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PTH counteracts Hippo signaling via Src-dependent YAP stabilization to enhance bone marrow stromal cell differentiation.
No full textParathyroid hormone (PTH) regulates serum calcium and phosphate through its actions in bone and kidney and is used to increase bone in osteoporosis treatment. In bone, PTH targets osteoblasts and osteocytes to regulate bone remodeling but also bone marrow stromal cells (BMSCs), regulating their differentiation in the osteoblast or the adipocyte lineage. PTH exerts its action through the PTH/PTH-related peptide (PTHrP) receptor, a G protein-coupled receptor (GPCR), activating adenylyl cyclase and phospholipase C (PLC). Although the effects of cAMP and PKA are well characterized, little is known about the effects of PLC activation or on the crosstalk between PTH signaling and other pathways. Here, bulk RNA-Seq of PTH-treated murine BMSC line (W-20) revealed significant changes in the Hippo pathway. In addition to increasing its transcription, PTH stabilized YAP protein, a key target of Hippo, by decreasing YAP/LArge Tumor Suppressor kinase 1 (LATS1) interaction, YAPS127 phosphorylation, and YAP ubiquitination, leading to YAP nuclear translocation and expression of YAP target genes. Similar events occurred in osteocyte cell lines. This occurred via an increase in Src kinase activity: We identified YAPY428 as a key tyrosine residue phosphorylated by Src in response to PTH. Preventing YAPY428 phosphorylation led to YAP instability, blocking both osteogenic and adipogenic differentiation of W-20 cells. These results demonstrate active crosstalk between the PTH/PTHrP and the Hippo signaling pathways and reveal that PTH signaling utilizes the PLC/Ca2+/Src tyrosine kinase signaling cascade to influence YAP stability, antagonizing Hippo signaling and favoring stromal cell differentiation. Thus, PTH signaling counteracts the effects of Hippo signaling in BMSCs to favor their differentiation
Safety of non-osseous union of type II odontoid fractures-a multi-institutional cohort study.
No full textBACKGROUND CONTEXT: The management of type II odontoid fractures in elderly patients presents significant clinical challenges. Surgical treatment may lead to operative complications, while conservative management may increase the risk of non-osseous union, potentially compromising fracture stability.
PURPOSE: This study aims to evaluate the safety of non-osseous union subtypes in type II odontoid fractures following conservative treatment and to identify risk factors for unstable fractures.
STUDY DESIGN: A multi-institutional retrospective cohort study.
PATIENT SAMPLE: A total of 307 patients with acute type II odontoid fractures treated conservatively between 2005 and 2022 were included. The mean age was 76±17 years, with a median follow-up of 24 months (IQR 9-55 months).
OUTCOME MEASURES: Fracture healing and stability were assessed. Safety of each healing subtype was determined by the incidence of new neurological deficits post collar removal or the need for surgical fixation. Risk factors for unstable fractures were also determined.
METHODS: Fracture healing was classified as osseous union, fibrous nonunion, or unstable nonunion based on CT and dynamic X-rays at collar removal. Fracture stability was assessed using only dynamic X-rays, with unstable fractures demonstrating active displacement. Neurological outcomes and the necessity for surgical fixation in each group were compared. Multivariable logistic regression was used to analyze risk factors for fracture instability.
RESULTS: Unstable nonunion occurred in 25% of patients, while fibrous nonunion occurred in 48% after a median collar wear of 3.7 months (IQR 2.9-6.2 months). New neurological deficits after collar removal were seen in 6% of patients with unstable nonunions during follow-up, but in none of those with fibrous nonunions or osseous unions, even after subsequent trauma. Risk factors for unstable nonunion included male sex (OR 2.14; 95% CI: 1.02-4.49), osteoporosis/osteopenia (OR 2.50; 95% CI: 1.17-5.37), and baseline fracture displacement (OR 4.81; 95% CI: 2.35-9.86).
CONCLUSIONS: Fibrous nonunion is a viable outcome in conservatively managed type II odontoid fractures, reducing the need for surgery or prolonged collar wear. Risk factors for unstable nonunion included male sex, osteoporosis/osteopenia, and baseline fracture displacement. Unstable nonunions may lead to new neurological deficits occurring after collar removal in a small percentage of cases
Physical and Mental Outcomes Associated with Patient with Cognitive Impairments Compared to Those Without
No full textIn hospitalized older adult patients with cognitive impairment and physical decline, how does an extended length of hospital stay, compared to a shorter or average length of stay, affect their physical and mental health outcomes?https://knowledgeconnection.mainehealth.org/nurseresidency/1140/thumbnail.jp
Higher mortality following SARS-CoV-2 infection in rural versus urban dwellers persists for two years post-infection
No full textPrevious studies demonstrated higher short-term mortality among rural compared with urban residents infected with SARS-CoV-2. However, whether this difference persists remains uncertain. This retrospective cohort study analyzed two-year post-COVID-19 mortality by rurality using the National Clinical Cohort Collaborative COVID-19 Enclave, a United States-based longitudinal electronic health record repository. We analyzed mortality among patients infected with SARS-CoV-2 between April 2020 and December 2022, with follow-up until December 2024. Patients were categorized into urban, urban-adjacent rural (UAR), and nonurban-adjacent rural (NAR) groups based on residential ZIP Code. Mortality differences were assessed using Kaplan-Meier analysis and weighted multivariable Cox regression, with weights derived from demographic factors and models adjusted for background clinical risk and social vulnerability. Among 3,082,978 SARS-CoV-2-infected patients, we found a significant association between rurality and increased two-year all-cause mortality post-infection. Adjusted hazards for two-year mortality for UAR and NAR were 1.19 (95% CI 1.18-1.21) and 1.26 (1.22-1.29). A reference cohort of 4,153,216 COVID-19-negative patients showed a modest yet consistent rural mortality penalty, with a similar relative hazard across cohorts, an observed rurality-COVID-19 interaction, and a greater absolute number of deaths following SARS-CoV-2 infection. Our findings emphasize ongoing rural mortality disparities and the importance of public health efforts in rural communities
Evolution of temporomandibular joint reconstruction: from autologous tissue transplantation to alloplastic joint replacement
No full textThe reconstruction of the temporomandibular joint presents a multifaceted clinical challenge in the realm of head and neck surgery, underscored by its relatively infrequent occurrence and the lack of comprehensive clinical guidelines. This review aims to elucidate the available approaches for TMJ reconstruction, with a particular emphasis on recent groundbreaking advancements. The current spectrum of TMJ reconstruction integrates diverse surgical techniques, such as costochondral grafting, coronoid process grafting, revascularized fibula transfer, transport distraction osteogenesis, and alloplastic TMJ replacement. Despite the available options, a singular, universally accepted \u27gold standard\u27 for reconstructive techniques or materials remains elusive in this field. Our review comprehensively summarizes the current available methods of TMJ reconstruction, focusing on both autologous and alloplastic prostheses. It delves into the differences of each surgical technique and outlines the implications of recent technological advances, such as 3D printing, which hold the promise of enhancing surgical precision and patient outcomes. This evolutionary progress aims not only to improve the immediate results of reconstruction but also to ensure the long-term health and functionality of the TMJ, thereby improving the quality of life for patients with end-stage TMJ disorders
A Value Framework for Achieving Environmental Equity
No full textCME available for 1 year after presentation
CME Text Code: 97013
In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1071/thumbnail.jp
MaineHealth Barbara Bush Children\u27s Hospital Scholars\u27 Academy: Scholarly Showcase
No full textCME available for 1 year after presentation
CME Text Code: 97017
In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1074/thumbnail.jp
May 7th, 2025: Systemic Sclerosis as Seen Through the Eyes of Paul Klee
No full texthttps://knowledgeconnection.mainehealth.org/medicine_gr/1041/thumbnail.jp
Adult Patient Perceptions of Nurse Listening Behaviors in an Ambulatory Surgery Setting
No full textPURPOSE: This study aimed to fill the knowledge gap by seeking the individual patient\u27s perception regarding nurse listening behaviors. Our research question was: what behaviors do adult day surgery patients believe conveyed nurse listening during a recent day surgery experience? DESIGN: A qualitative design was used for this study. METHODS: A stratified convenience sample of 20 English-speaking adult patients was interviewed about their experiences. Audio-recorded interviews were transcribed and analyzed manually using thematic analysis. FINDINGS: The analysis resulted in two themes. The first Interplay of Caring Communication was characterized by behaviors of nonverbal communication during the patient and nurse interaction, including observations of eye-to-eye contact, looking at the patient\u27s face and the nurse\u27s body language and facial expressions. Verbal communication behaviors occurred when nurses adapted or modified their teaching to meet patients\u27 learning needs. Patients perceived nurses\u27 oral communication styles as listening behaviors when they engaged in conversation by facilitating the dialog, asking and answering questions, and documenting the answers. The second theme Realization of Feeling Understood was characterized by descriptions of awareness of feelings and emotions, including patient experienced feelings and nurses acknowledging patient\u27s emotions. Furthermore, insights into the experience of being heard emerged that were composed of the experience of patient care, the perception that everybody listens, they paid attention, acknowledged and respected the patient\u27s wishes for care decisions. CONCLUSIONS: Patient perceptions of nurse listening are not limited to verbal exchanges between the patient and nurse but are also shaped by observations of nonverbal behaviors and the actions of nurses. These specific behaviors are important to patients, affecting their perception that my nurse is listening to me. Incorporated into daily practice, these behaviors can make patients feel they are being heard