bluuebunny/crossref_metadata_2025 huggingface dataset:
Does A Hinged Operating Table Facilitate Sagittal Correction in Transforaminal Lumbar Interbody Fusion With Smith-Peterson Osteotomy? A Radiographic Analysis
Authors: Polly David W. , Holton Kenneth J. , Haselhuhn Jason J. , Soriano Paul Brian O. , Jones Kristen E. , Sembrano Jonathan N. , Martin Christopher T.
Published: December 2023

Background

Osteotomies allow the restoration of appropriate sagittal alignment; however, closure of osteotomies can be challenging. Typical closure involves compressing pedicle screw heads across the rods, potentially causing screw loosening and failure. Motorized hinged operating tables are often used to assist with controlled closure of osteotomies without manual compression, but there is no published research quantifying the amount of correction provided solely by changes in the table angle.

Question/purpose

What is the incremental amount of correction achieved by change in the table angle versus instrumented manipulation during osteotomy closure in transforaminal lumbar interbody fusion (TLIF) with Smith-Petersen osteotomy?

Methods

Sixty-one patients undergoing Smith-Peterson osteotomy and bilateral TLIF using a motorized hinged table from October 2019 to March 2022 were prospectively enrolled. Two patients did not undergo surgery, two did not have table extension, and seven did not have data collected intraoperatively because of disruptions in research protocols owing to the coronavirus-19 pandemic. Fifty patients (24 male, 26 female) who underwent a total of 73 osteotomies were included in the final analysis. The mean ± standard deviation age was 61 ±11 years, and the mean BMI was 31 ± 6 kg/m2. Patients were positioned prone on the table and flexed to 10° for decompression, Smith-Petersen osteotomy, and TLIF. The table was then extended in 5° increments, and radiographs were taken until 10° of extension was achieved or the osteotomy was fully closed. Changes in segmental lordosis across the operative site for each 5° increment were measured to the nearest degree by two reviewers. Intraclass correlation coefficients for segmental lordosis measurements at each table angle change were calculated as 0.97 to 0.98, with all p values < 0.001, indicating excellent agreement.

Results

Table change from 10° to 5° yielded a mean segmental lordosis change of 1.9° ± 1.5° (73 osteotomies), 5° to 0° yielded a change of 1.3° ± 0.9° (73 osteotomies), 0° to -5° yielded a change of 1.3° ± 1.0° (69 osteotomies), and -5° to -10° yielded a change of 1.1° ± 1.3° (61 osteotomies). Rod placement and compression yielded a mean 1.8° ± 2.0° of additional segmental lordosis.

Conclusion

Using a motorized hinged table facilitated an average of 5.6° of total segmental lordosis correction during controlled Smith-Peterson osteotomy closure without the need for cantilevering forces across spinal instrumentation. Surgeons can use this technique to reduce the compression forces needed to close osteotomies, which could eliminate a potential source of complications.

Level of Evidence Level II, therapeutic study.
Sociodemographic inequalities in long-term exposure to air pollution, road traffic noise, and greenness: A population-based cohort study of women
Authors: Stucki Lara , Betnér Staffan , Selander Jenny , Lõhmus Mare , Åkesson Agneta , Eriksson Charlotta
Published: December 2023

Background:

Recent evidence suggests environmental health inequalities both within and between European countries and socially deprived groups may be more susceptible to pollution. However, evidence is still inconclusive and additional studies are warranted. This study aims to investigate sociodemographic inequalities in long-term residential exposure to air pollution, road traffic noise, and greenness, taking lifestyle and degree of urbanization into account.

Methods:

In total 20,407 women, born 1914–48 residing in Uppsala County, Sweden, were followed between 1997 and 2017. Time-varying sociodemographic variables were obtained from registers, and questionnaires provided lifestyle information. Generalized estimating equations were used to compute beta-coefficients (β) and 95% confidence intervals (95% CI) for associations between sociodemographic and lifestyle variables and spatial-temporal modeled particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), road traffic noise and greenness. All models were additionally stratified by urbanization type.

Results:

Urban area residency was the most important predictor of high exposure to air pollution and noise, and to low greenness. For instance, β for NO2 was −2.92 (95% CI = −3.00, −2.83) and −3.10 (95% CI = −3.18, −3.01) µg/m3 in suburban and rural areas, respectively, compared with urban areas. For greenness, the opposite held true with corresponding β of 0.059 (95% CI = 0.056, 0.062) and 0.095 (95% CI = 0.092, 0.098). Within urban areas, elderly, unmarried and well-educated women had the highest environmental burden. However, less pronounced, and even reversed associations were found in suburban and rural areas.

Conclusion:

This study provides evidence of a mixed pattern of environmental health inequalities across sociodemographic groups in urban areas.
EUS-guided versus percutaneous liver abscess drainage: A multicenter collaborative study
Authors: Shahid Haroon , Tyberg Amy , Sarkar Avik , Gaidhane Monica , Mahpour Noah Y. , Patel Roohi , Flumignan Victor K. , Vazquez-Sequeiros Enrique , Martínez Guadalupe Ma , Artifon Everson L. , Kahaleh Michel
Published: December 2023

Background and Objectives

Management of hepatic abscesses has traditionally been performed by image-guided percutaneous techniques. More recently, EUS drainage has been shown to be efficacious and safe. The aim of this study is to compare EUS-guided versus percutaneous catheter drainage (PCD) of hepatic abscesses.

Methods

Patients who underwent EUS-guided drainage or PCD of hepatic abscesses from January 2018 through November 2021 from 4 international academic centers were included in a dedicated registry. Demographics, clinical data preprocedure and postprocedure, abscess characteristics, procedural data, adverse events, and postprocedure care were collected.

Results

Seventy-four patients were included (mean age, 63.9 years; 45% male): EUS-guided (n = 30), PCD (n = 44). Preprocedure Charlson Comorbidity Index scores were 4.3 for the EUS group and 4.3 for the PCD group. The median abscess size was 8.45 × 6 cm (length × width) in the EUS group versus 7.3 × 5.5 cm in the PCD group. All of the abscesses in the EUS group were left-sided, whereas the PCD group contained both left- and right-sided abscesses (29 and 15, respectively). Technical success was 100% in both groups. Ten-millimeter-diameter stents were used in most cases in the EUS group, and 10F catheters were used in the PCD group. The duration to resolution of symptoms from the initial procedure was 10.9 days less in the EUS group compared with the PCD group (P < 0.00001). Hospital length of stay was shorter in the EUS group by 5.2 days (P = 0.000126). The EUS group had significantly fewer number of repeat sessions: mean of 2 versus 7.7 (P < 0.00001) and trended toward fewer number of procedure-related readmissions: 10% versus 34%. The PCD group had a significantly higher number of adverse events (n = 27 [61%]) when compared with the EUS group (n = 5 [17%]; P = 0.0001).

Conclusions

EUS-guided drainage is an efficacious and safe intervention for the management of hepatic abscesses. EUS-guided drainage allows for quicker resolution of symptoms, shorter length of hospital stay, fewer adverse events, and fewer procedural sessions needed when compared with the PCD technique. However, EUS-guided drainage may not be feasible in right-sided lesions.
Controversies in endobronchial ultrasound
Authors: Dietrich Christoph F. , Bugalho Antonio , Carrara Silvia , Clementsen Paul Frost , Dong Yi , Hocke Michael , Kolekar Shailesh Balasaheb , Konge Lars , Ignee André , Löwe Axel , Jenssen Christian
Published: December 2023

Endobronchial ultrasound (EBUS) is a minimally invasive highly accurate and safe endoscopic technique for the evaluation of mediastinal lymphadenopathy and mediastinal masses including centrally located lung tumors. The combination of transbronchial and transoesophageal tissue sampling has improved lung cancer staging, reducing the need for more invasive and surgical diagnostic procedures.

Despite the high level of evidence regarding EBUS use in the aforementioned situations, there are still challenges and controversial issues such as follows: Should informed consent for EBUS and flexible bronchoscopy be different? Is EBUS able to replace standard bronchoscopy in patients with suspected lung cancer? Which is the best position, screen orientation, route of intubation, and sedation/anesthesia to perform EBUS? Is it advisable to use a balloon in all procedures? How should the operator acquire skills and how should competence be ensured? This Pro-Con article aims to address these open questions.
Rationale for the Development of a Traumatic Brain Injury Case Definition for the Pilot National Concussion Surveillance System
Authors: Daugherty Jill , Peterson Alexis , Waltzman Dana , Breiding Matthew , Chen Jufu , Xu Likang , DePadilla Lara , Corrigan John D.
Published: December 2023

Background:

Current methods of traumatic brain injury (TBI) morbidity surveillance in the United States have primarily relied on hospital-based data sets. However, these methods undercount TBIs as they do not include TBIs seen in outpatient settings and those that are untreated and undiagnosed. A 2014 National Academy of Science Engineering and Medicine report recommended that the Centers for Disease Control and Prevention (CDC) establish and manage a national surveillance system to better describe the burden of sports- and recreation-related TBI, including concussion, among youth. Given the limitations of TBI surveillance in general, CDC took this recommendation as a call to action to formulate and implement a robust pilot National Concussion Surveillance System that could estimate the public health burden of concussion and TBI among Americans from all causes of brain injury. Because of the constraints of identifying TBI in clinical settings, an alternative surveillance approach is to collect TBI data via a self-report survey. Before such a survey was piloted, it was necessary for CDC to develop a case definition for self-reported TBI.

Objective:

This article outlines the rationale and process the CDC used to develop a tiered case definition for self-reported TBI to be used for surveillance purposes.

Conclusion:

A tiered TBI case definition is proposed with tiers based on the type of sign/symptom(s) reported the number of symptoms reported, and the timing of symptom onset.
Understanding the Workplace-Violence-Related Perceptions and Coping Strategies of Nurses in Emergency Rooms
Authors: HSIEH Hsiu-Fen , CHEN Yao-Mei , CHEN Shu-Lin , WANG Hsiu-Hung
Published: December 2023

Background

Workplace violence (WPV) is a well-known and serious issue in most countries, and WPV against healthcare providers is of particular concern, especially among nurses working in emergency rooms (ERs).

Purpose

We aimed to develop a deeper understanding of nurses' perceptions and coping strategies related to WPV that took place over a 1-year period from the perspective of nursing victims still working in ERs in southern Taiwan.

Methods

This is a qualitative study with in-depth and semistructured interviews. Nineteen ER nurse victims were recruited from six hospitals in southern Taiwan from June 2015 to April 2016. All of the interview recordings were analyzed using content analysis.

Results

The content analysis identified two themes of perceptions and two themes of coping strategies toward WPV. The two themes of perceptions were “adversity” and “dilemma,” with the former covering the three subthemes of “misunderstanding of health policy,” “unsafe environment,” and “nursing shortage” and the latter covering the two subthemes of “burnout” and “keeping or quitting the job.” The two themes of coping strategies were “adjustment” and “resilience,” with the former covering the three subthemes of “acceptance of the reality of WPV,” “self-regulation,” and “culture and belief” and the latter covering the two subthemes of “living with WPV” and “problem solving.”

Conclusions/Implications for Practice

The findings revealed that ER nurse victims of WPV experienced a complicated journey after encountering WPV. Their coping strategies may be referenced by other ER nurses to better prevent and manage violent events in ERs. To prevent and manage violence in ERs, hospital managers should create a safe working environment through, for example, assigning sufficient security personnel and staff; provide relevant training to ER nurses in communications and other skills; and implement support systems to strengthen nurse resilience.
Associations Between Preimplant Cancer Type and Left Ventricular Assist Device Outcomes: An INTERMACS Registry Analysis
Authors: Steinberg Rebecca S. , Nayak Aditi , Okoh Alexis , Wang Jeffrey , Matiello Erin , Morris Alanna A. , Cowger Jennifer A. , Nohria Anju
Published: December 2023

We used the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database to examine whether history of a solid versus hematologic malignancy impacts outcomes after left ventricular assist device (LVAD) implantation. We included LVAD recipients (2007–2017) with cancer history reported (N = 14,799, 21% female, 24% Black). Multivariate models examined the association between cancer type and post-LVAD mortality and adverse events. Competing risk analyses compared death and heart transplantation between cancer types and those without cancer in bridge-to-transplant (BTT) patients. A total of 909 (6.1%) patients had a history of cancer (4.9% solid tumor, 1.3% hematologic malignancy). Solid tumors were associated with higher mortality (adjusted hazard ratio [aHR] = 1.31, 95% confidence interval [CI] = 1.09–1.57), major bleeding (aHR = 1.15, 95% CI = 1.00–1.32), and pump thrombosis (aHR = 1.52, 95% CI = 1.09–2.13), whereas hematologic malignancies were associated with increased major infection (aHR = 1.43, 95% CI = 1.14–1.80). Compared to BTT patients without a history of cancer, solid tumor patients were less likely to undergo transplantation (adjusted subdistribution HR [aSHR] = 0.63, 95% CI = 0.45–0.89) and hematologic malignancy patients were as likely to experience death (aSHR = 1.16, 95% CI = 0.63–2.14) and transplantation (aSHR = 0.69, 95% CI = 0.44–1.08). Cancer history and type impact post-LVAD outcomes. As LVAD utilization in cancer survivors increases, we need strategies to improve post-LVAD outcomes in these patients.
Percutaneous Stenting of a Stenotic Berlin Heart Outflow Cannula Graft in a 2-Year-Old Child
Authors: Mejia Ernesto , Cole Jason , Soszyn Natalie , Auerbach Scott , Morgan Gareth J.
Published: December 2023

Left ventricular assist device (LVAD) outflow obstruction is a rare complication of long-term LVAD support. We present the first case of successful percutaneous stent implantation in a pediatric patient with LVAD outflow obstruction.
Moyamoya disease/cerebral vasculopathy in osteopathia striata with cranial sclerosis: a rare but important complication
Authors: Scrimshaw Lucy , Gorman Kathleen , Mansour Sahar , Ganesan Vijeya , Sabir Ataf
Published: December 2023

Osteopathia striata with cranial sclerosis (OSCS) is a rare X-linked dominant sclerosing osteodysplasia, due to AMER1 pathogenic variants. Characteristic features include craniofacial sclerosis and long-bone metaphyseal striations. Moyamoya disease (a type of progressive cerebral vasculopathy) and other types of cerebral vascular disease are not currently clearly associated with OSCS (except for two separate case reports), and can often first present with stroke. Through informal networks with UK-based bone experts and the UK skeletal dysplasia group, three cases from the UK and Ireland were identified. Medical literature was also reviewed to identify the known cases of OSCS with the described complications. We report four females, in whom OSCS and cerebral vasculopathy co-exist, with varying clinical outcomes. There appears to be an emerging association between OSCS and cerebral vasculopathy, which pre-disposes patients to stroke. Given this, screening OSCS patients for cerebral vasculopathy may be of value, especially pre-surgery. Further research regarding optimal screening and management is needed. The mechanism of cerebral vasculopathy and its progression remain unclear.
Dialysis initiation for patients with decompensated cirrhosis when liver transplant is unlikely
Authors: Bansal Amar D. , Patel Arpan A.
Published: December 2023

Purpose of review

The purpose of this review is to describe an approach that emphasizes shared decision-making for patients with decompensated cirrhosis and acute kidney injury when liver transplantation is either not an option, or unlikely to be an option.

Recent findings

When acute kidney injury occurs on a background of decompensated cirrhosis, outcomes are generally poor. Providers can also be faced with prognostic uncertainty. A lack of guidance from nephrology and hepatology professional societies means that providers rely on expert opinion or institutional practice patterns.

For patients who are unlikely to receive liver transplantation, the occurrence of acute kidney injury represents an opportunity for a goals of care conversation. In this article, we share strategies through which providers can incorporate more shared decision-making when caring for these patients. The approach involves creating prognostic consensus amongst multidisciplinary teams and then relying on skilled communicators to share the prognosis. Palliative care consultation can be useful when teams need assistance in the conversations.
Molecular profiling in the management of hepatocellular carcinoma
Authors: Soliman Nadine , Saharia Ashish , Abdelrahim Maen , Connor Ashton A.
Published: December 2023

Purpose of review

The purpose of this review is to both summarize the current knowledge of hepatocellular carcinoma molecular biology and to suggest a framework in which to prospectively translate this knowledge into patient care. This is timely as recent guidelines recommend increased use of these technologies to advance personalized liver cancer care.

Recent findings

The main themes covered here address germline and somatic genetic alterations recently discovered in hepatocellular carcinoma, largely owing to next generation sequencing technologies, and nascent efforts to translate these into contemporary practice.

Early efforts of translating molecular profiling to hepatocellular carcinoma care demonstrate a growing number of potentially actionable alterations. Still lacking are a consensus on what biomarkers and technologies to adopt, at what scale and cost, and how to integrate them most effectively into care.
Community Mental Health Services for Frequent Emergency Department Users
Authors: Samosh Jonathan , Agha Ayda , Pettey Donna , Sylvestre John , Aubry Tim
Published: December 2023

Purpose of Study:

This study aimed to investigate the perceived outcomes and mechanisms of change of a community mental health service combining system navigation and intensive case management supports for frequent emergency department users presenting with mental illness or addiction.

Primary Practice Setting:

The study setting was a community mental health agency receiving automated referrals directly from hospitals in a midsize Canadian city for all individuals attending an emergency department two or more times within 30 days for mental illness or addiction.

Methodology and Sample:

Qualitative interviews with 15 program clients. Focus groups with six program case managers. Data were analyzed using pragmatic qualitative thematic analysis.

Results:

Participants generally reported perceiving that the program contributed to reduced emergency department use, reduced mental illness symptom severity, and improved quality of life. Perceived outcomes were more mixed for outcomes related to addiction. Reported mechanisms of change emphasized the importance of positive working relationships between program clients and case managers, as well as focused efforts to develop practical skills.

Implications for Case Management Practice:

Community mental health services including intensive case management for frequent emergency department users presenting with mental illness or addiction were perceived to effectively address client needs while reducing emergency department resource burden. Similar programs should emphasize the development of consistent and warm working relationships between program clients and case managers, as well as practical skills development to support client health and well-being.
Necrotizing fasciitis: an update on epidemiology, diagnostic methods, and treatment
Authors: Allaw Fatima , Wehbe Saliba , Kanj Souha S.
Published: December 2023

Purpose of review

The aim of this review is to discuss the latest evidence of epidemiology, diagnostic methods, and treatment of necrotizing soft tissue infections (NSTIs) with a particular focus on necrotizing fasciitis (NF).

Recent findings

NSTIs have been historically referred to as NF but encompass a broader range of infections, with variable rates ranging from 0.86 to 32.64 per 100 000 person-years, influenced by factors such as climate and seasonal variations. They have diverse microbiological profiles categorized into different types based on the involved pathogens, including polymicrobial or monomicrobial infections caused by organisms such as group A streptococcus (GAS), Staphylococcus aureus, some Gram-negative pathogens, and filamentous fungi following trauma and natural disasters. Diagnosis relies on clinical symptoms and signs, laboratory markers, and imaging. However, the gold standard for diagnosis remains intraoperative tissue culture. Treatment involves repeated surgical debridement of necrotic tissues in addition to intravenous antibiotics. Adjuvant therapies with intravenous immunoglobulin (IVIG) and hyperbaric oxygen therapy (HBOT) might have a role. Soft tissue reconstruction may be necessary following surgery.

Prompt diagnosis and proper medical and surgical management of NSTI will improve outcomes.
Does imaging of the ischemic penumbra have value in acute ischemic stroke with large vessel occlusion?
Authors: Seners Pierre , Baron Jean-Claude , Olivot Jean-Marc , Albers Gregory W.
Published: December 2023

Purpose of review

In this review, we summarize current evidence regarding potential benefits and limitations of using perfusion imaging to estimate presence and extent of irreversibly injured ischemic brain tissue (‘core’) and severely ischemic yet salvageable tissue (‘penumbra’) in acute stroke patients with large vessel occlusion (LVO).

Recent findings

Core and penumbra volumes are strong prognostic biomarkers in LVO patients. Greater benefits of both intravenous thrombolysis and endovascular therapy (EVT) are observed in patients with small core and large penumbra volumes. However, some current definitions of clinically relevant penumbra may be too restrictive and exclude patients who may benefit from reperfusion therapies. Alongside other clinical and radiological factors, penumbral imaging may enhance the discussion regarding the benefit/risk ratio of EVT in common clinical situations, such as patients with large core – for whom EVT's benefit is established but associated with a high rate of severe disability –, or patients with mild symptoms or medium vessel occlusions – for whom EVT's benefit is currently unknown. Beyond penumbral evaluation, perfusion imaging is clinically relevant for optimizing patient's selection for neuroprotection trials.

In an emerging era of precision medicine, perfusion imaging is a valuable tool in LVO-related acute stroke.
In-vivo diagnosis of cerebral amyloid angiopathy: an updated review
Authors: Raposo Nicolas , Périole Charlotte , Planton Mélanie
Published: December 2023

Purpose of review

Sporadic cerebral amyloid angiopathy (CAA) is a highly prevalent small vessel disease in ageing population with potential severe complications including lobar intracerebral hemorrhage (ICH), cognitive impairment, and dementia. Although diagnosis of CAA was made only with postmortem neuropathological examination a few decades ago, diagnosing CAA without pathological proof is now allowed in living patients. This review focuses on recently identified biomarkers of CAA and current diagnostic criteria.

Recent findings

Over the past few years, clinicians and researchers have shown increased interest for CAA, and important advances have been made. Thanks to recent insights into mechanisms involved in CAA and advances in structural and functional neuroimaging, PET amyloid tracers, cerebrospinal fluid and plasma biomarkers analysis, a growing number of biomarkers of CAA have been identified. Imaging-based diagnostic criteria including emerging biomarkers have been recently developed or updated, enabling accurate and earlier diagnosis of CAA in living patients.

Recent advances in neuroimaging allow diagnosing CAA in the absence of pathological examination. Current imaging-based criteria have high diagnostic performance in patients presenting with ICH, but is more limited in other clinical context such as cognitively impaired patients or asymptomatic individuals. Further research is still needed to improve diagnostic accuracy.
Postdischarge telephone follow-up among chronic disease patients discharged from a vascular surgery service: a best practice implementation project
Authors: Sousa Pedro , Cardoso Daniela , Vrbová Tereza , Apóstolo João , Santos Margarida , Manso Gracinda , Mourão Daniel , Ferreira Goreti , Monteiro Manuela , Manata Jacinta , Vaz Alexandre , Klugarová Jitka , Klugar Miloslav
Published: December 2023

Objectives:

To improve postdischarge telephone follow-up in the context of chronic disease management (peripheral artery disease), in a vascular surgery service.

Introduction:

Patients with chronic diseases, such as peripheral artery disease, present a higher risk of complications and greater constraints regarding their adherence to treatment, leading to an increasing mortality rate and decreased functional capacity. Comprehensive discharge planning plus postdischarge telephone follow-up may reduce 30-day re-hospitalization rates.

Methods:

The project used the JBI audit and feedback methodological approach to implement the best available evidence into practice. Two audit criteria were used: existence of comprehensive discharge planning and timely telephone follow-up. A baseline audit was conducted, followed by analysis of barriers, which led to the implementation of several strategies, namely, a targeted training program, the development of educational resources and standardized procedures for the discharge process, and postdischarge telephone follow-up.

Results:

Results from the baseline and first follow-up audits showed improvement for both criteria. Compliance for criterion 1 (comprehensive discharge planning, including postdischarge telephone follow-up) increased from 0% to 40.7%, and for criterion 2 (patient is followed up by telephone within 2 weeks of discharge) increased from 0% to 44.4%. These two criteria sustained improvements in the second follow-up audit: compliance increased to 45% (criterion 1) and 60% (criterion 2).

Conclusions:

This implementation project contributed to the optimization of the chronic disease management, including improved compliance with discharge planning and early postdischarge telephone follow-up.
Breastfeeding support and avoiding inappropriate breast milk substitute marketing in a neonatal ward in the Czech Republic: a best practice implementation project
Authors: Kantorová Lucia , Poloková Andrea , Sýkora Michal , Vrbová Tereza , Klugar Miloslav , Klugarová Jitka
Published: December 2023

Objectives:

The aim of this implementation project was to improve breastfeeding support, and more specifically, to increase compliance with the Baby-Friendly Hospital Initiative (BFHI) and the requirements of the International Code of Marketing of Breastmilk Substitutes (the Code).

Introduction:

The Ten Steps to Successful Breastfeeding of the BFHI have been shown to improve breastfeeding outcomes at target hospitals. The Code is a minimum standard for the regulation of marketing practices related to breastfeeding support.

Methods:

We used the JBI evidence implementation model to identify a group of stakeholders in a hospital in the Czech Republic and carried out a best practice implementation project from January 2021 to May 2022. After conducting a baseline audit, the clinical team and external breastfeeding experts discussed challenges and devised an implementation plan using the JBI Getting Research into Practice framework. Follow-up audits were undertaken from January to December 2021 and in May 2022.

Results:

Compliance improved across all audited criteria, namely, to fully comply with the Code (0% to 100%); to have a written infant feeding policy (0% to 100%); to ensure staff have skills to support breastfeeding (0% to 100%); to discuss breastfeeding with pregnant women (0% to 100%); to facilitate skin-to-skin contact (67.86% to 83.58%); to support and provide help with breastfeeding (67.86% to 82.09%); to not provide fluids other than breast milk (50% to 58.21%); to practice rooming-in (57.14% to 61.19%); to respond to infant cues (50% to 64.18%); to provide information about community support services (32.14% to 62.69%); and to coordinate discharge and ongoing care (0% to 100%).

Conclusions:

Breastfeeding support requires a sustained long-term effort before it can become fully established. The involvement of national-level policy makers is needed.
Parsing digital or analogue TCR performance through piconewton forces
Authors: Akitsu Aoi , Kobayashi Eiji , Feng Yinnian , Stephens Hannah M. , Brazin Kristine N. , Masi Daniel J. , Kirpatrick Evan H. , Mallis Robert J. , Duke-Cohan Jonathan S. , Booker Matthew A. , Cinella Vincenzo , Feng William W. , Holliday Elizabeth L. , Lee Jonathan J. , Zienkiewicz Katarzyna J. , Tolstorukov Michael Y. , Hwang Wonmuk , Lang Matthew J. , Reinherz Ellis L.
Published: December 2023

αβ T-cell receptors (TCRs) recognize aberrant peptides bound to major histocompatibility complex molecules (pMHCs) on unhealthy cells, amplifying specificity and sensitivity through physical load placed on the TCR-pMHC bond during immunosurveillance. To understand this mechanobiology, TCRs stimulated by abundantly and sparsely arrayed epitopes (NP366-374/Dband PA224-233/Db, respectively) followingin vivoinfluenza A virus infection were studied with optical tweezers. While certain NP repertoire CD8 T lymphocytes require many ligands for activation, others are digital, needing just few. Conversely, all PA TCRs perform digitally, exhibiting pronounced bond lifetime increases through sustained, energizing volleys of structural transitioning. Optimal digital performance is superiorin vivo,correlating with ERK phosphorylation, CD3 loss, and activation marker upregulationin vitro. Given neoantigen array paucity, digital TCRs are likely critical for immunotherapies.

One Sentence Summary

Quality of ligand recognition in a T-cell repertoire is revealed through application of physical load on clonal T-cell receptor (TCR)-pMHC bonds
Identification of a targetable ST2-expressing fibroblast subset driving Peutz-Jeghers syndrome polyposis
Authors: Domènech-Moreno Eva , Lim Wei-Wen , Brandt Anders , Lemmetyinen Toni T , Viitala Emma W , Mäkelä Tomi P , Cook Stuart A , Ollila Saara
Published: December 2023

Peutz-Jeghers syndrome (PJS) is associated with early-onset and recurring gastrointestinal hamartomatous polyposis caused by hereditary inactivating mutations in the tumor suppressor gene LKB1 (STK11). Due to lack of efficient prophylactic therapies PJS patients require regular surgical interventions and have an increased risk of cancer. LKB1-deficient fibroblasts have been identified as drivers of polyposis, but a safely druggable target remains to be identified. Here we investigate tumorigenic mechanisms in PJS polyps using single-cell RNA sequencing of predisposed and tumor tissue and identified a ST2-expressing crypt top fibroblast (CTF) cluster enriched in polyps. The relevance of CTFs was supported by the fast polyposis following deletion of Lkb1 in CTFs. The transcriptional signature characterizing the ST2+ fibroblasts (ST2-CTFs) was enriched in inflammation-associated fibroblasts, and PJS polyposis was exacerbated by inflammation. Cell-cell communication analysis identified the ST2-CTF signature gene interleukin 11 (IL-11) as an upstream regulator of the ST2-CTFs, and consistently, reprogramming toward ST2 fibroblasts in vitro was dependent on IL-11. Importantly, a neutralizing IL-11 antibody efficiently reduced the tumor burden in a PJS mouse model. In summary, our results reveal ST2+ tumorigenic fibroblasts as drivers of PJS polyposis and identify IL-11 as the key mediator and a potential therapeutic target in PJS.
AMP-activated protein kinase is necessary for Treg cell functional adaptation to microenvironmental stress
Authors: Torres Acosta Manuel A , Mambetsariev Nurbek , Flores Carla P Reyes , Helmin Kathryn A , Liu Qianli , Joudi Anthony M , Morales-Nebreda Luisa , Gurkan Jonathan , Cheng Kathleen , Abdala-Valencia Hiam , Weinberg Samuel E , Singer Benjamin D
Published: December 2023

CD4+FOXP3+ regulatory T (Treg) cells maintain self-tolerance, suppress the immune response to cancer, and protect against tissue injury in the lung and other organs. Treg cells require mitochondrial metabolism to exert their function, but how Treg cells adapt their metabolic programs to sustain and optimize their function during an immune response occurring in a metabolically stressed microenvironment remains unclear. Here, we tested whether Treg cells require the energy homeostasis-maintaining enzyme AMP-activated protein kinase (AMPK) to adapt to metabolically aberrant microenvironments caused by malignancy or lung injury, finding that AMPK is dispensable for Treg cell immune-homeostatic function but is necessary for full Treg cell function in B16 melanoma tumors and during acute lung injury caused by influenza virus pneumonia. AMPK-deficient Treg cells had lower mitochondrial mass and exhibited an impaired ability to maximize aerobic respiration. Mechanistically, we found that AMPK regulates DNA methyltransferase 1 to promote transcriptional programs associated with mitochondrial function in the tumor microenvironment. In the lung during viral pneumonia, we found that AMPK sustains metabolic homeostasis and mitochondrial activity. Induction of DNA hypomethylation was sufficient to rescue mitochondrial mass in AMPK-deficient Treg cells, linking DNA methylation with AMPK function and mitochondrial metabolism. These results define AMPK as a determinant of Treg cell adaptation to metabolic stress and offer potential therapeutic targets in cancer and tissue injury.
Whole-genome screening for near-diagnostic genetic markers for white oak species identification in Europe
Authors: Kremer Antoine , Delcamp Adline , Lesur Isabelle , Wagner Stefanie , Christian Rellstab , Guichoux Erwan , Leroy Thibault
Published: December 2023

Context

Identifying species in the European white oak complex has been a long standing concern in taxonomy, evolution, forest research and management.Quercus petraea, Q. robur, Q. pubescensandQ. pyrenaicaare part of this species complex in western temperate Europe and hybridize in mixed stands, challenging species identification.

Aims

Our aim was to identify diagnostic single nucleotide polymorphisms (SNPs) for each of the four species that are suitable for routine use and rapid diagnosis in research and applied forestry.

Methods

We first scanned existing whole-genome and target-capture data sets in a reduced number of samples (training set) to identify candidate diagnostic SNPs, ie genomic positions being characterized by a reference allele in one species and by the alternative allele in all other species. Allele frequencies of the candidates SNPs were then explored in a larger, range-wide sample of populations in each species (validation step).

Results

We found a subset of 38 SNPs (ten forQ. petraea, seven forQ. pubescens, nine forQ. pyrenaicaand twelve forQ. robur) that showed near-diagnostic features across their species distribution ranges withQ. pyrenaicaandQ. pubescensexhibiting the highest and lowest diagnosticity, respectively.

Conclusions

We provide a new, efficient and reliable molecular tool for the identification of the speciesQ. petraea, Q. robur, Q. pubescensandQ. pyrenaica, which can be used as a routine tool in forest research and management. This study highlights the resolution offered by whole-genome sequencing data to design diagnostic marker sets for taxonomic assignment, even for species complexes with relatively low differentiation.
Multiplexed tumor profiling with generative AI accelerates histopathology workflows and improves clinical predictions
Authors: Pati Pushpak , Karkampouna Sofia , Bonollo Francesco , Comperat Eva , Radic Martina , Spahn Martin , Martinelli Adriano , Wartenberg Martin , Kruithof-de Julio Marianna , Rapsomaniki Maria Anna
Published: December 2023

Understanding the spatial heterogeneity of tumors and its links to disease is a cornerstone of cancer biology. Emerging spatial technologies offer unprecedented capabilities towards this goal, but several limitations hinder their clinical adoption. To date, histopathology workflows still heavily depend on hematoxylin & eosin (H&E) and serial immunohistochemistry (IHC) staining, a cumbersome and tissue-exhaustive process that yields unaligned tissue images. We propose the VirtualMultiplexer, a generative AI toolkit that translates real H&E images to matching IHC images for several markers based on contrastive learning. The VirtualMultiplexer learns from unpaired H&E and IHC images and introduces a novel multi-scale loss to ensure consistent and biologically reliable stainings. The virtually multiplexed images enabled training a Graph Transformer that simultaneously learns from the joint spatial distribution of several markers to predict clinically relevant endpoints. Our results indicate that the VirtualMultiplexer achieves rapid, robust and precise generation of virtually multiplexed imaging datasets of high staining quality that are indistinguishable from the real ones. We successfully employed transfer learning to generate realistic virtual stainings across tissue scales, patient cohorts, and cancer types with no need for model fine-tuning. Crucially, the generated images are not only realistic but also clinically relevant, as they greatly improved the prediction of different clinical endpoints across patient cohorts and cancer types, speeding up histopathology workflows and accelerating spatial biology.
Optimizingex-vitroone-step RUBY-equipped hairy root transformation in drug- and hemp-type Cannabis
Authors: Ajdanian Ladan , Niazian Mohsen , Torkamaneh Davoud
Published: December 2023

Using synthetic biology techniques to engineer secondary metabolic pathways through hairy root transformation is one of the most advanced approaches used in research. In this study, we optimized anex-vitroone-step hairy root transformation of theRUBYsystem in both drug- and hemp-type cannabis, shedding light on its potential applications in secondary metabolite production. Three different strains ofA. rhizogenesincluding (A4, ARqual, and K599) were used. Significant variation in HR induction and transformation efficiency (TE) was observed based onA. rhizogenesstrains and seed types. Drug-type seedlings exhibited the highest hairy root induction, increasing by 58.8% compared to hemp-type seedlings. Also, the A4 strain consistently demonstrated the highest transformation efficiency (75%) irrespective of genotype, while the ARqual strain yielded the lowest one (8.33%). In conclusion, our study is the first to present anex-vitroone-step transformation of both hemp- and drug-type cannabis. In comparison to the in vitro method, our ex-vitro method is simpler, faster, and has a lower risk of contamination, making it an excellent choice for the efficient production of secondary metabolites in cannabis using the CRISPR/Cas system.
Subfamily C7 Raf-like kinases MRK1, RAF26, and RAF39 regulate immune homeostasis and stomatal opening inArabidopsis thaliana
Authors: Dias Márcia Gonçalves , Doss Bassem , Rawat Anamika , Siegel Kristen R. , Mahathanthrige Tharika , Sklenar Jan , Derbyshire Paul , Dharmasena Thakshila , Cameron Emma , Zipfel Cyril , Menke Frank L.H. , Monaghan Jacqueline
Published: December 2023

The calcium-dependent protein kinase CPK28 is a regulator of immune homeostasis in multiple plant species. Here, we used a proteomics approach to uncover CPK28-associated proteins. We found that CPK28 associates with subfamily C7 Raf-like kinases MRK1, RAF26, and RAF39, and trans-phosphorylates RAF26 and RAF39. Metazoan Raf kinases function in mitogen-activated protein kinase (MAPK) cascades as MAPK kinase kinases (MKKKs). Although Raf-like kinases share some features with MKKKs, we found that MRK1, RAF26, and RAF39 are unable to trans-phosphorylate any of the 10 Arabidopsis MKKs. We show that MRK1, RAF26, and RAF39 localize to the cytosol and endomembranes, and we define redundant roles for these kinases in stomatal opening, immune-triggered reactive oxygen species (ROS) production, and resistance to a bacterial pathogen. Overall, our study suggests that C7 Raf-like kinases associate with and are phosphorylated by CPK28, function redundantly in stomatal immunity, and possess substrate specificities distinct from canonical MKKKs.
Perineuronal nets and the neuronal extracellular matrix can be imaged by genetically encoded labeling of HAPLN1in vitroandin vivo
Authors: Lemieux Sakina P. , Lev-Ram Varda , Tsien Roger Y. , Ellisman Mark H.
Published: December 2023

Neuronal extracellular matrix (ECM) and a specific form of ECM called the perineuronal net (PNN) are important structures for central nervous system (CNS) integrity and synaptic plasticity. PNNs are distinctive, dense extracellular structures that surround parvalbumin (PV)-positive inhibitory interneurons with openings at mature synapses. Enzyme-mediated PNN disruption can erase established memories and re-open critical periods in animals, suggesting that PNNs are important for memory stabilization and conservation. Here, we characterized the structure and distribution of several ECM/PNN molecules around neurons in culture, brain slice, and whole mouse brain. While specific lectins are well-established as PNN markers and label a distinct, fenestrated structure around PV neurons, we show that other CNS neurons possess similar extracellular structures assembled around hyaluronic acid, suggesting a PNN-like structure of different composition that is more widespread. We additionally report that genetically encoded labeling of hyaluronan and proteoglycan link protein 1 (HAPLN1) reveals a PNN-like structure around many neuronsin vitroandin vivo. Our findings add to our understanding of neuronal extracellular structures and describe a new mouse model for monitoring live ECM dynamics.
Early-life experience determines the social stability of adult communities in female mice
Authors: Doludda Birte , Bogado Lopes Jadna , Zocher Sara , Kempermann Gerd , Overall Rupert W
Published: December 2023

Early social interactions critically shape lifelong individual behaviour but their development and stability have been difficult to study in laboratory settings. Our experimental platform allows the automated real-time and longitudinal study of social structure in mice living in a shared environment, providing previously inaccessible behavioural measures. These include estimates of directed agonistic activity for the reconstruction of social hierarchies and their dynamics over the life-course. In an all-female colony of genetically identical mice, pairwise inter-individual interactions revealed stable dominance hierarchies that already emerged early in life. Older animals introduced into a new colony exhibited a steeper hierarchy compared to adolescent mice or mature mice that had been co-housed throughout life. Our longitudinal analysis of social dominance hierarchies highlights the critical role of early-life experience.

One-Sentence Summary

Automated tracking of mouse colonies revealed differences in social structure dependent on the animals’ early-life experience.
Lack of Purple Acid PhosphataseSlPAP26bcompromises the phosphorus starvation response in tomato independent of SlPHR1 and SlPHL1
Authors: Akash  , Srivastava Rajat , Roychowdhury Abhishek , Sharma Kapil , Cerny Martin , Kerchev Pavel , Kumar Rahul
Published: December 2023

The scarcity of soil phosphorus (P), an essential macronutrient, often limits plant growth and development. Enhanced secretion of intracellular and secretory acid phosphatases is essential to maintain cellular inorganic P (Pi) homeostasis in plants. Herein, using transcriptomics and proteomics approach, we observed upregulation of several purple acid phosphatases (PAPs), includingSlPAP1,SlPAP10b,SlPAP12,SlPAP15,SlPAP17b,SlPAP26a, andSlPAP26bin Pi-deficient tomato seedlings. Higher transcript levels ofSlPAP17bandSlPAP26bin the older senescing leaves than the younger leaves indicated active involvement of these PAPs in Pi remobilization. Subsequent detailed characterization ofSlPAP17b,SlPAP26a, andSlPAP26brevealed a prominent role ofSlPAP26bin Pi homeostasis. Silencing ofSlPAP26bled to an exacerbated P starvation response as these plants exhibited smaller shoots, lower soluble Pi, total P levels, and higher sucrose than their EV controls under Pi deprivation.SlPAP26b-silenced plants also showed misregulation of P starvation inducible genes such as phosphate transporters and glycerolipid remodellers, even under Pi-sufficient conditions. WhereasSlPAP26blevels were induced by external sucrose, its expression was found to be independent of the Myb class master regulators of P starvation response, SlPHR1 and SlPHL1. Altogether, this study identifies a prominent role ofSlPAP26bin the Pi compensation network in tomato seedlings.