Symmetric Catalyst Design Employing Ir Nanoparticles on Black WO3- x Nanofiber Support for Boosting Water Electrolysis.

The efficient evolution of gaseous hydrogen and oxygen from water is required to realize sustainable energy conversion systems. To address the sluggish kinetics of the multielectron transfer reaction, bifunctional catalyst materials for both the hydrogen evolution reaction (HER) and the oxygen evolution reaction (OER) should be developed. Herein, a tailored combination of atomically minimized iridium catalysts and highly conductive black WO3- x nanofiber supports are developed for the bifunctional electrolyzer system. Atomic Ir catalysts, particularly those that activate the OER, minimize the utilization of precious metals. The oxygen-deficient black WO3- x NF support, which boosts the HER, offers increased electronic conductivity and favorable nucleation sites for Ir loading. The Ir-black WO3- x NFs exhibit increased double-layer capacitance, a significantly reduced onset potential, lower Tafel slope, and stable cyclability for both the OER and HER, compared to large-sized Ir catalysts loaded on white WO3 nanofibers. This study offers a strategy for developing an optimal catalyst material with suitable supports for high-performance and economical water electrolysis systems for achieving carbon-negative targets.

Characterizing utilization patterns and reoperation risk factors of interspinous process devices: analysis of a national claims database.

INTRODUCTION: Interspinous process devices (IPDs) were developed as minimally invasive alternatives to open decompression surgery for spinal stenosis. However, given high treatment failure and reoperation rates, there has been minimal adoption by spine surgeons. This study leveraged a national claims database to characterize national IPD usage patterns and postoperative outcomes after IPD implantation. METHOD: Using the PearlDiver database, we identified all patients who underwent 1- or 2-level IPD implantation between 2010 and 2018. Univariate and multivariable logistic regression was performed to identify predictors of the number of IPD levels implanted and reoperation up to 3 years after the index surgery. Right-censored Kaplan-Meier curves were plotted for duration of reoperation-free survival and compared with log-rank tests. RESULTS: Patients (n = 4865) received 1-level (n = 3246) or 2-level (n = 1619) IPDs. Patients who were older (adjusted odds ratio [aOR] 1.02, 95% confidence interval [CI] 1.01-1.03, P < .001), male (aOR 1.31, 95% CI 116-1.50, P < .001), and obese (aOR 1.19, 95% CI 1.05-1.36, P < .01) were significantly more likely to receive a 2-level IPD than to receive a 1-level IPD. The 3-year reoperation rate was 9.3% of patients when mortality was accounted for during the follow-up period. Older age decreased (aOR 0.97, 95% CI 0.97-0.99, P = .0039) likelihood of reoperation, whereas 1-level IPD (aOR 1.37, 95% CI 1.01-1.89, P = .048), Charlson Comorbidity Index (aOR 1.07, 95% CI 1.01-1.14, P = .018), and performing concomitant open decompression increased the likelihood of reoperation (aOR 1.68, 95% CI 1.35-2.09, P = .0014). CONCLUSION: Compared with 1-level IPDs, 2-level IPDs were implanted more frequently in older, male, and obese patients. The 3-year reoperation rate was 9.3%. Concomitant open decompression with IPD placement was identified as a significant risk factor for subsequent reoperation and warrants future investigation.

Intracellular localization of the proteasome in response to stress conditions.

The ubiquitin-proteasome system fulfills an essential role in regulating protein homeostasis by spatially and temporally controlling proteolysis in an ATP- and ubiquitin-dependent manner. However, the localization of proteasomes is highly variable under diverse cellular conditions. In yeast, newly synthesized proteasomes are primarily localized to the nucleus during cell proliferation. Yeast proteasomes are transported into the nucleus through the nuclear pore either as immature subcomplexes or as mature enzymes via adapter proteins Sts1 and Blm10, while in mammalian cells, postmitotic uptake of proteasomes into the nucleus is mediated by AKIRIN2, an adapter protein essentially required for nuclear protein degradation. Stressful growth conditions and the reversible halt of proliferation, that is quiescence, are associated with a decline in ATP and the reorganization of proteasome localization. Cellular stress leads to proteasome accumulation in membraneless granules either in the nucleus or in the cytoplasm. In quiescence, yeast proteasomes are sequestered in an ubiquitin-dependent manner into motile and reversible proteasome storage granules in the cytoplasm. In cancer cells, upon amino acid deprivation, heat shock, osmotic stress, oxidative stress, or the inhibition of either proteasome activity or nuclear export, reversible proteasome foci containing polyubiquitinated substrates are formed by liquid-liquid phase separation in the nucleus. In this review, we summarize recent literature revealing new links between nuclear transport, ubiquitin signaling, and the intracellular organization of proteasomes during cellular stress conditions.

On-treatment derived neutrophil-to-lymphocyte ratio and survival with palbociclib and endocrine treatment: analysis of a multicenter retrospective cohort and the PALOMA-2/3 study with immune correlates.

BACKGROUND: Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors have been established as a standard treatment for hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer (ABC); however, predictive biomarkers with translational relevance have not yet been elucidated. METHODS: Data from postmenopausal women who received the CDK4/6 inhibitor palbociclib and letrozole for HR-positive, HER2-negative ABC from tertiary referral centers were analyzed (N = 221; exploratory cohort). Pre- and on-treatment neutrophil-to-lymphocyte ratio (NLR) and derived NLR (dNLR; neutrophil/[leukocyte-neutrophil]) were correlated with survival outcomes. Data from the PALOMA-2 (NCT01740427) and PALOMA-3 studies (NCT01942135) involving patients treated with endocrine treatment with or without palbociclib were also analyzed (validation cohort). Prospectively enrolled patients (N = 20) were subjected to immunophenotyping with circulating immune cells to explore the biological implications of immune cell dynamics. RESULTS: In the exploratory cohort, palbociclib administration significantly reduced leukocyte, neutrophil, and lymphocyte counts on day 1 of cycle 2. Although the baseline dNLR was not significantly associated with progression-free survival (PFS), higher on-treatment dNLRs were associated with worse PFS (hazard ratio = 3.337, P < 0.001). In the PALOMA-2 validation cohort, higher on-treatment dNLRs were associated with inferior PFS in patients treated with palbociclib and letrozole (hazard ratio = 1.498, P = 0.009), and reduction in the dNLR after treatment was predictive of a survival benefit (hazard ratio = 1.555, P = 0.026). On-treatment dNLRs were also predictive of PFS following palbociclib and fulvestrant treatment in the PALOMA-3 validation cohort. Using flow cytometry analysis, we found that the CDK4/6 inhibitor prevented T cell exhaustion and diminished myeloid-derived suppressor cell frequency. CONCLUSIONS: On-treatment dNLR significantly predicted PFS in patients with HR-positive, HER2-negative ABC receiving palbociclib and endocrine treatment. Additionally, we observed putative systemic immune responses elicited by palbociclib, suggesting immunologic changes upon CDK4/6 inhibitor treatment.

Lipid raft protein flotillin-1 is important for the interaction between SOS1 and H-Ras/K-Ras, leading to Ras activation.

Ras mutations have been frequently observed in human cancer. Although there is a high degree of similarity between Ras isomers, they display preferential coupling in specific cancer types. The binding of Ras to the plasma membrane is essential for its activation and biological functions. The present study elucidated Ras isoform-specific interactions with the membrane and their role in Ras-mediated biological activities. We investigated the role of a lipid raft protein flotillin-1 (Flot-1) in the activations of Ras. We found that Flot-1 was co-localized with H-Ras, but not with N-Ras, in lipid rafts of MDA-MB-231 human breast cells. The amino-terminal hydrophobic domain (1-38) of Flot-1 interacted with the hypervariable region of H-Ras. The epidermal growth factor-stimulated activation of H-Ras required Flot-1 which was not necessary for that of N-Ras in breast cancer cells. Flot-1 interacted with son of sevenless (SOS)-1, which promotes the conversion of Ras-bound GDP to GTP. Notably, Flot-1 was crucial for the interaction between SOS1 and H-Ras/K-Ras in breast and pancreatic cancer cells. Stable knockdown of Flot-1 reduced the in vivo metastasis in a mouse xenograft model with human breast carcinoma cells. A tissue microarray composed of 61 human pancreatic cancer samples showed higher levels of Flot-1 expression in pancreatic tumor tissues compared to normal tissues, and a correlation between K-Ras and Flot-1. Taken together, our findings suggest that Flot-1 may serve as a membrane platform for the interaction of SOS1 with H-Ras/K-Ras in human cancer cells, presenting Flot-1 as a potential target for Ras-driven cancers.

Cathodes Coating Layer with Li-Ion Diffusion Selectivity Employing Interactive Network of Metal-Organic Polyhedras for Li-Ion Batteries.

Surface modification of cathodes using Ni-rich coating layers prevents bulk and surface degradation for the stable operation of Li-ion batteries at high voltages. However, insulating and dense inorganic coating layers often impede charge transfer and ion diffusion kinetics. In this study, the fabrication of dual functional coating materials using metal-organic polyhedra (MOP) with 3D networks within microporous units of Li-ion batteries for surface stabilization and facile ion diffusion is proposed. Zr-based MOP is modified by introducing acyl groups as a chemical linkage (MOPAC), and MOPAC layers are homogenously coated by simple spray coating on the cathode. The coating allow the smooth transport of electrons and ions. MOPAC effectively suppress side reactions between the cathode and electrolyte and protect active materials against aggressive fluoride ions by forming a Li-ion selective passivation film. The MOPAC-coated Ni-rich layered cathode exhibited better cycle retention and enhanced kinetic properties than pristine and MOP-coated cathodes. Reduction of undesirable gas evolution on the cathode by MOPAC is also verified. Microporous MOPAC coating can simultaneously stabilize both the bulk and surface of the Ni-rich layered cathode and maintain good electrochemical reaction kinetics for high-performance Li-ion batteries.

Structural optimization of novel Ras modulator for treatment of Colorectal cancer by promoting ß-catenin and Ras degradation.

Ras protein has been considered a fascinating target for anticancer therapy because its malfunction is closely related to cancer. However, Ras has been considered undruggable because of the failure to regulate its malfunction by controlling the Ras activation mechanism. Recently, Lumakras targeting the G12C mutation was approved, and therapeutic interest in Ras for anticancer therapy has been rejuvenated. Here, we present a series of compounds that inhibit Ras via a unique mechanism of action that exploits the relationship between the Wnt/ß-catenin pathway and Ras. KYA1797K (1) binds to axin to stabilize the ß-catenin destruction complex that causes the phosphorylation and subsequent degradation of Ras, similar to canonical ß-catenin regulation. Based on the chemical structure of 1, we performed a structural optimization and identified 3-(2-hydroxyethyl)-5-((6-(4-nitrophenyl)pyridin-2-yl)methylene)thiazolidine-2,4-dione (13d) as the most potent compound. 13d displayed antitumor effects in a colorectal cancer model with enhanced inhibition activity on Ras. The results of this study suggest that the further development of 13d could contribute to the development of Ras inhibitors with novel mechanisms of action.

Coarse-Graining of Imaginary Time Feynman Path Integrals: Inclusion of Intramolecular Interactions and Bottom-up Force-Matching.

Feynman's imaginary time path integral formalism of quantum statistical mechanics and the corresponding quantum-classical isomorphism provide a tangible way of incorporating nuclear quantum effect (NQE) in the simulation of condensed matter systems using well-developed classical simulation techniques. Our previous work has presented the many-body coarse-graining of path integral (CG-PI) theory that builds an isomorphism between the quantum partition function of N distinguishable particles and the classical partition function of 2N pseudoparticles. In this present work, we develop a generalized version of the many-body CG-PI theory that incorporates many-body interactions in the force field. Based on the new derivation, we provide a numerical CG-PI (n-CG-PI) modeling strategy parametrized from the underlying path integral molecular dynamics (PIMD) trajectories using force matching and Boltzmann inversion. The n-CG-PI models for two liquid systems are shown to capture well both the intramolecular and intermolecular structural correlations of the reference PIMD simulations. The generalized derivation of the many-body CG-PI theory and the n-CG-PI model presented in this work extend the scope of the CG-PI formalism by generalizing the previously limited theory to incorporate force fields of realistic molecular systems.

Resource Allocation in Downlink VLC-NOMA Systems for Factory Automation Scenario.

Industry 4.0 requires high-speed data exchange that includes fast, reliable, low-latency, and cost-effective data transmissions. As visible light communication (VLC) can provide reliable, low-latency, and secure connections that do not penetrate walls and are immune to electromagnetic interference; it can be considered a solution for Industry 4.0. The non-orthogonal multiple access (NOMA) technique can achieve high spectral efficiency using the same frequency and time resources for multiple users. It means that smaller amounts of resources will be used compared with orthogonal multiple access (OMA). Therefore, handling multiple data transmissions with VLC-NOMA can be easier for factory automation than OMA. However, as the transmit power is split, the reliability is reduced. Therefore, this study proposed a deep neural network (DNN)-based power-allocation algorithm (DBPA) to improve the reliability of the system. Further, to schedule multiple nodes in VLC-NOMA system, a priority-based user-pairing (PBUP) scheme is proposed. The proposed techniques in VLC-NOMA system were evaluated in terms of the factory automation scenario and showed that it improves reliability and reduces missed deadlines.

Suppression of Wnt/ß-catenin and RAS/ERK pathways provides a therapeutic strategy for gemcitabine-resistant pancreatic cancer.

Pancreatic cancer is a major malignant tumor without an effective treatment. KRAS mutations occur in 90% of the pancreatic cancer patients and are a major obstacle for treatment of pancreatic cancer. Pancreatic cancer patients have been treated with limited chemotherapeutic agents such as gemcitabine. However, patients often develop resistance to gemcitabine that is attributed to KRAS mutations. Gemcitabine treatment activates both the Wnt/ß-catenin and RAS/ERK pathways. These signaling pathways are also activated in the gemcitabine-resistant pancreatic cancer cell lines, suggesting that they play an important role in gemcitabine resistance in pancreatic cancer. The gemcitabine-resistant cell lines show enhanced migratory and invasive capabilities than their parental lines. Therefore, we investigated the effects of a small molecule, KYA1797K that degrades both ß-catenin and RAS, on pancreatic cancer. KYA1797K decreased the expression level of both ß-catenin and KRAS in pancreatic cancer cell lines expressing either wild-type or mutant KRAS. It also suppressed migration and invasion of gemcitabine-resistant and parental pancreatic cancer cells. Overall, we demonstrated that inhibiting the Wnt/ß-catenin and RAS/ERK pathways by destabilizing ß-catenin and RAS could be a therapeutic approach to overcome gemcitabine resistance in pancreatic cancer.

Black Tungsten Oxide Nanofiber as a Robust Support for Metal Catalysts: High Catalyst Loading for Electrochemical Oxygen Reduction.

Black valve metal oxides with low oxygen vacancies are identified to be promising for various industrial applications, such as in gas sensing, photocatalysis, and rechargeable batteries, owing to their high reducibility and stability, as well as considerable fractions of low-valent metal species and oxygen vacancies in their lattices. Herein, the nanofiber (NF) of black oxygen-deficient tungsten trioxide (WO3- x ) is presented as a versatile and robust support for the direct growth of a platinum catalyst for oxygen reduction reaction (ORR). The nonstoichiometric, poorly crystallized black WO3- x NFs are prepared by electrospinning the W precursor into NFs followed by their low-temperature (650 °C) reductive calcination. The black WO3- x NFs have adequate electrical conductivity owing to their decreased bandgap and amorphous structure. Remarkably, the oxygen-deficient surface (surface O/W = 2.44) facilitates the growth of small Pt nanoparticles, which resist aggregation, as confirmed by structural characterization and computational analysis. The Pt-loaded black WO3- x NFs outperform the Pt-loaded crystalline white WO3- x NFs in both the electrochemical ORR activity and the accelerated durability test. This study can inspire the use of oxygen-deficient metal oxides as supports for other electrocatalysts, and can further increase the versatility of oxygen-deficient metal oxides.

Good Visual Outcomes After Pituitary Tumor Surgery Are Associated With Increased Visual Cortex Functional Connectivity.

BACKGROUND: Patients presenting with visual impairment secondary to pituitary macroadenomas often experience variable recovery after surgery. Several factors may impact visual outcomes including the extent of neuroaxonal damage in the afferent visual pathway and cortical plasticity. Optical coherence tomography (OCT) measures of retinal structure and resting-state functional MRI (rsfMRI) can be used to evaluate the impact of neuroaxonal injury and cortical adaptive processes, respectively. The purpose of this study was to determine whether rsfMRI patterns of functional connectivity (FC) distinguish patients with good vs poor visual outcomes after surgical decompression of pituitary adenomas. METHODS: In this retrospective cohort study, we compared FC patterns between patients who manifested good (GO) vs poor (PO) visual outcomes after pituitary tumor surgery. Patients (n = 21) underwent postoperative rsfMRI a minimum of 1 year after tumor surgery. Seed-based connectivity of the visual cortex (primary [V1], prestriate [V2], and extrastriate [V5]) was compared between GO and PO patients and between patients and healthy controls (HCs) (n = 19). Demographics, visual function, and OCT data were compared preoperatively and postoperatively between patient groups. The threshold for GO was visual field mean deviation equal or less than -5.00 dB and/or visual acuity equal to or better than 20/40. RESULTS: Increased postoperative FC of the visual system was noted for GO relative to PO patients. Specifically, good visual outcomes were associated with increased connectivity of right V5 to the bilateral frontal cortices. Compared with HCs, GO patients showed increased connectivity of V1 and left V2 to sensorimotor cortex, increased connectivity of right and left V2 to medial prefrontal cortex, and increased connectivity of right V5 the right temporal and frontal cortices. CONCLUSIONS: Increased visual cortex connectivity is associated with good visual outcomes in patients with pituitary tumor, at late phase of recovery. Our findings suggest that rsfMRI does distinguish GO and PO patients after pituitary tumor surgery. This imaging modality may have a future role in characterizing the impact of cortical adaptation on visual recovery.

On the Performance Evaluations of Cooperative Retransmission Scheme for Cell-Edge Users of URLLC in Multi-Carrier Downlink NOMA Systems.

Non-orthogonal multiple access (NOMA) has a key feature that the cell-center user (CCU) has prior information about the messages of the cell-edge user (CEU) in the same user-pair. It means that CCU can be used for retransmission when the CEU requests retransmission. As ultra-reliability and low-latency communication (URLLC) requires high-reliability constraints (e.g., 99.999%), using CCU for retransmission can be useful to satisfy the reliability constraint. In this study, to ensure the reliability of CEU, cooperative retransmission (CR) scheme for downlink NOMA systems is proposed. And the CR scheme is evaluated with Block error rate (BLER) considering reliability and with packet loss rate (PLR) in terms of reliability and latency constraints. And the evaluation results showed that the proposed CR scheme can satisfy the target BLER for URLLC low SNR compared to the conventional retransmission scheme, and showed the improved PLR compared to the conventional retransmission scheme in low SNRs.

Effects of Covalency on Anionic Redox Chemistry in Semiquinoid-Based Metal-Organic Frameworks.

Two iron-semiquinoid framework materials, (H2NMe2)2Fe2(Cl2 dhbq)3 (1) and (H2NMe2)4Fe3(Cl2 dhbq)3(SO4)2 (Cl2 dhbqn- = deprotonated 2,5-dichloro-3,6-dihydroxybenzoquinone) (2-SO4), are shown to possess electrochemical capacities of up to 195 mAh/g. Employing a variety of spectroscopic methods, we demonstrate that these exceptional capacities arise from a combination of metal- and ligand-centered redox processes, a result supported by electronic structure calculations. Importantly, similar capacities are not observed in isostructural frameworks containing redox-inactive metal ions, highlighting the importance of energy alignment between metal and ligand orbitals to achieve high capacities at high potentials in these materials. Prototype lithium-ion devices constructed using 1 as a cathode demonstrate reasonable capacity retention over 50 cycles, with a peak specific energy of 533 Wh/kg, representing the highest value yet reported for a metal-organic framework. In contrast, the capacities of devices using 2-SO4 as a cathode rapidly diminish over several cycles due to the low electronic conductivity of the material, illustrating the nonviability of insulating frameworks as cathode materials. Finally, 1 is further demonstrated to access similar capacities as a sodium-ion or potassium-ion cathode. Together, these results demonstrate the feasibility and versatility of metal-organic frameworks as energy storage materials for a wide range of battery chemistries.

Histogram compensation algorithm for an efficient phase-only hologram calculation.

A fast computer-generated phase-only hologram (POH) calculation is needed to realize a holographic display. Existing iterative methods require many iterations and thus require speed improvement, and noniterative methods add constraints to the image, resulting in restrictions on quality or range of expression. In this paper, we propose an efficient iteration algorithm without using a feedback process. For the several initial iterations among the entire iteration process, the image constraint was replaced by a histogram adjusted image. This pre-iteration can compensate for the loss of bright and dark pixels in the image reconstructed by the POH, resulting in a more accurate POH. The quality of image reconstructed by the proposed method was compared with that of existing algorithms by computer simulation and optical regeneration. Compared to the previous method, a 1.17dB increase in peak signal-to-noise ratio was obtained, and the number of iterations to achieve the same image quality has been reduced by 23%. The proposed method hardly increased the amount of computation and could be used simultaneously with the existing feedback methods.

Coarse-graining of many-body path integrals: Theory and numerical approximations.

Feynman's imaginary time path integral approach to quantum statistical mechanics provides a theoretical formalism for including nuclear quantum effects (NQEs) in simulation of condensed matter systems. Sinitskiy and Voth [J. Chem. Phys. 143, 094104 (2015)] have presented the coarse-grained path integral (CG-PI) theory, which provides a reductionist coarse-grained representation of the imaginary time path integral based on the quantum-classical isomorphism. In this paper, the many-body generalization of the CG-PI theory is presented. It is shown that the N interacting particles obeying quantum Boltzmann statistics can be represented as a system of N pairs of classical-like pseudoparticles coupled to each other analogous to the pseudoparticle pair of the one-body theory. Moreover, we present a numerical CG-PI (n-CG-PI) method applying a simple approximation to the coupling scheme between the pseudoparticles due to numerical challenges of directly implementing the full many-body CG-PI theory. Structural correlations of two liquid systems are investigated to demonstrate the performance of the n-CG-PI method. Both the many-body CG-PI theory and the n-CG-PI method not only present reductionist views of the many-body quantum Boltzmann statistics but also provide theoretical and numerical insight into how to explicitly incorporate NQEs in the representation of condensed matter systems with minimal additional degrees of freedom.

Effect of Having a Usual Source of Care on Medical Expenses - Using the Korea Health Panel Data.

BACKGROUND: There is a controversy about the effect of having a usual source of care on medical expenses. Although many studies have shown lower medical expenses in a group with a usual source of care, some have shown higher medical expenses in such a group. This study aimed to empirically demonstrate the effect of having a usual source of care on medical expenses. METHODS: The participants included those aged 20 years and older who responded to the questionnaire about "having a usual source of care" from the Korean Health Panel Data of 2012, 2013, and 2016 (6,120; 6,593; and 7,598 respectively). Those who responded with "I do not get sick easily" or "I rarely visit medical institutions" as the reasons for not having a usual source of care were excluded. The panel regression with random effects model was performed to analyze the effect of having a usual source of care on medical expenses. RESULTS: The group having a usual source of care spent 20% less on inpatient expenses and 25% less on clinic expenses than the group without a usual source of care. Particularly, the group having a clinic-level usual source of care spent 12% less on total medical expenses, 9% less on outpatient expenses, 35% less on inpatient expenses, and 74% less on hospital expenses, but 29% more on clinic expenses than the group without a usual source of care. CONCLUSION: This study confirmed that medical expenses decreased in the group with a usual source of care, especially a clinic-level usual source of care (USC), than in the group without a usual source of care. Encouraging people to have a clinic-level USC can control excessive medical expenses and induce desirable medical care utilization.

Systematic review of health economic studies in cranial neurosurgery.

OBJECTIVE As the cost of health care continues to increase, there is a growing emphasis on evaluating the relative economic value of treatment options to guide resource allocation. The objective of this systematic review was to evaluate the current evidence regarding the cost-effectiveness of cranial neurosurgery procedures. METHODS The authors performed a systematic review of the literature using PubMed, EMBASE, and the Cochrane Library, focusing on themes of economic evaluation and cranial neurosurgery following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Included studies were publications of cost-effectiveness analysis or cost-utility analysis between 1995 and 2017 in which health utility outcomes in life years (LYs), quality-adjusted life years (QALYs), or disability-adjusted life years (DALYs) were used. Three independent reviewers conducted the study appraisal, data abstraction, and quality assessment, with differences resolved by consensus discussion. RESULTS In total, 3485 citations were reviewed, with 53 studies meeting the inclusion criteria. Of those, 34 studies were published in the last 5 years. The most common subspecialty focus was cerebrovascular (32%), followed by neurooncology (26%) and functional neurosurgery (24%). Twenty-eight (53%) studies, using a willingness to pay threshold of US$50,000 per QALY or LY, found a specific surgical treatment to be cost-effective. In addition, there were 11 (21%) studies that found a specific surgical option to be economically dominant (both cost saving and having superior outcome), including endovascular thrombectomy for acute ischemic stroke, epilepsy surgery for drug-refractory epilepsy, and endoscopic pituitary tumor resection. CONCLUSIONS There is an increasing number of cost-effectiveness studies in cranial neurosurgery, especially within the last 5 years. Although there are numerous procedures, such as endovascular thrombectomy for acute ischemic stroke, that have been conclusively proven to be cost-effective, there remain promising interventions in current practice that have yet to meet cost-effectiveness thresholds.

Immunoglobulin G4 (IgG4)-Positive Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphoma and Idiopathic Orbital Inflammation.

PURPOSE: To report clinical and pathological characteristics of idiopathic orbital inflammation and ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma with immunoglobulin G4 (IgG4)-positive plasma cells. METHODS: A retrospective histopathological review and clinical case series. A total of 51 biopsy samples from January 2005 to December 2015 were used in this study, including 21 cases of biopsy-confirmed idiopathic orbital inflammation and 30 cases of biopsy-confirmed ocular adnexal MALT lymphoma. Most cases of ocular adnexal lymphoma were conjunctival tissue. Retrospective immunohistochemical studies were performed to estimate the IgG4 and IgG4/IgG ratios. Histopathologic features, demographic and clinical data, radiologic findings, treatment, and follow-up information for each patient were analyzed. RESULTS: Among idiopathic orbital inflammation, 6 (28.6%) of the 21 patients were diagnosed as "probable" ocular adnexal IgG4-related diseases and 13 (43.3%) of the 30 patients were diagnosed as MALT lymphoma with IgG4-positive plasma cells. Six cases of 13 IgG4-positive MALT lymphoma group had contralateral chronic inflammatory lesions infiltrated by IgG4-positive plasma cells, which was significantly (p = 0.007) higher than that in the IgG4-negative group. Conjunctival involvement was 69% of the IgG4-positive MALT lymphoma cases. Bilateral involvement of the ocular adnexa was significantly (p = 0.02) more frequent among IgG4-positive MALT lymphoma patients than that in IgG4-positive idiopathic orbital inflammation patients. Recurrence rate in the IgG4-positive group was higher (p = 0.05) than that in the IgG4-negative group but not significantly. CONCLUSIONS: This study presented an unusual framework of ocular adnexal IgG4-related inflammation, in conjunctiva. It is important to understand contralateral chronic inflammatory lesions and their relationship with IgG4-positive MALT lymphoma. Tissue biopsy and IgG4 immunostaining are required for all cases because IgG4-positive MALT lymphoma can arise from a pre-existing IgG4-positive chronic inflammatory lesions. This is the first study that performs IgG4 immunostaining for tissue from a relatively large number of conjunctival MALT lymphomas in a single center. Therefore, it will help to diagnose conjunctival lymphoproliferative disease.