[Assessing Relationship Satisfaction with Four Items? Psychometric Evaluation of the Ultra-short German Version of the Dyadic Adjustment Scale (DAS-4)]. / Erfassung der Partnerschaftszufriedenheit mit vier Items? Psychometrische Evaluation der deutschen Version einer Kurzform der Dyadic Adjustment Scale (DAS-4).

The quality of an individual's relationship plays a central role in their personal well-being as well as their mental and physical health. Despite its great importance, there are only a few ultra-short self-report measures for the assessment of relationship quality. An exception is the four-item version of the Dyadic Adjustment Scale (DAS-4), which is gaining increasing popularity internationally. In this study, the German version of the DAS-4 was evaluated for the first time with regard to its psychometric properties in a general population sample of individuals in a romantic relationship (N=1296). In addition to satisfactory item characteristics, the unidimensional measurement model showed sufficient goodness of fit and the internal consistency was satisfactory (ω=0.80). Measurement invariance was shown for men and women based on the latent construct of the DAS-4. In line with the hypothesis, associations of the DAS-4 with gender, general life satisfaction, psychopathology and attachment styles were found, which suggests construct validity. Despite the lack of application experiences and pending psychometric analyses of the DAS-4 in relevant target groups, such as individuals in couples counselling or therapy, the four-item version can be recommended for assessing relationship satisfaction.

Mindreading measures misread? A multimethod investigation into the validity of self-report and task-based approaches.

Mindreading ability-also referred to as cognitive empathy or mentalizing-is typically conceptualized as a relatively stable dimension of individual differences in the ability to make accurate inferences about the mental states of others. This construct is primarily assessed using self-report questionnaires and task-based performance measures. However, the validity of these measures has been questioned: According to rival interpretations, mindreading tasks may capture general cognitive ability, whereas mindreading self-reports may capture perceived rather than actual mindreading ability. In this preregistered multimethod study involving 700 participants from the U.S. general population, we tested the validity of mindreading measures by examining the nomological network of self-reports and task-based methods using structural equation modeling. Specifically, we contrasted the empirical associations with theoretical predictions that assume mindreading measures are valid versus invalid. More consistent with rival interpretations, mindreading tasks showed a negligible latent correlation with mindreading self-reports (.05) and a large one with general cognitive ability (.85), whereas mindreading self-reports were specifically associated with perceived performance in mindreading tasks (.29). Also more consistent with rival interpretations, neither mindreading self-reports nor task-based measures showed positive unique associations with psychosocial functioning when controlling for general cognitive ability and general positive self-evaluation. Instead, negative unique associations emerged for both methods, although this effect was not robust for tasks. Overall, the results cast doubt on the validity of commonly used mindreading measures and support their rival interpretations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Measuring Change in Attachment Insecurity Using Short Forms of the ECR-R: Longitudinal Measurement Invariance and Sensitivity to Treatment.

Attachment insecurity is important for psychotherapy both as an aspect influencing the therapeutic process as well as potential outcome variable of a treatment. Two German short forms of the Experiences in Close Relationships - Revised (ECR-R) have been proposed to assess individual differences in attachment anxiety and avoidance. In this research, we examined whether these questionnaires are suitable for measuring change in attachment anxiety and avoidance by testing longitudinal measurement invariance in two independent clinical samples (N1 = 493, N2 = 273) using a pre-post design. Results indicated that strict longitudinal measurement invariance can be assumed for both measures. Thus, changes in scale scores before and after treatment can be interpreted as changes in the latent dimensions of attachment anxiety and avoidance. Both questionnaires were also sensitive to treatment in that attachment insecurity was overall reduced after therapy. Although both measures appear to be generally suitable for investigating treatment effects, they exhibited consistent problems with structural validity across samples that should be reexamined in future research.

[Validation of a German version of the self-rating Adult Disorganized Attachment scale (ADA-D)]. / Validierung der deutschsprachigen Version der Adult Disorganized Attachment Scale (ADA-D).

OBJECTIVE: Disorganized attachment represents the greatest risk factor for psychopathology compared to the "organized" insecure attachment dimensions in various meta-analyses. Recently, the Adult Disorganized Attachment Scale (ADA) was developed as a self-rating scale for measuring disorganized attachment in romantic partnerships. However, a translation and evaluation in German-speaking samples is not yet available. METHODS: A German Translation of the scale (ADA-D) comprising nine items was assessed in a general population sample (N=1101) and in a student sample (N=328). The factor structure, psychometric properties, and validity of the scale with respect to psychopathology and the Experiences in Close Relationships questionnaire (ECR-RD) were examined. The differential associations of ADA-D and ECR-RD with psychopathology were determined using linear regression models. RESULTS: The unidimensional factor structure of the original version could be confirmed for the ADA-D and the instrument exhibited high internal consistency (McDonalds ω=0.91 / 0.89). Compared to attachment anxiety and avoidance, ADA-D was the strongest predictor of dissociative symptoms (Sample 1: ß=0.48; p<0.001; Sample 2: ß=0.23; p<0.01) and, in Sample 1, additionally for physical aggression (ß=0.37; p<0.001). DISCUSSION: The ADA-D exhibits good psychometric properties that are comparable to the original version of the scale. The associations with aggressiveness and dissociation are in line with previous findings regarding the unresolved attachment status in the Adult Attachment Interview. CONCLUSION: The ADA-D can be recommended for further use in research as a screening instrument for disorganized attachment in adulthood. An application in psychotherapeutic diagnostics seems promising, however, evaluations in clinical samples are necessary beforehand.

[Comparison of Self-Reported Childhood Maltreatment Between East and West Germany]. / Selbstberichtete Kindesmisshandlungen im Vergleich zwischen Ost- und Westdeutschland.

OBJECTIVE: The socioecological model emphasize the relevance of political, cultural and economic socialization effects for the prevalence of childhood maltreatment, which are analyzed by comparing child maltreatment between East and West German subjects who came of age before the fall of the Berlin Wall. METHODS: Using an online survey, a representative general population sample with respect to age, gender distribution and income was assessed regarding child maltreatment and current psychological distress using standardized self-report instruments. RESULTS: Of 507 study participants, 22,5% reported being born and socialized in East Germany. They reported significantly less emotional abuse than the 77,5% who grew up in the FRG. The East and West German subjects did not differ in any other form of abuse. CONCLUSION: Our findings underline the importance of socialization and enculturation effects on memory, which should be considered when interpreting the results.

Development and Validation of the Certainty About Mental States Questionnaire (CAMSQ): A Self-Report Measure of Mentalizing Oneself and Others.

The Certainty About Mental States Questionnaire (CAMSQ) is a self-report measure of the perceived capacity to understand mental states of the self and others (i.e., mentalizing). In two studies (total N = 1828), we developed the CAMSQ in both English and German as a two-dimensional measure of Self- and Other-Certainty, investigated associations with other measures of mentalizing, and explored relationships to personality functioning and mental health. The CAMSQ performed well in terms of convergent and discriminant validity, internal consistency, test-retest reliability, and measurement invariance across the United States and Germany. The present research indicates that the CAMSQ assesses maladaptive forms of having too little or too much certainty about mental states (consistent with hypomentalizing and hypermentalizing). A psychologically adaptive profile of perceived mentalizing capacity appears to be characterized by high Self-Certainty that exceeds Other-Certainty, suggesting that imbalances between Self-Certainty and Other-Certainty (Other-Self-Discrepancy) play an important role within personality pathology.

Genetic variation in TERT modifies the risk of hepatocellular carcinoma in alcohol-related cirrhosis: results from a genome-wide case-control study.

OBJECTIVE: Hepatocellular carcinoma (HCC) often develops in patients with alcohol-related cirrhosis at an annual risk of up to 2.5%. Some host genetic risk factors have been identified but do not account for the majority of the variance in occurrence. This study aimed to identify novel susceptibility loci for the development of HCC in people with alcohol related cirrhosis. DESIGN: Patients with alcohol-related cirrhosis and HCC (cases: n=1214) and controls without HCC (n=1866), recruited from Germany, Austria, Switzerland, Italy and the UK, were included in a two-stage genome-wide association study using a case-control design. A validation cohort of 1520 people misusing alcohol but with no evidence of liver disease was included to control for possible association effects with alcohol misuse. Genotyping was performed using the InfiniumGlobal Screening Array (V.24v2, Illumina) and the OmniExpress Array (V.24v1-0a, Illumina). RESULTS: Associations with variants rs738409 in PNPLA3 and rs58542926 in TM6SF2 previously associated with an increased risk of HCC in patients with alcohol-related cirrhosis were confirmed at genome-wide significance. A novel locus rs2242652(A) in TERT (telomerase reverse transcriptase) was also associated with a decreased risk of HCC, in the combined meta-analysis, at genome-wide significance (p=6.41×10-9, OR=0.61 (95% CI 0.52 to 0.70). This protective association remained significant after correction for sex, age, body mass index and type 2 diabetes (p=7.94×10-5, OR=0.63 (95% CI 0.50 to 0.79). Carriage of rs2242652(A) in TERT was associated with an increased leucocyte telomere length (p=2.12×10-44). CONCLUSION: This study identifies rs2242652 in TERT as a novel protective factor for HCC in patients with alcohol-related cirrhosis.

Validating the German version of the Personality Disorder Severity-ICD-11 Scale using nominal response models.

The International Classification of Diseases (ICD-11) features a new classification of personality disorders (PD), focusing on the severity of PD. Although there are numerous self-report measures that assess PD severity, to date only the Personality Disorder Severity-ICD-11 (PDS-ICD-11) is based on ICD-11's operationalization of PD. Initial results indicated that the PDS-ICD-11 measures a unidimensional construct, but the assumptions made for scoring its bipolar items had not been fully examined. The aim of this study is to fill this gap and investigate the latent structure of the German version of the PDS-ICD-11 using nominal response models (NRM), which allow for testing these assumptions. We applied the PDS-ICD-11 together with other self-report measures in a sample of 1,228 individuals from the general population. NRM indicated an acceptable fit of a unidimensional model, with only few deviations from the theoretically imposed scoring scheme. The total score was sufficiently reliable and correlated meaningfully with other self-report measures of PD severity. Regarding Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and ICD-11 maladaptive trait domains, the total score was found to be most strongly associated with negative affectivity, whereas associations with antagonism and anankastia were small or nonsignificant. We conclude that the proposed scoring scheme of the PDS-ICD-11 items is acceptable, and the examined psychometric properties of the German version largely correspond to the results from the English-language development study. The total score, however, depicts more internalizing than externalizing personality pathology. Future studies should investigate the diagnostic efficiency of the PDS-ICD-11 scale using multiple methods and time points as well as clinical and forensic samples. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

[An Ultra-Short Instrument to Assess Sensation Seeking: Psychometric Evaluation of the German Version of the Brief Sensation Seeking Scale (BSSS-4)]. / Ein ultrakurzer Test zur Erfassung von Sensation Seeking: Psychometrische Evaluation der deutschen Version der Brief Sensation Seeking Scale (BSSS-4).

The personality trait of sensation seeking (SS) plays a prominent role in health-related risk behaviors and is associated with psychopathology, emotion regulation, and delinquency. Despite this high relevance, hardly any ultra-short self-report measures optimized for test duration exist for the assessment of SS. An exception is the Brief Sensation Seeking Scale (BSSS-4) consisting of four items, which is gaining international popularity. In this study, the German version of the BSSS-4 was psychometrically evaluated for the first time in a student sample (N=419). A unidimensional confirmatory measurement model showed adequate goodness of fit and internal consistency was in the satisfactory range (ω=0,73). As first evidence for adequate construct validity and in line with the hypotheses, associations of the BSSS-4 with male gender, self-reported risk-taking, and risk-taking behavior (operationalized via a lottery-based behavioral paradigm) but not with current depression were found. An examination of measurement invariance across men and women using multigroup CFA suggested that partial scalar measurement invariance can be assumed for the BSSS-4, when equality constraints for loadings and intercepts of Item 1 are relaxed. Considering its increasing international use, the German version of the BSSS-4 can be recommended overall: For an ultra-short instrument, it is sufficiently internally consistent and rather suitable for gender comparisons. In this regard, the facet of experience seeking may be problematic in terms of gender-dependent differences in measurement properties. In light of insufficiently rigorous tests of instruments for the assessment of SS, the results of comparisons between women and men may thus be interpreted with caution.

Passing patients' tests-But how? An analysis of therapists' helping skills in response to patient testing.

According to control mastery theory, patients in psychotherapy try to master their problems by disconfirming their pathogenic beliefs. This can be done by testing the therapist. So far, there is hardly any evidence on what concrete interventions or statements of therapists are specifically helpful in passing those tests. In our study, we analyzed the verbal utterances of therapists in test situations to determine whether there is a difference in statements used for passing or failing tests. A total of 168 session transcripts of 21 patients were selected from a total of six therapists, two each in psychoanalytic therapy, psychodynamic therapy, and cognitive behavioral therapy. Test situations were identified, and therapist responses were coded using the helping skills system. There were significant differences in the therapists' reactions to test situations. In particular, closed questions, approval, interpretation, and reflection of the patients' feelings by therapists were associated with a high probability of passing tests. These findings can especially support therapists-in-training to obtain an orientation on how to deal with their patients' test situations that may be perceived as challenging and are important for therapy success while respecting the individuality of their patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Caffeine for intestinal transit after laparoscopic colectomy: randomized clinical trial (CaCo trial).

BACKGROUND: Coffee has been suggested to help postoperative gastrointestinal motility but the mechanism is not known. This trial assessed whether caffeine shortened time to bowel activity after laparoscopic colectomy. METHODS: This was a single-centre, randomized, double-blinded, placebo-controlled superiority trial (October 2015 to August 2020). Patients aged at least 18 years undergoing elective laparoscopic colectomy were assigned randomly to receive 100 mg or 200 mg caffeine, or a placebo (250 mg corn starch) three times a day orally. The primary endpoint was the time to first bowel movement. Secondary endpoints included colonic transit time, time to tolerance of solid food, duration of hospital stay, and perioperative morbidity. RESULTS: Sixty patients were assigned randomly to either the 200-mg caffeine group (20 patients), the 100-mg caffeine group (20) or the placebo group (20). In the intention-to-treat analysis, the mean(s.d.) time to first bowel movement was 67.9(19.2) h in the 200-mg caffeine group, 68.2(32.2) h in the 100-mg caffeine group, and 67.3(22.7) h in the placebo group (P = 0.887). The per-protocol analysis and measurement of colonic transit time confirmed no measurable difference with caffeine. CONCLUSION: Caffeine was not associated with reduced time to first bowel movement. REGISTRATION NUMBER: NCT02510911 (http://www.clinicaltrials.gov).

Childhood maltreatment, traumatic experiences, and posttraumatic stress disorder in pathological skin picking: An online case-control study.

OBJECTIVE: Although traumatic stress including childhood maltreatment (CM) has a profound impact on mental health, its relation to pathological skin picking (PSP) has been understudied and results remain inconclusive. Likewise, posttraumatic stress disorder (PTSD) as the most typical sequelae of traumatic stress has hardly been investigated in those with PSP. The objective of our online case-control study was to shed further light on this issue. METHODS: Using an anonymous online survey, 325 adult participants with PSP defined by Skin Picking Scale-Revised (SPS-R) scores ≥ 7 as well as Skin Picking Impact Scale (SPIS) scores ≥ 7 were administered the Childhood Trauma Questionnaire (CTQ), the Short Screening Scale for DSM-IV PTSD (PTSD-7) including a list of traumatic events, and a brief measure of psychopathological distress. They were compared to an age-, sex-, and education-matched control group recruited online by means of analyses of variance (ANOVA). RESULTS: The PSP sample scored significantly higher on the CTQ dimensions of sexual and emotional abuse as well as emotional neglect with small to moderate effect sizes (d between 0.27 and 0.49). Accounting for psychological distress, the only significant difference related to emotional abuse with a small effect (d = 0.23). Participants with PSP reported significantly more traumatic experiences in adulthood than the control group (59.1% vs. 38.2%; χ2(1; N=638) = 28.02, p < .001). Among those with PSP, a probable diagnosis of PTSD was found in 44 (13.5%) compared to zero cases in the control group. CONCLUSIONS: Our findings indicate that emotional abuse in childhood may be of relevance in skin picking. Since exposure to traumatic events in adulthood as well as PTSD seem to be more frequent in those with PSP compared to a control group, it might be worthwhile to consider these factors in the assessment of patients with skin picking.

Impairment of the cellulose degradation machinery enhances Fusarium oxysporum virulence but limits its reproductive fitness.

Fungal pathogens grow in the apoplastic space, in constant contact with the plant cell wall (CW) that hinders microbe progression while representing a source of nutrients. Although numerous fungal CW modifying proteins have been identified, their role during host colonization remains underexplored. Here, we show that the root-infecting plant pathogen Fusarium oxysporum (Fo) does not require its complete arsenal of cellulases to infect the host plant. Quite the opposite: Fo mutants impaired in cellulose degradation become hypervirulent by enhancing the secretion of virulence factors. On the other hand, the reduction in cellulase activity had a severe negative effect on saprophytic growth and microconidia production during the final stages of the Fo infection cycle. These findings enhance our understanding of the function of plant CW degradation on the outcome of host-microbe interactions and reveal an unexpected role of cellulose degradation in a pathogen's reproductive success.

[Parental Stress: Psychometric Evaluation of the German Version of the Parental Stress Scale in the General Population]. / Stress durch Elternschaft: Psychometrische Evaluation der deutschen Version der Parental Stress Scale in der Allgemeinbevölkerung.

Parental stress has negative impact on parents and their children. Parental stress may be of special interest for family and child well-being due to Covid-19 pandemic. A reliable and valid assessment of parental stress would be beneficial both in research and clinical practice. The Parental Stress Scale (PSS) is internationally well established as an economic and psychometric valid assessment. It consists of 18 items. The study evaluated the factor structure of the German version of the PSS in a general population (n=386 parents with children<16 years) for the first time. The sample was part of a representative sample (n=2519). The confirmatory factor analysis did not confirm internationally previously reported models. Eliminating one item, the explorative factor analysis suggested a two factor structure with the dimensions "lack of confident" and "worries and strain". Both subscales showed a good internal consistence (McDonalds ω≥0,87). We observed correlations of the PSS-17 items with family dysfunction and elevated scores for depressive or anxiety symptoms, but not with sociodemographic factors. One conclusion is that the multidimensional construct of parental stress maybe is not comprehensively represented by the PSS. For the use in clinical practice and research this has to be taken into account. Albeit, the German version of the PSS is an economic, reliable and valid assessment.

A Critical Evaluation of the Reflective Functioning Questionnaire (RFQ).

The Reflective Functioning Questionnaire (RFQ) is an 8-item self-report measure of reflective functioning that is presumed to capture individual differences in hypo- and hypermentalizing. Despite its broad acceptance by the field, we argue that the validity of the measure is not well-established. The current research elaborates on problems of the RFQ related to its item content, scoring procedure, dimensionality, and associations with psychopathology. We tested these considerations across three large clinical and non-clinical samples from Germany and the US (total N = 2289). In a first study, we found that the RFQ may assess a single latent dimension related to hypomentalizing but is rather unlikely to capture maladaptive forms of hypermentalizing. Moreover, the RFQ exhibited very strong associations with measures of personality pathology, while associations with measures of symptom distress were less strong. In a second preregistered study focused on convergent and discriminant validity, however, a commonality analysis indicated that associations with indicators of personality pathology are inflated because some of the RFQ items tap into emotional lability and impulsivity rather than mentalizing. Our findings demonstrate limitations of the RFQ. We discuss key challenges in assessing mentalizing via self-report.

[Assessment of General Family Functioning: Psychometric Evaluation of the German Version of the Brief Assessment of Family Functioning Scale]. / Die Erfassung des allgemeinen familiären Funktionsniveaus: Psychometrische Evaluation der deutschen Version der Brief Assessment of Family Functioning Scale.

The functionality of the family system is not only a central theme in developmental psychology and family research, but also plays a key role in many physical illnesses and mental disorders. Despite its high relevance, there are only a very few brief and user-friendly self-report measures assessing general family functioning. This gap is closed by the Brief Assessment of Family Functioning Scale (BAFFS), which consists of three items of the General Functioning Scale of the internationally well-established Family Assessment Device. In this study, the German version (KSAFF) of the BAFFS was psychometrically evaluated for the first time in a large and representative general population sample (n=2463). Using multigroup confirmatory factor analyses, strong measurement invariance was shown for relevant subsamples (women vs. men; participants in partnerships with vs. without children) with good model fit. Although one of the three items, which is the only negatively formulated item, yielded insufficient psychometric item characteristics, the internal consistency was Cronbach's α=0.71. As an indication of adequate construct validity, associations of family functioning with socioeconomic status as well as with current depression and anxiety were found in accordance with the hypothesis. Although application experiences and psychometric analyses of the German version of the BAFFS in relevant clinical samples are pending, this three-item self-report measure can be recommended as an economic, user-friendly assessment device for general family functioning, particularly since it yielded satisfactory to good psychometric properties in the general population.

[The German Version of the Reflective Functioning Questionnaire (RFQ): A Psychometric Evaluation in the General Population]. / Die deutsche Version des Reflective Functioning Questionnaire (RFQ): Eine teststatistische Überprüfung in der Allgemeinbevölkerung.

The concept of mentalization has attracted broad clinical and scientific interest, particularly because of its high clinical and therapeutic relevance. To make this concept accessible for empirical research, the 8-item Reflective Functioning Questionnaire (RFQ-8) was developed, which comprises 2 subscales tapping into uncertainty about mental states (or hypomentalizing), and certainty about mental states (i. e. hypermentalizing). Although first psychometric examinations have evaluated the RFQ-8 positively, these findings must be interpreted with caution for methodological reasons. The aim of this study was the psychometric evaluation of the German version of the RFQ-8 in a large general population sample (n=2477). Various confirmatory and exploratory factor analyses indicated that the originally introduced 2-factor solution is mis-specified. Instead, the RFQ-8 seems to cover a unidimensional construct. Having excluded 2 items due to their insufficient psychometric qualities, the 6-item measure (RFQ-6) showed high internal consistency (McDonald's ω=0,88) as well as significant rank correlations with depression, anxiety and bodily complaints. Considering the psychometric limitations of the RFQ-8, its use in clinical routine and research should be viewed very critically, particularly with respect to its ability to assess hypermentalizing.

Role of lymphadenectomy in resectable pancreatic cancer.

BACKGROUND: Pancreatic cancer (PC) remains one of the most devastating malignant diseases, predicted to become the second leading cause of cancer-related death by 2030. Despite advances in surgical techniques and in systemic therapy, the 5-year relative survival remains a grim 9% for all stages combined. The extent of lymphadenectomy has been discussed intensively for decades, given that even in early stages of PC, lymph node (LN) metastasis can be detected in approximately 80%. PURPOSE: The primary objective of this review was to provide an overview of the current literature evaluating the role of lymphadenectomy in resected PC. For this, we evaluated randomized controlled studies (RCTs) assessing the impact of extent of lymphadenectomy on OS and studies evaluating the prognostic impact of anatomical site of LN metastasis and the impact of the number of resected LNs on OS. CONCLUSIONS: Lymphadenectomy plays an essential part in the multimodal treatment algorithm of PC and is an additional therapeutic tool to increase the chance for surgical radicality and to ensure correct staging for optimal oncological therapy. Based on the literature from the last decades, standard lymphadenectomy with resection of at least ≥ 15 LNs is associated with an acceptable postoperative complication risk and should be recommended to obtain local radicality and accurate staging of the disease. Although radical surgery including appropriate lymphadenectomy of regional LNs remains the only chance for long-term tumor control, future studies specifically assessing the impact of neoadjuvant therapy on extraregional LNs are warranted.

Combination of stable isotope ratio data and chromatographic impurity signatures as a comprehensive concept for the profiling of highly prevalent synthetic cannabinoids and their precursors.

In this study, we utilized elemental analyser (EA) and gas-chromatography (GC) isotope ratio mass spectrometry (IRMS) and ultra-high-performance liquid chromatography coupled to mass spectrometry (UHPLC-MS) in a comprehensive profiling approach assessing the chromatographic impurity signatures and δ13C and δ15N isotope ratios of synthetic cannabinoids from police seizures and internet test purchases. Main target of this study was the highly prevalent synthetic cannabinoid MDMB-CHMICA (methyl (2S)-2-([1-(cyclohexylmethyl)-1H-indol-3-yl]formamido)-3,3-dimethylbutaoate). Overall, 61 powder and 118 herbal blend (also called "Spice-Products") samples were analysed using both analytical techniques and evaluated in a joint model to link samples from a common source. As a key finding, three agglomerates of Spice-product samples with similar dates of purchase were identified in the IRMS data, possibly representing larger shipments of MDMB-CHMICA, each produced with the same precursor material, successively delivered to the European market. The three agglomerates were refined into multiple sub-clusters based on the impurity profiling data, each representing an individual synthesis batch. One of the agglomerates identified in the IRMS data was found to consist two groups of four sub-clusters, respectively, with majorly different impurity profiles, demonstrating the necessity for both analytical techniques to extract the maximum amount of information from a limited sample pool. Additionally, 31 samples containing the recently surfaced synthetic cannabinoid Cumyl-PeGaClone (5-pentyl-2-(2-phenylpropan-2-yl)-2,5-dihydro-1H-pyrido[4,3-b]indol-1-one) were analysed for their and δ13C and δ15N isotope ratios to put the isotopic data recorded for MDMB-CHMNICA in a more global perspective. Three building blocks of precursor chemicals (indole, tert-leucine, cumylamine) potentially used for the synthesis of the two named synthetic cannabinoids were acquired from different global vendors and measured for their δ13C and δ15N isotope ratios to better understand variations in the isotopic composition of the synthetic cannabinoids and to trace their origin.

Role of lymphadenectomy, adjuvant chemotherapy, and treatment at high-volume centers in patients with resected pancreatic cancer-a distinct view on lymph node yield.

PURPOSE: While the importance of lymphadenectomy is well-established for patients with resectable pancreatic cancer, its direct impact on survival in relation to other predictive factors is still ill-defined. METHODS: The National Cancer Data Base 2006-2015 was queried for patients with resected pancreatic adenocarcinoma (stage IA-IIB). Patients were dichotomized into the following two groups, those with 1-14 resected lymph nodes and those with ≥ 15. Optimal number of resected lymph nodes and the effect of lymphadenectomy on survival were assessed using various statistical modeling techniques. Mediation analysis was performed to differentiate the direct and indirect effect of lymph node resection on survival. RESULTS: A total of 21,912 patients were included; median age was 66 years (IQR 59-73), 48.9% were female. Median number of resected lymph nodes was 15 (IQR 10-22), 10,163 (46.4%) had 1-14 and 11,749 (53.6%) had ≥ 15 lymph nodes retrieved. Lymph node positivity increased by 4.1% per lymph node up to eight examined lymph nodes, and by 0.6% per lymph node above eight. Five-year overall survival was 17.9%. Overall survival was better in the ≥ 15 lymph node group (adjusted HR 0.91, CI 0.88-0.95, p < 0.001). On a continuous scale, survival improved with increasing LNs collected. Patients who underwent adjuvant chemotherapy and were treated at high-volume centers had improved overall survival compared with their counterparts (adjusted HR 0.59, CI 0.57-0.62, p < 0.001; adjusted HR 0.86, CI 0.83-0.89, p < 0.001, respectively). Mediation analysis revealed that lymphadenectomy had only 18% direct effect on improved overall survival, while 82% of its effect were mediated by other factors like treatment at high-volume hospitals and adjuvant chemotherapy. DISCUSSION: While higher number of resected lymph nodes increases lymph node positivity and is associated with better overall survival, most of the observed survival benefit is mediated by chemotherapy and treatment at high-volume centers.