Repetitive transcranial magnetic stimulation for post-stroke non-fluent aphasia: a systematic review and meta-analysis of randomized controlled trials.

Objective: To systematically evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) on language function in patients with non-fluent aphasia post-stroke. Methods: We selected randomized clinical trials (RCT) that involved stroke patients with non-fluent aphasia, whose intervention was rTMS vs. no therapy or other therapy. Two researchers autonomously reviewed the literature based on the specified criteria for inclusion and exclusion and completed the process of data extraction, data verification, and quality evaluation. Meta-analysis was performed using RevMan 5.4 and Stata MP 17, while the assessment of risk of bias was carried out utilizing the Risk of Bias version 2 tool (RoB2). Results: The meta-analysis involved 47 RCTs, encompassing 2,190 patients overall. The indexes indicated that rTMS has the potential to decrease the severity of non-fluent aphasia in stroke patients, including improvement of the capability of repetition, naming, and spontaneous language. The determination of BDNF in the serum of patients was also increased. In addition, rTMS reduced the likelihood of depression in stroke patients. Conclusion: To summarize the relevant studies, rTMS has significant effects on improving the language abilities of stroke patients suffering from non-fluent aphasia, including the abilities of repetition, naming, and spontaneous language.

Starch-mediated colloidal chemistry for highly reversible zinc-based polyiodide redox flow batteries.

Aqueous Zn-I flow batteries utilizing low-cost porous membranes are promising candidates for high-power-density large-scale energy storage. However, capacity loss and low Coulombic efficiency resulting from polyiodide cross-over hinder the grid-level battery performance. Here, we develop colloidal chemistry for iodine-starch catholytes, endowing enlarged-sized active materials by strong chemisorption-induced colloidal aggregation. The size-sieving effect effectively suppresses polyiodide cross-over, enabling the utilization of porous membranes with high ionic conductivity. The developed flow battery achieves a high-power density of 42 mW cm-2 at 37.5 mA cm-2 with a Coulombic efficiency of over 98% and prolonged cycling for 200 cycles at 32.4 Ah L-1posolyte (50% state of charge), even at 50 °C. Furthermore, the scaled-up flow battery module integrating with photovoltaic packs demonstrates practical renewable energy storage capabilities. Cost analysis reveals a 14.3 times reduction in the installed cost due to the applicability of cheap porous membranes, indicating its potential competitiveness for grid energy storage.

Antioxidant network-based signatures cluster glioblastoma into distinct redox-resistant phenotypes.

Introduction: Aberrant reactive oxygen species (ROS) production is one of the hallmarks of cancer. During their growth and dissemination, cancer cells control redox signaling to support protumorigenic pathways. As a consequence, cancer cells become reliant on major antioxidant systems to maintain a balanced redox tone, while avoiding excessive oxidative stress and cell death. This concept appears especially relevant in the context of glioblastoma multiforme (GBM), the most aggressive form of brain tumor characterized by significant heterogeneity, which contributes to treatment resistance and tumor recurrence. From this viewpoint, this study aims to investigate whether gene regulatory networks can effectively capture the diverse redox states associated with the primary phenotypes of GBM. Methods: In this study, we utilized publicly available GBM datasets along with proprietary bulk sequencing data. Employing computational analysis and bioinformatics tools, we stratified GBM based on their antioxidant capacities and evaluated the distinctive functionalities and prognostic values of distinct transcriptional networks in silico. Results: We established three distinct transcriptional co-expression networks and signatures (termed clusters C1, C2, and C3) with distinct antioxidant potential in GBM cancer cells. Functional analysis of each cluster revealed that C1 exhibits strong antioxidant properties, C2 is marked with a discrepant inflammatory trait and C3 was identified as the cluster with the weakest antioxidant capacity. Intriguingly, C2 exhibited a strong correlation with the highly aggressive mesenchymal subtype of GBM. Furthermore, this cluster holds substantial prognostic importance: patients with higher gene set variation analysis (GSVA) scores of the C2 signature exhibited adverse outcomes in overall and progression-free survival. Conclusion: In summary, we provide a set of transcriptional signatures that unveil the antioxidant potential of GBM, offering a promising prognostic application and a guide for therapeutic strategies in GBM therapy.

A Temperature Self-Adaptive Electrolyte for Wide-Temperature Aqueous Zinc-Ion Batteries.

The advancement of aqueous zinc-ion batteries (AZIBs) is often hampered by the dendritic zinc growth and the parasitic side reactions between the zinc anode and the aqueous electrolyte, especially under extreme temperature conditions. This study unveils the performance decay mechanism of zinc anodes in harsh environments, characterized by "dead zinc" at low temperatures and aggravated hydrogen evolution and adverse by-products at elevated temperatures. To address these issues, a temperature self-adaptive electrolyte (TSAE), founded on the competitive coordination principle of co-solvent and anions, is introduced. This electrolyte exhibits a dynamic solvation capability, engendering an inorganic-rich solid electrolyte interface (SEI) at low temperatures while an organic alkyl ether- and alkyl carbonate-containing SEI at elevated temperatures. The self-adaptability of the electrolyte significantly enhances the performance of the zinc anode across a broad temperature range. A Zn//Zn symmetrical cell, based on the TSAE, showcases reversible plating/stripping exceeding 16 800 h (>700 d) at room temperature under 1 mA cm-2 and 1 mAh cm-2, setting a record of lifespan. Furthermore, the TSAE enables stable operation of the zinc full batteries across an ultrawide temperature range of -35 to 75 °C. This work illuminates a pathway for optimizing AZIBs under extreme temperatures by fine-tuning the interfacial chemistry.

Bioinformatics analysis and experimental verification of TIGD1 in non-small cell lung cancer.

Introduction: Non-small cell lung cancer (NSCLC) is a prevalent respiratory system tumor. Triggered transposable element derivative 1 (TIGD1) exhibits significant overexpression in various tumor cells and tissues, suggesting its involvement in cancer progression. Methods: Clinical data and gene expression profiles of lung adenocarcinoma were collected from TCGA, UCSC XENA, and GEO databases. Computational techniques and empirical studies were employed to analyze the role of TIGD1 in NSCLC. Cellular experiments were conducted using the H1299 cell line, including RNA interference, cell viability assays, quantitative PCR, wound-healing assays, western blotting, and plate clone formation assays. Results: Bioinformatics analysis revealed TIGD1's potential as a biomarker for diagnosing and predicting lung cancer. It also indicated promise as a target for immune-related therapy and targeted drug therapy. Cellular studies confirmed TIGD1's involvement in cancer cell proliferation, invasion, and migration. Furthermore, an association between TIGD1 and the PI3K/AKT signaling pathway was suggested. Discussion: The findings suggest that TIGD1 plays a vital role in NSCLC progression, making it a potential diagnostic biomarker and therapeutic target. The association with the PI3K/AKT signaling pathway provides insights into the underlying molecular mechanisms. Integrating computational analysis with empirical studies enhances our understanding of TIGD1's significance in NSCLC and opens avenues for further research into targeted therapies.

Improving trans-cleavage activity of CRISPR-Cas13a using engineered crRNA with a uridinylate-rich 5'-overhang.

The engieering of Cas13a crRNA to enhance its binding affinity with the Cas enzyme or target is a promising method of improving the collateral cleavage efficiency of CRISPR-Cas13a systems, thereby amplifying the sensitivity of nucleic acid detection. An examination of the top-performing engineered crRNA (24 nt 5'7U LbuCas13a crRNA, where the 5'-end was extended using 7-mer uridinylates) and optimized conditions revealed an increased rate of LbuCas13a-mediated collateral cleavage activity that was up to seven-fold higher than that of the original crRNA. Particularly, the 7-mer uridinylates extension to crRNA was determined to be spacer-independent for enhancing the LbuCas13a-mediacted collateral cleavage activity, and also benefited the LwaCas13a system. The improved trans-cleavage activity was explained by the interactions between crRNA and LbuCas13a at the molecular level, i.e. the 5'-overhangs were anchored in the cleft formed between the Helical-1 and HEPN2 domains with the consequence of more stable complex, and experimentally verified. Consequently, the improved CRISPR-Cas13a system detected the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA with a sensitivity of 2.36 fM that was 160-times higher than that of the original system. Using isothermal amplification via reverse transcription-recombinase polymerase amplification (RT-RPA), the system was capable to detect SARS-CoV-2 with attomolar sensitivity and accurately identified the SARS-CoV-2 Omicron variant (20/21 agreement) in clinical samples within 40 min.

Tumor-associated macrophages in non-small-cell lung cancer: From treatment resistance mechanisms to therapeutic targets.

Non-small cell lung cancer (NSCLC) remains one of the leading causes of cancer-related deaths worldwide. Different treatment approaches are typically employed based on the stage of NSCLC. Common clinical treatment methods include surgical resection, drug therapy, and radiation therapy. However, with the introduction and utilization of immune checkpoint inhibitors, cancer treatment has entered a new era, completely revolutionizing the treatment landscape for various cancers and significantly improving overall patient survival. Concurrently, treatment resistance often poses a critical challenge, with many patients experiencing disease progression following an initial response due to treatment resistance. Increasing evidence suggests that the tumor microenvironment (TME) plays a pivotal role in treatment resistance. Tumor-associated macrophages (TAMs) within the TME can promote treatment resistance in NSCLC by secreting various cytokines activating signaling pathways, and interacting with other immune cells. Therefore, this article will focus on elucidating the key mechanisms of TAMs in treatment resistance and analyze how targeting TAMs can reduce the levels of treatment resistance in NSCLC, providing a comprehensive understanding of the principles and approaches to overcome treatment resistance in NSCLC.

Is the interspinous process device safe and effective in elderly patients with lumbar degeneration? A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND CONTEXT: Lumbar spinal stenosis is one of the most common diseases affecting the elderly that is characterized by the narrowing of the spinal canal and peripheral neural pathways which may cause back pain and neurogenic intermittent claudication in affected patients. Recently, as an alternative treatment between conservative therapy and decompression surgery, interspinous process device (IPD) such as X-stop, Coflex, DIAM, Aperius, Wallis, etc., has gained enough popularity. PURPOSE: The purpose of this study was to evaluate the efficacy and safety of IPD in the treatment of degenerative lumbar spinal stenosis compared with decompression surgery. STUDY DESIGN: This study was a systematic review and meta-analysis of randomized controlled trials. PATIENT SAMPLE: 555 patients' samples were collected for this study. OUTCOME MEASURES: The Visual Analogue Scale and the Oswestry Disability Index were analyzed, as well as the Zurich Claudication Questionnaire For efficacy evaluation. Complication and reoperation rate was utilized for the assessment of safety. METHODS: A comprehensive literature search was performed through Pubmed, EMBASE, Web of Science, and Cochrane Library until October 2023. Among the studies meeting the eligible criteria, any study in which IPD was utilized in the treatment of degenerative lumbar spinal stenosis was included in the current review. For efficacy evaluation, the Visual Analogue Scale and the Oswestry Disability Index were analyzed, as well as the Zurich Claudication Questionnaire. Complication and reoperation rates were utilized for the assessment of safety. RESULTS: Five randomized controlled trials with 555 patients were included. There were no significant differences in VAS leg pain (SMD - 0.08, 95% CI - 0.32 to 0.15) and back pain (SMD 0.09, 95%CI-0.27 to 0.45), ODI scores (MD 1.08, 95% CI - 11.23 to 13.39) and ZCQ physical function (MD-0.09, 95% CI-0.22 to 0.05) for IPD compared with decompression surgery. In terms of ZCQ symptom severity (MD - 0.22, 95% CI - 0.27 to - 016), decompression surgery showed superior to the IPD. As for complications (RR 1.08, 95% CI 0.36 to 3.27), the IPD had no advantages compared to decompression surgery, whereas inferior to it in reoperation rate (RR 2.58, 95% CI 1.67 to 3.96). CONCLUSIONS: This systematic review and meta-analysis indicated no superiority in the clinical outcome for IPD compared with decompression surgery. However, more clinical studies are warranted to determine the efficacy and safety of IPD.

ROS-mediated up-regulation of SAE1 by Helicobacter pylori promotes human gastric tumor genesis and progression.

Helicobacter pylori (H. pylori) is a major risk factor of gastric cancer (GC). The SUMO-activating enzyme SAE1(SUMO-activating enzyme subunit 1), which is indispensable for protein SUMOylation, involves in human tumorigenesis. In this study, we used the TIMER and TCGA database to explore the SAE1 expression in GC and normal tissues and Kaplan-Meier Plotter platform for survival analysis of GC patients. GC tissue microarray and gastric samples from patients who underwent endoscopic treatment were employed to detect the SAE1expression. Our results showed that SAE1 was overexpressed in GC tissues and higher SAE1 expression was associated with worse clinical characteristics of GC patients. Cell and animal models showed that H. pylori infection upregulated SAE1, SUMO1, and SUMO2/3 protein expression. Functional assays suggested that suppression of SAE1 attenuated epithelial-mesenchymal transition (EMT) biomarkers and cell proliferation abilities induced by H. pylori. Cell and animal models of ROS inhibition in H. pylori showed that ROS could mediate the H. pylori-induced upregulation of SAE1, SUMO1, and SUMO2/3 protein. RNA sequencing was performed and suggested that knockdown of SAE1 could exert an impact on IGF-1 expression. General, increased SUMOylation modification is involved in H. pylori-induced GC.

Bio-inspired carbon electrodes for metal-ion batteries.

Carbon has been widely used as an electrode material in commercial metal-ion batteries (MIBs) because of its desirable electrical, mechanical, and physical properties. Still, traditional carbon electrodes suffer from limited mechanical stability and electrochemical performance in MIBs. Drawing inspiration from biological species, the carbon allotropes, such as fullerenes, carbon nanotubes, and graphene, can be engineered into mechanically robust, highly conductive frameworks with enhanced ion storage and transport capabilities for MIBs. Here, we present an assortment of bio-inspired carbon electrodes that have enhanced the cycling stability, capacity retention, and overall performance of MIBs. In addition, mimicking the structure and functionality of biological systems has led to the development of flexible MIBs whose performance does not degrade even when stretched, bent, or twisted. Finite element analysis (FEA) is a useful guide in identifying such bio-inspired carbon frameworks because it can simulate and analyze potential failure scenarios, such as stress build-up or structural collapse in MIBs. This review highlights through several examples that there is much scope for improving carbon-based electrode materials through bio-inspired designs for practical high-performance MIBs.

Microbial resistance and resilience to drought and rewetting modulate soil N2O emissions with different fertilizers.

Future climate models indicate an enhanced severity of regional drought and frequent rewetting events, which may cause cascading impacts on soil nitrogen cycle and nitrous oxide (N2O) emissions, but the underlying microbial mechanism remains largely unknown. Here we report an incubation study that examined the impacts of soil moisture status and nitrification inhibitor (DCD) on the N2O-producers and N2O-reducers following the application of urea and composted swine manure in an acid soil. The soil moisture treatments included 100 % water-holding capacity (WHC) (wetting, 35.3 % gravimetric soil water content), 40 % WHC (drought, 7 % gravimetric soil water content), and 40 % to 100 % WHC (rewetting). The results showed that N2O emissions were significantly decreased under drought conditions and were significantly increased after rewetting. The resistance of ammonia-oxidizing bacteria and nosZII, which was inhibited by urea or manure application, modulated N2O emissions under drought conditions. The resilience of the functional guilds modulated their dominant role in N2O emissions with rewetting. Ammonia-oxidizing bacteria, nirS-type denitrifying bacteria and nosZI showed significant resilience in response to rewetting. Significant negative relationships were observed between N2O emissions and nosZII clade under wetting condition and between N2O emissions and nosZI clade after rewetting. Our results highlighted the importance of microbial resistance and resilience in modulating N2O emissions, which help to better understand the dominant way of N2O emissions, and consequently make efficient mitigation strategies under the global climate change.

Vascular endothelial glycocalyx shedding in ventilator-induced lung injury in rats.

Endothelial permeability deterioration is involved in ventilator-induced lung injury (VILI). The integrality of vascular endothelial glycocalyx (EG) is closely associated with endothelial permeability. The hypothesis was that vascular EG shedding participates in VILI through promoting endothelial permeability. In the present study, male Sprague-Dawley (SD) rats were ventilated with high tidal volume (VT =40 ml/kg) or low tidal volume (VT =8 ml/kg) to investigate the effects of different tidal volume and ventilation durations on EG in vivo. We report disruption of EG during the period of high tidal volume ventilation characterized by increased glycocalyx structural components (such as syndecan-1, heparan sulfate, hyaluronan) in the plasma and decreased the expression of syndecan-1 in the lung tissues. Mechanistically, the disruption of EG was associated with increased proinflammatory cytokines and matrix metalloproteinase in the lung tissues. Collectively, these results demonstrate that the degradation of EG is involved in the occurrence and development of VILI in rats, and the inflammatory mechanism mediated by activation of the NF-κB signaling pathway may be partly responsible for the degradation of EG in VILI in rats. This study enhances our understanding of the pathophysiological processes underlying VILI, shedding light on potential therapeutic targets to mitigate VILI.

Development of Inverse-Opal-Structured Charge-Deficient Co9S8@nitrogen-Doped-Carbon to Catalytically Enable High Energy and High Power for the Two-Electron Transfer I+/I- Electrode.

The iodine (I) electrode involving two-electron transfer chemistry by converting between I+ and I-, has the potential to deliver theoretically doubled capacity and higher working voltage platforms, thus achieving higher energy density. However, owing to the slow kinetics of the cascade two-electron transfer reactions, the system suffers from large overpotentials and low power density, especially at high working currents and low temperatures. Here, an inverse-opal-structured cobalt sulfide@nitrogen-doped-carbon (Co9S8@NC) catalyst with unique charge-deficient states is developed to promote the reaction kinetics of the I-/I+ electrode. The charge-deficient Co9S8@NC catalyst not only enables strong physicochemical adsorption with the iodine species but also significantly reduces the activation energy and interfacial charge transfer resistance of the cascade I+/I0/I- conversion reaction. Consequently, the prototypical Zn‖I+/I0/I- battery equipped with the Co9S8@NC catalyst can deliver a high energy density of 554 Wh kg-1 and a stable cycle life of 5000 cycles at 30 °C. Moreover, at a subzero temperature of -30 °C, the battery can exhibit enhanced kinetics and a high power density of 1514 W kg-1, high energy density of 485 Wh kg-1.

Hydrogel and Nanomedicine-Based Multimodal Therapeutic Strategies for Spinal Cord Injury.

Spinal cord injury (SCI) is a severe neurodegenerative disease caused by mechanical and biological factors, manifesting as a loss of motor and sensory functions. Inhibition of injury expansion and even reversal of injury in the acute damage stage of SCI are important strategies for treating this disease. Hydrogels and nanoparticle (NP)-based drugs are the most effective, widely studied, and clinically valuable therapeutic strategies in the field of repair and regeneration. Hydrogels are 3D flow structures that fill the pathological gaps in SCI and provide a microenvironment similar to that of the spinal cord extracellular matrix for nerve cell regeneration. NP-based drugs can easily penetrate the blood-spinal cord barrier, target SCI lesions, and are noninvasive. Hydrogels and NPs as drug carriers can be loaded with various drugs and biological therapeutic factors for slow release in SCI lesions. They help drugs function more efficiently by exerting anti-inflammatory, antioxidant, and nerve regeneration effects to promote the recovery of neurological function. In this review, the use of hydrogels and NPs as drug carriers and the role of both in the repair of SCI are discussed to provide a multimodal strategic reference for nerve repair and regeneration after SCI.

Terahertz reconfigurable metasensor for specific recognition multiple and mixed chemical substances based on AIT fingerprint enhancement.

Terahertz (THz) fingerprint metasensing is an effective method to identify chemical substances in a rapid and non-destructive way. Currently, two main principles are used in THz metasensing: the change of the real part of permittivity causing the dip resonance frequency deviation, and the fingerprint peak of the imaginary part of permittivity causing the dip resonance splitting (absorption induced transparency, AIT). Most previous work investigated AIT detection for only single chemical substance. The suitable AIT metasensor structure are still required for simultaneously measurement of multiple and mixture chemical substances. In this manuscript, we proposed the N-order concentric rings metasensor for specific recognition multiple and mixed chemical substances based on AIT fingerprint enhancement. The structure has broadband multiple plasmonic resonance dips which are generated by near field dipole resonances. The equivalent circuit model was built to realize the reconfigurable function. Then, 5-order concentric rings structure was designed and fabricated for simultaneously specific recognition of four chemical substances (α-lactose, benzoic acid, vitamin B2 and 2, 5-dichloroanline). The influence of the real and imaginary part of the chemical substances' permittivity on AIT effect had discussed in details. Simulation results indicated that the frequency-deviation of the resonance dip can be stabilized and will not be changed when the concentration of chemical substances is over 20 mg/mL. As shifted plasmonic resonance peaks match the chemical substances' imaginary part of permittivity fingerprint spectra, the perfect AIT effect can be realized. The metasensor can simultaneously and non-destructively conduct a specific detection of α-lactose, benzoic acid, vitamin B2 and 2,5-dichloroanline, and their mixture. The limit of detections of α-lactose, benzoic acid, vitamin B2 and 2,5-dichloroanline are 8.61 mg/mL, 6.96 mg/mL, 7.54 mg/mL and 8.35 mg/mL, respectively. Also, the sensitivity of the metasensor can reach 0.00211, 0.00208, 0.00211 and 0.00219 (unit: 1/mg/mL), respectively. By utilizing one-way analysis of variance method, the possibility of recognition error for each chemical substance is lower than 0.001. Our metasensor provides a novel and accurate platform for THz fingerprint sensing.

The sprT Gene of Bacillus velezensis FZB42 Is Involved in Biofilm Formation and Bacilysin Production.

Bacillus velezensis FZB42, a representative strain of plant-growth-promoting rhizobacteria (PGPR), can form robust biofilm and produce multiple antibiotics against a wild range of phytopathogens. In this study, we observed different biofilm morphology of the mutant Y4, derived from a TnYLB-1 transposon insertion library of B. velezensis FZB42. We identified that the transposon was inserted into the sprT gene in Y4. Our bioinformatics analysis revealed that the SprT protein is an unstable hydrophilic protein located in the cytoplasm. It is highly conserved in Bacillus species and predicted to function as a metalloprotease by binding zinc ions. We also demonstrated that ΔsprT significantly reduced the swarming ability of FZB42 by ~5-fold and sporulation capacity by ~25-fold. In addition, the antagonistic experiments showed that, compared to the wild type, the ΔsprT strain exhibited significantly reduced inhibition against Staphylococcus aureus ATCC-9144 and Phytophthora sojae, indicating that the inactivation of sprT led to decreased production of the antibiotic bacilysin. The HPLC-MS analysis confirmed that bacilysin was indeed decreased in the ΔsprT strain, and qPCR analysis revealed that ΔsprT down-regulated the expression of the genes for bacilysin biosynthesis. Our results suggest that the sprT gene plays a regulatory role in multiple characteristics of B. velezensis FZB42, including biofilm formation, swarming, sporulation, and antibiotic production.

Feature Pyramid Fusion Network for Hyperspectral Pansharpening.

Hyperspectral (HS) pansharpening aims at fusing an observed HS image with a panchromatic (PAN) image, to produce an image with the high spectral resolution of the former and the high spatial resolution of the latter. Most of the existing convolutional neural networks (CNNs)-based pansharpening methods reconstruct the desired high-resolution image from the encoded low-resolution (LR) representation. However, the encoded LR representation captures semantic information of the image and is inadequate in reconstructing fine details. How to effectively extract high-resolution and LR representations for high-resolution image reconstruction is the main objective of this article. In this article, we propose a feature pyramid fusion network (FPFNet) for pansharpening, which permits the network to extract multiresolution representations from PAN and HS images in two branches. The PAN branch starts from the high-resolution stream that maintains the spatial resolution of the PAN image and gradually adds LR streams in parallel. The structure of the HS branch remains highly consistent with that of the PAN branch, but starts with the LR stream and gradually adds high-resolution streams. The representations with corresponding resolutions of PAN and HS branches are fused and gradually upsampled in a coarse to fine manner to reconstruct the high-resolution HS image. Experimental results on three datasets demonstrate the significant superiority of the proposed FPFNet over the state-of-the-art methods in terms of both qualitative and quantitative comparisons.

Chief resident behaviors that lead to effective morning reports, a multisite qualitative study.

BACKGROUND: Morning report is a fundamental component of internal medicine training and often represents the most significant teaching responsibility of Chief Residents. We sought to define Chief Resident behaviors essential to leading a successful morning report. METHODS: In 2016, we conducted a multi-site qualitative study using key informant interviews of morning report stakeholders. 49 residents, Chief Residents, and faculty from 4 Internal Medicine programs participated. Interviews were analyzed and coded by 3 authors using inductive reasoning and thematic analysis. A preliminary code structure was developed and expanded in an iterative process concurrent with data collection until thematic sufficiency was reached and a final structure was established. This final structure was used to recode all transcripts. RESULTS: We identified four themes of Chief Resident behaviors that lead to a successful morning report: report preparation, delivery skills, pedagogical approaches, and faculty participation. Preparation domains include thoughtful case selection, learning objective development, content editing, and report organization. Delivery domains include effective presentation skills, appropriate utilization of technology, and time management. Pedagogical approach domains include learner facilitation techniques that encourage clinical reasoning while nurturing a safe learning environment, as well as innovative teaching strategies. Moderating the involvement of faculty was identified as the final key to morning report effectiveness. Specific behavior examples are provided. CONCLUSION: Consideration of content preparation, delivery, pedagogical approaches, and moderation of faculty participation are key components to Chief Resident-led morning reports. Results from this study could be used to enhance faculty development for Chief Residents.