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Background: Pneumothorax is a common complication of cardiac implantable electronic device (CIED) procedures. There is a paucity of data on the natural history and management of a CIED-associated pneumothorax. Methods: This is a single-centre retrospective study of all consecutive patients with a CIED-associated pneumothorax between March 2010 and March 2020. Pneumothorax size was determined on all chest x-rays after device implantation and before chest tube insertion (if placed). Changes in pneumothorax size on serial chest x-rays were reported. Clinical outcomes in patients with a severe-sized pneumothorax treated with a chest tube were compared with those treated conservatively. Results: A total of 86 CIED-associated pneumothoraxes were identified, with 55 (63.9%) patients having a pneumothorax severe in size. Thirty-seven patients with a severe pneumothorax received a chest tube, whereas 18 were managed conservatively. Chest tube use was associated with a higher rate of admission to hospital (100% vs 63%, P = 0.02) for patients undergoing outpatient procedure, longer length of stay (6.3 ± 3.9 vs 2.7 ± 2.9 days, P = 0.04), but fewer chest x-rays (1.9 ± 0.7 vs 4.1 ± 2.5, P = 0.002). Conclusion: An initial strategy of conservative management of a CIED-associated pneumothorax in select patients may be feasible and safe. Résumé: Contexte: Le pneumothorax est une complication courante des interventions visant à mettre en place un dispositif cardiaque électronique implantable (DCEI). Il n’existe que très peu de données sur l’évolution naturelle et la prise en charge du pneumothorax lié à la pose d’un DCEI. Méthodologie: Nous avons étudié rétrospectivement les cas de patients ayant présenté un pneumothorax lié à un DCEI et traités consécutivement dans un même centre entre mars 2010 et mars 2020. La taille du pneumothorax a été déterminée dans toutes les cradiographies pulmonaires obtenues après la pose du DCEI et avant l’insertion d’un drain thoracique (le cas échéant). Les variations de la taille du pneumothorax mesurée sur les radiographies pulmonaires successives ont été rapportées. Les résultats cliniques observés chez les patients présentant un pneumothorax important traités par drainage thoracique ont été comparés à ceux de patients traités selon l’approche classique. Résultats: Au total, 86 cas de pneumothorax liés à un DCEI ont été relevés; 55 patients (63,9 %) présentaient un pneumothorax important. De ce nombre, 37 patients ont subi un drainage thoracique, tandis que les 18 autres ont été pris en charge selon l’approche classique. Le recours à un drain thoracique a été associé à un taux d’admission à l’hôpital plus élevé (100 % vs 63 %; p = 0,02) dans le cas des interventions ambulatoires et à une hospitalisation plus longue (6,3 ± 3,9 vs 2,7 ± 2,9 jours; p = 0,04), mais à un moins grand nombre de radiographies pulmonaires (1,9 ± 0,7 vs 4,1 ± 2,5; p = 0,002). Conclusion: Dans certains cas, il est possible et sûr d’avoir recours à une prise en charge initiale classique du pneumothorax lié à un DCEI.

Purpose: Guidelines for locally advanced non-small cell lung cancer (LA-NSCLC) recommend definitive chemoradiation therapy (CRT) for cN2-N3 disease, reserving surgery for patients with minimal nodal involvement at presentation. The current literature suggests that surgery after CRT for stage III NSCLC can improve freedom-from-recurrence (FFR) but has not consistently demonstrated an improvement in overall survival, perhaps partly due to the low (45-50.4 Gy) preoperative doses delivered that result in low rates of mediastinal nodal clearance. We therefore analyzed factors associated with trimodality therapy receipt and determined outcomes in patients with LA-NSCLC who were treated with definitive doses (≥60 Gy) of neoadjuvant CRT prior to surgery. Methods and materials: We retrospectively analyzed 355 consecutive patients with LA-NSCLC who were treated with curative intent between January 2000 and December 2013. The Kaplan-Meier method was used to estimate the overall survival and FFR of patients who were initially planned to receive trimodality treatment but never underwent surgery (unplanned bimodality) compared with those who were never considered to be surgical candidates (planned bimodality) and those who underwent surgical resection after CRT (trimodality). Cox proportional hazards regression with forward selection was used for multivariate analyses, and the Fisher exact test was used to test contingency tables. Results: Patients who received trimodality therapy had a longer median survival than those with unplanned or planned bimodality therapy at 59.9, 20.1, and 17.3 months, respectively (P < .001). The survival benefit with surgery persisted in patients with stage IIIB (P < .001) and N3 (P = .010) nodal disease when mediastinal nodal clearance was achieved. FFR was also improved with surgical resection (P = .001). Race (P < .001), stage (P < .001), performance status (P < .001), age (P < .001), and diagnosis of chronic obstructive pulmonary disease (P = .009) were significant indicators that influenced both the decision to initially choose trimodality therapy at consultation and to actually perform surgical resection. Conclusions: Trimodality treatment significantly improves survival and FFR in patients with LA-NSCLC when definitive doses of radiation with neoadjuvant chemotherapy are employed. We identified important demographic features that predict the use of surgical intervention in patients with stage III NSCLC.

Extracellular vesicles (EVs) are anucleate particles enclosed by a lipid bilayer that are released from cells via exocytosis or direct budding from the plasma membrane. They contain an array of important molecular cargo such as proteins, nucleic acids, and lipids, and can transfer these cargoes to recipient cells as a means of intercellular communication. One of the overarching paradigms in the field of EV research is that EV cargo should reflect the biological state of the cell of origin. The true relationship or extent of this correlation is confounded by many factors, including the numerous ways one can isolate or enrich EVs, overlap in the biophysical properties of different classes of EVs, and analytical limitations. This presents a challenge to research aimed at detecting low-abundant EV-encapsulated nucleic acids or proteins in biofluids for biomarker research and underpins technical obstacles in the confident assessment of the proteomic landscape of EVs that may be affected by sample-type specific or disease-associated proteoforms. Improving our understanding of EV biogenesis, cargo loading, and developments in top-down proteomics may guide us towards advanced approaches for selective EV and molecular cargo enrichment, which could aid EV diagnostics and therapeutics research., (© 2024 The Author(s). PROTEOMICS published by Wiley‐VCH GmbH.)

Food-derived extracellular vesicles (FDEVs) such as those found in mammalian milk and plants are of great interest for both their health benefits and ability to act as biological nanocarriers. While the extracellular vesicle (EV) field is expanding rapidly to perform characterisation studies on FDEVs from plants, yeasts and bacteria, species-specific differences in EV uptake and function in the human gastrointestinal (GI) tract are poorly understood. Moreover, the effects of food processing on the EV surfaceome and intraluminal content also raises questions surrounding biological viability once consumed. Here, I present a case for increasing community-wide focus on understanding the cellular uptake of FDEVs from different animal, plant, yeast, and bacterial species and how this may impact their function in the human, which will have implications for human health and therapeutic strategies alike., Competing Interests: The author declares no competing financial interest., (© 2024 The Authors. Journal of Extracellular Biology published by Wiley Periodicals LLC on behalf of International Society for Extracellular Vesicles.)

The endocannabinoid (ECB) system has recently been considered a potential treatment target for various clinical disorders. However, research around age- and sex-related changes within the ECB system is relatively limited. To improve our understanding of these changes, the current study measured arachidonoyl ethanolamide (AEA), 2-arachidonoyl glycerol (2-AG), oleoylethanolamine (OEA), palmitoylethanolamine (PEA), arachidonic acid (AA), cortisol, and progesterone in pooled serum samples stratified by sex (male and female) and age groups (5-15; 15-30; 30-45; 45-60; 60-75; 85+), using liquid-chromatography tandem mass spectrometry. Serum progesterone levels significantly increased in females of the 15-30 and 30-45 age groups, before declining. Significantly higher cortisol, AEA, 2-AG, OEA, and PEA were found in males and in older age, while significantly higher AA was found in females. Our results indicate that ECBs and related hormones exhibit sexual dimorphism in the age ranges that correspond with female pregnancy, menopause, and post menopause. Male testosterone levels most likely influences male ECB changes throughout the lifespan. Future research could capitalise on these findings by performing repeated measurements in individuals in a longitudinal style, to further refine the temporal profile of age-specific changes to the ECB system identified here., (© 2024. The Author(s).)

Scope: Milk and milk products such as infant formula (IF) play a fundamental role in serving the nutritional needs of the developing infant. Extracellular vesicles (EVs) in human (HM) and cow milk (CM) contain molecular cargo such as proteins and micro(mi)RNAs that serve as functional messengers between cells and may be of importance to infant health. Most IF is derived from a CM protein base, however differences between HM and CM EV molecular cargo have not been extensively studied., Methods and Results: This study develops a pipeline using advanced proteomics and transcriptomics to enable cross-species comparison of milk and IF EVs. The number of nanoparticles per mL of IF is significantly reduced compared to unprocessed CM. 130 proteins and 514 miRNAs are differentially abundant between HM and CM EVs. While 90% of CM EV miRNAs are also identified in IF EVs, only 20% of CM EV proteins are identified in IF EVs., Conclusions: This workflow identifies key species-specific differences that can be used to optimize IF recipes and enhance infant nutrition. Improved preservation of EV functional molecular cargo in IF products is of critical importance to retaining molecular drivers of good health and should be the focus of future investigations., (© 2023 The Authors. Molecular Nutrition & Food Research published by Wiley-VCH GmbH.)

Proteomic analysis of small extracellular vesicles (sEVs) poses a significant challenge. A 'gold-standard' method for plasma sEV enrichment for downstream proteomic analysis is yet to be established. Methods were evaluated for their capacity to successfully isolate and enrich sEVs from plasma, minimise the presence of highly abundant plasma proteins, and result in the optimum representation of sEV proteins by liquid chromatography tandem mass spectrometry. Plasma from four cattle (Bos taurus) of similar physical attributes and genetics were used. Three methods of sEV enrichment were utilised: ultracentrifugation (UC), size-exclusion chromatography (SEC), and ultrafiltration (UF). These methods were combined to create four groups for methodological evaluation: UC + SEC, UC + SEC + UF, SEC + UC and SEC + UF. The UC + SEC method yielded the highest number of protein identifications (IDs). The SEC + UC method reduced plasma protein IDs compared to the other methods, but also resulted in the lowest number of protein IDs overall. The UC + SEC + UF method decreased sEV protein ID, particle number, mean and mode particle size, particle yield, and did not improve purity compared to the UC + SEC method. In this study, the UC + SEC method was the best method for sEV protein ID, purity, and overall particle yield. Our data suggest that the method and sequence of sEV enrichment strategy impacts protein ID, which may influence the outcome of biomarker discovery studies.

Nurse practitioner (NP) faculty have not fully used data collected in NP clinical education for data mining. With current advances in database technology including data storage and computing power, NP faculty have an opportunity to data mine enormous amounts of clinical data documented by NP students in electronic clinical management systems. The purpose of this project was to examine the use of big data and data mining from NP clinical education and to establish a foundation for competency-based education. Using a data mining knowledge discovery process, faculty are able to gain increased understanding of clinical practicum experiences to inform competency-based NP education and the use of entrusted professional activities for the future., (Copyright © 2020. Published by Elsevier Inc.)

Building clinical education training capacity in nurse practitioner programs is critical to build the primary care workforce and to address the access to care problem in the country. Challenges related to obtaining clinical sites and qualified preceptors are well reported, but few practical solutions are presented. Clinical sites and qualified preceptors willing to serve can be found, but nurse practitioner faculty must remove obstacles and strengthen resources by discovering untapped capacity. Nurse practitioner faculty can design, implement, and test innovative clinical models to maximize clinical training capacity. Clinical capacity development in geriatrics and long-term care, convenience care, distance immersions, correctional nursing, occupational health, and through interprofessional collaborations and faculty practice partnerships can be expanded., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Two different optical techniques for surface tracking and linewidth measurement are evaluated. First, an evaluation is made of the performance of a double-focus polarization microscope, based on results from a computer model and from experimental measurements. The assessment shows that a phase curvature effect makes the operation of this configuration impractical as a surface tracking device and linewidth measurement system. An alternative arrangement of using a double aperture is evaluated. The phase curvature effect is reduced in this type of microscope. A practical optical arrangement to implement a double-aperture microscope is given.