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A protocol for the mechanochemical synthesis of copper(I)/N-heterocyclic carbene complexes using cheap and readily available K3PO4 as base has been developed. This method employing a ball mill is amenable to typical simple copper(I)/NHC complexes but also to a sophisticated copper(I)/N-heterocyclic carbene complex bearing a guanidine moiety. In this way, the present approach circumvents commonly employed silver(I) complexes which are associated with significant and undesired waste formation and the excessive use of solvents. The resulting bifunctional catalyst has been shown to be active in a variety of reduction/hydrogenation transformations employing dihydrogen as terminal reducing agent.

Since its first proposal, the concept of on- and off-track lesions in anterior shoulder instability has gained clinical relevance as a tool to predict the failure rate of arthroscopic Bankart repair. Current literature only reports either short-term follow-up or long-term results of small sample sizes. The aim of this study was to provide a long-term evaluation of recurrent instability following arthroscopic Bankart repair in a large cohort using the on-track vs. off-track concept as a predictor for failure.We retrospectively analyzed 271 patients who underwent primary arthroscopic Bankart repair for anterior shoulder instability between 1998 and 2007. All patients with a minimum follow-up of 78 months and a preoperative computed tomographic (CT) or magnetic resonance imaging (MRI) scan were included into the study. Preoperative CT and/or MRI scans were used to determine the glenoid track and width of Hill-Sachs lesion. Recurrence of instability was defined as presence of instability symptoms (dislocation, subluxation, and/or apprehension) or revision surgery (stabilization procedure) and was assessed as the primary outcome parameter.The glenoid track of 163 shoulders was assessed (female n = 51, male n = 112) with a mean follow-up of 124 months (99.4-145.6, standard deviation = 2.5) and a mean age of 24 years (20-34.). An off-track Hill-Sachs lesion was found in 77 cases (47%), and in 86 cases (53 %) it was on-track. The rate of recurrent instability in the off-track group was 74% (n = 57) compared with 27% (n = 23) in the on-track group (P.001). The overall rate of revision surgery due to instability was 29% (n = 48) after a mean time of 50.9 months (±42.8) following Bankart repair. The rate of revision surgery in the off-track group was 48% (n = 37) after a mean of 53.5 months (±42.0) vs. 13% (n = 11) after 42.3 months (±46.3) in the on-track group (P.001).This study shows that the on- and off-track concept helps to distinguish patients for whom an isolated arthroscopic Bankart repair yields long-term benefits. Because of the high rate of recurrent instability in the off-track group, an off-track lesion should be treated surgically in such a way that the off-track lesion is converted into an on-track lesion.

This scientific commentary refers to ‘Transcriptomic and connectomic correlates of differential spatial patterning among gliomas’ by Romero-Garcia et al. (https://doi.org/10.1093/brain/awac378)

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Headache is a common symptom during pregnancy and in puerperium that requires careful consideration, as it may be caused by a life-threatening condition. Headaches in pregnant women and women in puerperium are classified as primary or secondary; acute, severe and newly diagnosed headaches should prompt further investigation. We aimed to further characterise the demographic features, symptoms, examination findings, and neuroimaging results of cases of headache during pregnancy and in puerperium. All pregnant women or women in postpartum conditions who attended neurological consultations at the emergency department of the clinic for Gynaecology, Obstetrics and Reproductive Medicine of Saarland University/Germany between 2001/2015 and 2012/2019 were enrolled in this retrospective chart review. Data collected from the charts included demographic/pregnancy characteristics, clinical features and imaging findings. Descriptive statistics as well as binary logistic regression were performed. More than 50% of 97 patients had abnormal findings in their neurological examination. Magnetic resonance imaging findings were pathological for almost 20% of patients—indicating conditions such as cerebral venous thrombosis, reversible posterior leukoencephalopathy, brain tumour and intracranial bleeding. The odds of abnormal neuroimaging results were 2.2-times greater among women with abnormal neurological examination findings than among those with normal examination results. In cases of headache during pregnancy and in puerperium, neuroimaging should be indicated early on. Further research is needed to determine which conditions indicate a need for immediate neuroimaging.

PurposeIntraoperative hinge fractures in distal femur osteotomies represent a risk factor for loss of alignment and non-union. Using finite element analysis, the goal of this study was to investigate the influence of different hinge widths and osteotomy corrections on hinge fractures in medial closed-wedge and lateral open-wedge distal femur osteotomies.MethodsThe hinge was located at the proximal margin of adductor tubercle for biplanar lateral open-wedge and at the upper border of the lateral femoral condyle for biplanar medial closed-wedge distal femur osteotomies, corresponding to optimal hinge positions described in literature. Different hinge widths (5, 7.5, 10 mm) were created and the osteotomy correction was opened/closed by 5, 7.5 and 10 mm. Tensile and compressive strain of the hinge was determined in a finite element analysis and compared to the ultimate strain of cortical bone to assess the hinge fracture risk.ResultsDoubling the correction from 5 to 10 mm increased mean tensile and compressive strain by 50% for lateral open-wedge and 48% for medial closed-wedge osteotomies. A hinge width of 10 mm versus 5 mm showed increased strain in the hinge region of 61% for lateral open-wedge and 32% for medial closed-wedge osteotomies. Medial closed-wedge recorded a higher fracture risk compared to lateral open-wedge osteotomies due to a larger hinge cross-section area (60-67%) for all tested configurations. In case of a 5 mm hinge, medial closed-wedge recorded 71% higher strain in the hinge region compared to lateral open-wedge osteotomies.ConclusionDue to morphological features of the medial femoral condyle, finite element analysis suggests that lateral-open wedge osteotomies are the preferable option if larger corrections are intended, as a thicker hinge can remain without an increased hinge fracture risk., Journal of Experimental Orthopaedics, 10 (1), ISSN:2197-1153

Background: Previous studies have shown that quality of life improves after coronary revascularization more so after coronary artery bypass grafting (CABG) than after percutaneous coronary intervention (PCI). This study aimed to evaluate the effect of fractional flow reserve guidance and current generation, zotarolimus drug-eluting stents on quality of life after PCI compared with CABG. Methods: The FAME 3 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) is a multicenter, international trial including 1500 patients with 3-vessel coronary artery disease who were randomly assigned to either CABG or fractional flow reserve–guided PCI. Quality of life was measured using the European Quality of Life–5 Dimensions (EQ-5D) questionnaire at baseline and 1 and 12 months. The Canadian Cardiovascular Class angina grade and working status were assessed at the same time points and at 6 months. The primary objective was to compare EQ-5D summary index at 12 months. Secondary end points included angina grade and work status. Results: The EQ-5D summary index at 12 months did not differ between the PCI and CABG groups (difference, 0.001 [95% CI, –0.016 to 0.017]; P =0.946). The trajectory of EQ-5D during the 12 months differed ( P Conclusions: In the FAME 3 trial, quality of life after fractional flow reserve–guided PCI with current generation drug-eluting stents compared with CABG was similar at 1 year. The rate of significant angina was low in both groups and not significantly different. The trajectory of improvement in quality of life was significantly better after PCI, as was working status in those Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02100722.

Companies offer products in different variants to reach more customers. This increases internal variety and cost. However, reducing those cost is difficult due to complexity. Complexity arises from: combinatorics; many design variables interacting with each other; coupling of technical and economical perspectives. This paper presents an approach based on (1) building a complex system model of modular models; (2) identifying the potential for standardization from a technical perspective; (3) cost-optimizing the degree of standardization. A product family of electric vehicles was optimized.

Complexity in systems design can be reduced by computing permissible ranges for some crucial design variables that need to be defined in an early design phase. These ranges are calculated such that there is sufficient tolerance for the remaining design variables in later design phases, while still achieving the overall system design goals. A new algorithm for this approach is presented and applied to the design of a vehicle powertrain mount system. The results show large permissible ranges for mount positions while maintaining sufficient tolerance for mount stiffnesses.

A digital twin (DT) relies on a detailed, virtual representation of a physical product. Since uncertainties and deviations can lead to significant changes in the functionality and quality of products, they should be considered in the DT. However, valuable product properties are often hidden and thus difficult to integrate into a DT. In this work, a Bayesian inverse approach based on surrogate models is applied to infer hidden composite laminate ply angles from strain measurements. The approach is able to find the true values even for ill-posed problems and shows good results up to 6 plies.

O desenvolvimento de novos materiais, tem se pautado, de forma cada vez mais crescente, visando produções mais sustentáveis, com o aproveitamento de matérias-primas já existentes ou resíduos industriais, a fim de diminuir os impactos ambientais. Este manuscrito tem como objetivo um levantamento bibliográfico detalhado entre dissertações e teses defendidas no Brasil, bem como artigos publicados em periódicos especializados, com ênfase aos nacionais, de 2000 até a atualidade, envolvendo estudos com compósitos à base de polipropileno. Também tem como finalidade apresentar propostas de cargas alternativas (minerais, vegetais e resíduos industriais) para matrizes termoplásticas. Esta abordagem de revisão contribuirá tanto com as instituições de ensino e pesquisa, quanto com os setores privados de manufatura de poliolefinas, e desta forma, atraindo também o interesse do setor produtivo por este periódico.

Lactic acid (LA) fermentation of dog’s mercury (M. perennis L.) herbal parts was investigated in samples inoculated with either Lactobacteria (Lactobacillus plantarum and Pediococcus pentosaceus, LBF) or whey (WF). Depending on fermentation time, LA concentrations were monitored in a range of 3.4–15.6 g/L with a concomitant pH decline from 6.5 to 3.9. A broad spectrum of cinnamic acids depsides containing glucaric, malic and 2-hydroxyglutaric acids along with quercetin and kaempferol glycosides were detected by LC-DAD-ESI-MSn. Moreover, in this study novel constituents were also found both in unfermented and fermented extracts. Furthermore, amino acids and particular Lactobacteria metabolites such as biogenic amines (e.g., putrescine, 4-aminobutyric acid, cadaverine) and 5-oxoproline were assigned in WF extracts by GC-MS analysis after silylation. Enhanced NFκB and cytokine expression (IL-6, TNFα, IL-8 and IL-1β) was induced by all extracts, both non-fermented and fermented, in NFκB-THP-1 reporter cells, showing a concentration-dependent immunostimulatory effect. The WF extracts were tested for micronuclei formation in THP-1 cells and toxicity in luminescent bacteria (V. fischeri), whereby no mutagenic or toxic effects could be detected, which corroborates their safe use in pharmaceutical remedies.

A 58-year-old male with prior history of mechanical aortic valve replacement (AVR) in 2009 for severe symptomatic aortic regurgitation in a bicuspid aortic valve, and since 2013 a new-onset severe asymptomatic primary mitral regurgitation (MR) due to prolapse of the anterior mitral valve leaflet (AMVL) presented himself with acute heart failure. Based on current guidelines recommendations, this patient was not eligible for transcutaneous mitral valve edge-to-edge repair (TEER), as well he was found as too high risk for conventional mitral valve repair. However, as a last resort TEER was undertaken with an unconventional strategy, which resulted in resolution of the MR and improvement of clinical, biochemical findings.

The uptake of COVID-19 vaccines has varied considerably across European countries. This study investigates people’s decision-making process regarding vaccination by analyzing qualitative interviews (n = 214) with residents from five European countries: Austria, Germany, Italy, Portugal, and Switzerland. We identify three factors that shape vaccination decision-making: individual experiences and pre-existing attitudes towards vaccination, social environment, and socio-political context. Based on this analysis, we present a typology of decision-making regarding COVID-19 vaccines, where some types present stable stances towards vaccines and others change over time. Trust in government and relevant stakeholders, broader social factors, and people’s direct social environment were particularly relevant to these dynamics. We conclude that vaccination campaigns should be considered long-term projects (also outside of pandemics) in need of regular adjustment, communication and fine-tuning to ensure public trust. This is particularly pertinent for booster vaccinations, such as COVID-19 or influenza., The first and corresponding authors contributed to this manuscript in equal parts and share first authorship. Funding for this study was received from: University of Basel research grant [3BE1003]; Federal Ministry of Education and Research in Germany: Global Health Research in the Wake of the Sars-CoV-2 Outbreak Grant [01KI20510]; FWF – Austrian Science Fund (Elise Richter grant V561 and START grant Y1433); Cariplo Foundation, Social Science Research Grant (Bando Ricerca Sociale), 2020-1314. Open access funded by the FWF - Austrian Science Fund.

Solidarity and personal responsibility have been repeatedly called upon during the COVID-19 pandemic. This study quantifies and contextualizes the use of these terms in newspaper coverage in Germany and German-speaking Switzerland based on n = 640 articles from six functionally equivalent newspapers. The term solidarity in the context of the COVID-19 pandemic was mentioned in 541/640 articles (84.5%) and was primarily used during phases with high death rates and comparatively stringent policies in place, supporting the idea that solidarity was used to explain restrictive measures to the population and motivate people to comply with these measures. German newspapers published more articles on solidarity than Swiss-German newspapers, consistent with more stringent COVID-19 policies in Germany. Personal responsibility was mentioned in 133/640 articles (20.8%), meaning that the term was less frequently discussed than solidarity. Articles covering personal responsibility included more negative evaluations during phases of high infection rates as compared to phases of low infection rates. Findings indicate that the two terms were, at least to some extent, used in newspaper reporting to contextualize and justify COVID-19 policy during phases of high infection rates. Moreover, the term solidarity was used in a high variety of different contexts and the inherent limits of solidarity were rarely mentioned. Policymakers and journalists need to take this into account for future crises to not jeopardize the positive effects of solidarity.

The natural product aurachin D is a farnesylated quinolone alkaloid, which is known to possess activity against the causative agent of malaria, Plasmodium spp. In this study, we show that aurachin D inhibits other parasitic protozoa as well. While aurachin D had only a modest effect on Trypanosoma brucei rhodesiense, two other trypanosomatids, T. cruzi and Leishmania donovani, were killed at low micromolar and nanomolar concentrations, respectively, in an in vitro assay. The determined IC50 values of aurachin D were even lower than those of the reference drugs benznidazole and miltefosine. Due to these promising results, we set out to explore the impact of structural modifications on the bioactivity of this natural product. In order to generate aurachin D derivatives with varying substituents at the C-2, C-6 and C-7 position of the quinolone ring system, we resorted to whole-cell biotransformation using a recombinant Escherichia coli strain capable of aurachin-type prenylations. Quinolone precursor molecules featuring methyl, methoxy and halogen groups were fed to this E. coli strain, which converted the substrates into the desired analogs. None of the generated derivatives exhibited improved antiprotozoal properties in comparison to aurachin D. Obviously, the naturally occurring aurachin D features already a privileged structure, especially for the inhibition of the causative agent of visceral leishmaniasis.

The human SEC62 gene is located on chromosome 3q, was characterized as a tumor driver gene and is found to be overexpressed in an ever-growing number of tumors, particularly those with 3q26 amplification. Where analyzed, SEC62 overexpression was associated with poor prognosis. Sec62 protein is a membrane protein of the endoplasmic reticulum (ER) and has functions in endoplasmic reticulum protein import, endoplasmic reticulum-phagy and -in cooperation with the cytosolic protein calmodulin- the maintenance of cellular calcium homeostasis. Various human tumors show SEC62 overexpression in immunohistochemistry and corresponding cell lines confirm this phenomenon in western blots and immunofluorescence. Furthermore, these tumor cells are characterized by increased stress tolerance and migratory as well as invasive potential, three hallmarks of cancer cells. Strikingly, plasmid-driven overexpression of SEC62 in non-SEC62 overexpressing cells introduces the same three hallmarks of cancer into the transfected cells. Depletion of Sec62 from either type of SEC62 overexpressing tumor cells by treatment with SEC62-targeting siRNAs leads to reduced stress tolerance and reduced migratory as well as invasive potential. Where tested, treatment of SEC62 overexpressing tumor cells with the small molecule/calmodulin antagonist trifluoperazine (TFP) phenocopied the effect of SEC62-targeting siRNAs. Recently, first phase II clinical trials with the prodrug mipsagargin/G202, which targets cellular calcium homeostasis in prostate cells as well as neovascular tissue in various tumors were started. According to experiments with tumor cell lines, however, SEC62 overexpressing tumor cells may be less responsive or resistant against such treatment. Therefore, murine tumor models for tumor growth or metastasis were evaluated with respect to their responsiveness to treatment with a mipsagargin analog (thapsigargin), or trifluoperazine, which had previously been in clinical use for the treatment of schizophrenia, or with the combination of both drugs. So far, no additive effect of the two drugs was observed but trifluoperazine had an inhibitory effect on tumor growth and metastatic potential in the models. Here, we review the state of affairs.

The sudden and dramatic advent of the COVID-19 pandemic led to urgent demands for timely, relevant, yet rigorous research. This paper discusses the origin, design, and execution of the SolPan research commons, a large-scale, international, comparative, qualitative research project that sought to respond to the need for knowledge among researchers and policymakers in times of crisis. The form of organization as a research commons is characterized by an underlying solidaristic attitude of its members and its intrinsic organizational features in which research data and knowledge in the study is shared and jointly owned. As such, the project is peer-governed, rooted in (idealist) social values of academia, and aims at providing tools and benefits for its members. In this paper, we discuss challenges and solutions for qualitative studies that seek to operate as research commons. ispartof: SSM: Qualitative Research in Health vol:2 ispartof: location:England status: published

Vaccine uptake is essential to managing the ongoing COVID-19 pandemic, and vaccine hesitancy is a persistent concern. At the same time, both decision-makers and the general population have high hopes for COVID-19 vaccination. Drawing from qualitative interview data collected in October 2020 as part of the pan-European SolPan study, this study explores early and anticipatory expectations, hopes and fears regarding COVID-19 vaccination across seven European countries. We find that stances towards COVID-19 vaccines were shaped by personal lived experiences, but participants also aligned personal and communal interests in their considerations. Trust, particularly in expert institutions, was an important prerequisite for vaccine acceptance, but participants also expressed doubts about the rapid vaccine development process. Our findings emphasise the need to move beyond the study of factors driving vaccine hesitancy, and instead to focus on how people personally perceive vaccination in their particular social and political context. ispartof: Social Science & Medicine - Qualitative Research in Health vol:2 pages:100035- ispartof: location:England status: Published online

Background The use of genome-wide sequencing in pediatric medicine and research is growing exponentially. While this has many potential benefits, the normative and empirical literature has highlighted various ethical issues. There have not been, however, any systematic reviews of these issues. The aim of this systematic review is to determine systematically the spectrum of ethical issues that is raised for stakeholders in in pediatric genome-wide sequencing. Methods A systematic review in PubMed and Google Books (publications in English or German between 2004 and 2021) was conducted. Further references were identified via reference screening. Data were analyzed and synthesized using qualitative content analysis. Ethical issues were defined as arising when a relevant normative principle is not adequately considered or when two principles come into conflict. Results Our literature search retrieved 3175 publications of which 143 were included in the analysis. Together these mentioned 106 ethical issues in pediatric genome-wide sequencing, categorized into five themes along the pediatric genome-wide sequencing lifecycle. Most ethical issues identified in relation to genome-wide sequencing typically reflect ethical issues that arise in general genetic testing, but they are often amplified by the increased quantity of data obtained, and associated uncertainties. The most frequently discussed ethical aspects concern the issue of unsolicited findings. Conclusion Concentration of the debate on unsolicited findings risks overlooking other ethical challenges. An overarching difficulty presents the terminological confusion: both with regard to both the test procedure/ the scope of analysis, as well as with the topic of unsolicited findings. It is important that the genetics and ethics communities together with other medical professions involved work jointly on specific case related guidelines to grant the maximum benefit for the care of the children, while preventing patient harm and disproportionate overload of clinicians and the healthcare system by the wealth of available options and economic incentives to increase testing.

Background: The best treatment of degenerative hip abductor tendon lesions remains largely unknown, as the natural course of the disease has not yet been reported. The aim of the present study was to investigate the natural history of symptomatic degenerative hip abductor lesions. Hypothesis: Nonoperatively treated hip abductor lesions progress over time, resulting in refractory hip pain and low functional outcomes. Study Design: Case series (prognosis); Level of evidence, 4. Methods: Consecutive patients with greater trochanteric pain syndrome and degenerative changes on magnetic resonance imaging (MRI) of the symptomatic hip were included. Bilateral hip MRI scans and a clinical examination were performed at a minimum follow-up of 36 months to study the type and location of hip abductor lesion. Progression of a lesion was defined as a more severe lesion as compared with the initial MRI results or if the lesion extended to another, initially not involved, trochanteric facet. The muscle’s fatty infiltration (FI) was also described. Results: From 106 patients identified, 58 patients (64 hips) aged 66 ± 14 years (mean ± SD) agreed to return to the clinic for follow-up MRI and met the inclusion criteria. At a mean 71-month follow-up, an overall 34% (22/64) of lesions had progressed over time: from trochanteric bursitis to tendinopathy (9/64, 14%) or partial tear (5/64, 8%), from tendinopathy to partial tear (4/64, 6%), from a partial to complete tear (3/64, 4.5%), and with 1 complete tear (1/64, 1.5%) extending to another trochanteric facet. Interestingly, 90% of partial tears remained stable or transformed into a scar. Although patients with a progressive lesion experienced more trochanteric pain (visual analog scale, 4.6 vs 2.8; P = .001), the functional outcomes were comparable with patients with a stable lesion. The majority of hips with a partial tear (64%) demonstrated a progression of gluteus minimus FI from a median grade of 1 to 2, whereas only 1 hip (3%) progressed from grade 2 to 3. Only 3 hips (9%) with a partial tear had a progression of gluteus medius FI, which did not differ significantly from the contralateral unaffected side. Conclusion: Nonoperative treatment might be a valid long-term option for degenerative hip abductor lesions, especially for partial tears, which demonstrated a low risk of clinically relevant progression or muscle FI and similar clinical outcomes to those reported in the literature for operatively treated hip abductor tendon lesions.

Background: Absolute hyperaemic coronary blood flow (Q, in mL/min) and resistance (R, in Wood units [WU]) can be measured invasively by continuous thermodilution. Aims: The aim of this study was to assess normal reference values of Q and R. Methods: In 177 arteries (69 patients: 25 controls, i.e., without identifiable coronary atherosclerosis; 44 patients with mild, non-obstructive atherosclerosis), thermodilution-derived hyperaemic Q and total, epicardial, and microvascular absolute resistances (R tot, R epi, and R micro) were measured. In 20 controls and 29 patients, measurements were obtained in all three major coronary arteries, thus allowing calculations of Q and R for the whole heart. In 15 controls (41 vessels) and 25 patients (71 vessels), vessel-specific myocardial mass was derived from coronary computed tomography angiography. Results: Whole heart hyperaemic Q tended to be higher in controls compared to patients (668±185 vs 582±138 mL/min, p=0.068). In the left anterior descending coronary artery (LAD), hyperaemic Q was significantly higher (293±102 mL/min versus 228±71 mL/min, p=0.004) in controls than in patients. This was driven mainly by a difference in R epi (43±23 vs 83±41 WU, p=0.048), without significant differences in R micro. After adjustment for vessel-specific myocardial mass, hyperaemic Q was similar in the three vascular territories (5.9±1.9, 4.9±1.7, and 5.3±2.1 mL/min/g, p=0.44, in the LAD, left circumflex and right coronary artery, respectively). Conclusions: The present report provides reference values of absolute coronary hyperaemic Q and R. Q was homogeneously distributed in the three major myocardial territories but the large ranges of observed hyperaemic values of flow and of microvascular resistance preclude their clinical use for inter-patient comparison.

Assessment of the microcirculation of the heart has gained interest over recent years. This is partly due to the fact that up to 50% of patients with chest pain visiting the catherization laboratory do not present with significant epicardial stenosis (so-called Angina with Non Obstructive Coronary Artery disease (ANOCA).1Most knowledge regarding microvascular resistance came from non-invasive imaging, from invasive index of microvascular resistance2, or from doppler wires3, both being semi-quantitative and operator dependent.Recently, direct quantitative measurement of coronary blood flow and microvascular resistancehas become possible by thermodilution with saline infusion, using a pressure-temperature guidewire and a multisidehole infusion catheter. Such measurements have been validated versus Positron Emission Tomography (PET)4, have a high reproducibility and are operator independent.5 Procedural safety has been reported before5, but long term safety and absence of late complications have not been described yet. The present study evaluates the safety of absolute flow measurements, both periprocedural, at 30 days and to one year follow-up.

The human

To evaluate how hysterectomy performed for benign gynecologic pathologies affects the quality of life and sexual function of patients aged 35 years or younger, and if outcomes differ according to the surgical technique.Seventy-three patients who underwent total laparoscopic hysterectomy (TLH), supracervical laparoscopic hysterectomy (SLH), or vaginal hysterectomy (VH) for benign uterine disorders between April 2014 and June 2020 at the Department of Gynecology and Obstetrics, Saarland University Hospital, Homburg, Germany, were enrolled in this prospective observational cohort study. Quality of life and sexual function were assessed preoperatively and 6 months postoperatively using standardized validated questionnaires: the European Quality of Life Five-Dimension Scale (EQ-5D) and the Female Sexual Function Index (FSFI).Thirty-three (45%) patients underwent TLH, 25 (34%) underwent SLH, and 15 (21%) patients underwent VH. The median preoperative EQ-5D score, FSFI score, and EQ-5D visual analog scale were 0.9 (range 0.62-1), 19.25 (range 2.4-27.4), and 50 (range 0-100); postoperative scores were 1 (range 0.61-1), 24.15 (range 3.9-29.3), and 90 (range 30-100), respectively (P ≤ 0.001). Postoperative scores were significantly higher than preoperative scores, with no significant difference according to the surgical technique.Hysterectomy for benign indication in women aged 35 years or less significantly improved the patients' quality of life and sexual function with no differences regarding the surgical technique.The study was registered in the German trial registry (no. DRKS00005622).

Background: It would be ideal for a non-hyperaemic index to predict fractional flow reserve (FFR) more accurately, given FFR's extensive validation in a multitude of clinical settings. Aims: The aim of this study was to derive a novel non-hyperaemic algorithm based on deep learning and to validate it in an internal validation cohort against FFR. Methods: The ARTIST study is a post hoc analysis of three previously published studies. In a derivation cohort (random 80% sample of the total cohort) a deep neural network was trained (deep learning) with paired examples of resting coronary pressure curves and their FFR values. The resulting algorithm was validated against unseen resting pressure curves from a random 20% sample of the total cohort. The primary endpoint was diagnostic accuracy of the deep learning-derived algorithms against binary FFR ≤0.8. To reduce the variance in the precision, we used a fivefold cross-validation procedure. Results: A total of 1,666 patients with 1,718 coronary lesions and 2,928 coronary pressure tracings were included. The diagnostic accuracy of our convolutional neural network (CNN) and recurrent neural networks (RNN) against binary FFR ≤0.80 was 79.6±1.9% and 77.6±2.3%, respectively. There was no statistically significant difference between the accuracy of our neural networks to predict binary FFR and the most accurate non-hyperaemic pressure ratio (NHPR). Conclusions: Compared to standard derivation of resting pressure ratios, we did not find a significant improvement in FFR prediction when resting data are analysed using artificial intelligence approaches. Our findings strongly suggest that a larger class of hidden information within resting pressure traces is not the main cause of the known disagreement between resting indices and FFR. Therefore, if clinicians want to use FFR for clinical decision making, hyperaemia induction should remain the standard practice.

Zusammenfassung Die fortschreitende Digitalisierung stellt auch die Verbraucherpolitik und den Verbraucherschutz vor Herausforderungen. Gegenstand des vorliegenden Beitrags ist es, diese Herausforderungen zu strukturieren und anhand dreier aktueller Problembereiche zu diskutieren. Ein übergreifendes Ergebnis der Diskussion ist, dass eine zukunftsgerichtete Verbraucherpolitik über den klassischen Verbraucherschutz hinausgehen und eine Perspektivenerweiterung erfahren sollte. Ein wesentliches Element einer in diesem Sinne modernen Verbraucherpolitik wäre es, die Verbraucherinnen und Verbraucher stärker noch als bisher als aktive Akteure des Wirtschaftslebens zu verstehen.

Objective To evaluate family and maternity leave policies and examine the social and professional impacts on female ophthalmologists Participants Participants were recruited through the Women in Ophthalmology online list-serv to complete a survey evaluating maternity leave policies and their impacts. Survey questions were repeated for each birth event after medical school for up to five birth events. Results The survey was accessed 198 times, and 169 responses were unique. Most participants were practicing ophthalmologists (92%), with a minority in residency (5%), in fellowship (1.2%), on disability/leave (0.6%), or retired (0.6%). Most participants (78%) were within their first ten years of practice. Experiences were recorded for each leave event, with 169 responses for the first leave, 120 for the second, 28 for the third, and 2 for the fourth. Nearly half of participants reported the information they received about maternity leave to be somewhat or extremely inadequate (first: 50%; second: 42%; third: 41%). Many reported a greater sense of burnout after returning to work (first: 61%, second: 58%, third: 46%). A minority of participants received full pay during the first through third maternity leave events, 39%, 27%, and 33%, respectively. About a third of participants reported being somewhat or very dissatisfied with their maternity leave experience (first: 42%, second: 35%; third: 27%). Conclusions Female ophthalmologists have varying experiences with maternity leave, but many encounter similar challenges. This study demonstrates that many women receive inadequate information about family leave, desire more weeks of leave, experience a wide variation in pay practices, and lack support for breastfeeding. Understanding the shared experiences of women in ophthalmology identifies areas where improvements are needed in maternity leave practices within the field to create a more supportive environment for physician mothers.

Beauchamp and Childress' definition of autonomous decision-making includes the conditions of intentionality, understanding, and non-control. In genetics, however, a relational conception of autonomy has been increasingly recognized. This article aims to empirically assess aspects of social influence in genetic testing decision-making and to connect these with principlist and relational theories of autonomy. We interviewed 18 adult genetic counsellees without capacity issues considering predictive genetic testing for cancer predisposition for themselves and two counselling physicians in Switzerland. We conducted a qualitative analysis, building on a grounded theory study about predictive genetic testing decision-making. We found that some participants agreed to predictive genetic testing predominantly because relatives wanted them to do it, with some even acting contrary to their own convictions. Others, in contrast, based their decision on purely individualistic reasons but expressed difficulties in explaining their decision to their social environment. Healthcare professionals had a critical influence on decision-making in many cases without being manipulative, as perceived by counsellees. Still, cases of coercion and social pressure occurred within social relationships. In conclusion, predictive genetic testing decision-making includes relational and individualistic aspects, and both are compatible with autonomous decision-making. While the principlist and relational notions of autonomy compete on a theoretical level, they are two sides of the same coin when used as analytical lenses for genetic testing decision-making. Social acceptance of refusal of testing should be improved to mitigate social pressure. Individuals should be encouraged to decide for themselves how much their social environment influences their decision regarding predictive genetic testing.

Background: Newly diagnosed patients with inflammatory bowel disease (IBD) encounter many physical, mental, and social uncertainties. In other chronic diseases, patients having access to disease-specific information and psychological support adhere better to medical regimens. Currently, there is a paucity of data on how newly diagnosed patients with IBD interact with their medical providers. Methods: Patients diagnosed with IBD within 5 years completed a series of questionnaires related to heath-related quality of life (HRQoL), disease activity, health education resources, medical provider relationship, and psychological support. Results: A total of 89 patients were included in the study. IBD activity correlated with disease-specific quality of life (r=−0.69, p