Crystal Structure of Caryolan-1-ol Synthase, a Sesquiterpene Synthase Catalyzing an Initial Anti-Markovnikov Cyclization Reaction.

In a continuing effort to understand reaction mechanisms of terpene synthases catalyzing initial anti-Markovnikov cyclization reactions, we solved the X-ray crystal structure of (+)-caryolan-1-ol synthase (CS) from Streptomyces griseus, with and without an inactive analog of the farnesyl diphosphate (FPP) substrate, 2-fluorofarnesyl diphosphate (2FFPP), bound in the active site of the enzyme. The CS-2FFPP structure was solved to 2.65 Å resolution and showed the ligand in an elongated orientation, incapable of undergoing the initial cyclization event to form a C1-C11 bond. Intriguingly, the apo CS structure (2.2 Å) also had electron density in the active site, in this case, well fit by a curled-up tetraethylene glycol molecule recruited, presumably, from the crystallization medium. The density was also well fit by a molecule of farnesene suggesting that the structure may mimic an intermediate along the reaction coordinate. The curled-up conformation of tetraethylene glycol was accompanied by dramatic rotation of some active-site residues in comparison to the 2FFPP-structure. Most notably, W56 and F183 undergo 90° rotations between the 2FFPP complex and apoenzyme structures, suggesting that these residues provide interactions that help curl the tetraethylene glycol molecule in the active site, and by extension perhaps also a derivative of the FPP substrate in the normal course of the cyclization reaction. In support of this proposal, the CS W56L and F183A variants were observed to be severely restricted in their ability to catalyze C1-C11 cyclization of the FPP substrate and instead produced predominantly acyclic terpene products dominated by farnesol, ß-farnesene, and nerolidol.

Quasi-steady aerodynamic theory under-predicts glide performance in flying snakes.

Flying snakes (genus Chrysopelea) glide without the use of wings. Instead, they splay their ribs and undulate through the air. A snake's ability to glide depends on how well its morphing wing-body produces lift and drag forces. However, previous kinematics experiments under-resolved the body, making it impossible to estimate the aerodynamic load on the animal or to quantify the different wing configurations throughout the glide. Here, we present new kinematic analyses of a previous glide experiment, and use the results to test a theoretical model of flying snake aerodynamics using previously measured lift and drag coefficients to estimate the aerodynamic forces. This analysis is enabled by new measurements of the center of mass motion based on experimental data. We found that quasi-steady aerodynamic theory under-predicts lift by 35% and over-predicts drag by 40%. We also quantified the relative spacing of the body as the snake translates through the air. In steep glides, the body is generally not positioned to experience tandem effects from wake interaction during the glide. These results suggest that unsteady 3D effects, with appreciable force enhancement, are important for snake flight. Future work can use the kinematics data presented herein to form test conditions for physical modeling, as well as computational studies to understand unsteady fluid dynamics effects on snake flight.

Secondary structure propensities of the Ebola delta peptide E40 in solution and model membrane environments.

The Ebola delta peptide is an amphipathic, 40-residue peptide encoded by the Ebola virus, referred to as E40. The membrane-permeabilising activity of the E40 delta peptide has been demonstrated in cells and lipid vesicles suggesting the E40 delta peptide likely acts as a viroporin. The lytic activity of the peptide increases in the presence of anionic lipids and a disulphide bond in the C-terminal part of the peptide. Previous in silico work predicts the peptide to show a partially helical structure, but there is no experimental information on the structure of E40. Here, we use circular dichroism spectroscopy to report the secondary structure propensities of the reduced and oxidised forms of the E40 peptide in water, detergent micelles, and lipid vesicles composed of neutral and anionic lipids (POPC and POPG, respectively). Results indicate that the peptide is predominately a random coil in solution, and the disulphide bond has a small but measurable effect on peptide conformation. Secondary structure analysis shows large uncertainties and dependence on the reference data set and, in our system, cannot be used to accurately determine the secondary structure motifs of the peptide in membrane environments. Nevertheless, the spectra can be used to assess the relative changes in secondary structure propensities of the peptide depending on the solvent environment and disulphide bond. In POPC-POPG vesicles, the peptide transitions from a random coil towards a more structured conformation, which is even more pronounced in negatively charged SDS micelles. In vesicles, the effect depends on the peptide-lipid ratio, likely resulting from vesicle surface saturation. Further experiments with zwitterionic POPC vesicles and DPC micelles show that both curvature and negatively charged lipids can induce a change in conformation, with the two effects being cumulative. Electrostatic screening from Na+ ions reduced this effect. The oxidised form of the peptide shows a slightly lower propensity for secondary structure and retains a more random coil conformation even in the presence of PG-PC vesicles.

Differences in urban arthropod communities may not limit the nestling diet of a generalist songbird.

Anthropogenic land use, including urbanization, has caused population declines across diverse taxa including arthropods and songbirds. Declines in one taxa can impact other groups based on its role in a community. In particular, declines in lower trophic level taxa, such as arthropods, could have negative impacts on higher trophic level species. Here, we examined how urban arthropod communities compare to rural ones and how these differences may impact song sparrow (Melospiza melodia) nestlings living in urban and rural habitats. We quantified differences in the abundance, biomass, and diversity of arthropod communities between replicate urban and rural sites. At the same sites, we also compared the stomach contents of nestlings because song sparrows rely upon arthropod prey during development. We found that the arthropod community in urban habitats had lower average abundance, average biomass, and Simpson's diversity compared to rural habitats. The arthropod communities also significantly differed in the relative abundance of some higher trophic level taxa, such as spiders. However, we found no difference in the total stomach content mass, nor the mass of invertebrate food items in the stomachs of urban and rural nestlings. Thus, though urban habitats had lower availability of arthropods, possibly driven by the simplification of urban habitats, there was no evidence of a negative impact on the quantity of food provided to urban song sparrow nestlings.

Responsive nanocellulose-PNIPAM millicapsules.

HYPOTHESIS: Milli- and micro-capsules are developed to facilitate the controlled release of diverse active ingredients by passive diffusion or a triggered burst. As applications expand, capsules are required to be increasingly multi-functional, combining benefits like encapsulation, response, release, and even movement. Balancing the increasingly complex demands of capsules is a desire to minimize material usage, requiring efficient structural and chemical design. Designing multifunctional capsules with complex deformation should be possible even after minimizing the material usage through use of sparse fiber networks if the fibers are coated with responsive polymers. EXPERIMENTS: Here capsules are created with a shell made from a mesh of nanoscale bacterial cellulose fibers that provide mechanical strength at very low mass levels, while a coating of thermoresponsive Poly(N-isopropylacrylamide), PNIPAM, on the fibers provides control of permeability, elastic response, and temperature response. These properties are varied by grafting different amounts of polymer using particular reaction conditions. FINDINGS: The addition of PNIPAM to the cellulose mesh capsule enhances its mechanical properties, enabling it to undergo large deformations and recover once stress is removed. The increased elastic response of the capsule also provides reinforcement against drying-induced capillary stresses, limiting the degree of shrinkage during dehydration. Time-lapse microscopy demonstrates thermoreversible swelling of the capsules in response to temperature change. Cycles of swelling and shrinkage drive solvent convection to and from the capsule interior, allowing exchange of contents and mixing with the bulk fluid on a time scale of seconds. Because the cellulose capsules are produced via emulsion-templated fermentation, the polymer-modified biocapsule concept introduced here presents a pathway toward the sustainable and scalable manufacture of multifunctional responsive capsules.

Cryo-EM Structure of Phospholipase Cε Defines N-terminal Domains and their Roles in Activity.

Phospholipase Cε (PLCε) increases intracellular Ca 2+ and protein kinase C (PKC) activity in the cardiovascular system in response to stimulation of G protein coupled receptors (GPCRs) and receptor tyrosine kinases (RTKs). The ability of PLCε to respond to these diverse inputs is due, in part, to multiple, conformationally dynamic regulatory domains. However, this heterogeneity has also limited structural studies of the lipase to either individual domains or its catalytic core. Here, we report the 3.9 Šreconstruction of the largest fragment of PLCε to date in complex with an antigen binding fragment (Fab). The structure reveals that PLCε contains a pleckstrin homology (PH) domain and four tandem EF hands, including subfamily-specific insertions and intramolecular interactions with the catalytic core. The structure, together with a model of the holoenzyme, suggest that part of the N-terminus and PH domain form a continuous surface that could engage cytoplasmic leaflets of the plasma and perinuclear membranes, contributing to activity. Functional characterization of this surface confirm it is critical for maximum basal and G protein-stimulated activities. This study provides new insights into the autoinhibited, basal conformation of PLCε and the first mechanistic insights into how it engages cellular membranes for activity.

The Relationship Between Obesity and Lateral Condyle Fracture Healing: A Pilot Study.

OBJECTIVE: Childhood obesity is a growing public health concern in the United States. Obesity has been shown to lead to increased complications with regards to orthopaedic injuries, such as more severe fracture patterns, notably observed in injuries like lateral condyle fractures of the humerus. However, there is currently a gap in the literature regarding the relationship between obesity and the healing potential of these fractures. This study aims to determine whether obesity is associated with increased surgical time, wound/pin site infections, delayed union/nonunion, and time to union in pediatric patients with lateral condyle fractures of the humerus. METHODS: A retrospective chart review was conducted at a level 1 trauma center on all patients 18 years or younger who sustained a lateral condyle fracture of the humerus. Patients were stratified into groups based on their body mass index-for-age percentile as defined by the Centers for Disease Control and Prevention; normal weight (<85%), overweight (85 to <95%), and obese (≥95%). Demographic data, Weiss classification, postoperative complications (infection, delayed union or nonunion, malunion, and need for repeat surgery), length of surgery, and time to union were recorded. Comparisons of categorical data were analyzed using χ2 tests. Analysis of variance was used to compare the means between weight cohorts for continuous data. RESULTS: A total of 123 patients were analyzed. Sixty-six were categorized as normal weight, 20 were overweight, and 37 were obese. There were no significant differences between weight classes for any complications, including infection, delayed/nonunion, malunion, or repeat surgery. There was no correlation with fracture severity as defined by the Weiss classification of lateral condyle fractures in regards to weight cohort (P = 0.098). There was no significant difference in length of surgery (P = 0.393) or average time to union (P = 0.236) between the weight cohorts. CONCLUSION: In this study, population with higher pediatric obesity rates than the population average, there was no significant correlation between body mass index-for-age and each of the surgical complications reviewed, length of surgery, or time to union, indicating the healing potential of lateral condyle fractures in obese pediatric patients is no more compromised than that of their normal weight peers. LEVEL OF EVIDENCE: Level III-a retrospective study.

The landscape of use of NCCN-guideline chemotherapy regimens in stage I-IIIA breast cancer in an integrated healthcare delivery system.

PURPOSE: The National Comprehensive Cancer Network (NCCN) guidelines recommend a variety of drug combinations with specific administration schedules for the treatment of early-stage breast cancer, allowing physicians to deliver treatments recognizing individual patient complexities, including comorbidities, and patient-physician preference. While use of guideline regimens has shifted over time, there is little data to describe changes in how treatment for early-stage breast cancer has evolved over time. METHODS: In a cohort of 34,109 women treated for stage I-IIIA breast cancer between 2006-2019 at Kaiser Permanente Northern California and Kaiser Permanente Washington, we present the changes in chemotherapy regimens over time, and explore use of NCCN-guideline regimens (GR), guideline regimens used when said regimens were not included in guidelines, referred to as time-discordant regimens (TDR), and non-guideline regimens (NGR). Results are presented by drug combination and over time. RESULTS: Among 12,506 women receiving chemotherapy, 77.4% (n = 9681) received GRs, 9.1% (n = 1140) received TDRs, and 13.5% (n = 1685) received NGRs. In 2006, AC-T (cyclophosphamide-doxorubicin, paclitaxel) was the most common regimen, with TC (cyclophosphamide-docetaxel) becoming the most prevalent by 2019. NGRs were more common in cyclophosphamide-methotrexate-5-fluorouracil (CMF); cyclophosphamide-doxorubicin-paclitaxel-trastuzumab (ACTH); and paclitaxel-trastuzumab (TH). The use of GR has increased over time (p-trend < 0.001), while use of NGR (both in terms of administration schedule and drug combination) and TDR have decreased, although patterns vary by drug combination. CONCLUSION: Chemotherapy delivery has changed markedly over time, with a move toward more use of GR. These data are important for understanding the landscape of chemotherapy delivery in community healthcare settings.

Health Achieved Through Lifestyle Transformation (HALT): A Kaiser Permanente Diet and Lifestyle Intervention Program for Coronary Artery Disease and Type 2 Diabetes.

A whole-food plant-based (WFPB) diet in combination with healthful lifestyle modifications has been shown to be an effective approach to managing and reversing the progression of coronary artery disease and type 2 diabetes mellitus (T2DM). The Health Achieved Through Lifestyle Transformation Program (HALT) is a 20-week real-world healthful diet and lifestyle intervention program implemented at Kaiser Permanente South Sacramento Medical Center (KPSSC), whose goal is to treat, and where possible, reverse CAD and T2DM. Here, our objective is to describe HALT, including enrollment, the intervention, adherence, and data collection activities during a 2-year period from October 15th, 2016, through October 9th, 2018. There were 204 KPSSC members enrolled, of which, 19 (9.3%) had CAD only, 166 (81.4%) had T2DM only, and 19 (9.3%) had both CAD and T2DM. Among the enrolled, 196 (96.1%) completed self-administered questionnaires, and 88.2 to 97.5% completed blood tests, depending on the test. The enrolled were predominantly female (63.2%), ≥50 years old at program entry (83.3%), and white (32.8%) or black (25.5%). HALT has the potential to become a valuable resource for examining the impact of dietary and lifestyle modifications on patients diagnosed with CAD and/or T2DM.

Multiplex spatial omics reveals changes in immune-epithelial crosstalk during inflammation and dysplasia development in chronic IBD patients.

Patients with long-standing inflammatory bowel disease (IBD) face an increased risk of developing colitis-associated cancer (CAC). Although IBD-induced prolonged inflammation seems to be involved in CAC pathogenesis, the specific molecular changes that contribute remain unknown. Here, we applied digital spatial RNA profiling, RNAscope, and imaging mass cytometry to examine paired uninflamed, inflamed, and early dysplastic mucosa of patients with IBD. We observed robust type 3 (IL-17) responses during inflammation, accompanied by elevated JAK-STAT signaling and phosphorylated STAT3 (P-STAT3) levels, with both inflamed and dysplastic mucosa displaying immune cell activation. Higher stromal P-STAT3 was detected in uninflamed and inflamed mucosa of patients who eventually developed dysplasia. CD8a+ T cells did not infiltrate inflamed or dysplastic epithelial regions in these patients, while control patients showed elevated CD8a in inflamed mucosa. Our study reveals distinct inflammatory patterns throughout CAC development, marked by an activated IL-17 pathway, engaged STAT3, and diminished cytotoxic T cell infiltration.

U.S. Ethane Emissions and Trends Estimated from Atmospheric Observations.

Oil and natural gas (O&G) production and processing activities have changed markedly across the U.S. over the past several years. However, the impacts of these changes on air pollution and greenhouse gas emissions are not clear. In this study, we examine U.S. ethane (C2H6) emissions, which are primarily from O&G activities, during years 2015-2020. We use C2H6 observations made by the NOAA Global Monitoring Laboratory and partner organizations from towers and aircraft and estimate emissions from these observations by using an inverse model. We find that U.S. C2H6 emissions (4.43 ± 0.2 Tg·yr-1) are approximately three times those estimated by the EPA's 2017 National Emissions Inventory (NEI) platform (1.54 Tg·yr-1) and exhibit a very different seasonal cycle. We also find that changes in U.S. C2H6 emissions are decoupled from reported changes in production; emissions increased 6.3 ± 7.6% (0.25 ± 0.31 Tg) between 2015 and 2020 while reported C2H6 production increased by a much larger amount (78%). Our results also suggest an apparent correlation between C2H6 emissions and C2H6 spot prices, where prices could be a proxy for pressure on the infrastructure across the supply chain. Overall, these results provide insight into how U.S. C2H6 emissions are changing over time.

Smartphone pupillometry for detection of cerebral vasospasm after aneurysmal subarachnoid hemorrhage.

OBJECTIVES: Vasospasm is a complication of aneurysmal subarachnoid hemorrhage (aSAH) that can change the trajectory of recovery and is associated with morbidity and mortality. Earlier detection of vasospasm could improve patient outcomes. Our objective is to evaluate the accuracy of smartphone-based quantitative pupillometry in the detection of radiographic vasospasm and delayed cerebral ischemia (DCI) after aSAH. MATERIALS AND METHODS: We prospectively collected pupillary light reflex (PLR) parameters from patients with aSAH admitted to a neurocritical care unit at a single hospital twice daily using quantitative smartphone pupillometry recordings. PLR parameters included: Maximum pupil diameter, minimum pupil diameter, percent change in pupil diameter, latency in beginning of pupil constriction to light, mean constriction velocity, maximum constriction velocity, and mean dilation velocity. Two-tailed t-tests for independent samples were performed to determine changes in average concurrent PLR parameter values between the following comparisons: (1) patients with and without radiographic vasospasm (defined by angiography with the need for endovascular intervention) and (2) patients with and without DCI. RESULTS: 49 subjects with aSAH underwent 323 total PLR recordings. For PLR recordings taken with (n=35) and without (n=241) radiographic vasospasm, significant differences were observed in MIN (35.0 ± 7.5 pixels with vasospasm versus 31.6 ± 6.2 pixels without; p=0.002). For PLR recordings taken with (n=43) and without (n=241) DCI, significant differences were observed in MAX (48.9 ± 14.3 pixels with DCI versus 42.5 ± 9.2 pixels without; p<0.001). CONCLUSIONS: Quantitative smartphone pupillometry has the potential to be used to detect radiographic vasospasm and DCI after aSAH.

Patient Characteristics Associated with Intended Nonguideline Chemotherapy in Women with Stage I to IIIA Breast Cancer.

BACKGROUND: Guidelines informing chemotherapy regimen selection are based on clinical trials with participants who do not necessarily represent general populations with breast cancer. Understanding who receives nonguideline regimens is important for understanding real-world chemotherapy administration and how it relates to patient outcomes. METHODS: Using data from the Optimal Breast Cancer Chemotherapy Dosing (OBCD) study, based at Kaiser Permanente Northern California (2006-2019) and Kaiser Permanente Washington (2004-2015), we use logistic regression to examine the associations between patient characteristics and receipt of nonguideline chemotherapy regimens among 11,293 women with primary stage I to IIIA breast cancer receiving chemotherapy. RESULTS: The use of nonguideline regimens was strongly associated with several factors, including older age [≥80 vs. 18-39 years: OR, 5.25; 95% confidence interval (CI), 3.06-9.00; P-trend = 0.002] and HER2 status (HER2+ vs. HER2-: OR, 3.44; 95% CI, 3.06-3.87) and was less likely in women with larger tumor size (>5 cm vs. 0.1 to ≤0.5 cm: OR, 0.56; 95% CI, 0.36-0.87; P-trend = 0.01) and diagnosed in later years (2012-2019 vs. 2005-2011: OR, 0.80; 95% CI, 0.71-0.90). Factors associated varied by type of nonguideline regimens. For example, women with comorbidity and older age were more likely to receive nonguideline drug combinations in particular, whereas women with larger tumor size were less likely to receive nonguideline administration schedules. CONCLUSIONS: Nonguideline chemotherapy regimens are more likely in certain patient populations. IMPACT: These associations highlight that vulnerable patient populations may be less likely to receive guideline care, and thus, real-world studies are essential for understanding how the use of nonguideline regimens impacts patient outcomes in these groups.

Interferon subverts an AHR-JUN axis to promote CXCL13+ T cells in lupus.

Systemic lupus erythematosus (SLE) is prototypical autoimmune disease driven by pathological T cell-B cell interactions1,2. Expansion of T follicular helper (TFH) and T peripheral helper (TPH) cells, two T cell populations that provide help to B cells, is a prominent feature of SLE3,4. Human TFH and TPH cells characteristically produce high levels of the B cell chemoattractant CXCL13 (refs. 5,6), yet regulation of T cell CXCL13 production and the relationship between CXCL13+ T cells and other T cell states remains unclear. Here, we identify an imbalance in CD4+ T cell phenotypes in patients with SLE, with expansion of PD-1+/ICOS+ CXCL13+ T cells and reduction of CD96hi IL-22+ T cells. Using CRISPR screens, we identify the aryl hydrocarbon receptor (AHR) as a potent negative regulator of CXCL13 production by human CD4+ T cells. Transcriptomic, epigenetic and functional studies demonstrate that AHR coordinates with AP-1 family member JUN to prevent CXCL13+ TPH/TFH cell differentiation and promote an IL-22+ phenotype. Type I interferon, a pathogenic driver of SLE7, opposes AHR and JUN to promote T cell production of CXCL13. These results place CXCL13+ TPH/TFH cells on a polarization axis opposite from T helper 22 (TH22) cells and reveal AHR, JUN and interferon as key regulators of these divergent T cell states.

Efficacy of Interceptor G2, Royal Guard and PermaNet 3.0 against pyrethroid-resistant Anopheles gambiae s.l. from Za-Kpota, southern Benin: an experimental hut trial.

BACKGROUND: The widespread use of insecticide-treated nets (ITNs) has significantly contributed to the reduction in malaria cases and deaths observed across Africa. Unfortunately, this control strategy is threatened by the rapid spread of pyrethroid resistance in malaria vectors. Dual-active-ingredient insecticidal nets are now available to mitigate the impact of pyrethroid resistance. To facilitate evidence-based decisions regarding product selection in specific use settings, data are needed on the efficacy of these different nets against local mosquito populations. METHODS: Two experimental hut trials were performed in Za-Kpota, southern Benin in 2021 to evaluate the performance of Interceptor G2 (BASF), Royal Guard (Disease Control Technologies) and PermaNet 3.0 (Vestergaard Frandsen), all dual-active-ingredient bednets, in comparison to untreated or standard pyrethroid-treated bednets, against free-flying wild Anopheles gambiae mosquitoes. The performance of some of these next-generation nets was compared to the same type of nets that have been in use for up to 2 years. Mosquitoes collected in the huts were followed up after exposure to assess the sublethal effects of treatments on certain life-history traits. RESULTS: The predominant species in the study site was Anopheles gambiae sensu stricto (An. gambiae s.s.). Both Anopheles coluzzii and An. gambiae s.s. were resistant to pyrethroids (deltamethrin susceptibility was restored by piperonyl butoxide pre-exposure). In the experimental hut trials, the highest blood-feeding inhibition (5.56%) was recorded for the Royal Guard net, relative to the standard PermaNet 2.0 net (44.44% inhibition). The highest 72-h mortality rate (90.11%) was recorded for the Interceptor G2 net compared to the PermaNet 2.0 net (56.04%). After exposure, the risk of death of An. gambiae sensu lato (An. gambiae s.l.) was 6.5-fold higher with the Interceptor G2 net and 4.4-fold higher with the PermaNet 3.0 net compared to the respective untreated net. Lower mosquito mortality was recorded with an aged Interceptor G2 net compared to a new Interceptor G2 net. Oviposition rates were lower in mosquitoes collected from huts containing ITNs compared to those of untreated controls. None of the mosquitoes collected from huts equipped with Royal Guard nets laid any eggs. CONCLUSIONS: The Royal Guard and Interceptor G2 nets showed a potential to significantly improve the control of malaria-transmitting vectors. However, the PermaNet 3.0 net remains effective in pyrethroid-resistant areas.

Patient characteristics associated with delayed time to adjuvant chemotherapy among women treated for stage I-IIIA breast cancer.

For patients with breast cancer, delays in chemotherapy initiation have been adversely associated with recurrence and survival. We evaluated patient-level factors associated with delayed chemotherapy initiation, from both diagnosis and surgery, in a community-based cohort of women with early-stage breast cancer. For the Optimal Breast Cancer Chemotherapy Dosing study, we identified a cohort of 34,109 women diagnosed with stage I-IIIA breast cancer at two U.S. integrated healthcare delivery systems between 2004 and 2019. We used logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI) to identify patient factors associated with delays in chemotherapy initiation after diagnosis (≥90 days) and surgery (≥60 days). Among 10,968 women receiving adjuvant chemotherapy, 21.1% experienced delays in chemotherapy initiation after diagnosis and 21.3% after surgery. Older age, non-Hispanic Black and Hispanic race and ethnicity, and ER+ and/or PR+ disease were associated with increased likelihood of delays to chemotherapy initiation after diagnosis and surgery. People diagnosed in 2012-2019 (vs. 2005-2011), with a higher grade and larger tumor size were less likely to experience delays. Other factors were associated with a higher likelihood of delays specifically from diagnosis (earlier stage, mastectomy vs. breast-conserving surgery), or surgery (higher comorbidity, increased nodal number). Women diagnosed with breast cancer who were at highest risk of progression and recurrence were less likely to experience delays in chemotherapy initiation after diagnosis and surgery. Understanding reasons for chemotherapy delays beyond patient factors may be potentially important to reduce risk of breast cancer recurrence and progression.

ß-Amino Acids Reduce Ternary Complex Stability and Alter the Translation Elongation Mechanism.

Templated synthesis of proteins containing non-natural amino acids (nnAAs) promises to expand the chemical space available to biological therapeutics and materials, but existing technologies are still limiting. Addressing these limitations requires a deeper understanding of the mechanism of protein synthesis and how it is perturbed by nnAAs. Here we examine the impact of nnAAs on the formation and ribosome utilization of the central elongation substrate: the ternary complex of native, aminoacylated tRNA, thermally unstable elongation factor, and GTP. By performing ensemble and single-molecule fluorescence resonance energy transfer measurements, we reveal that both the (R)- and (S)-ß2 isomers of phenylalanine (Phe) disrupt ternary complex formation to levels below in vitro detection limits, while (R)- and (S)-ß3-Phe reduce ternary complex stability by 1 order of magnitude. Consistent with these findings, (R)- and (S)-ß2-Phe-charged tRNAs were not utilized by the ribosome, while (R)- and (S)-ß3-Phe stereoisomers were utilized inefficiently. (R)-ß3-Phe but not (S)-ß3-Phe also exhibited order of magnitude defects in the rate of translocation after mRNA decoding. We conclude from these findings that non-natural amino acids can negatively impact the translation mechanism on multiple fronts and that the bottlenecks for improvement must include the consideration of the efficiency and stability of ternary complex formation.

Partial coil embolization before surgical clipping of ruptured intracranial aneurysms.

OBJECTIVE: Intraoperative rupture (IOR) is the most common adverse event encountered during surgical clip obliteration of ruptured intracranial aneurysms. Besides increasing surgeon experience and early proximal control, no methods exist to decrease IOR risk. Thus, our objective was to assess if partial endovascular coil embolization to protect the aneurysm before clipping decreases IOR. METHODS: We conducted a retrospective analysis of patients with ruptured intracranial aneurysms that were treated with surgical clipping at two tertiary academic centers. We compared patient characteristics and outcomes of those who underwent partial endovascular coil embolization to protect the aneurysm before clipping to those who did not. The primary outcome was IOR. Secondary outcomes were inpatient mortality and discharge destination. RESULTS: We analyzed 100 patients. Partial endovascular aneurysm protection was performed in 27 patients. Age, sex, subarachnoid hemorrhage severity, and aneurysm location were similar between the partially-embolized and non-embolized groups. The median size of the partially-embolized aneurysms was larger (7.0 mm [interquartile range 5.95-8.7] vs. 4.6 mm [3.3-6.0]; P < 0.001). During surgical clipping, IOR occurred less frequently in the partially-embolized aneurysms than non-embolized aneurysms (2/27, 7.4%, vs. 30/73, 41%; P = 0.001). Inpatient mortality was 14.8% (4/27) in patients with partially-embolized aneurysms and 28.8% (21/73) in patients without embolization (P = 0.20). Discharge to home or inpatient rehabilitation was 74.0% in patients with partially-embolized aneurysms and 56.2% in patients without embolization (P = 0.11). A complication from partial embolization occurred in 2/27 (7.4%) patients. CONCLUSIONS: Preoperative partial endovascular coil embolization of ruptured aneurysms is associated with a reduced frequency of IOR during definitive treatment with surgical clip obliteration. These results and the impact of preoperative partial endovascular coil embolization on functional outcomes should be confirmed with a randomized trial.