Management of a rare symptomatic retrocaval ureter: a case report with review of literature.

Retrocaval ureter is a rare congenital vascular anomaly with an incidence of 0.13%, leading to the passage of the right ureter behind the inferior vena cava and then turning around it to attain its lateral position. The condition is usually associated with obstruction in the right kidney and proximal ureter leading to symptoms like dull aching pain in the flanks, recurrent episodes of urinary tract infections, and recurrent stone formation. The patient presented with recurrent episodes of burning micturition and pain in the right flank for the past 6 months. A contrast-enhanced computed tomography kidney-ureter-bladder was done to diagnose the condition. The patient was managed by open pelviureteric anastomosis lateral to the inferior vena cava, thus eliminating the obstruction on the ureter. The patient has had an uneventful postoperative follow-up. Retrocaval ureter is a rare condition and should be clinically suspected in cases of hydronephrosis where other causes have been ruled out. Different approaches can be used to correct the anomaly. In this case report, an open transperitoneal intraabdominal approach has been used.

Oligomeric Remodeling by Molecular Glues Revealed Using Native Mass Spectrometry and Mass Photometry.

Molecular glues stabilize interactions between E3 ligases and novel substrates to promote substrate degradation, thereby facilitating the inhibition of traditionally "undruggable" protein targets. However, most known molecular glues have been discovered fortuitously or are based on well-established chemical scaffolds. Efficient approaches for discovering and characterizing the effects of molecular glues on protein interactions are required to accelerate the discovery of novel agents. Here, we demonstrate that native mass spectrometry and mass photometry can provide unique insights into the physical mechanism of molecular glues, revealing previously unknown effects of such small molecules on the oligomeric organization of E3 ligases. When compared to well-established solution phase assays, native mass spectrometry provides accurate quantitative descriptions of molecular glue potency and efficacy while also enabling the binding specificity of E3 ligases to be determined in a single, rapid measurement. Such mechanistic insights should accelerate the rational development of molecular glues to afford powerful therapeutic agents.

Ion Heating in Advanced Dielectric Barrier Discharge Ion Sources for Ambient Mass Spectrometry.

Dielectric barrier discharges (DBD) are highly versatile plasma sources for forming ions at atmospheric pressure and near ambient temperatures for the rapid, direct, and sensitive analysis of molecules by mass spectrometry (MS). Ambient ion sources should ideally form intact ions, as in-source fragmentation can limit sensitivity, increase spectral complexity, and hinder interpretation. Here, we report the measurement of ion internal energy distributions for the four primary classes of DBD-based ion sources, specifically DBD ionization (DBDI), low-temperature plasma (LTP), flexible microtube plasma (FµTP), and active capillary plasma ionization (ACaPI), in addition to atmospheric pressure chemical ionization (APCI) using para-substituted benzylammonium thermometer ions. Surprisingly, the average extent of energy deposited by the use of ACaPI (90.6 kJ mol-1) was ∼40 kJ mol-1 lower than the other ion sources (DBDI, LTP, FµTP, and APCI; 130.2 to 134.1 kJ mol-1) in their conventional configurations, and slightly higher than electrospray ionization (80.8 kJ mol-1). The internal energy distributions did not depend strongly on the sample introduction conditions (i.e., the use of different solvents and sample vaporization temperatures) or the DBD plasma conditions (i.e., maximum applied voltage). By positioning the DBDI, LTP, and FµTP plasma jets on axis with the capillary entrance to the mass spectrometer, the extent of internal energy deposition could be reduced by up to 20 kJ mol-1, although at the expense of sensitivity. Overall, the use of an active capillary-based DBD can result in substantially less fragmentation of ions with labile bonds than alternate DBD sources and APCI with comparably high sensitivity.

An atmospheric pressure ion funnel with a slit entrance for enhancing signal and resolution in high resolution differential ion mobility mass spectrometry.

Differential ion mobility (DMS) is a versatile ion separation method that is often integrated with mass spectrometry (MS). In DMS, extremely high electric fields are used such that ion mobility depends non-linearly on electric field and thus, ion separations can be more orthogonal to MS than lower field ion mobility-based methods. DMS can have sufficiently high resolution to be used for enantiomer analysis of small molecules and to separate protein ions with peak widths comparable to those obtained for peptides. However, the performance of high resolution DMS-MS can be limited owing to the substantial loss of ions (>10-fold) that can occur upon their transfer from atmospheric pressure (where DMS separation typically occurs) to vacuum through a narrow conductance limited inlet (e.g. capillary) to the MS. Here, results from simulated ion trajectory simulations suggest that in high resolution DMS most ions can be lost by 'crashing' onto the narrow capillary inlet after exiting the DMS separation channel. To enhance DMS sensitivity and resolving power, an integrated DMS-MS interface concept is reported that consists of a slit electrode and a 12-electrode atmospheric pressure ion funnel (APIF). By using an APIF with slit entrance, the simulated ion transmission efficiencies increase by up to 257% for singly charged ions ([DMMP + H]+, [tryptophan + H]+, and [(2-dodecanone)2 + H]+) and by 209% for [ubiquitin + 12H]12+, without compromising resolving power. The use of APIF improves the ion focussing from the DMS exit to the MS capillary to improve sensitivity, and the slit ensures that ion dispersion in the analytically relevant direction perpendicular to the DMS electrodes is restricted to enhance resolution. By narrowing the slit of the DMS-Slit-APIF interface, the DMS resolving power can be increased further by at least 20%. Overall, these results indicate that the integrated DMS-Slit-APIF interface is promising for improving the sensitivity and resolution for many different types of DMS-MS experiments.

Ambient Pressure Ion Funnel: Concepts, Simulations, and Analytical Performance.

In mass spectrometry (MS), a major loss of ions can readily occur during their transfer from atmospheric pressure to a lower pressure, which limits performance. Here, we report an ion funnel that can be used to effectively focus ions at ambient pressure (∼777 Torr) to significantly enhance performance in electrospray ionization (ESI) MS. For seven singly charged test ions (m/z 124-1131), the ambient pressure ion funnel (APIF) is demonstrated to improve ion abundances, sensitivity, and detection limits by up to factors of ∼17, ∼16, and ∼3, respectively, compared to the operation of conventional ESI-MS. Simulated ion trajectories were used to rationalize the enhanced performance of the APIF, which is attributed primarily to using a relatively high RF field amplitude to radially confine ions, a high DC field, and a wide exit ring electrode. The effective focusing of ions at ambient pressures should be beneficial in the future for improving the performance of (i) additional methods that ionize molecules at atmospheric pressure, (ii) ambient pressure ion mobility-based instruments, and (iii) high flow rate liquid chromatography mass spectrometry platforms.

Metal-Organic Framework-Enhanced Solid-Phase Microextraction Mass Spectrometry for the Direct and Rapid Detection of Perfluorooctanoic Acid in Environmental Water Samples.

We report the development of metal-organic framework (MOF)-based probes for the direct and rapid detection and quantification of perfluorooctanoic acid (PFOA) by mass spectrometry. Four water-resistant MOFs-ZIF-8, UiO-66, MIL88-A, and Tb2(BDC)3-were coated on poly(dopamine) precoated stainless steel needles and used to rapidly preconcentrate PFOA from water for direct analysis by nanoelectrospray ionization mass spectrometry. The analytical performance of each MOF for detecting PFOA was correlated with both the calculated binding energy of the MOF for PFOA and the relative change in the surface area of the MOF upon exposure to PFOA. MOF-functionalized probes can be used for the rapid (<5 min) and sensitive quantification of PFOA molecules at low ng L-1 levels in environmental water samples (i.e., tap water, rainwater, and seawater) with no sample preparation. The limit of detection of PFOA in ultrapure water was 11.0 ng L-1. Comparable accuracy to an accredited analytical method was achieved, despite the MOF-functionalized probe approach being ∼40 times quicker and requiring ∼10 times less sample. These features indicate that MOF-coated probes are promising for the direct and rapid monitoring of polyfluorinated substances and other pollutants in the field.

Nanosecond Pulsed Dielectric Barrier Discharge Ionization Mass Spectrometry.

Dielectric barrier discharge ionization (DBDI) is an emerging technique for ionizing volatile molecules directly from complex mixtures for sensitive detection by mass spectrometry (MS). In conventional DBDI, a high frequency and high voltage waveform with pulse widths of ∼50 µs (and ∼50 µs between pulses) is applied across a dielectric barrier and a gas to generate "low temperature plasma." Although such a source has the advantages of being compact, economical, robust, and sensitive, background ions from the ambient environment can be formed in high abundances, which limits performance. Here, we demonstrate that high voltage pulse widths as narrow as 100 ns with a pulse-to-pulse delay of ∼900 µs can significantly reduce background chemical noise and increase ion signal. Compared to microsecond pulses, ∼800 ns pulses can be used to increase the signal-to-noise and signal-to-background chemical noise ratios in DBDI-MS by up to 172% and 1300% for six analytes, including dimethyl methylphosphonate (DMMP), 3-octanone, and perfluorooctanoic acid. Using nanosecond pulses, the detection limit for DMMP and PFOA in human blood plasma can be lowered by more than a factor of 2 in comparison to microsecond pulses. In "nanopulsed" plasma ionization, the extent of internal energy deposition is as low as or lower than in electrospray ionization and micropulsed plasma ionization based on thermometer ion measurements. Overall, nanosecond high-voltage pulsing can be used to significantly improve the performance of DBDI-MS and potentially other ion sources involving high voltage waveforms.

Rapid separation of isomeric perfluoroalkyl substances by high-resolution differential ion mobility mass spectrometry.

The analysis of persistent organic pollutants, such as perfluoroalkyl substances (PFAS) including perfluorooctanoic acid (C7F15COOH, PFOA) and perfluorooctane sulfonate (C8F17SO3-, PFOS) by hyphenated chromatography-mass spectrometry methods is crucial in ensuring water quality. One of the challenges in PFOA and PFOS analysis is the separation of linear and branched isomers that have the same mass-to-charge ratio but can have different toxicological properties. Current methods that are used for separating isomeric PFAS require relatively long analysis times (min to h) that can limit throughput. An emerging technique for the direct analysis of isomeric compounds is differential mobility spectrometry (DMS), which can rapidly separate gas phase ions prior to detection by mass spectrometry (MS). However, an ion mobility-based method for the analysis of PFAS has not been reported in the literature. Herein, high-resolution DMS-MS is used to separate and detect isomeric PFAS compounds for the first time in a separation process that occurs in milliseconds. The resolution of isomeric peaks increased by over 200% and 500% for PFOA and PFOS isomers, respectively, using a DMS carrier gas composed of 50:50% He:N2 by volume compared to 100% N2, which was crucial in the separation of PFAS isomers under these conditions. Linear, secondary-branched, and tertiary-branched isomers of PFOA and PFOS including those that differ by the position of a single perfluoromethyl group can be resolved by DMS-MS. The DMS compensation field required to transmit different isomers increases as the extent of branching increases. For isomeric PFASs with a single branching point, the compensation field for optimal transmission also increases as the perfluoromethyl group is positioned closer to the carboxylate and sulfonate groups under these conditions. These results indicate that high-resolution DMS-MS should be a useful approach for the rapid analysis of isomeric PFAS.

Sorptive process and breakthrough behavior of odorous volatile compounds on inert surfaces.

The use of glass impinger is an important device for sampling and handling when measuring volatile organic compounds (SVOCs). Thus, it is important to check for possible analyte losses to the inner glass surface when carrying out sample analysis with the aid of impinger system. In this research, we evaluated the sorptive loss patterns of vapor-phase semi-volatile organic compounds [SVOCs (n = 10): acetic acid (ACA), propionic acid (PPA), i-butyric acid (IBA), n-butyric acid (BTA), i-valeric acid (IVA), n-valeric acid (VLA), phenol (PhAl), p-cresol (p-C), indole (ID), and skatole (SK)] on inert surfaces of an impinger in reference to sampling bags. The gaseous standard of these SVOCs (48-406 ppb) in polyester aluminum (PEA) bags was passed through an empty impinger in 1 L steps. The exiting SVOCs were collected on three-bed sorbent tubes for subsequent analysis by thermal desorption-gas chromatography-mass spectroscopy (TD-GC-MS). Impinger wall sorption capacities ranged from 2.0 to 21.0 ng cm-2. The 10% breakthrough adsorption capacities on the impinger wall for acids, phenols, and indoles ranged from 1.21 ± 0.15 to 5.39 ± 0.79, 0.92 ± 0.12 to 13.4 ± 2.25, and 4.47 ± 0.42 to 5.23 ± 0.35 ng cm-2, respectively. The observed sorptive patterns suggest that the sorptive losses of the volatile fatty acids, phenols, and indoles can occur very effectively at low ppb levels onto a glass surface.

Performance comparison of MOF and other sorbent materials in removing key odorants emitted from pigpen slurry.

A batch-type dynamic headspace (HS) system was used to generate vapor-phase volatile organic compounds (VOCs) from a pigpen slurry sample. Sorptive removal capability of MOF-199 and other sorbents (zeolite (ZL) and activated carbon (AC)) was assessed against a total of 13 slurry-borne odorants ((methyl ethyl ketone (MEK), isobutyl alcohol (i-BuAl), benzene (B), toluene (T), p-xylene (p-X), m-xylene (m-X), o-xylene (o-X), styrene (S), o-cresol (o-C), phenol (PhAl), p-cresol (p-C), indole (ID), and skatole (SK)). Adsorption capacity of MOF-199 and two sorbents, when assessed for the 13 odorants at a 10% breakthrough volume (BTV), was 22.6 ± 42.3, 0.70 ± 1.08, and 11.0 ± 18.3 µg g(-1), respectively. The adsorption capacity (µg g(-1)) assessed at 10% BTV showed the superiority of MOF-199 towards phenolic and indolic compounds (such as o-C (0.31 ± 0.04), PhAl (61.6 ± 4.98), p-C (140 ± 7.95), ID (27.8 ± 2.23), and SK (63.9 ± 1.55)), demonstrating the feasibility of MOF as sorption media for treating certain nuisance components.

Six habits to enhance MET performance under stress: A discussion paper reviewing team mechanisms for improved patient outcomes.

Effective team decision making has the potential to improve the quality of health care outcomes. Medical Emergency Teams (METs), a specific type of team led by either critical care nurses or physicians, must respond to and improve the outcomes of deteriorating patients. METs routinely make decisions under conditions of uncertainty and suboptimal care outcomes still occur. In response, the development and use of Shared Mental Models (SMMs), which have been shown to promote higher team performance under stress, may enhance patient outcomes. This discussion paper specifically focuses on the development and use of SMMs in the context of METs. Within this process, the psychological mechanisms promoting enhanced team performance are examined and the utility of this model is discussed through the narrative of six habits applied to MET interactions. A two stage, reciprocal model of both nonanalytic decision making within the acute care environment and analytic decision making during reflective action learning was developed. These habits are explored within the context of a MET, illustrating how applying SMMs and action learning processes may enhance team-based problem solving under stress. Based on this model, we make recommendations to enhance MET decision making under stress. It is suggested that the corresponding habits embedded within this model could be imparted to MET members and tested by health care researchers to assess the efficacy of this integrated decision making approach in respect to enhanced team performance and patient outcomes.

Long term trends of methane, non methane hydrocarbons, and carbon monoxide in urban atmosphere.

The concentrations of methane (CH4), non-methane hydrocarbons (NMHC), and carbon monoxide (CO) were measured at two urban locations (Guro (GR) and Nowon (NW)) in Seoul, Korea between 2004 and 2013. The mean amount fractions of CH4, NMHC, and CO, measured at GR over this period were 2.06±0.02, 0.32±0.03, and 0.61±0.05 ppm, respectively, while at NW they were 2.08±0.06, 0.33±0.05, and 0.54±0.06 ppm, respectively. The ratio of CH4 to the total hydrocarbon amount fraction remained constant across the study years: 0.82 to 0.90 at GR and 0.81 to 0.89 at NW. Similarly, stable ratios were also observed between NMHC and THC at the two sites. In contrast, the annual mean ratios for CH4/NMHC showed a larger variation: between 4.55 to 8.67 at GR and 4.25 to 8.45 at NW. The seasonality of CO was characterized by wintertime maxima, while for CH4 and NMHC the highest amount fractions were found in fall. The analysis of their long-term trends based on Mann-Kendall and Sen's methods showed an overall increase of THC and CH4, whereas a decreasing trend was observed for NMHC and CO.