Micropyramid structured photo capacitive interfaces.

Optically driven electronic neuromodulation devices are a novel tool in basic research and offer new prospects in medical therapeutic applications. Optimal operation of such devices requires efficient light capture and charge generation, effective electrical communication across the device's bioelectronic interface, conformal adhesion to the target tissue, and mechanical stability of the device during the lifetime of the implant-all of which can be tuned by spatial structuring of the device. We demonstrate a 3D structured opto-bioelectronic device-an organic electrolytic photocapacitor spatially designed by depositing the active device layers on an inverted micropyramid-shaped substrate. Ultrathin, transparent, and flexible micropyramid-shaped foil was fabricated by chemical vapour deposition of parylene C on silicon moulds containing arrays of inverted micropyramids, followed by a peel-off procedure. The capacitive current delivered by the devices showed a strong dependency on the underlying spatial structure. The device performance was evaluated by numerical modelling. We propose that the developed numerical model can be used as a basis for the design of future functional 3D design of opto-bioelectronic devices and electrodes.

Preoperative Parameters to Predict the Development of Symptomatic Lymphoceles after Radical Prostatectomy.

INTRODUCTION: Symptomatic lymphoceles (SLs) represent the most common complication after radical prostatectomy (RP) and pelvic lymph node dissection (PLND). To date, preoperative risk factors are missing. METHODS: Clinical and pathological data of 592 patients who underwent RP and PLND were evaluated. Included parameters were age, BMI, prostate-specific antigen (PSA), PSA ratio, PSA density, number of resected and/or positive lymph nodes, previous abdominal surgery/pelvic radiotherapy, anticoagulation, and surgical approach. RESULTS: Fifty-nine patients (10%) developed an SL, of which 57 underwent open retropubic radical prostatectomy (RRP) and 2 underwent robot-assisted radical prostatectomy (RARP). Multivariate logistic regression revealed the following parameters as statistically significant risk factors: PSA (odds ratio [OR] = 2.23; 95% CI [1.25; 5.04], p = 0.04), number of resected lymph nodes (OR = 1.47; 95% CI [1.10; 1.97], p < 0.01), previous abdominal surgery (OR = 2.58; 95% CI [1.38; 4.91], p < 0.01), and surgical approach (OR = 0.08; 95% CI [0.01; 0.27], p < 0.01). Previous oral anticoagulation showed almost statistically significant results (OR = 2.39 [0.92; 5.51], p = 0.05). CONCLUSION: The risk for SL might be predictable considering preoperative risk factors such as PSA, previous abdominal surgery and anticoagulation. To avoid SL, RARP should be the procedure of choice. If RRP is considered, patients at risk for SL may benefit from peritoneal fenestration during RP.

Feasibility and Oncologic Outcome of Salvage Surgery in Isolated Seminal Vesicle Remnants after Radical Prostatectomy.

BACKGROUND: To demonstrate the feasibility of resecting isolated locally relapsing seminal vesicle remnants after primary radical prostatectomy and radiotherapy. Early oncologic outcomes and prognostic risk factors for relapse are demonstrated. OBJECTIVES AND METHODS: A total of 32 patients underwent open resection of locoregional prostate cancer recurrence in seminal vesicles, as documented on either MRI, 11C-choline, or 68Ga-PSMA PET/CT scans. Age, PSA-DT, PSA, and time to recurrence after primary treatment resection status were used in a uni- and multivariate Cox regression analysis for biochemical relapse after surgery. RESULTS: Median patient age at time of salvage surgery was 70 (57-77) years. Median PSA and PSA-DT was 2.79 (0.4-61.54) ng/mL and 5.4 (1.6-20.1) months, respectively. Median surgical time and hospital stay was 132 (75-313) min and 5.5 (4-13) days, respectively. After a mean follow-up of 29 (2-92) months, 3 patients died at 8, 14, and 40 months after salvage surgery, and 6 (18.75%) patients remain without biochemical relapse and further treatment. Median progression-free survival was 12 (1-81) months. In the univariable Cox regression analysis, age at time of surgery, preoperative PSA, and the time from primary treatment to salvage surgery were identified as significant parameters for biochemical relapse. Only the interval from primary to salvage surgery was significant in the multivariate analysis with a hazard ratio of 1.008 (95% CI: 1.001-1.015, p = 0.018). In the entire cohort, 4 adjunctive surgeries (3 ureteroneocystostomies and 1 nephrectomy) were needed due to local progressive disease. CONCLUSION: Seminal vesicle resection is feasible with no significant intra- or postoperative complications. Almost all patients progressed to biochemical or systemic relapse. Salvage surgery must be seen as a preventive for local symptoms, in our experience most often postrenal ipsilateral obstruction.

Resilient yet entirely degradable gelatin-based biogels for soft robots and electronics.

Biodegradable and biocompatible elastic materials for soft robotics, tissue engineering or stretchable electronics with good mechanical properties, tunability, modifiability or healing properties drive technological advance, and yet they are not durable under ambient conditions and do not combine all the attributes in a single platform. We have developed a versatile gelatin-based biogel, which is highly resilient with outstanding elastic characteristics, yet degrades fully when disposed. It self-adheres, is rapidly healable and derived entirely from natural and food-safe constituents. We merge all the favourable attributes in one material that is easy to reproduce and scalable, and has a low-cost production under ambient conditions. This biogel is a step towards durable, life-like soft robotic and electronic systems that are sustainable and closely mimic their natural antetypes.

Salvage radical prostatectomy after local radiotherapy in prostate cancer.

PURPOSE OF REVIEW: Salvage surgeries are rarely offered and performed in prostate cancer except for isolated lymph node metastases. Meanwhile, data are sufficient that salvage radical prostatectomy is recommended by the guidelines. In the following review, we focus on different treatment strategies comparing open and DaVinci laparoscopic approach with regard to functional and oncologic outcome. Of further interest are palliative surgeries. RECENT FINDINGS: Salvage radical prostatectomy is mainly performed in high volume centres. Data are increasing on minimal invasive surgery, although data on functional outcome are conflicting. As patients with prostate cancer have longer life expectancy even in metastasized disease, the possibility of developing symptomatic progression increases as well. We need to be aware that the confrontation with symptomatic prostate cancer patients will be more frequent in the future and that there are surgical approaches to palliate these patients sufficiently. SUMMARY: Data on minimal invasive salvage radical prostatectomy are getting more valid and are an option in experienced centres. Salvage radical prostatectomy is a definitive curative option for the patients. To avoid local progression, palliative local surgeries need to be discussed with the patients.

Evidence from the 'PROspective MulticEnTer RadIcal Cystectomy Series 2011 (PROMETRICS 2011)' study: how are preoperative patient characteristics associated with urinary diversion type after radical cystectomy for bladder cancer?

PURPOSE: The aim of this study was to examine preoperative patients' characteristics associated with the urinary diversion (UD) type (continent vs. incontinent) after radical cystectomy (RC) and UD-associated postoperative complications. MATERIALS: In 2011, 679 bladder cancer patients underwent RC at 18 European tertiary care centers. Data were prospectively collected within the 'PROspective MulticEnTer RadIcal Cystectomy Series 2011' (PROMETRICS 2011). Logistic regression models assessed the impact of preoperative characteristics on UD type and evaluated diversion-related complication rates. RESULTS: Of 570 eligible patients, 28.8, 2.6, 59.3, and 9.3% received orthotopic neobladders, continent cutaneous pouches, ileal conduits, and ureterocutaneostomies, respectively. In multivariable analyses, female sex (odds ratio [OR] 3.9; p = 0.002), American Society of Anesthesiologists score ≥3 (OR 2.3; p = 0.02), an age-adjusted Charlson Comorbidity Index ≥3 (OR 4.1; p < 0.001), and a positive biopsy of the prostatic urethra in the last transurethral resection of the bladder prior to RC (OR 4.9; p = 0.03) were independently associated with incontinent UD. There were no significant differences in 30- and/or 90-day complication rates between the UD types. Perioperative transfusion rates and 90-day mortality were significantly associated with incontinent UD (p < 0.001, respectively). Limitations included the small sample size and a certain level of heterogeneity in the application of clinical pathways between the different participating centers. CONCLUSIONS: Within this prospective contemporary cohort of European RC patients treated at tertiary care centers, the majority of patients received an incontinent UD. Female sex and pre-existing comorbidities were associated with receiving an incontinent UD. The risk of overall complications did not vary according to UD type.

Retroperitoneal Lymph Node Dissection in Clinical Stage IIA/B Metastatic Seminoma: Results of the COlogne Trial of Retroperitoneal Lymphadenectomy In Metastatic Seminoma (COTRIMS).

BACKGROUND: Radiation therapy and systemic chemotherapy are recommended treatment options in marker-negative clinical stage (CS) IIA/B seminoma. Despite high cure rates of 82-94%, both therapeutic options are associated with significant long-term toxicities. OBJECTIVE: To evaluate the feasibility, oncological efficacy, and treatment-associated morbidity of primary nerve-sparing retroperitoneal lymph node dissection (nsRPLND) in CS IIA/B seminoma. DESIGN, SETTING, AND PARTICIPANTS: A prospective, single-arm, clinical phase 2 trial including CS IIA/B seminoma patients was conducted. INTERVENTION: Primary nerve-sparing retroperitoneal lymphadenectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Relapse-free and overall survival, surgery-associated complications according to the Clavien-Dindo classification, and Kaplan-Meier methods for survival calculation were assessed. RESULTS AND LIMITATIONS: Thirty patients at a mean age of 39.1 (34-52) yr with marker-negative CS IIA and IIB seminomas were recruited. The median follow-up was 22 (8-30) mo. Nineteen (63%) and 11 (36%) patients were diagnosed with stages IIA and B, respectively, at the time of primary diagnosis. Fourteen (47%) and 16 (53%) patients were diagnosed with CS IIA and IIB, respectively, at the time of nsRPLND. Twenty-seven and three patients underwent open and robot-assisted nsRPLND, respectively. The median operating room time was 125 (115-145) min, median blood loss was <150 ml, and median time of hospitalization was 4.5 (3-9) d. Four (13%) patients experienced Clavien-Dindo grade 3a complications. Lymph node histology revealed seminoma in 25 (80%) patients; two and three patients demonstrated embryonal carcinoma and benign disease, respectively. Sixteen patients underwent a serum analysis of miR371 preoperatively, which predicted metastatic disease in 12/13 and benign histology in 3/3 patients. Three of 30 (10%) patients developed an outfield relapse 4, 6, and 9 mo postoperatively and were salvaged by systemic chemotherapy. Limitations are the low patient number and length of follow-up. CONCLUSIONS: The nsRPLND approach results in a high cure rate at midterm follow-up and is associated with a low frequency of treatment-associated morbidities, making this approach a feasible alternative to radiation therapy or systemic chemotherapy. PATIENT SUMMARY: The standard treatment of clinical stage IIA/B seminomas is radiation therapy or chemotherapy, which results in a significantly increased frequency of long-term toxicity and secondary neoplasms. In this trial, we demonstrate that nerve-sparing retroperitoneal lymph node dissection is a feasible therapeutic approach with low morbidity and high oncological efficacy.

Biodegradable electrohydraulic actuators for sustainable soft robots.

Combating environmental pollution demands a focus on sustainability, in particular from rapidly advancing technologies that are poised to be ubiquitous in modern societies. Among these, soft robotics promises to replace conventional rigid machines for applications requiring adaptability and dexterity. For key components of soft robots, such as soft actuators, it is thus important to explore sustainable options like bioderived and biodegradable materials. We introduce systematically determined compatible materials systems for the creation of fully biodegradable, high-performance electrohydraulic soft actuators, based on various biodegradable polymer films, ester-based liquid dielectric, and NaCl-infused gelatin hydrogel. We demonstrate that these biodegradable actuators reliably operate up to high electric fields of 200 V/µm, show performance comparable to nonbiodegradable counterparts, and survive more than 100,000 actuation cycles. Furthermore, we build a robotic gripper based on biodegradable soft actuators that is readily compatible with commercial robot arms, encouraging wider use of biodegradable materials systems in soft robotics.

Impact of Interest Congruence on Study Outcomes.

Grounding on Holland's RIASEC model of vocational interests and the respective assumptions on person-environment fit (congruence), this paper focuses on how congruence is related to study outcomes, especially students' persistence, performance, and satisfaction. The paper distinguishes the measure of congruence with respect to social congruence (SOC) (interest fit with the study mates) and aspirational congruence (ASP) (interest fit with the occupation aspired) and also distinguishes the effects of congruence for gender and six different study areas including Science, Technology, Engineering, Mathematics (STEM), medicine, economics, education, and languages. The paper analyses 10,226 university freshmen of the German National Educational Panel Study (NEPS) and follows them longitudinally with respect to their study outcomes. The results show that students' persistence was more related to SOC than to ASP, especially for male students. Furthermore, SOC was particularly important for students in STEM areas. Regarding performance, however, ASP was more important. Here, we notably found correlations for STEM subjects with a balanced proportion of female students. Regarding satisfaction, mainly marginal correlations could be found. The results indicate conceptual differences between social and aspirational congruence as well as specific effects for gender and study area. While research might take this into account by specifically developing their models for different study areas, career counseling may reflect on the different significance of the interest-based person-environment fit for different study areas. Initiatives for raising young people's participation in STEM should therefore specifically focus on students that have high chances to develop interest profiles that are congruent to STEM rather than students who show profiles which already indicate a low congruence.

Ultrafast small-scale soft electromagnetic robots.

High-speed locomotion is an essential survival strategy for animals, allowing populating harsh and unpredictable environments. Bio-inspired soft robots equally benefit from versatile and ultrafast motion but require appropriate driving mechanisms and device designs. Here, we present a class of small-scale soft electromagnetic robots made of curved elastomeric bilayers, driven by Lorentz forces acting on embedded printed liquid metal channels carrying alternating currents with driving voltages of several volts in a static magnetic field. Their dynamic resonant performance is investigated experimentally and theoretically. These robust and versatile robots can walk, run, swim, jump, steer and transport cargo. Their tethered versions reach ultra-high running speeds of 70 BL/s (body lengths per second) on 3D-corrugated substrates and 35 BL/s on arbitrary planar substrates while their maximum swimming speed is 4.8 BL/s in water. Moreover, prototype untethered versions run and swim at a maximum speed of 2.1 BL/s and 1.8 BL/s, respectively.

Becoming Sustainable, The New Frontier in Soft Robotics.

The advancement of technology has a profound and far-reaching impact on the society, now penetrating all areas of life. From cradle to grave, one is supported by and depends on a wide range of electronic and robotic appliances, with an ever more intimate integration of the digital and biological spheres. These advances, however, often come at the price of negatively impacting our ecosystem, with growing demands on energy, contributions to greenhouse gas emissions and environmental pollution-from production to improper disposal. Mitigating these adverse effects is among the grand challenges of the society and at the forefront of materials research. The currently emerging forms of soft, biologically inspired electronics and robotics have the unique potential of becoming not only like their natural antitypes in performance and capabilities, but also in terms of their ecological footprint. This review outlines the rise of sustainable materials in soft and bioinspired robotics, targeting all robotic components from actuators to energy storage and electronics. The state-of-the-art in biobased robotics spans flourishing fields and applications ranging from microbots operating in vivo to biohybrid machines and fully biodegradable yet resilient actuators. These first steps initiate the evolution of robotics and guide them into a sustainable future.

Soft Tunable Lenses Based on Zipping Electroactive Polymer Actuators.

Compact and entirely soft optics with tunable and adaptive properties drive the development of life-like soft robotic systems. Yet, existing approaches are either slow, require rigid components, or use high operating voltages of several kilovolts. Here, soft focus-tunable lenses are introduced, which operate at practical voltages, cover a high range of adjustable focal lengths, and feature response times in the milliseconds range. The nature-inspired design comprises a liquid-filled elastomeric lens membrane, which is inflated by zipping electroactive polymers to tune the focal length. An analytic description of the tunable lens supports optimized designs and accurate prediction of the lens characteristics. Focal length changes between 22 and 550 mm (numerical aperture 0.14-0.005) within 260 ms, equal in performance to human eyes, are demonstrated for a lens with 3 mm aperture radius, while applying voltages below 500 V. The presented model, design rules, and fabrication methods address central challenges of soft electrostatic actuators and optical systems, and pave the way toward autonomous bio-inspired robots and machines.

The Interest Profiles and Interest Congruence of Male and Female Students in STEM and Non-STEM Fields.

The goal of the following study is to investigate whether first-year students in STEM fields that have a low proportion of females (STEM-L) show vocational interests that fit their vocational aspirations. To place our investigation into a broader context, we compared students in STEM-L with students of STEM subjects with a medium proportion of women (STEM-M) as well as with other subjects with a medium or a high proportion of females. We analyzed their vocational interests, vocational aspirations and their interest congruence. In both the comparison regarding interest profiles and the comparison of vocational aspirations, we focused on the things-orientation and people-orientation, all while taking respective gender differences into account. Following the suggestion from previous studies, in a further step we differentiated between subjects within STEM-L. Using data from the German National Educational Panel Study (NEPS), we analyzed the interest congruence of 5,530 male and 7,406 female students in STEM majors (with a low or medium proportion of women) and non-STEM majors (with a medium or high proportion of women). Students from different subjects showed different magnitudes regarding their things- and people-orientation. STEM-L students had a high things-orientation and a low people-orientation regarding both their interests and aspired occupations. Students of STEM-L and STEM-M showed a lower interest congruence than students from other subjects. With the exception of education, gender differences regarding the people- and things-orientation also existed within most of the subjects. Gender differences partly remain when distinguishing between the different subjects within STEM-L. And so, the result that not all STEM-L subjects are "created equal" is discussed in the context of their theoretical and methodological aspects.

Meant to merge: Fabrication of stretchy electronics for robotics.

With the next generation of squishy robots on the rise, advanced soft electronic skins could provide the ultimate touch.

Instant tough bonding of hydrogels for soft machines and electronics.

Introducing methods for instant tough bonding between hydrogels and antagonistic materials-from soft to hard-allows us to demonstrate elastic yet tough biomimetic devices and machines with a high level of complexity. Tough hydrogels strongly attach, within seconds, to plastics, elastomers, leather, bone, and metals, reaching unprecedented interfacial toughness exceeding 2000 J/m2. Healing of severed ionic hydrogel conductors becomes feasible and restores function instantly. Soft, transparent multilayered hybrids of elastomers and ionic hydrogels endure biaxial strain with more than 2000% increase in area, facilitating soft transducers, generators, and adaptive lenses. We demonstrate soft electronic devices, from stretchable batteries, self-powered compliant circuits, and autonomous electronic skin for triggered drug delivery. Our approach is applicable in rapid prototyping and in delicate environments inaccessible for extended curing and cross-linking.

Amplification and overexpression of the ID4 gene at 6p22.3 in bladder cancer.

BACKGROUND: Amplifications at 6p22.3 are prevalent in advanced stage bladder cancer (TCC). Previous studies have identified SOX4, CDKAL, and E2F3 as targets of this amplification and therefore potential oncogenes, but the more telomeric DEK gene too has been reported as overexpressed and amplified. We have therefore investigated whether the intermediate region harboring the oncogene candidate ID4 is also part of the amplicon. RESULTS: Expression of E2F3, DEK, and ID4 was investigated by real-time RT-PCR in 28 TCC compared to 6 normal bladder tissues and in 15 TCC cell lines compared to cultured normal urothelial cells. Expression of E2F3 as well as DEK increased on average in tumor vs. normal tissues (3-fold and 2.5-fold, resp.), but only the increase for E2F3 was statistically significant (p = 0.039). ID4 overexpression was observed in selected specimens. Each of the three genes was overexpressed in several cell lines, up to 150-fold (ID4), 30-fold (E2F3), and 9-fold (DEK), but these increases were not correlated to each other. Instead, moderate (DEK) to excellent (ID4) correlations were observed with copy number increases of microsatellites near each gene. Microsatellite copy number increases were highly heterogeneous across the investigated several Mb region revealing at least three subregions of amplification. CONCLUSION: Extending previous reports, our data indicate that the 6p22.3 amplicon in TCC is highly heterogeneous and targets several genes in a variable fashion. Among these, expression of E2F3 and DEK appear to be generally increased in TCC, with additional increases caused by amplifications. In contrast, over-expression of ID4, which is normally predominantly expressed in testes and brain, appears to depend more strictly on gene amplification. Accordingly, the effect of amplifications at 6p22.3 in bladder cancer is expected to be non-uniform, thereby contributing to the highly variable biological and clinical behavior of advanced stage tumors. ID4 is a potential oncogene in a small subset of bladder cancers.

Feasibility of touch-less control of operating room lights.

PURPOSE: Today's highly technical operating rooms lead to fairly complex surgical workflows where the surgeon has to interact with a number of devices, including the operating room light. Hence, ideally, the surgeon could direct the light without major disruption of his work. We studied whether a gesture tracking-based control of an automated operating room light is feasible. METHODS: So far, there has been little research on control approaches for operating lights. We have implemented an exemplary setup to mimic an automated light controlled by a gesture tracking system. The setup includes a articulated arm to position the light source and an off-the-shelf RGBD camera to detect the user interaction. We assessed the tracking performance using a robot-mounted hand phantom and ran a number of tests with 18 volunteers to evaluate the potential of touch-less light control. RESULTS: All test persons were comfortable with using the gesture-based system and quickly learned how to move a light spot on flat surface. The hand tracking error is direction-dependent and in the range of several centimeters, with a standard deviation of less than 1 mm and up to 3.5 mm orthogonal and parallel to the finger orientation, respectively. However, the subjects had no problems following even more complex paths with a width of less than 10 cm. The average speed was 0.15 m/s, and even initially slow subjects improved over time. Gestures to initiate control can be performed in approximately 2 s. Two-thirds of the subjects considered gesture control to be simple, and a majority considered it to be rather efficient. CONCLUSIONS: Implementation of an automated operating room light and touch-less control using an RGBD camera for gesture tracking is feasible. The remaining tracking error does not affect smooth control, and the use of the system is intuitive even for inexperienced users.