What does it take to successfully lead a Division of Geriatrics? Is it the same skill set today as it was two or three decades ago? Is it the same for each chief, given the wide spectrum of geriatrics programs across our nation? Early leaders in our field showcased and role-modeled the career and job satisfaction that accompanies leadership of traditional geriatrics academic programs. This has been well articulated in past issues of the Journal of the American Geriatrics Society in articles by Dr William Hazzard and Dr Greg Sachs. How can we develop the next generation of geriatrics program leaders and ensure their success? Developed as a conversation between three generations of geriatrics division chiefs, this reflective article offers a shared perspective on what is required for success in advancing as a leader in our field and wholeheartedly enjoying the best job in the world.In this study, we have investigated the cheese starter culture as a microbial community through a question can the metabolic behaviour of a co-culture be explained by the characterized individual organism that constituted the co-culture? To address this question, the dairy-origin lactic acid bacteria Lactococcus lactis subsp. cremoris, Lactococcus lactis subsp. lactis, Streptococcus thermophilus and Leuconostoc mesenteroides, commonly used in cheese starter cultures, were grown in pure and four different co-cultures. We used a dynamic metabolic modelling approach based on the integration of the genome-scale metabolic networks of the involved organisms to simulate the co-cultures. The strain-specific kinetic parameters of dynamic models were estimated using the pure culture experiments and they were subsequently applied to co-culture models. Biomass, carbon source, lactic acid and most of the amino acid concentration profiles simulated by the co-culture models fit closely to the experimental results and the co-culture models explained the mechanisms behind the dynamic microbial abundance. We then applied the co-culture models to estimate further information on the co-cultures that could not be obtained by the experimental method used. This includes estimation of the profile of various metabolites in the co-culture medium such as flavour compounds produced and the individual organism level metabolic exchange flux profiles, which revealed the potential metabolic interactions between organisms in the co-cultures.
  Omental milky spots (OMSs) are the primary lymphoid structures of the greater omentum. However, the presence of lymph nodes (LNs) has occasionally been mentioned as well. Understanding which lymphoid structures are present is of significance, especially in gastric tumor metastasis; tumor deposits in omental LNs suggest local lymphatic spread, whereas tumor deposits in OMSs suggest peritoneal spread and hence extensive disease. Since LNs and OMSs share morphological characteristics and OMSs might be wrongly identified as LNs, reliable hallmarks facilitating easy discrimination are needed.
 
  A series of microscopic morphological hallmarks unique to LNs were selected as potential candidates and were assessed for their discriminative capacity 1) capsule, 2) trabeculae, 3) subcapsular sinus, 4) afferent lymphatic vessels, 5) distinct B- and T cell regions, and 6) a layered organization with, from the outside in a capsule, cortex, paracortex, and medulla. These hallmarks were visualized by multiple staining techniques.
 
  Hallmarks 1, 2 5 and 6 were shown to be the most efficient as these were consistent and discriminative. They were best visualized by Picrosirius red, smooth muscle actin and a B-cell / T-cell double staining.
 
  The presence of a capsule, trabeculae, distinct B- and T-cell regions and a layered organization represent consistent and reliable morphological features which allow to easily distinguish LNs from OMSs, especially when applied in combination.
 The presence of a capsule, trabeculae, distinct B- and T-cell regions and a layered organization represent consistent and reliable morphological features which allow to easily distinguish LNs from OMSs, especially when applied in combination.
  While the well-known DaVinci ® robotic system (Intuitive Surgical, Inc., Sunnyvale, CA) uses 8 mm articulated instruments, the Senhance ® robotic system (TransEnterix, Morrisville, NC), available since 2016, uses 5 mm instruments, which is the standard size in laparoscopy. We report here the first 43 procedures using 5 mm articulating instruments with the Senhance ® system (TransEnterix).
 
  From September 9, 2019, to January 15, 2020, we performed 43 various robotic-assisted abdominal procedures. Before the first clinical intervention, the surgeons and surgical nurses were trained in the handling and operation of the articulating instruments. The main procedure was Inguinal Hernia Repair with the TAPP technique. We performed the operations with a 5 mm articulating bipolar forceps and a 5 mm articulating needle holder. In all cases, the Senhance ® (TransEnterix) articulating instruments were inserted through a 5 or 10 mm trocar, connected to the robotic arm and used for tissue dissection (inguinal hernia repsaw advantages with the use of 5 mm articulating instruments.
 
  Senhance ® (TransEnterix) 5 mm articulating instruments are technically stable and can be safely used in various abdominal procedures. The initial results suggest that these 5 mm articulating instruments can be a supportive tool in further robotic surgery, providing advantages in suturing and dissection with less risk of injury to surrounding tissue.
 Senhance ® (TransEnterix) 5 mm articulating instruments are technically stable and can be safely used in various abdominal procedures. The initial results suggest that these 5 mm articulating instruments can be a supportive tool in further robotic surgery, providing advantages in suturing and dissection with less risk of injury to surrounding tissue.Laser Interstitial Thermal Therapy (LITT) is used to treat patients with intracranial lesions such as epileptogenic foci, radiation necrosis, cavernomas and brain tumors in the United States.  https://www.selleckchem.com/products/CP-690550.html  The approval for this treatment in Europe has first been granted in 2018, with the first treatment(s) in the Nordic countries - in the form of 3 brain tumor patients - performed at the Karolinska University Hospital in 2019. In this article we briefly describe our initial experience in the context of current literature.