Evidence shows that the centrality of a loss-event maintains emotional distress following loss. Aims of the current study were to examine (i) if subgroups of bereaved people can be distinguished based on their endorsement of different manifestations of loss-centrality, (ii) if subgroup membership was associated with socio-demographic and loss-related variables, and (iii) the linkage of subgroup membership with symptom-levels of prolonged grief (PG), posttraumatic stress (PTS), and depression assessed concurrently and 6 months later.
 
  Three-hundred ninety-eight bereaved people completed the 7-item Centrality of Event Scale, with their loss as anchor-event and completed symptom-measures concurrently and 6 months later. Latent profile analysis (LPA) was used to identity profiles of loss-centrality.
 
  LPA revealed a three-profile solution representing low, average, and high centrality classes, respectively. The death of a partner and younger age increased the likelihood of membership of classes evidencing stronger centrality. Membership of the low centrality class was associated with lower concurrent PG, PTS, and depression; membership of the high centrality class predicted elevated PG 6 months later, beyond baseline PG.
 
  Subgroups of loss-centrality were distinguished by increasing endorsement of all (rather than some) manifestations of loss-centrality. Clinical implications are discussed.
 Subgroups of loss-centrality were distinguished by increasing endorsement of all (rather than some) manifestations of loss-centrality. Clinical implications are discussed.Vascularized joint transfer (VJT) from the proximal interphalangeal joint (PIPJ) of the toe is an attractive reconstructive option in cases of nonsalvageable finger PIPJ but is limited by equivocal functional outcomes. This systematic review aims to provide an update on vascularized toe-to-finger PIPJ transfers, examining functional outcomes, complications, and the latest refinements in operative technique. A systematic review of the available literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies examining vascularized toe-to-finger PIPJ transfer for post-traumatic indications were included for analysis. Outcomes assessed included postoperative active range of motion, extension lag, and complications. Thirteen studies examining 210 VJTs were analyzed. Five VJTs experienced microsurgical failure giving an overall survival rate of 97.6%.  https://www.selleckchem.com/Akt.html  Average postoperative PIPJ active range of motion (ROM) was 40.3° ± 12.9°, with an average extensor lag of 29° ± 10.5° and mean flexion of 68.9° ± 10.9°. For studies reporting complication outcomes, 59/162 complications were seen. No significant differences were seen between studies published prior to 2013 and after 2013 when comparing digital ROM (P = .123), flexion (P = .602), and extensor lag (P = .280). Studies using a reconstructive algorithm based on prior assessment of the donor toe central slip and recipient finger anatomy had significantly improved ROM outcomes (P = .013). Although VJT provides a reliable option for autologous reconstruction in posttraumatic joints, it is limited by impaired postoperative ROM. Careful assessment of the donor toe and recipient finger anatomy followed by systematic and meticulous reconstruction may lead to improved functional outcomes.The procedure of calibrating in-house water standards suitable for routine analyses of triple-isotope composition of water samples using Picarro L2140-i CRDS analyser is presented and discussed. Such standards are indispensable for achieving and maintaining high quality of isotope analyses of water in terms of their precision and accuracy. A set of seven different water standards consisting of three in-house standards and four secondary standards commercially available was calibrated against VSMOW2/SLAP2 primary reference materials. The calibrated standards cover a wide range of isotopic composition, with δ values ranging from close to zero to the values comparable with SLAP2. The apparent consistency of the calibrated values of δ2H, δ18O and d-excess with corresponding certified values for commercially available USGS47-50 standards and the consistency of the calibrated values of δ17O and Δ17O with its literature values for USGS47-48 standards confirm the high quality of the performed calibration. Moreover, the calibration exercise allowed to obtain δ17O and Δ17O values for USGS49 and USGS50 standards, not reported so far.
  Retrospective cohort study.
 
  Symptoms caused by spinal metastases are often difficult to distinguish from symptoms caused by non-malignant spinal disease, complicating timely diagnosis, referral and treatment. The ensuing delays may promote the risk of neurological deficits or severe mechanical instability and consequent emergency surgery, leading to poorer prognosis. Presumably, treatment delay may subsequently lead to more health-care consumption and therefore increased average costs of treatment.
 
  All patients surgically treated for spinal metastases were included in the current study. Based on the presence of alarming symptoms and urgency of the required intervention, patients were categorized as having received timely or delayed treatment. Pre-surgical, in-hospital, aftercare and total costs were analyzed and compared between the 2 groups.
 
  In total, 299 patients were included, of which 205 underwent timely and 94 delayed treatment. There was no significant difference in pre-surigcal costs (€3.229,1t outcome, leading to better clinical outcomes at lower costs.
  Biomechanical study.
 
  Cross-links are a type of common clinical spinal instrumentation. However, the effects of the position and number of cross-links have never been investigated in long-segment spinal fixation, and the variables have not been optimized. We conducted an in vitro biomechanical study by using a porcine long-segment spinal model with 5 different crosslink configurations to determine the optimal construct for clinical practice.
 
  Five modalities with paired segmental screws from T15-L5 were tested in 20 porcine spines. The spines without cross-links composed the control group, Group A; those with a single cross-link from L2-3 composed Group B; those with 2 cross-links from L1-2 and L3-4 composed Group C; those with 2 cross-links from T15-L1 and L4-5 composed Group D; and those with 3 cross-links from T15-L1, L2-3 and L4-5 composed Group E. Spinal stiffnesses in flexion, extension, lateral bending, and axial rotation were compared among 5 different cross-link configurations in 5-level porcine spinal units.