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Although metastatic disease is the leading cause of cancer-related deaths, its tumor microenvironment remains poorly characterized due to technical and biospecimen limitations. In this study, we assembled a multi-modal spatial and cellular map of 67 tumor biopsies from 60 patients with metastatic breast cancer across diverse clinicopathological features and nine anatomic sites with detailed clinical annotations. We combined single-cell or single-nucleus RNA sequencing for all biopsies with a panel of four spatial expression assays (Slide-seq, MERFISH, ExSeq and CODEX) and H&E staining of consecutive serial sections from up to 15 of these biopsies. We leveraged the coupled measurements to provide reference points for the utility and integration of different experimental techniques and used them to assess variability in cell type composition and expression as well as emerging spatial expression characteristics across clinicopathological and methodological diversity. Finally, we assessed spatial expression and co-localization features of macrophage populations, characterized three distinct spatial phenotypes of epithelial-to-mesenchymal transition and identified expression programs associated with local T cell infiltration versus exclusion, showcasing the potential of clinically relevant discovery in such maps., Competing Interests: Competing interests A. Regev, J.K. and D.L.A. are co-inventors on patent application number 17/156,392, filed by the Broad Institute, for inventions relating to work in this manuscript. A. Regev is a co-founder and equity holder of Celsius Therapeutics, an equity holder in Immunitas and, until 31 July 2020, a scientific advisory board (SAB) member of Thermo Fisher Scientific, Syros Pharmaceuticals, Neogene Therapeutics and Asimov. From 1 August 2020, A. Regev is an employee of Genentech and has equity in Roche. A. Rotem is an employee of AstraZeneca since September 2020 and has equity in AstraZeneca. E.S.B. co-founded a company that is exploring commercial applications of expansion microscopy. G.N. holds equity in and consults for Akoya Biosciences. J.G.T.Z. owns stocks in the biotechnology exchange-traded funds CNCR, IDNA, IBB and XBI, owns stock in Novo Nordisk and owns stock in Adaptive Biotechnologies, 2seventy bio and bluebird bio. J.J-V. is a contractor at Genentech since 2021. M.S. is a contractor at Genentech since November 2020. O.R.-R. is a co-inventor on patent applications filed by the Broad Institute for inventions related to single-cell genomics. She has given numerous lectures on the subject of single-cell genomics to a wide variety of audiences and, in some cases, has received remuneration to cover time and costs. O.R.-R. is an employee of Genentech since 19 October 2020 and has equity in Roche. S.J.R. is a member of the SAB of Immunitas Therapeutics and receives research funding from Bristol Myers Squibb and Kite/Gilead. X.Z. is a co-founder of and consultant for Vizgen. The other authors declare no competing interests., (© 2024. The Author(s).)

In the setting of femoroacetabular impingement of the hip joint, paralabral cysts are well-documented sequelae. These cysts are typically associated with labral tears caused by CAM and/or pincer-type bony lesions. Synovial fluid extravasation through a tear in the labrum, similar to a popliteus cyst, leads to formation of a capsular-based cyst that is usually self-limiting. Few documented cases of these cysts causing compression of nearby neurovascular structures exist. There are several studies documenting arthroscopic decompression of these cysts, but none reporting compression of the femoral vein by a paralabral cyst resulting in deep vein thrombosis. We present the case of a large anterior paralabral cyst causing compression of the right femoral vein in a patient presenting with deep vein thrombosis and hip pain. Treatment consisted of arthroscopic decompression, followed by definitive aspiration by interventional radiology after labral repair and bipolar hip osteoplasty. The purpose of this case report was to document this rare presentation and offer learning points from our experience., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Expansion microscopy (ExM), by physically enlarging specimens in an isotropic fashion, enables nanoimaging on standard light microscopes. Key to existing ExM protocols is the equipping of different kinds of molecules, with different kinds of anchoring moieties, so they can all be pulled apart from each other by polymer swelling. Here we present a multifunctional anchor, an acrylate epoxide, that enables proteins and RNAs to be equipped with anchors in a single experimental step. This reagent simplifies ExM protocols and reduces cost (by 2-10-fold for a typical multiplexed ExM experiment) compared to previous strategies for equipping RNAs with anchors. We show that this united ExM (uniExM) protocol can be used to preserve and visualize RNA transcripts, proteins in biologically relevant ultrastructures, and sets of RNA transcripts in patient-derived xenograft (PDX) cancer tissues and may support the visualization of other kinds of biomolecular species as well. uniExM may find many uses in the simple, multimodal nanoscale analysis of cells and tissues., Competing Interests: Y.C., G.Y. and E.S.B. have filed for provisional patent protection on the design, steps and applications of uniExM through MIT Technology Licensing Office (U.S. Appl. No. 63/326,346). E.S.B. is a cofounder of the company Expansion Technologies to help with commercialization of ExM related techniques. This does not alter our adherence to PLoS ONE policies on sharing data and materials., (Copyright: © 2023 Cui et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Methods for highly multiplexed RNA imaging are limited in spatial resolution and thus in their ability to localize transcripts to nanoscale and subcellular compartments. We adapt expansion microscopy, which physically expands biological specimens, for long-read untargeted and targeted in situ RNA sequencing. We applied untargeted expansion sequencing (ExSeq) to the mouse brain, which yielded the readout of thousands of genes, including splice variants. Targeted ExSeq yielded nanoscale-resolution maps of RNAs throughout dendrites and spines in the neurons of the mouse hippocampus, revealing patterns across multiple cell types, layer-specific cell types across the mouse visual cortex, and the organization and position-dependent states of tumor and immune cells in a human metastatic breast cancer biopsy. Thus, ExSeq enables highly multiplexed mapping of RNAs from nanoscale to system scale., (Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

Twelve month minimum follow-up was available for 19 Oriental Jewish patients who underwent surgery for Dupuytren's disease over a 10-year period. In this population, the disease is uncommon. The initial deformity, operative findings and results of surgery were similar to those described for North European Caucasian patients. Possible factors that may result in a low genetic predisposition to Dupuytren's disease amongst Jews are discussed.

Sixteen patients with established mallet finger deformity as a result of extensor tendon injury were treated by tenodermodesis and fixation of the distal interphalangeal joint with a Kirshner wire. The patients were followed for a mean of 36 months (range 10-60). The results were excellent in eight patients, good in six, and fair in two. The mean extension lag was decreased from 50 degrees (range 30-70) to 9 degrees (range 0-30), but not at the expense of impaired flexion capacity. All patients were pleased with their resultant function and cosmesis. No complications were encountered. We recommend the operation for passively correctable deformities with suitable joints; it is easy to do and yields consistently successful results.

Excision of the trapezium with Gelfoam interposition was performed in 35 thumbs, 34 of which were evaluated after an average 5 years. Twenty-four patients had unilateral procedures. The follow-up examination included a standardized questionnaire and clinical and radiological examinations. Pain relief was achieved in all cases. The patients considered that 32 of their operated hands had improved function, while two had not improved. All patients were satisfied with the final postoperative result. Adduction of the thumb to the index finger, and opposition to the tip of the little finger was possible in all cases. Weakness, in comparison to the other thumb, of lateral pinch (71%; P=0.0001), tip pinch (74%; P=0.007), and grip strength (85%; P=0.006) were observed. The first web span was preserved in all hands. Calculation of the trapezial space ratio demonstrated only slight, insignificant shortening (7%; P=0.06) of the thumb ray. No significant correlations between the postoperative trapezial space ratio and lateral pinch strength, tip pinch strength, and grip strength were observed. We conclude that excision of the trapezium and Gelfoam interposition has no specific complications and is a reliable surgical treatment for osteoarthritis of the trapeziometacarpal joint.

Treatment of displaced or rotated avulsion fractures of the ulnar base of the proximal phalanx of the thumb remains controversial. There is limited information on the outcome of management of these injuries by non-surgical means. We undertook a retrospective follow-up study of the non-operative treatment of these fractures. The study included 28 thumbs that were stable to lateral stress testing at the time of initial investigation. The patients were treated by immobilisation of the thumb in a spica cast. The mean follow-up interval was 2.5 years (range 1-4). None of the patients changed their permanent employment or was unable to participate in their usual sporting activities. Twenty-six patients (93%) reported no pain on movement of the thumb. At follow-up, grip and pinch strengths did not differ significantly on the injured and non-injured sides. No thumbs showed instability on stress testing. The fractures had a 40% rate of bony union and 60% rate of fibrous non-union. All the patients were satisfied with their outcome. None of the patients was operated on after treatment. Non-operative treatment is recommended in cases of displaced or rotated avulsion fractures provided that there is no lateral instability of the metacarpophalangeal joint. Patients with unstable thumbs should always be treated surgically.

A rare case of an extra-abdominal desmoid tumour in the hand is reported. Its treatment and a short survey of the literature is given.

Magnetic resonance imaging (MRI) was used for a patient with severe pain in the fourth finger of her left hand when other imaging modalities had failed. Magnetic resonance scan with short T1 inversion recovery (STIR) sequences and gadolonium enhancement successfully aided in the diagnosis of a tiny glomus tumour.

If neglected or misdiagnosed, non-union of a scaphoid fracture will almost inevitably progress to radiographic and symptomatic osteoarthritis of the wrist with subsequent morbidity and lifelong disability, especially in young males in which the fracture is more common. Fractures of the scaphoid bone are the most common fractures of the carpus and second in occurrence among fractures of the wrist. The diagnosis and treatment are not simple. Familiarity with different imaging methods and treatment options is required. The treatment in most cases is conservative and will lead to uneventful union, but an operation may be needed in certain cases primarily and in the treatment of non-union. The current literature on the diagnosis and treatment of scaphoid fractures is reviewed, and the authors try to make a clear and concise picture of this complex and sometimes controversial field.

We adapted the use of talcum powder in chest surgery to create a reactive pleuritis for treating recurrent olecranon bursitis. The 11 patients who underwent this procedure all had favorable outcomes.

We report a condition we call the "plastic bag syndrome" in which pressure on the neurovascular bundles causes temporary ischaemia in the distal part of the finger together with a neuropraxia of the digital nerves. Although in most cases the discomfort or numbness is fleeting, requires no medical assistance and is readily forgotten, in some instances the symptoms are such that medical advice is sought. Since the injury can lead to permanent damage and subsequent limitation in the use of the finger, we believe that the public should be advised to take simple precautions to prevent it from happening.

A questionnaire to evaluate patient satisfaction following general anaesthesia was designed with the aid of focus groups. A subsequent audit identified aspects of care which could be improved on the basis of responses to the satisfaction questionnaire. It is possible to design a discriminating satisfaction questionnaire for general anaesthesia.

The diversity of case management approaches raises many questions. Are multiple case managers really required to duplicate each others' services, and if so, to what degree? How does the case manager actually "case manage" a client? How do the activities of the case manager in a direct care environment differ from case managers employed by case management companies or insurance companies? In this article, the author describes differences in case management activities in various employment settings.

Administrators and directors of home health agencies are increasingly accountable for the productive use of resources and quality patient outcomes. However, few reliable ways exist to measure and influence these components. The author proposes the use of the critical pathway typically used in acute care case management as an efficient tool to guide home health nursing practice. The author presents the process for developing a critical pathway for congestive heart failure patients in a home health agency, as well as results of a study determining when nursing interventions were implemented.

The Health Care Financing Administration 485/486 forms constitute the greatest paperwork burden for most agencies. This article suggests a method for analysis of the amount of resources consumed in the 485/486 process and estimates labor costs incurred to produce these documents.

Two cases are reported of acute median nerve compression due to calcium pyrophosphate deposition in the wrist, masquerading as a septic condition. There have been recent reports in the literature of the effects of calcium pyrophosphate in joints of the upper limb (Resnick 1983 and Hensley, 1983) These conditions are uncommon and the presentation and initial symptomatology of our case led in the first patient to misdiagnosis and an unnecessary operation, which was avoided in the second case.

The longterm results of surgical and conservative treatment in two almost identical groups of patients with fractures of the ankle have been analyzed. The results were better after conservative treatment; delayed operation and repeated manipulations were found to be the main reason for the poorer postoperative results, especially in elderly osteoporotic patients. The damage consequent to repeated manipulations, the difficulties resulting from delaying operation, and the advantages of early open reduction are discussed. It may be that under certain conditions of unavoidable delay, a mild residual displacement should be accepted rather than repeated manipulation and delayed open reduction. It is concluded that, when indicated, operations should be performed as early as possible after injury, probably giving the best end results as evidenced by the preliminary findings of a prospective study currently under way.

From 1982, patients with finger-tip injuries were treated with sulphadiazine occlusion dressings. The average time taken for the wound to heal, incidence of infection and absence from work were studied. The results of this method gave consistently good results when compared with other techniques which are summarized.

This is a report of an unusual surgical curiosity involving the median nerve at the wrist. A sewing needle, which penetrated the region of the wrist joint anteriorly, unknown to the patient, also penetrated the median nerve without causing any initial discomfort or neurological deficit. There was no damage to the nerve but locating the "disappearing" needle at operation was difficult.