Cemented Constrained Liners Used as an Articulating Hip Spacer for the Treatment of Chronic Prosthetic Joint Infection.

Background: Two-stage exchange arthroplasty remains the gold standard for treating chronic hip periprosthetic joint infections. However, controversy remains regarding the optimal spacer type, particularly among patients with increased dislocation risk. This study reports on the outcomes of articulating hip spacers utilizing a single constrained-liner design. Methods: All patients who underwent treatment for hip periprosthetic joint infection at a single institution were screened. Patients were included if they received an articulating spacer utilizing a constrained liner of a single manufacturer design. Indications for constrained liner, demographic variables, and surgical variables were recorded. Patients were assessed for dislocation and component loosening prior to the second stage or at the final follow-up if the second stage was not undertaken. Comparative analysis was performed. Results: Overall, 26 constrained liners were utilized in 25 patients. Indications for constrained liner included history of dislocation (n = 14), massive proximal femoral bone loss (n = 14), greater trochanteric deficiency (n = 12), and absent abductors (n = 7). Many patients had more than one indication. In total, 9 hips (34.6%) underwent a second stage at an average of 7.4 months, while 17 hips never underwent a second stage with an average follow-up of 27.6 months. One patient experienced failure of their constrained liner prior to the second stage due to pelvic discontinuity and massive acetabular bone loss. Conclusions: Utilization of a constrained liner as an articulating spacer is a viable option for patients at high risk of instability. Meticulous cement technique, appropriate component position, and implant selection are crucial in achieving successful outcomes.

Potential role of B- and NK-cells in the pathogenesis of pediatric aplastic anemia through deep phenotyping.

Introduction: Pediatric patients with unexplained bone marrow failure (BMF) are often categorized as aplastic anemia (AA). Based on the accepted hypothesis of an auto-immune mechanism underlying AA, immune suppressive therapy (IST) might be effective. However, due to the lack of diagnostic tools to identify immune AA and prognostic markers to predict IST response together with the unequaled curative potential of hematopoietic stem cell transplantation (HSCT), most pediatric severe AA patients are momentarily treated by HSCT if available. Although several studies indicate oligoclonal T-cells with cytotoxic activities towards the hematopoietic stem cells, increasing evidence points towards defective inhibitory mechanisms failing to inhibit auto-reactive T-cells. Methods: We aimed to investigate the role of NK- and B-cells in seven pediatric AA patients through a comprehensive analysis of paired bone marrow and peripheral blood samples with spectral flow cytometry in comparison to healthy age-matched bone marrow donors. Results: We observed a reduced absolute number of NK-cells in peripheral blood of AA patients with a skewed distribution towards CD56bright NK-cells in a subgroup of patients. The enriched CD56bright NK-cells had a lower expression of CD45RA and TIGIT and a higher expression of CD16, compared to healthy donors. Functional analysis revealed no differences in degranulation. However, IFN-γ production and perforin expression of NK-cells were reduced in the CD56bright-enriched patient group. The diminished NK-cell function in this subgroup might underly the auto-immunity. Importantly, NK-function of AA patients with reduced CD56bright NK-cells was comparable to healthy donors. Also, B-cell counts were lower in AA patients. Subset analysis revealed a trend towards reduction of transitional B-cells in both absolute and relative numbers compared to healthy controls. As these cells were previously hypothesized as regulatory cells in AA, decreased numbers might be involved in defective inhibition of auto-reactive T-cells. Interestingly, even in patients with normal distribution of precursor B-cells, the transitional compartment was reduced, indicating partial differentiation failure from immature to transitional B-cells or a selective loss. Discussion: Our findings provide a base for future studies to unravel the role of transitional B-cells and CD56bright NK-cells in larger cohorts of pediatric AA patients as diagnostic markers for immune AA and targets for therapeutic interventions.

Postoperative outcomes and trends in computer-navigated and robotic-assisted total hip arthroplasty.

INTRODUCTION: As the volume of technology-assisted total hip arthroplasty (THA) increases, there is a need to characterise the outcomes of robotic-assisted (RA) and computer-navigated (CN) THA. The goal of this study was to assess outcomes and opioid consumption following CN-THA and RA-THA compared to conventionally-instrumented (CON) THA. METHODS: The Premier Database was queried for all patients who underwent primary, elective THA from 2015-2020. Patients were divided into 3 groups: CN, RA, or CON-THA. Yearly usage trends were assessed. Univariate and multivariate analyses were performed to assess the 90-day risk of postoperative complications. Opioid consumption was reported in morphine milligram equivalents (MME) for postoperative days (POD) 0 and 1. RESULTS: Overall, 474,707 elective THAs were identified (95.7% CON, 2.1% CN, 2.2% RA. After accounting for confounders, CN-THA patients were at decreased risk for periprosthetic joint infection (PJI) (aOR: 0.55, p < 0.001) and dislocation (aOR 0.45, p < 0.001), but increased risk for blood transfusion (aOR 1.97, <0.001) compared to CON-THA. RA-THA patients were at decreased risk of dislocation (aOR:0.66, p < 0.001) but increased risk for transfusion (aOR 1.20, p < 0.001), prosthesis breakage (aOR 3.88, p < 0.001), and periprosthetic fracture (aOR 1.72, p < 0.001). Opioid consumption for CN-THA patients was lower on POD1 and lower for RA-THA patients POD0 and 2 compared to CON-THA. DISCUSSION: CN-THA was associated with reduced rates of PJI and dislocation, but increased rates of blood transfusion while RA-THA was associated with decreased rates of dislocation, but increased rates of blood transfusion, prosthesis complications, and periprosthetic fracture compared to CON-THA. Technology-assisted THA was associated with lower postoperative opioid consumption.

Structures of TGF-ß with betaglycan and the signaling receptors reveal the mechanism whereby betaglycan potentiates receptor complex assembly and signaling.

Betaglycan (BG) is a transmembrane co-receptor of the transforming growth factor-ß (TGF-ß) family of signaling ligands. It is essential for embryonic development and tissue homeostasis and fertility in adults. It functions by enabling binding of the three TGF-ß isoforms to their signaling receptors and is additionally required for inhibin A (InhA) activity. Despite its requirement for the functions of TGF-ßs and InhA in vivo, structural information explaining BG ligand selectivity and its mechanism of action is lacking. Here, we determine the structure of TGF-ß bound both to BG and the signaling receptors, TGFBR1 and TGFBR2. We identify key regions responsible for ligand engagement, which has revealed novel binding interfaces that differ from those described for the closely related co-receptor of the TGF-ß family, endoglin, thus demonstrating remarkable evolutionary adaptation to enable ligand selectivity. Finally, we provide a structural explanation for the hand-off mechanism underlying TGF-ß signal potentiation.

Photon Momentum Enabled Light Absorption in Silicon.

Photons do not carry sufficient momentum to induce indirect optical transitions in semiconducting materials, such as silicon, necessitating the assistance of lattice phonons to conserve momentum. Compared to direct bandgap semiconductors, this renders silicon a less attractive material for a wide variety of optoelectronic applications. In this work, we introduce an alternative strategy to fulfill the momentum-matching requirement in indirect optical transitions. We demonstrate that when confined to scales below ∼3 nm, photons acquire sufficient momentum to allow electronic transitions at the band edge of Si without the assistance of a phonon. Confined photons allow simultaneous energy and momentum conservation in two-body photon-electron scattering; in effect, converting silicon into a direct bandgap semiconductor. We show that this less-explored concept of light-matter interaction leads to a marked increase in the absorptivity of Si from the UV to the near-IR. The strategy provides opportunities for more efficient use of indirect semiconductors in photovoltaics, energy conversion, light detection, and emission.

Resolution of a chronic occipital wound with exposed skull bone with a fish skin graft: a successful treatment approach.

Chronic skin defects in the head, face and neck pose challenges for closure, especially after multiple surgeries or radiation therapy. We report the case of a woman in her 70s with a chronic occipital wound following squamous cell carcinoma resections, resulting in exposed skull bone. Despite various options, we successfully treated the 4 cm x 5 cm wound with a Kerecis fish skin graft (FSG), observing significant improvement within a week. The FSG promoted granulation tissue formation, enabling subsequent full-thickness skin grafting from the patient's groin. Complete wound closure was achieved within 2 weeks, indicating FSG's efficacy in complex wound management. Our experience highlights FSG's potential as a valuable tool in wound healing and reconstruction, particularly in challenging cases involving the head and neck.

Career trajectories, transition rates, and birthdate distributions: the rocky road from youth to senior level in men's European football.

This study aimed to assess youth-to-senior transition rates, quantify the magnitude of relative age effect (RAEs), and evaluate how RAEs affect these transitions in 9,527 men's national football players of England, France, Germany, Italy, and Spain. Regardless of national team, only -15%, 25%, and 40% of U17, U19, and U21 players successfully transitioned to the senior team, respectively, whilst -14%-24% progressed to senior level without being selected during youth. Data suggested a skewed birthdate distribution favouring relatively older players at U17, U19, and U21 levels across all countries, whereas RAEs were also present in England, Italy, and Spain at senior level. Youth-to-senior transition rates were modulated by birthdate at U17 and U19, whereby Q4 players were -2 and 1.5 times more likely to successfully transition at senior level than Q1 players, respectively. Selection at youth international level does not guarantee selection at senior level, but does make it more likely. Moreover, relatively younger athletes are disadvantaged in youth categories, although are more likely to transition to senior level once they have entered the pathway.

Parallel Minisci Reaction of gem-Difluorocycloalkyl Building Blocks.

Parallel Minisci reactions of nonfluorinated and gem-difluorinated C4-C7 cycloalkyl building blocks (trifluoroborates and carboxylic acids) with a series of electron-deficient heterocycles were studied. A comparison of the reaction's outcome revealed better product yields in the case of carboxylic acids as the radical precursors in most cases, albeit these reagents were used with three-fold excess under optimized conditions. The nature of the heterocyclic core was found to be important for successful incorporation of the cycloalkyl fragment. The impact of the CF2 moiety on the oxidation potential of fluorinated cycloalkyl trifluoroborates and the reaction outcome, in general, was also evaluated.

Evaluating Research Activity and NIH-Funding Among Academic Ophthalmologists Using Relative Citation Ratio.

PURPOSE: The objective of this study was to evaluate the relationship between research activity and National Institutes of Health (NIH) funding status of the United States (US) academic ophthalmologists. METHODS: A retrospective cross-sectional analysis of bibliometric data was conducted. The NIH Research Portfolio Online Reporting Tools Expenditures and Reports (rePORTER) website was utilized to identify ophthalmology departments in the US that received NIH funding. Affiliated faculty from these institutions were then identified using NIH rePORTER and institutional websites. H-index was calculated using the Scopus database, and the NIH iCite tool was used to determine the Relative Citation Ratio (RCR). The h-index and w-RCR quantified research productivity, while m-RCR measured research impact. RESULTS: Data on 2688 faculty members from 66 departments we re identified, of which 21% were NIH-funded. Faculty members who received NIH-funding had significantly greater research productivity and impact as measured by h-index (32.5 vs 16.6; p < .001), m-RCR (2.2 vs 1.6; p < .001), and w-RCR (147.2 vs 70.1; p < .001) than their non-funded peers. When stratified by academic rank, NIH-funded faculty still had significantly higher h-index (16.1 vs 7.9; p < .001), m-RCR (2.2 vs 1.4; p < .001), and w-RCR (63.2 vs 61.8; p < .001) than non-funded peers. A similar trend was observed among non-tenured faculty members. CONCLUSION: NIH funding is associated with higher research productivity and impact among US academic ophthalmologists as measured by h-index and RCR, which suggests that NIH funding may be a critical factor in enhancing scholarly contributions of ophthalmologists.  These findings underscore the importance of continued investment in NIH funding to foster high-impact research within the field of ophthalmology.

Peripheral blood cytokines and outcomes with immune checkpoint blockade: a systematic review and meta-analysis.

Background: Tumor-promoting inflammation and inflammatory cytokines are linked to immune checkpoint blockade (ICB) resistance. Methods: We assessed the associations between pre-treatment Interleukin-6 (IL-6), Interleukin-8 (IL-8) levels and on-treatment changes in IL-6, IL-8 and C-reactive protein (CRP) with ICB trial end points. Results: 27 studies representing 6,719 patients were included. Low pre-treatment IL-6 levels were associated with improved objective response rate (ORR) (odds ratio (OR) = 0.31 [0.18-0.55]) and better progression-free survival (PFS) (hazard ratio (HR) = 0.59 [0.48-0.72]) and overall survival (OS) [95% confidence interval (CI)] (HR = 0.42 [0.35-0.50]). Low pre-treatment IL-8 levels were associated with improved ORR (OR = 0.47 [0.36-0.61]) and better PFS (HR = 0.65 [0.58-0.74]) and OS (HR = 0.44 [0.39-0.51]). On-treatment decline in CRP was associated with improved ORR (OR = 0.18 [0.11-0.20]), PFS (HR = 0.40 [0.31-0.91]) and OS (HR = 0.48 [0.40-0.58]). Conclusion: Peripheral blood cytokines warrant further evaluation as enrichment and pharmacodynamic biomarkers for strategies targeting tumor-promoting inflammation.

Measuring a substance called C-reactive protein (CRP) in the blood can help predict if cancer treatments that boost the immune system, like immune checkpoint blockers (ICB), will work. CRP levels are increased when there is inflammation in the body, helping cancer cells grow. IL-6 and IL-8 are related blood markers that are more specific to cancer cells and may improve our ability to predict if ICB will effectivity destroy cancer cells. Our study found that having lower levels of IL-6 and IL-8 before treatment and low levels of CRP during treatment might mean patients live longer and respond better to ICB treatments. Measuring IL-6 and IL-8 before treatment and CRP during treatment could help improve how doctors use ICB to treat cancer by managing inflammation that helps cancer grow.

'Athletes', 'Talents', and 'Players': Conceptual Distinctions and Considerations for Researchers and Practitioners.

A clearer understanding of, and tighter boundaries between, terms are important for researchers designing studies as well as for other sport stakeholders creating evidence-informed policies. This article considers the terms 'athlete', 'talent', and 'player' from psychological and sociocultural perspectives and in different sporting communities to highlight the importance of terminological clarity in sport research. We present considerations to clarify the use of these terms within different contexts and how the use of specific terms may affect knowledge mobilization in diverse sporting populations. A conceptual discussion is provided to help operationalize development-related terminology and its associated stages, to better reflect contemporary academic thought, and enhance practical interpretations. Importantly, we also call for greater transparency from researchers when presenting findings and encourage practitioners to clearly define key terms when working in sport. Our intention in this paper is to energize readers to consider how we use language in athlete identification and development contexts, to stimulate deeper thought and discourse around the possible implications these terms may have at any point of an individual's development in sport. Greater deliberation, identification, and acknowledgment of the drawbacks accompanying these terms will be needed before more confident assertions can be made on how researchers and practitioners could (or even should) implement certain terminology across youth sport contexts moving forward. This paper adds to a growing literature on the importance of clarity in terminology and acts as an impetus for those working in specific sports to co-design key terms used by researchers, practitioners, and policy makers.

High-field pulsed EPR spectroscopy under magic angle spinning.

In this work, we demonstrate the first pulsed electron paramagnetic resonance (EPR) experiments performed under magic angle spinning (MAS) at high magnetic field. Unlike nuclear magnetic resonance (NMR) and dynamic nuclear polarization (DNP), commonly performed at high magnetic fields and under MAS to maximize sensitivity and resolution, EPR is usually measured at low magnetic fields and, with the exception of the Spiess group work in the late 1990s, never under MAS, due to great instrumentational challenges. This hampers the investigation of DNP mechanisms, in which electron spin dynamics play a central role, because no experimental data about the latter under DNP-characteristic conditions are available. We hereby present our dedicated, homebuilt MAS-EPR probehead and show the pulsed MAS-EPR spectra of P1 center diamond defect recorded at 7 tesla. Our results reveal unique effects of MAS on EPR line shape, intensity, and signal dephasing. Time-domain simulations reproduce the observed changes in the line shapes and the trends in the signal intensity.

Bacteriocin production facilitates nosocomial emergence of vancomycin-resistant Enterococcus faecium.

Vancomycin-resistant Enterococcus faecium (VREfm) is a prevalent healthcare-acquired pathogen. Gastrointestinal colonization can lead to difficult-to-treat bloodstream infections with high mortality rates. Prior studies have investigated VREfm population structure within healthcare centers. However, little is known about how and why hospital-adapted VREfm populations change over time. We sequenced 710 healthcare-associated VREfm clinical isolates from 2017-2022 from a large tertiary care center as part of the Enhanced Detection System for Healthcare-Associated Transmission (EDS-HAT) program. Although the VREfm population in our center was polyclonal, 46% of isolates formed genetically related clusters, suggesting a high transmission rate. We compared our collection to 15,631 publicly available VREfm genomes spanning 20 years. Our findings describe a drastic shift in lineage replacement within nosocomial VREfm populations at both the local and global level. Functional and genomic analysis revealed, antimicrobial peptide, bacteriocin T8 may be a driving feature of strain emergence and persistence in the hospital setting.

Frequency-Chirped Magic Angle Spinning Dynamic Nuclear Polarization Combined with Electron Decoupling.

Magic angle spinning (MAS) dynamic nuclear polarization (DNP) increases the signal intensity of solid-state nuclear magnetic resonance. DNP typically uses continuous wave (CW) microwave irradiation close to the resonance frequency of unpaired electron spins. In this study, we demonstrate that frequency-chirped microwaves improve DNP performance under MAS. By modulating the gyrotron anode potential, we generate a train of microwave chirps with a maximum bandwidth of 310 MHz and a maximum incident power on the spinning sample of 18 W. We characterize the efficiency of chirped DNP using the following polarizing agents: TEMTriPol-1, AsymPolPOK, AMUPol, and Finland trityl. The effects of different chirp widths and periods are analyzed at different MAS frequencies and microwave powers. Furthermore, we show that chirped DNP can be combined with electron decoupling to improve signal intensity by 59%, compared to CW DNP without electron decoupling, using Finland trityl as a polarizing agent.

Synaptic reorganization of synchronized neuronal networks with synaptic weight and structural plasticity.

Abnormally strong neural synchronization may impair brain function, as observed in several brain disorders. We computationally study how neuronal dynamics, synaptic weights, and network structure co-emerge, in particular, during (de)synchronization processes and how they are affected by external perturbation. To investigate the impact of different types of plasticity mechanisms, we combine a network of excitatory integrate-and-fire neurons with different synaptic weight and/or structural plasticity mechanisms: (i) only spike-timing-dependent plasticity (STDP), (ii) only homeostatic structural plasticity (hSP), i.e., without weight-dependent pruning and without STDP, (iii) a combination of STDP and hSP, i.e., without weight-dependent pruning, and (iv) a combination of STDP and structural plasticity (SP) that includes hSP and weight-dependent pruning. To accommodate the diverse time scales of neuronal firing, STDP, and SP, we introduce a simple stochastic SP model, enabling detailed numerical analyses. With tools from network theory, we reveal that structural reorganization may remarkably enhance the network's level of synchrony. When weaker contacts are preferentially eliminated by weight-dependent pruning, synchrony is achieved with significantly sparser connections than in randomly structured networks in the STDP-only model. In particular, the strengthening of contacts from neurons with higher natural firing rates to those with lower rates and the weakening of contacts in the opposite direction, followed by selective removal of weak contacts, allows for strong synchrony with fewer connections. This activity-led network reorganization results in the emergence of degree-frequency, degree-degree correlations, and a mixture of degree assortativity. We compare the stimulation-induced desynchronization of synchronized states in the STDP-only model (i) with the desynchronization of models (iii) and (iv). The latter require stimuli of significantly higher intensity to achieve long-term desynchronization. These findings may inform future pre-clinical and clinical studies with invasive or non-invasive stimulus modalities aiming at inducing long-lasting relief of symptoms, e.g., in Parkinson's disease.

Permissible HLA mismatches in 9/10 unrelated donor pediatric stem cell transplants using HLA-EMMA, an EBMT IEWP Study.

HSCT with mismatched unrelated donors (MMUD) is associated with inferior outcome compared to matched unrelated donors. We aimed to identify permissible mismatches using HLA-EMMA, which determines permissibility by analyzing amino-acid (AA) sequences, in a single center cohort of 70 pediatric 9/10 MMUD HSCTs and 157 10/10 MUDs for comparison. AA matching was evaluated for the whole HLA protein, the α-helices, and the ß-sheets, in both Host versus Graft (HvG) and Graft vs Host (GvH) direction. Superior EFS was found in 13 patients permissibly mismatched in the HvG direction (totalHvG, 92% vs 58% at 1 year, p=0.009), and in 21 patients matched for AA on the α-helices (αHvG, 90% vs 53%, p=0.002), similar to EFS with 10/10 MUDs (90% vs 80%, p=0.60). EFS was not related to ß-sheet AA matching, nor to matching in the GvH direction. OS trended similarly as EFS for AA mismatches (totalHvG, 92% vs 74%, p=0.075 and αHvG90% vs 71%, p=0.072). These findings were reproduced in an EBMT inborn errors cohort of 271 pediatric 9/10 MMUD HSCTs and 929 10/10 MUD HSCTs, showing a significant effect of αHvG matching on both OS and EFS and similar OS and EFS between αHvG matched MMUDs and 10/10 MUDs. In summary, HvG-AA matching on the α-helices identifies 9/10 MMUD with permissible mismatches correlated with a favorable transplant outcome similar to matched donors.

Serum protein and imaging biomarkers after intermittent steroid treatment in muscular dystrophy.

Background: Weekly Steroids in Muscular Dystrophy (WSiMD) was a pilot study to evaluate once weekly prednisone in patients with Limb Girdle and Becker muscular dystrophy (LGMD and BMD, respectively). At study endpoint, there were trends towards increased lean mass, reduced fat mass, reduced creatine kinase and improved motor function. The investigation was motivated by studies in mouse muscular dystrophy models in which once weekly glucocorticoid exposure enhanced muscle strength and reduced fibrosis. Methods: WSiMD participants provided blood samples for aptamer serum profiling at baseline and after 6 months of weekly steroids. A subset completed magnetic resonance (MR) evaluation of muscle at study onset and endpoint. Results/Conclusions: At baseline compared to age and sex-matched healthy controls, the aggregate serum protein profile in the WSiMD cohort was dominated by muscle proteins, reflecting leak of muscle proteins into serum. Disease status produced more proteins differentially present in serum compared to steroid-treatment effect. Nonetheless, a response to prednisone was discernable in the WSiMD cohort, even at this low dose. Glucocorticoids downregulated muscle proteins and upregulated certain immune process- and matrix-associated proteins. Muscle MR fat fraction showed trends with functional status. The prednisone-responsive markers could be used in larger trial of prednisone efficacy.

Compressed-sensing-inspired reconstruction algorithms in low-dose computed tomography: A review.

BACKGROUND: Optimization of the dose the patient receives during scanning is an important problem in modern medical X-ray computed tomography (CT). One of the basic ways to its solution is to reduce the number of views. Compressed sensing theory helped promote the development of a new class of effective reconstruction algorithms for limited data CT. These compressed-sensing-inspired (CSI) algorithms optimize the Lp (0 ≤ p ≤ 1) norm of images and can accurately reconstruct CT tomograms from a very few views. The paper presents a review of the CSI algorithms and discusses prospects for their further use in commercial low-dose CT. METHODS: Many literature references with the CSI algorithms have been were searched. To structure the material collected the author gives a classification framework within which he describes Lp regularization methods, the basic CSI algorithms that are used most often in few-view CT, and some of their derivatives. Lots of examples are provided to illustrate the use of the CSI algorithms in few-view and low-dose CT. RESULTS: A list of the CSI algorithms is compiled from the literature search. For better demonstrativeness they are summarized in a table. The inference is done that already today some of the algorithms are capable of reconstruction from 20 to 30 views with acceptable quality and dose reduction by a factor of 10. DISCUSSION: In conclusion the author discusses how soon the CSI reconstruction algorithms can be introduced in the practice of medical diagnosis and used in commercial CT scanners.