on lake hydrology. However, we lack cost-effective indicators to quantify anthropogenic hydrologic alteration potential in lakes at regional and national extents. We developed a framework to rank lakes by the potential for dams and land use to alter lake hydrology (HydrAP) that can be applied at a national scale. The HydrAP framework principles are that 1) dams are primary drivers of lake hydro-alteration, 2) land use activities are secondary drivers that alter watershed hydrology, and 3) topographic relief limits where land use and dams are located on the landscape. We ranked lakes in the United States Environmental Protection Agency National Lakes Assessment (NLA) on a HydrAP scale from zero to seven, where a zero indicates lakes with no potential for anthropogenic hydro-alteration, and a seven indicates large dams and/or intensive land use with high potential to alter lake hydrology. We inferred HydrAP population distributions in the conterminous US (CONUS) using the NLA probabilistic weights. Half of CONUS lakes had moderate to high hydro-alteration potential (HydrAP ranks 3–7), the other half had minimal to no hydro-alteration potential (HydrAP ranks 0–2). HydrAP ranks generally corresponded with natural and man-made lake classes, but >15% of natural lakes had moderate to high HydrAP ranks and ~10% of man-made lakes had low HydrAP ranks. The Great Plains, Appalachians, and Coastal Plains had the largest percentages (>50%) of high HydrAP lakes, and the West and Midwest had the lowest percentages (~30%). Water residence time (τ) and water-level change were associated with HydrAP ranks, demonstrating the framework’s intended ability to differentiate anthropogenic stressors that can alter lake hydrology. Consistently across ecoregions high HydrAP lakes had shorter τ. But HydrAP relationships with water-level change varied by ecoregion. In the West and Appalachians, high HydrAP lakes experienced excessive water-level declines compared to low-ranked lakes. In contrast, high HydrAP lakes in the Great Plains and Midwest showed stable water levels compared to low-ranked lakes. These differences imply that water management in western and eastern mountainous regions may result in large water-level fluctuations, but water management in central CONUS may promote water-level stabilization. The HydrAP framework using accessible, national datasets can support large-scale lake assessments and be adapted to specific locations where data are available.