Although resection is the standard curative treatment in the United States for nonmetastatic colon cancer, postoperative recurrence remains a major concern. The incidence, risk factors, and outcomes of postoperative recurrence have primarily been derived from clinical trials, which may differ significantly from the 'real-world' experience. Therefore, the primary aim of this study is to determine the incidence and risk factors for postoperative recurrence in nonclinical trial patients undergoing surgical resection for nonmetastatic colon cancer at the University of Chicago Comprehensive Cancer Center (UCCCC). This retrospective review included patients of ≥18 y old who were diagnosed with nonmetastatic colon adenocarcinoma, were not enrolled in a clinical trial, and underwent resection of their primary tumor between 2015 and 2023 at UCCCC. Demographic and clinical variables were abstracted from the UCCCC registry. A total of 491 patients were included in the study. The overall recurrence rate was 14.5%, with a median time to recurrence of 10 mo (interquartile range 6-19). Almost all recurrences occurred at distant sites (87.3%). Univariable and multivariable Cox regression analyses showed that a higher overall stage was associated with increased recurrence and decreased survival. The overall recurrence rates were 2% for stage I, 14% for stage II, and 24% for stage III (P < 0.001). This report documents the incidence and risk factors for postoperative recurrence after attempted curative resection for colon cancer in patients not enrolled in a clinical trial. This data can be used to benchmark quality improvement and to educate patients about their expected prognosis.
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We report a cross-sectional analysis of prevalence and distribution of goiter among commercially insured adults ages 18-64 in the United States using the 2022-2023 Merative™ MarketScan® Commercial Claims and Encounters Database. Cases of goiter were identified using ICD-10 diagnosis codes. Prevalence was estimated under nested case definitions and by goiter subtype. Estimates were compared across U.S. Census regions. Multivariable regression was used to model the association of demographic, clinical, and regional variables on goiter prevalence. Among 15.2 million commercially insured adults enrolled in MarketScan on December 31, 2023, overall goiter prevalence was 12.7-24.6 per 1000 persons. Prevalence was substantially higher among women and increased steadily with age. Non-toxic multinodular goiter accounted for most cases. Prevalence varied by U.S. Census region after adjusting for age, sex, toxic status, and diagnostic intensity. The prevalence of goiter, comprised predominantly of non-toxic multinodular goiter, is estimated to be 1.3-2.5% among working-age adults in the U.S. and varies by sex, age, and potentially by geography. Further research is needed to investigate environmental and social drivers of the goiter burden.
Advanced and recurrent uterine cancer has a poor prognosis despite emerging treatment options, complicating the decision-making process. This study aimed to assess patient decision preferences and identify important factors in treatment choices to investigate whether these preferences vary by clinical and demographic characteristics, including race. This was a mixed-methods cross-sectional study, with the administration of validated surveys on quality of life and shared decision-making. Participants with advanced or recurrent uterine cancer at a single urban academic medical center completed an exploratory survey tool and a semi-structured interview. Descriptive statistical analysis, logistic regression, and thematic qualitative analysis were performed. A total of 110 patients were included, with a mean age of 65.7 years. Fifty-three (48.2%) patients identified as White, and 46 (41.8%) identified as Black. Sixty patients (60/110, 54%) preferred "shared decision-making," with no association between this preference and demographics, co-morbidities, or disease characteristics (all P > .1). Participants who were currently employed preferred shared decision-making compared with those who were not employed (odds ratio 0.32, 0.12-0.88, p < .05). While participants reported a range of factors influencing their treatment decisions, the most frequently identified were treatment efficacy (78%), physician recommendation (73%), and side effects (54%). Top decision preferences varied by race: White participants ranked treatment efficacy or physician recommendation more often than Black patients (treatment efficacy, White 86.8% vs Black 70.8%, p < .05; physician recommendation, White 84.9% vs Black 64.6%, p = .02), while more Black participants than White participants reported "length of treatment visits" as the most important factor (Black 18.8% vs White 3.8%, p = .02). The majority of participants with advanced and recurrent uterine cancer preferred shared decision-making. Various factors, such as treatment efficacy, physician recommendation, and side effects, among others, are important in decision-making processes. Individual patient characteristics such as race, employment status, and others should be considered in a patient-centered approach to care.
Hybrid organic-inorganic MXenes (h-MXenes) offer a versatile platform for tailoring the surface chemistry of two-dimensional transition-metal carbides and nitrides through covalently bound organic ligands. Although monodentate amido/imido functionalization has been demonstrated previously, chelating ligand binding has remained unexplored. Here, we report the synthesis of Ti3C2(en)x h-MXenes via substitution of Br terminations in Ti3C2Br2 with deprotonated ethylenediamine (en). By varying the amount of n-BuLi used for en deprotonation, the surface coordination evolves from predominantly monodentate to bidentate binding. This transition is evidenced by a contraction of the interlayer spacing and attenuation of the ─NH2 signal in x-ray photoelectron spectroscopy. Solid-state NMR reveals that bidentate coordination dominates when 4 equiv. of n-BuLi is employed, while inelastic neutron scattering, supported by simulated vibrational spectra, provides independent confirmation of the bidentate binding motif. Density functional theory calculations show that bidentate en is significantly more stable than monodentate configurations for replacing Br terminations. Ab initio molecular dynamics further reveal dynamic surface chemistry involving proton transfer, β-H elimination, surface imine-Ti bond formation, and partial reversion to monodentate coordination. These findings establish ligand denticity as a new design parameter for engineering MXene surface chemistry and tuning material properties.
Chemical secretion deployment is a widespread defensive strategy in arthropods, typically aimed at surviving encounters with predators. However, the ecological forces shaping variation in its use across species remain unclear. We quantified chemical secretion behavior in 11 sympatric species of Prionostemma within the understudied arachnid order Opiliones. We surveyed species in two distinct forests in Costa Rica and tested their secretion propensity when stimulated, and whether these differences correlate with interspecific variation in morphology, leg-loss levels, or social behavior. We found that species varied in their tendency to release chemical secretions, forming a continuous gradient from taxa that rarely secreted to those that secreted in nearly all encounters. However, this variation was not explained by body size or leg loss. Species with similar morphology or comparable leg loss displayed contrasting patterns of secretion. Among the seven sympatric species with available social data, aggregation patterns showed no straightforward association with secretion propensity: species spanned the full range of secretion behavior, regardless of whether they frequently formed roosting aggregations with conspecifics or heterospecifics or roosted alone. Instead, each species combined secretion propensity, leg loss, body size, and aggregation tendencies in distinct ways, indicating a mosaic of defensive strategies rather than a single axis of trait covariation. Together, these results suggest that chemical defense in this group of tropical arachnids is evolutionarily labile and shaped by species-specific ecological and social histories. This work also provides a foundation for future research on the chemical and behavioral mechanisms underlying chemical defensive diversification in arthropods.
Sarcomas with MEIS1 fusions represent a rare, recently recognized group of mesenchymal neoplasms with a predilection for genitourinary and gynecologic sites. A subset exhibits skeletal muscle differentiation resembling spindle cell rhabdomyosarcoma. Existing literature is limited to case reports and small series, with scant comprehensive clinicopathologic, molecular, and outcome data. In this study, we analyzed a multi-institutional cohort of 20 MEIS1-rearranged sarcomas using integrated clinicopathologic review, genomic profiling, and DNA methylation analysis. The tumors occurred in 17 females and 3 males (median age 41 years, range 6-58), arising mainly in the uterus/vagina (n=12), vulva/perineum (n=4), bone (n=2), and kidney (n=2), with a median size of 9 cm (range 2.5-20 cm). Histology showed mostly bland spindle cells in fascicles/storiform patterns, alternating cellularity, fibromyxoid stroma, prominent vascularity, and adipose metaplasia (45%). A subset of cases featured high-grade morphology with epithelioid cells and increased mitotic activity. Skeletal muscle markers were variably positive in 9 cases. Fusions involved MEIS1 with NCOA2 (16/20), NCOA1 (3/20), or FOXO1 (1/20). Recurrent additional genomic alterations included CTNNB1 mutations (31.6%) and MDM2 amplification (15%). DNA methylation profiling showed that MEIS1-rearranged sarcomas formed a unifying cluster comprising two subgroups, regardless of rhabdomyosarcomatous phenotype, clearly separated from other mesenchymal neoplasms, including various rhabdomyosarcoma subtypes and uterine sarcomas. The two DNA methylation subgroups correlated with differences in genome-wide copy-number variation status (Meth-CNVh vs Meth-CNVl), with Meth-CNVh tumors characterized by high mitotic rate, frequent tumor necrosis, recurrent co-occurring CTNNB1 and MDM2 alterations, and recurrent chromosomal arm-level changes. Most importantly, this subgroup exhibited significantly worse overall survival (median 25 vs 44.5 months; p=0.027) and disease-free survival (5 vs 28 months; p=0.017). This study establishes MEIS1-rearranged sarcoma as a distinct entity with generally indolent but potentially aggressive behavior. The two methylation/CNV subgroups provide potential utility for prognostic stratification and highlight actionable molecular targets in high-risk cases.
To evaluate the association between asthma documentation at school (asthma diagnosis and asthma action plan [AAP]) and outcomes after stock inhaler use at school. This observational study examined respiratory events and outcomes in a statewide program that provided albuterol metered dose inhalers to Illinois public schools. Nurses registered online and reported each inhaler use (event). This report collected individual characteristics, asthma documentation, and event outcomes. Analyses included Pearson's Chi-squared tests, Fisher's exact tests, Wilcoxon rank-sum tests, and logistic regression models. In 2023-2024 school year, 656 events occurred requiring stock inhaler use among students across Illinois schools. Students had an asthma diagnosis on file at school in 63% of events (n=413); among these students, 42% had an AAP on file (42%, n=175). For disposition after stock inhaler use, 76% of students returned to class (n=497). Students with an asthma diagnosis documented at school had 2.6 times higher odds of returning to class after stock inhaler use versus those without documentation (95% CI 1.81-3.75). Similarly, students with asthma who also had AAPs on file at school had 2.41 times higher odds of returning to class after respiratory events versus those without AAPs (95% CI 1.39-4.33). These associations remained significant in adjusted models. In a statewide stock inhaler program in Illinois, we found students with asthma diagnoses and AAPs documented at school had higher rates of return to class after stock inhaler use for respiratory symptoms compared to students without such documentation.
Myotonic dystrophy type 1 (DM1) presents significant anesthetic challenges. A 46-year-old woman with DM1 underwent emergent exploratory laparotomy. This case highlights the importance of conservative neuromuscular blocker dosing, quantitative neuromuscular monitoring, clinically-guided timing of sugammadex administration, careful airway planning, and use of opioid-sparing multimodal analgesia in a patient with DM1.
This JAMA Clinical Guidelines Synopsis summarizes the 2026 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on management of dyslipidemia.
Frontotemporal dementia (FTD) and Lewy body dementia (LBD) are distinct neurodegenerative disorders that rarely co-occur. However, their overlapping features can obscure diagnosis and complicate management. We present the case of a 65-year-old man with a history of alcohol use disorder, diabetes, and blindness who developed acute behavioral changes, catatonia, and fluctuating mental status. He exhibited signs consistent with a behavioral variant FTD, including disinhibition, executive dysfunction, and hypersexuality, as well as features associated with LBD, including visual hallucinations, autonomic instability, and waxing-and-waning impairment in cognition. His hospital course was marked by episodic disorientation, variable language use, and persecutory delusions. Neuroimaging, cerebrospinal fluid analysis, and serial neuropsychological testing yielded mixed and inconclusive results, contributing to the diagnostic ambiguity. Treatment included lorazepam, which improved catatonic symptoms but was discontinued due to risk of delirium, and aripiprazole, which was tapered due to suspected neuroleptic sensitivity. The patient was ultimately discharged to memory care with a diagnosis of an unspecified dementia. This case underscores the challenges of diagnosing and managing patients with overlapping features of multiple neurodegenerative disorders. Recognizing points of overlap between syndromes like FTD and LBD is key to tailoring interventions and avoiding harm. Serial cognitive assessments, functional neuroimaging, and biomarker analysis may improve diagnostic accuracy, although these tools have limitations. A deeper understanding of the pathophysiology of overlapping dementia syndromes is crucial for improving diagnostic clarity and guiding treatment strategies.
The ovary consists of heterogeneous populations of somatic cells, both within the follicle and the surrounding stroma, which are critical to support ovarian function and for the generation of high-quality gametes. We report methods for isolating somatic cells from mouse ovaries, including endothelial, epithelial, steroidogenic, stromal, and immune cells. When these primary ovarian somatic cells are plated and cultured in a traditional 2D culture system, the cellular heterogeneity, organization, as well as cell-cell and cell-matrix interactions typically found in the ovary are lost. Thus, we also describe how to generate mouse ovarian somatic organoids using a scaffold-free approach. These organoids self-assemble, maintain diverse cell populations, and produce extracellular matrix and secreted factors, including cytokines. Organoids can be utilized for co-culture experiments and can be maintained in culture for at least 3 weeks with high viability. Overall, these models enable interrogation of ovarian physiology and pathology from the somatic cell perspective.
This retrospective cohort study sought to determine whether higher levels of engagement with the Recovery Record (RR) app were associated with better outcomes on eating disorder (ED) symptoms (Eating Disorder Examination-Questionnaire) (EDE-Q), depression (Patient Health Questionnaire-9), and generalised anxiety (GAD-7) for individuals receiving ED treatment. Participants were 4852 adolescents and young adults receiving treatment between March 2021 and August 2024. RR was made available to all patients during their treatment. Cluster analysis identified three distinct groups: engagement, low engagement, and no engagement. After controlling for baseline severity and treatment duration, engagement was correlated with lower EDE-Q scores at discharge compared to low engagement (β = -0.18, p = 0.010). Engagement was also correlated with significantly lower PHQ-9 scores at discharge relative to both low (β = -0.93, p = 0.004) and no engagement (β = -0.84, p = 0.015) groups. Engagement was associated with lower GAD-7 scores at discharge compared to low engagement (β = -0.90, p = 0.003). Greater average daily logging in the RR app was associated with incremental improvements in all outcomes: EDE-Q (β = -0.042, p = 0.030), PHQ-9 (β = -0.287, p = 0.001), and GAD-7 (β = -0.216, p = 0.010). Findings suggest that engagement with the RR app is associated with better outcomes in terms of ED symptoms, depression, and anxiety.
End user co-design in the personal digital health technology space is underdeveloped. Clinical uptake of personal digital health technologies has been poor, highlighting a need to cocreate solutions with end users. The study aimed to describe an "end user" co-design framework in the development of 5 prototype personal health apps for patients with different rare or complex diseases. A patient-led, user-centered, collaborative personal health app plus wearable plug-in co-design methodology was developed. Five prototype apps were developed for end users with long COVID-19, pancreatitis, primary ciliary dyskinesia, sarcoidosis, and valosin-containing protein disease by a multidisciplinary partnership including patients, app design and development experts, user experience experts, clinicians, and patient-driven organizations. Phase 1 involved a 6-month co-design process with 5 modules involving patient-driven organizations that included the codevelopment of specifications through group workshops and independent exercises that defined the goals, content, features, and user experience of each app. Phase 2 involved app build-out, internal alpha testing, and beta study preparations. Phase 3 involved a usability beta testing study in which end users used the app and associated wearable/smart devices (Oura ring, Lumia ear device, Empatica EmbracePlus, and MIR Spirobank Spirometer) for up to 5 months. Participant feedback was documented continuously and systematically, centering on the following themes: functionality, usability, harms, benefits, self-explorations, and beta testing study details related to retention and adherence. While unique app goals were codeveloped by each disease group, a central goal across groups was to develop a personal health app enabling users to track subjective, self-reported symptoms, objective measures of health, and unique modifiers of symptoms. A total of 239 end user participants participated in the beta testing pilot study. Enrollment and retention rates were high, ranging from 94% to 100% and 92.2% to 100%, respectively. All active participants gave some form of feedback: there were 257 unique participant suggestions of how to specifically modify or improve the study app experience. Participant feedback themes commonly centered around customization to reduce daily burden and improve personal tailoring of the app. Participants' desires surrounding symptom displays were heterogeneous. Personal health app co-design is rooted in a complex digital landscape that requires a significant amount of up-front effort and time. However, the up-front investment of time can result in rich and diverse end user feedback that could save time in the app development trajectory to implementation. This paper provides a co-design framework and the building blocks of 5 prototype personal health apps with publicly available open-source code on GitHub. These prototypes could be leveraged for improving understanding of, communicating symptoms of, and providing n-of-1 suggestions for rare or complex diseases, providing benefit to patient communities and individual patients.
N6-methyladenosine (m6A) RNA methylation is one of the most prevalent reversible post-transcriptional RNA modifications and has been recognized as a crucial regulator of host immune responses. Intestinal epithelial cells (IECs) constitute an important component of gastrointestinal mucosal immunity. Interferons (IFNs) play a central role in maintaining intestinal homeostasis, and m6A methylation status influences IFN-mediated cell-intrinsic defense. In this study, we investigated the potential role of m6A RNA modifications in IFN-γ-stimulated IEC-intrinsic defense. We observed significant alterations in the topology of the m6A mRNA methylome in murine IECs following IFN-γ stimulation. A subset of IFN-γ-stimulated immune gene transcripts exhibited increased m6A RNA methylation, including several members of the immunity-related GTPase family M (IRGM) genes. In addition, IFN-γ-responsive long non-coding RNAs may modulate the m6A methylation levels of multiple IFN-γ-stimulated immune transcripts. Enhanced m6A methylation of the Irgm2/3 transcripts was associated with strengthened cell-intrinsic defense against infection by the protozoan parasite Cryptosporidium. Notably, Cryptosporidium infection altered the host m6A mRNA methylome in IECs, thereby counteracting the IFN-γ-mediated defense response. Although the RNA levels of Irgm2/3 genes were upregulated, their m6A RNA methylation levels and protein expression were reduced in infected cells. This effect was associated with host delivery of dsRNAs derived from Cryptosporidium parvum virus 1, a virus harbored in the parasite. Collectively, our findings suggest that m6A methylation of RNA transcripts enhances IFN-γ-mediated IEC-intrinsic antiparasitic defense, while Cryptosporidium has evolved mechanisms to evade this response by suppressing m6A RNA methylation of IFN-γ-stimulated immune genes.
To describe the prevalence of clinical exercise physiologists (CEPs), hiring criteria, and job tasks in early outpatient cardiac and pulmonary rehabilitation (CR/PR) programs in the United States. In this cross-sectional study, a survey was sent by the American Association of Cardiovascular and Pulmonary Rehabilitation to CR/PR program leaders. Data were analyzed using descriptive statistics. Among 311 programs, 96% (n = 297) offered CR, 71% (n = 222) offered PR, and CEPs were the most frequently reported staff in both CR (86%; n = 256) and PR (83%; n = 185). Staff were exclusively CEPs in 10% (n = 30) of CR and 5% (n = 12) of PR. Hiring criteria for CEPs were a bachelor's degree in 92% (n = 240) and a master's in the remaining programs. Advanced Cardiac Life Support certification was required before or within 1 year of hire in 70% (n = 183) of programs. The American College of Sports Medicine Clinical Exercise Physiologist (ACSM-CEP) credential was required before or within 1 year of hire in 24% (n = 62) of programs. In 75% (n = 196) of programs, CEPs were responsible for the majority (≥23 of 29) of job tasks that are common to CR/PR. Clinical exercise physiologists serve integral roles in CR/PR programs in the United States with job responsibilities that allow them to work at the top of their scope of practice in many programs. Underutilization of CEPs at some institutions might be improved by better understanding the variability in academic preparation and the importance of the ACSM-CEP credential.
In patients with moderate atopic dermatitis (AD), topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI) often do not sufficiently control AD signs/symptoms, and escalation to systemic therapy may be required. Report 8-week results of ruxolitinib cream in TRuE-AD4 (NCT06238817) in patients with moderate AD who had an inadequate response/intolerance/contraindication to TCS and TCI in the past 12 months (post-TCS and -TCI). Patients aged ≥18 years with AD, an Investigator's Global Assessment (IGA) of 3, Eczema Area and Severity Index (EASI) >7, itch numerical rating scale (NRS) ≥4, 10%-20% affected body surface area and Dermatology Life Quality Index score > 10 post-TCS and -TCI were randomized (2:1) to twice-daily 1.5% ruxolitinib cream or vehicle for 8 weeks. Coprimary endpoints at Week 8 were ≥75% improvement in EASI from baseline (EASI-75) and IGA score of 0/1 with a ≥ 2-point improvement from baseline (IGA treatment success [TS]). Of 241 randomized patients (mean age, 37.0 y; 54.4% female), mean EASI and itch NRS scores were 12.6 and 7.4, respectively, at baseline. At Week 8, significantly more patients who applied 1.5% ruxolitinib cream versus vehicle achieved IGA-TS (61.3% vs. 13.6%; p < 0.0001) and EASI-75 (70.0% vs. 18.5%; p < 0.0001). Significantly more patients achieved a ≥ 4-point improvement in itch NRS (itch NRS4) at Day 2 (29.8% vs. 13.7%; p = 0.0072); improvement in current itch (no recall) was observed in 15 min after the first application. No treatment-related adverse events were serious, and the most common adverse event occurring with ruxolitinib cream was application site acne (3.8%). In adults with moderate AD post-TCS and -TCI, who may otherwise be eligible for systemic therapy, 1.5% ruxolitinib cream significantly improved clinical signs of AD, rapidly improved itch and was well tolerated. Thus, ruxolitinib cream may represent an effective topical option before escalation to systemic therapy in patients with moderate AD. Atopic dermatitis (AD), also known as eczema, generally consists of red (inflamed), dry and itchy skin that affects about 2%–10% of adults worldwide. Patients with AD of moderate severity are usually treated with topical corticosteroid (TCS) and topical calcineurin inhibitor (TCI) creams/ointments. If these medicines are not effective, systemic treatments taken by mouth or injected are usually required. We investigated whether ruxolitinib cream is effective and safe in patients with moderate AD after failure of TCS and TCI. A total of 241 adults were recruited in Europe and North America and were asked to apply either ruxolitinib cream or nonmedicated comparator cream 2 times per day for 8 weeks. We found that patients who applied ruxolitinib cream experienced greater reductions in skin inflammation and itch than those who applied nonmedicated comparator cream over the first 8 weeks of treatment. Inflammation was reduced as early as 2 weeks (the first measurement), and itch was reduced 15 min after starting treatment. The most common side effect related to ruxolitinib cream was acne on the areas of skin where ruxolitinib cream was applied (3.8% of patients). No side effects considered related to ruxolitinib cream were serious. These study findings show that ruxolitinib cream is both effective and well‐tolerated in patients with moderate AD after failure of TCS and TCI. Therefore, ruxolitinib cream may be an alternative treatment option for patients before starting systemic treatments.
To compare radiographic and clinical outcomes of vestibular schwannoma management using stereotactic radiosurgery (SRS) and microsurgical resection, with emphasis on paired pre- and post-treatment changes in tumor size and patient outcomes. A retrospective review was conducted of 87 patients treated for vestibular schwannoma between 2013 and 2024 at a single tertiary center. Demographic, clinical, and radiographic variables, including hearing loss, facial weakness, brainstem compression, tumor area, and Koos grade, were analyzed. Tumor area was determined from radiology reports and compared using nonparametric statistical tests, with significance defined as p < 0.05. Microsurgery achieved a median 76% reduction in tumor area, while SRS was associated with relative stability or modest growth (+ 5%) (p < 0.001). Post-treatment rates of hearing loss and facial weakness were similar between groups, suggesting that substantial tumor reduction following microsurgery was not associated with increased morbidity in this cohort. Koos grade correlated with both brainstem compression and hearing loss, with higher grades favoring surgical management (p = 0.049). In the Koos IV subset, surgery achieved significant tumor reduction without disproportionate postoperative deficits compared with lower grades. Microsurgery provides immediate and substantial tumor reduction without increased morbidity, while SRS maintains radiographic stability with favorable clinical outcomes. These findings underscore the complementary roles of both modalities and support the Koos classification as a practical and reliable framework for treatment selection.
Mesenchymal stem cell (MSC)-derived extracellular vesicles (EVs) exhibit significant therapeutic potential across various regenerative applications. When applied to targeted tissue repair such as bone regeneration, precise and site-specific delivery of EVs is essential to ensure optimal therapeutic efficacy. To address this, we evaluated a leucine zipper (LZ)-based self-assembling hydrogel incorporating function-specific motifs as a platform to support site-specific EV delivery in this study. Based on the integrin-mediated binding capability of EVs to extracellular matrix (ECM) components, we generated LZ chimeric proteins containing ECM-derived EV binding motifs and tested their efficacy to bind EVs. As a proof-of-concept approach, we tethered engineered osteoinductive MSC EVs (BMP2 EVs) to RGD-functionalized LZ hydrogels. The combination of these engineered EVs and hydrogels were characterized and evaluated in vitro and in vivo. In vitro results demonstrated the importance of tethering peptides for EV retention within hydrogels as well as the ability of the tethered BMP2 EVs to maintain their physicochemical characteristics and osteoinductive function. When applied in vivo in a rat calvarial defect model, the combination of BMP2 EVs and hydrogels significantly enhanced bone formation and bone quality. Overall, we present a versatile LZ-based self-assembling peptide platform with tunable properties for EV delivery and tissue regeneration.
To examine the strength of perception of tobacco smoking risk, maternal-fetal attachment, and perceived stress as factors for predicting pregnant women's smoking status, after controlling for socioeconomic variables. This is a cross-sectional, predictive correlational study with a convenience sample recruited from a private prenatal clinic and a federally funded community health clinic in one central Illinois county. Women 18 years or older, at 24 weeks gestation or greater, were surveyed during their prenatal appointments, utilizing the Maternal Antenatal Attachment Scale, the Perceived Stress Scale, the Modified Perception of Pregnancy Risk Questionnaire (MPPRQ), and obstetric, demographic and socioeconomic questions to determine if maternal-fetal attachment, perceived stress, and perceived risks from smoking tobacco (smoking) predict smoking status during pregnancy. We found higher perceived smoking tobacco risk predicted women were likely to not currently use tobacco [p = .004, Exp(B) = 0.96, 95% CI (0.94, 0.99)]. Specifically, for each increase of 1 out of 100 on the MPPRQ scale, a woman is 4% less likely to currently smoke (smoke) tobacco. Maternal-fetal attachment and perceived stress did not predict smoking status. A woman's choice to continue to smoke during pregnancy is complex and personal. Understanding the impact of her personal perception for risk of smoking can assist providers with conversations and improve interventions, leading to increased cessation success and subsequently improve pregnancy and neonatal health outcomes.