Custom-Design of Strong Electron/Proton Extractor on COFs for Efficient Photocatalytic H2O2 Production.

The development of photocatalysts with continuous electron extraction and rapid proton transfer could kinetically accelerate the artificial photosynthesis, but remains a challenge. Herein, we report the topology-guided synthesis of a high-crystalline triazine covalent organic framework (COF) decorated by uniformly distributed polar oxygen functional groups (sulfonic group or carboxyl) as the strong electron/proton extractor for efficient photocatalytic H2O2 production. It was found that the polarity-based proton transfer as well as electron enrichment in as-obtained COFs played a crucial role in improving the H2O2 photosynthesis efficiency (i.e., with an activity order of sulfonic acid- (SO3H-COF)>carboxyl- (COOH-COF)>hydrogen- (H-COF) functionalized COFs). The strong polar sulfonic acid group in the high-crystalline SO3H-COF triggered a well-oriented built-in electric field and more hydrophilic surface, which serves as an efficient carrier extractor enabling a continuous transportation of the photogenerated electrons and interfacial proton to the active sites (i.e., C atoms linked to -SO3H group). As-accelerated proton-coupled electron transfer (PCET), together with the stabilized O2 adsorption finally leads to the highest H2O2 production rate of 4971 µmol g-1 h-1 under visible light irradiation. Meanwhile, a quantum yield of 15 % at 400 nm is obtained, superior to most reported COF-based photocatalysts.

Lung Cancer Patients' and Caregivers' Satisfaction With Multidisciplinary Versus Serial Care in a Community Healthcare Setting: A Prospective Comparative-Effectiveness Cohort Study.

BACKGROUND: Multidisciplinary Care is recommended for complex oncologic conditions. We compared lung cancer patients' and caregivers' satisfaction with Multidisciplinary Care to routine, serial care. MATERIALS AND METHODS: We analyzed validated surveys administered at baseline, 3 and 6 months to patients and their caregivers enrolled in a prospective cohort comparative-effectiveness study of Multidisciplinary versus Serial Care (clinicaltrials.gov NCT02123797). Multivariate mixed linear models examined the cross-group differences, time-related variances, and how interaction between groups and time-periods influenced satisfaction. RESULTS: Compared to serial care (N = 297), the Multidisciplinary Care cohort (N = 159), was older (69 vs. 66 years), had earlier clinical stage (41% vs. 33% stage I/II), and less severe symptoms (45% vs. 35% asymptomatic). Demographic and social-economic characteristics of caregivers (N = 99 for Multidisciplinary and 123 for Serial Care, respectively) were similar. Multidisciplinary Care patients and caregivers were more likely to perceive their care to be better than that of other patients (p < .01). Although Serial Care patients and caregivers expressed greater satisfaction with their treatment plan (p < .01 patients, p = 0.04 caregivers), Multidisciplinary Care patients showed greater improvement at 6-months (p < .01). Multidisciplinary Care patients and caregivers reported better overall satisfaction with team members (p < .01) while Serial Care patients had greater improvement in their satisfaction with team members at 6-months (p = .04). Multidisciplinary Care patients perceived more financial burden at 6-months compared to Serial Care patients (p = .04). CONCLUSION: Patient-caregiver dyads had mixed perceptions of their care experience. Recipients of Multidisciplinary Care perceived better experience with care and team members; Serial Care recipients expressed greater satisfaction with their treatment plan.

Exploring the pH Sensitivity of Ion-Pair Interactions on a Self-Assembled Monolayer by Scanning Electrochemical Microscopy.

Insights into the chemical essence of weak interactions on the surface of biomacromolecules may help to regulate biological processes. In this work, the pH sensitivity of ion-pair interactions occurring on a cysteine self-assembled monolayer (Cys SAM) that simulates the local surface of a protein was probed by scanning electrochemical microscopy (SECM). Cys SAM and the ion-pair interactions subsequently formed with the introduced aspartic acid (Asp) were both pH-sensitive, as confirmed by the tip current changes in the feedback mode. After continuous pH measurements, the most significant negative feedback was observed at pH 5.50, indicating the most robust ion-pair interactions, which were simultaneously identified by voltammetry. In this case, the extra addition of the inorganic cation (i.e., Ca2+) did not disrupt the existing ion-pair interactions, and the binding constant (K) and Gibbs free energy (ΔGo) of the ion pair were finally determined to be 6.44 × 105 M-1 and -33.14 kJ mol-1, respectively. Overall, the pH sensitivity of ion-pair interactions was found to be mainly attributable to pH-induced changes in the deprotonated/protonated states of the α-amino acid moieties, which may provide insights into the artificial manipulation of complex binding events at the molecular level on the biological surface.

Radiation Without Endocrine Therapy in Older Women With Stage I Estrogen-Receptor-Positive Breast Cancer is Not Associated With a Higher Risk of Second Breast Cancer Events.

PURPOSE: The omission of radiation therapy (RT) in older women with stage 1 estrogen-receptor-positive (ER+) breast cancer receiving endocrine therapy (ET) is an acceptable strategy based on randomized trial data. Less is known about the omission of ET with or without RT. METHODS AND MATERIALS: We analyzed surveillance, epidemiology, and end results (SEER)-Medicare data for 13,321 women age 66 years or older with stage I ER+ breast cancer from 2007 to 2012 who underwent breast-conserving surgery. Patients were classified into 4 groups: (1) ET + RT (reference); (2) ET alone; (3) RT alone; and (4) neither RT nor ET (NT). Second breast cancer events (SBCEs) were captured using the Chubak high-specificity algorithm. We used χ2 tests for descriptive statistics, multivariable multinomial logistic regression to estimate relative risk of undergoing a treatment, and multivariable, propensity-weighted competing-risks survival regression to estimate standardized hazard ratio (SHR) of SBCE. We set significance at P ≤ .01. RESULTS: Most women underwent both treatments, with 44% undergoing ET + RT, 41% RT alone, 6.6% ET alone, and 8.6% NT, but practice patterns varied over time. From 2007 to 2012, RT decreased from 49% to 30%, whereas ET alone and ET + RT increased (ET alone, 5.4%-9.6%; ET + RT, 38%-51%). Compared with patients age 66 to 69 years, patients age 80 to 85 years were more likely to receive NT (odds ratio [OR], 8.9), RT (OR, 1.9), or ET (OR, 8.8) versus ET + RT (P < .01). Three percent of subjects had an SBCE (2.2% ET + RT, 3.0% RT alone, 3.2% ET alone, 7.0% NT). Relative to ET + RT, NT and ET alone were associated with higher SBCE (NT: SHR, 3.7, P < .001; ET alone: SHR, 2.2, P = .008), whereas RT was not associated with a higher SBCE (SHR 1.21; P = .137). Clinical factors associated with higher SBCE were HER2 positivity and pT1c (SHR, 1.7; P = .006). CONCLUSIONS: Treatment with RT alone in older women with stage I ER+ disease is decreasing. RT alone is not associated with an increased risk for SBCE. By contrast, NT and ET are both associated with higher SBCE in multivariable analysis with propensity weighting. Further study of the omission of endocrine therapy in this patient population is warranted.

Reborn Three-Dimensional Graphene with Ultrahigh Volumetric Desalination Capacity.

The constructing of 3D materials with optimal performance is urgently needed to meet the growing demand of advanced materials in the high-tech sector. A distinctive 3D graphene (3DG) is designed based on a repeated rebirth strategy to obtain a better body and performance after each round of rebirth, as if it is Phoenix Nirvana. The properties of reborn graphene, namely 3DG after Nirvana (NvG), has been dramatically upgraded compared to 3DG, including high density (3.36 times) together with high porosity, as well as better electrical conductivity (1.41 times), mechanical strength (32.4 times), and ultrafast infiltration behavior. These advantages of NvG make it a strong intrinsic motivation for application in capacitive deionization (CDI). Using NvG directly as the CDI electrode, it has an extremely high volumetric capacity of 220 F cm-3 at 1 A cm-3 and a maximum salt absorption capacity of 8.02~9.2 mg cm-3 (8.9-10.2 times), while the power consumption for adsorption of the same mass of salt is less than a quarter of 3DG. The "Phoenix Nirvana"-like strategy of manufacturing 3D structures will undoubtedly become the new engine to kick-start the development of innovative carbon materials through an overall performance upgrade.

Controllable release of dopamine from simulated enzyme-containing biomembrane by biased potential.

Controllable release of dopamine (DA) is worth studying for its significant in physiological metabolic process. ß-cyclodextrin/11-mercaptoundecanoic acid self-assembled monolayer (ß-CD/MUA SAM) based on hydrogen bonds network was constructed as simulated enzyme-containing biomembrane. DA interacted with ß-CD based on intermolecular hydrogen bond and formed inclusion complexes in SAM, namely DA@ß-CD/MUA SAM. The desorption process of DA from DA@ß-CD/MUA SAM revealed the release behavior of DA from enzyme-containing biomembrane at molecular level. Positive biased potential as external stimulus was applied at DA@ß-CD/MUA SAM, reducing the negative charge density of SAM. The decrease of negative charge density of SAM resulted in the weakening of hydrogen bond between DA and ß-CD, which in turn caused DA to be released. Using scanning electrochemical microscopy, positive biased potential not only had specificity induction for the release of DA, but also was able to monitor the release quantitatively in real time. These results showed that positive biased potential as external stimulus was favorable for the controllable release of DA, suggesting the possible application of biased potential in controllable regulation field.

Frontiers of carbon materials as capacitive deionization electrodes.

Capacitive deionization (CDI), which is based on ion electrosorption on the surface of electrically charged electrodes, has attracted widespread attention as a novel, cost-effective and environment-friendly desalination technology. Carbon materials are widely used as CDI electrodes due to their high specific surface area (SSA), superior conductivity, and better stability. Many research efforts have been made to further enhance the CDI performance of carbon materials. In this review, the performance-enhancing strategies of various carbon materials including activated carbon, porous carbon, carbon aerogels, carbon nanotubes and graphene are systematically presented. We also explain the significance of the development of CDI technology and identify where further work is urgently required and where challenges are still faced.

Association of Diabetes and Other Clinical and Sociodemographic Factors With Guideline-concordant Breast Cancer Treatment for Breast Cancer.

BACKGROUND: Women with breast cancer have worse health outcomes with co-occurring type 2 diabetes, possibly due to suboptimal breast cancer treatment. METHODS: We created a cohort of women ages 66 to 85 y with stage I to III breast cancer from 1993 to 2012 from an integrated health care delivery system (n=1612) and fee-for-service Medicare beneficiaries (n=98,915), linked to Surveillance, Epidemiology, and End Results (SEER) data (total n=100,527). We evaluated associations between type 2 diabetes and other factors with undergoing guideline-concordant cancer treatment. We estimated χ tests for univariate analysis and relative risks (RRs) using multivariable log-binomial models for outcomes of (1) overall guideline-concordant treatment, (2) definitive surgical therapy (mastectomy or lumpectomy with radiation), (3) chemotherapy if indicated, and (4) endocrine therapy. RESULTS: Our cohort included 60% of subjects with stage 1 tumors, one quarter below 70 years old, 23% had diabetes, 35% underwent overall guideline-concordant treatment, 24% chemotherapy, and 83% endocrine therapy. Women with diabetes were less likely to undergo overall guideline-concordant treatment (RR: 0.96; 95% confidence interval: 0.94-0.98), and only slightly less likely to undergo guideline-concordant definitive surgical therapy (RR: 0.99; 95% confidence interval: 0.99-1.00). No differences were found for chemotherapy or endocrine therapy. Other factors significantly associated with a lower risk of guideline-concordant care were cancer stages II to III (vs. I; RR=0.47-0.69, P<0.0001), older age (vs. 66 to 69 y; RR=0.56-0.90, P<0.0001), higher comorbidity burden, and Medicaid dual-eligibility. CONCLUSIONS: Diabetes was associated with lower adherence to overall guideline-concordant breast cancer treatment. However, higher stage, older age, higher comorbidity burden, and Medicaid insurance were more strongly associated with lower use of guideline-concordant treatment. Given the heavy burden of breast cancer and diabetes, long-term outcomes analysis should consider guideline-concordant treatment. IMPACT: Other factors besides diabetes are more strongly associated with guideline-concordant breast cancer treatment.

Probing a Reversible Cationic Switch on a Mixed Self-Assembled Monolayer Using Scanning Electrochemical Microscopy.

Probing a switch on biomimic membrane surfaces would offer some references to the research on permeability of cytomembranes. In this work, a mixed 11-mercaptoundecanoic acid/1-undecanethiol self-assembled monolayer (MUA/UT SAM) was constructed as a model of a biomembrane. In this mixed SAM, the MUA molecules work as functional parts for the switch and the UT molecules work as diluents. The surface coverage, wetting property, and pKa of this mixed SAM all have been well-inspected. The mixed SAM exhibits excellent switchable properties for cations, which is well-monitored by scanning electrochemical microscopy. When the pH of a solution is higher than the pKa, protons would stimulate a shift of dissociation equilibrium of terminal carboxyl groups. The dissociated carboxylate ions would lead to a switch on the state of the SAM. Otherwise, the SAM shows an off state when the pH is lower than the pKa. In addition, the repeatability, applicability, and the mechanism of the switch all have been well-evaluated.

Diabetes and differences in detection of incident invasive breast cancer.

Many women diagnosed with breast cancer have chronic conditions such as diabetes that may impact other health behaviors. Our purpose was to determine if breast cancer screening and detection differs among women with and without diabetes. We conducted a cross-sectional analysis of a retrospective cohort of women aged 52-74 years diagnosed with incident stages I-III breast cancer enrolled in an integrated health plan between 1999 and 2014 with linkage to the Surveillance, Epidemiology and End Results registry (n = 2040). Screening data were taken from electronic health records. We used multivariable modified Poisson regression models with robust standard errors to estimate relative risks (RR) and 95% confidence intervals (CI) for outcomes of (i) receipt of screening in the 2 years prior to diagnosis; (ii) symptom-detected breast cancer; and (iii) diagnosis of locally advanced stage III breast cancer. Compared to women without diabetes, women with diabetes were similar with respect to receipt of screening mammography (78% and 77%), symptom-detected breast cancer (46% and 49%), and stage III diagnosis (7% and 7%). In multivariable models adjusting for age and year of diagnosis, race, BMI, Charlson comorbidity score and depression diagnosis no differences were observed in the outcomes by presence of diabetes. Further investigation is warranted to determine how diabetes acts as a mediating factor in adverse breast cancer outcomes.

A Cut-Resistant and Highly Restorable Graphene Foam.

High-pressure resistant and multidirectional compressible materials enable various applications but are often hindered by structure-derived collapse and weak elasticity. Here, a super-robust graphene foam with ladder shape microstructure capable of withstanding high pressure is presented. The multioriented ladder arrays architecture of the foam, consisting of thousands of identically sized square spaces, endow it with a great deal of elastic units. It can easily bear an iterative and multidirectional pressure of 44.5 MPa produced by a sharp blade, and may completely recover to its initial state by a load of 180 000 times their own weight even under 95% strain. More importantly, the foam can also maintain structural integrity after experiencing a pressure of 2.8 GPa through siphoning. Computational modeling of the "buckling of shells" mechanism reveals the unique ladder-shaped graphene foam contributes to the superior cut resistance and good resilience. Based on this finding, it can be widely used in cutting resistance sensors, monitoring of sea level, and the detection of oily contaminants in water delivery pipelines.

Versatile Graphene Oxide Putty-Like Material.

Versatile graphene oxide putty-like material (GOP) with excellent processability is developed by mediating a graphene oxide suspension with aniline. Arbitrarily predesigned architectures on both microscopic and macroscopic scales can be molded easily. GOP cannot only be used as starting material for direct 3D printing of particular configurations, but also can be tailored into the patterned structures on various substrates for large-scale production of device arrays.

Spontaneous, Straightforward Fabrication of Partially Reduced Graphene Oxide-Polypyrrole Composite Films for Versatile Actuators.

A facile one-step approach has been developed to fabricate partially reduced graphene oxide-polypyrrole (prGO-PPy) film via self-oxidation-reduction strategy, in which graphene oxide acts as the oxidant to polymerize pyrrole into PPy leading to the spontaneous partial reduction of GO and cross-linking between prGO and PPy via π-π interaction. With the convenient preparation method, a well controlled designed asymmetric actuator based on GO (or G)/prGO-PPy film with excellent humidity and electrochemical responses has been achieved for versatile stimulated actuations that will also play essential roles in advanced actuators for many important intelligent applications.

Antidepressant Medication Management Among Older Patients Receiving Home Health Care.

OBJECTIVE: Antidepressant management for older patients receiving home health care (HHC) may occur through two pathways: nurse-physician collaboration (without patient visits to the physician) and physician management through office visits. This study examines the relative contribution of the two pathways and how they interplay. METHODS: Retrospective analysis was conducted using Medicare claims of 7,389 depressed patients aged 65 years or older who received HHC in 2006-2007 and who possessed antidepressants at the start of HHC. A change in antidepressant therapy (versus discontinuation or refill) was the main study outcome and could take the form of a change in dose, switch to a different antidepressant, or augmentation (addition of a new antidepressant). Logistic regressions were estimated to examine how use of home health nursing care, patient visits to physicians, and their interactions predict a change in antidepressant therapy. RESULTS: About 30% of patients experienced a change in antidepressants versus 51% who refilled and 18% who discontinued. Receipt of mental health specialty care was associated with a statistically significant, 10- to 20-percentage-point increase in the probability of antidepressant change; receipt of primary care was associated with a small and statistically significant increase in the probability of antidepressant change among patients with no mental health specialty care and above-average utilization of nursing care. Increased home health nursing care in absence of physician visits was not associated with increased antidepressant change. CONCLUSIONS: Active antidepressant management resulting in a change in medication occurred on a limited scale among older patients receiving HHC. Addressing knowledge and practice gaps in antidepressant management by primary care providers and home health nurses and improving nurse-physician collaboration will be promising areas for future interventions.

Thin-film voltammetry and its analytical applications: a review.

Electrochemical reactions at the interfaces of immiscible electrolyte solutions (ITIES) are of fundamental importance in the fields of chemical, biological and pharmaceutical sciences. Four-electrode cell setup, scanning electrochemical microscopy (SECM) and thin-film voltammetry are the three most frequently used methods for studying the electrochemical processes at these interfaces. The principle, experimental design, advantages and challenges of the three methods are described and compared. The thin-film voltammetry is highlighted for its simplicity in experimental operation and kinetic data analysis. Its versatile analytical applications are discussed in detail, including the study of redox properties of hydrophobic compounds, evaluation of interfacial electron transfer kinetics, synthesis of nanoparticles/nanostructures, and illustration of cross-membrane ion transport phenomena.

Diffusion of accelerated partial breast radiotherapy in the United States: physician-level and patient-level analyses.

PURPOSE: To evaluate diffusion of brachytherapy-based accelerated partial breast radiotherapy (RT) in the United States, a new breast cancer treatment requiring 5 days twice daily, rather than daily treatment for 6-7 weeks. It has limited long-term effectiveness data compared with standard whole breast RT. DATA AND METHODS: We used 2005-2008 Medicare claims for female Medicare beneficiaries receiving RT after breast-conserving surgery merged with physician and area-based data (n=74,254 patient-subjects; n=1901 physicians), applying logistic regression to estimate: (1) proportion of patients for whom the radiation oncologist used brachytherapy-based accelerated RT, and (2) probability a patient received brachytherapy-based accelerated RT, clustering on physician. RESULTS: Use of accelerated partial breast RT increased over time (8% in 2005 to 17% in 2008). Physician-level analysis indicates rural physicians were less likely to perform accelerated RT [odds ratio (OR): 0.35-0.49; P<0.002)]; as were those licensed 20+years [OR: 0.54; 95% confidence interval (CI), 0.39-0.74]. Overall, 11.7% of patients received accelerated RT. Treatment post 2005 was associated with increasing odds of receiving accelerated RT (P<0.0001). Older age was associated with lower odds of receiving accelerated RT (reference, 66-69 years old, OR: 0.90, P<0.006), as was black (OR: 0.73;95% CI, 0.63-0.85) or other race (OR: 0.80; 95% CI, 0.65-1.00), living in rural areas (OR: 0.8; P<0.0001), or seeing an older physician [20+years postgraduation (OR: 0.7; 95% CI, 0.5-0.9)]. Patients living in counties with more hospitals with advanced RT facilities were more likely to undergo accelerated RT (OR: 1.4; 95% CI, 1.1-1.8). DISCUSSION: This new technology appears to be in the early phase of diffusion across the United States and is more rapidly being taken up in younger, white patients living in urban and suburban areas with availability of advanced RT facilities. Rural and older patient populations are not tending to undergo the treatment.

Uniquely arranged graphene-on-graphene structure as a binder-free anode for high-performance lithium-ion batteries.

3D graphene interconnected frameworks homogeneously connected with a few-layer graphene film (3DG/FLG) constitute a novel hierarchical hybrid structure for anodes in lithium-ion batteries. The pore-rich 3D graphene network is favorable for Li(+) diffusion and electron transport, and the FLG is a non-metallic current collector that effectively collects/transports charge carriers from/to the 3D graphene network and provides an excellent scaffold to support the 3DG.

The current and ideal state of mental health training: pediatric program director perspectives.

OBJECTIVE: To assess pediatric residency program director (PD) perceptions of the current state of mental health (MH) training, their receptivity to curricular changes, and perceptions of their residents' knowledge and skills in MH care. METHODS: We performed a cross-sectional study utilizing a Web-based survey of pediatric residency PDs to assess program characteristics, learning modalities PDs currently had or would implement, and their knowledge of the new American Academy of Pediatrics' MH competencies. PDs then ranked their residents' knowledge and skills for 29 MH competencies. Analyses included descriptive statistics and bivariate and multivariate analyses to assess for associations between variables, particularly MH model of care and perceived competence. RESULTS: Ninety-nine PDs (51%) responded. A total of 87% of PDs reported that MH care was taught as part of another rotation, yet PDs were receptive to curricular changes. Only 45% of PDs were aware of the 2009 American Academy of Pediatrics competencies, and PDs infrequently rated their residents' MH skills and knowledge to be above average. Attention-deficit/hyperactivity disorder (ADHD) was an exception: 64% reported above-average ADHD knowledge in diagnoses and 57% in treatment. There was an association between enhanced MH services in continuity clinics and perceived resident systems-based practice (P < .01) and medical knowledge (P = .04). CONCLUSIONS: PDs acknowledged that MH training is not emphasized, leading to deficiencies in their residents' knowledge and skills in MH care. The receptivity of PDs suggests the need for targeted dissemination of national guidelines or curriculum. Integrated models of care may be one way to improve resident competencies, but this deserves further study.

Graphene quantum dots-three-dimensional graphene composites for high-performance supercapacitors.

Graphene quantum dots (GQDs) have been successfully deposited onto the three-dimensional graphene (3DG) by a benign electrochemical method and the ordered 3DG structure remains intact after the uniform deposition of GQDs. In addition, the capacitive properties of the as-formed GQD-3DG composites are evaluated in symmetrical supercapacitors. It is found that the supercapacitor fabricated from the GQD-3DG composite is highly stable and exhibits a high specific capacitance of 268 F g(-1), representing a more than 90% improvement over that of the supercapacitor made from pure 3DG electrodes (136 F g(-1)). Owing to the convenience of the current method, it can be further used in other well-defined electrode materials, such as carbon nanotubes, carbon aerogels and conjugated polymers to improve the performance of the supercapacitors.

Incidence and significance of intraoperative cerebrospinal fluid leak in endoscopic pituitary surgery using intrathecal fluorescein.

OBJECTIVE: The true rate of intraoperative cerebrospinal fluid (iCSF) leak during pituitary surgery is not well known because small iCSF leaks are easily missed. Our objective is to determine the rate and significance of iCSF leak in endoscopic pituitary surgery with intrathecal (IT) fluorescein administration and determine factors predictive of iCSF leak. METHODS: IT fluorescein was administered in 203 consecutive endoscopic, endonasal pituitary surgeries. The rate of iCSF leak was noted prospectively and correlated with tumor diameter and volume, gross total resection, and the learning curve. Postoperative CSF leak rate, complications, and nasoseptal flap utility were also investigated. RESULTS: The rate of iCSF leak was 61% overall, 44% for tumors<2 cm compared to 72% for tumors≥2 cm and 35% for tumors<1.5 cm3 compared to 68% for those≥1.5 cm3 (P<0.001). Postoperative CSF leak was significantly lower after the first 50 cases (0.7% vs. 10%; P<0.005) with overall leak of 3%. For tumors>2 cm, the introduction of nasoseptal flap reduced the rate of postoperative CSF leak from 5.6% to 1.4%. We did not find any complications clearly related with the use of IT fluorescein. CONCLUSION: The rate of iCSF leak during endoscopic pituitary surgery using IT fluorescein is higher than previously reported. Tumor diameter and volume are best predictors of the risk of iCSF leak. Based on this knowledge and a closure algorithm that includes a lumbar drain and nasoseptal flap for larger tumors (>2.5 cm), we can conclude that the postoperative CSF leak rate remains exceptionally low, particularly once the learning curve is overcome.