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An International Delphi Consensus About Tumor Rupture During Robotic Partial Nephrectomy (Researching UnPredictable TUmor RupturE during Robotic Partial Nephrectomy-The RUPTURE Project).
No full textBACKGROUND AND OBJECTIVE: Tumor rupture during robot-assisted partial nephrectomy (RAPN) poses oncological risks, including potential malignant cell spread and recurrence. Despite these risks, standardized guidelines for defining, managing, and assessing risk factors of tumor rupture in RAPN are lacking. This Delphi consensus study aimed to frame the definition, risk factors, and oncological implications of tumor rupture in RAPN, as well as to propose management strategies.
METHODS: Using a modified Delphi method, a steering committee from multiple urological societies (the RUPTURE project) led a consensus-building study that followed the ACcurate COnsensus Reporting Document (ACCORD) checklist. A panel of international experts participated in a two-phase Delphi survey, rating their agreement with statements on tumor rupture, risk factors, and management in RAPN. Consensus was defined as ≥70% agreement, with unresolved statements discussed in an online meeting and subjected to a second voting round.
KEY FINDINGS AND LIMITATIONS: Thirty-three experts evaluated 58 statements. Consensus was reached on 33% of statements in the first round and 37.5% in the second round. Tumor rupture was defined, with risk factors including larger tumor size, complexity, and endophytic growth patterns. Recommended management strategies focused on minimizing tumor spillage by suctioning-rather than grasping-the cancerous tissue, and promptly securing the specimen in an endobag. Routine conversion to radical nephrectomy was not advised unless unresectable tumor remnants were found. Tumor rupture was not linked to distant metastasis, although its oncological impact varied by the rupture extent (ie, gross rupture vs focal; tumor spilled out macroscopically completely removed vs not).
CONCLUSIONS AND CLINICAL IMPLICATIONS: This consensus forms a basis for future research on tumor rupture in RAPN, emphasizing standardized definitions and uniform management strategies. Empirical validation through future clinical research is warranted.
PATIENT SUMMARY: This research looks at tumor rupture during robotic kidney surgery, which can happen but is rare. The study involved a panel of experts who discussed finding a consensus on when it is more likely to occur and how to manage it effectively to reduce risks. It was also emphasized that while a rupture may not always lead to cancer spreading, the impact on a patient\u27s health can vary and is yet to be determined
Predicting Flourishing in ADHD Youth: Positive Childhood Experiences and Mood Disturbances in Context of Adversity.
No full textBACKGROUND: In response to the increasing prevalence of ADHD, efforts have focused on understanding methods to optimize psychosocial, emotional, and behavioral well-being, defined as flourishing. Mood disturbances, environmental vulnerabilities, and Adverse Childhood Experiences (ACEs) are risk factors for not flourishing. There is limited research on protective relational factors, as measured by Positive Childhood Experiences (PCEs), as facilitators of flourishing in children with ADHD and comorbid mood disturbances.
METHOD: Using a nationally representative sample of 4,847 children, aged 6 to 17 years-old, currently diagnosed with ADHD, hierarchical binary logistic regression examined whether the number of PCEs present for children with and without mood disturbances could significantly predict who was flourishing or not. The initial model included demographics, ADHD treatment-related variables, and the number of ACEs encountered.
RESULTS: After controlling for covariates, the odds of flourishing measured by the Child Flourishing Index (CFI) for children with ADHD were 7.31 [4.51, 11.86] times greater for those with 6 to 7 PCEs compared to peers with 0 to 2 PCEs, and 3.37 [2.24, 5.06] times greater for those with 3 to 5 PCEs relative to peers with 0 to 2 PCEs. Furthermore, parents who reported their children had neither current anxiety nor depression were 2.92 [1.87, 4.55] times more likely to flourish than children currently reported to have both anxiety and depression. These associations were consistent regardless of the level of ACEs.
CONCLUSIONS: Our findings suggest that more PCEs and the absence of mood disturbance may attenuate the influence of ACEs on healthy adjustment for children with ADHD. Encouraging resilience in families, connecting with caregivers, and community volunteering were the most predictive positive childhood experiences of flourishing in this national sample of youth with ADHD and comorbid mood disturbance. Current results also provide guidance for future research on PCEs measurement, screening for comorbidities, and clinical intervention in neurodiverse samples
The ProteomeXchange consortium in 2026: making proteomics data FAIR.
No full textThe ProteomeXchange consortium of proteomics resources (http://www.proteomexchange.org) was established to standardize open data practices in the mass spectrometry (MS)-based proteomics field. Here, we describe the main developments in ProteomeXchange in the last 3 years. The six member databases of ProteomeXchange, spread out in three different continents, are the PRIDE database, PeptideAtlas, MassIVE, jPOST, iProX, and Panorama Public. We provide updated data submission statistics, showcasing that the number of datasets submitted to ProteomeXchange resources has continued to accelerate every year. Through June 2025, 64 330 datasets had been submitted to ProteomeXchange resources, and from those, 30 097 (47%) just in the last 3 years. We also report on the improvements in the support for the standards developed by the Proteomics Standards Initiative, e.g. for Universal Spectrum Identifiers and for SDRF (Sample and Data Relationship Format)-Proteomics. Additionally, we highlight the increase in data reuse activities of public datasets, including targeted reanalyses of datasets of different proteomics data types, and the development of novel machine learning approaches. Finally, we summarize our plans for the near future, covering the development of resources for controlled-access human proteomics data, and for the support of non-MS proteomics approaches
Moral Distress, Coping Resilience, and Self-Care: A Study of Nurses in the Intensive Care Unit.
No full textBACKGROUND: Critical care nurses are regularly exposed to situations that may create moral distress. Moral distress has been correlated with higher rates of nursing burnout, emotional withdrawal, and traumatic stress syndrome.
OBJECTIVES: This descriptive correlational study aimed to describe the relationships between moral distress, coping resilience, and self-care practices.
METHODS: An electronic survey was sent to nurses in 5 intensive care units within 1 hospital system from February 2023 through April 2023. Nurses were asked to answer questions about their demographic characteristics, moral distress, coping resiliency, and self-care practices.
RESULTS: Seventy-four staff nurses participated in the survey. Overall, nurses reported the highest levels of moral distress from the following: a family\u27s insistence on aggressive treatment, continuing to provide aggressive treatment despite unlikely effectiveness, and excessive documentation requirements. Results showed a statistically significant (but weak) positive correlation between mindful self-care and resilient coping (r65 = 0.27, P = .03).
CONCLUSIONS: A positive correlation between mindful self-care and coping resilience was identified, which suggests that self-care may influence resiliency. Participants indicated frequent use of outside support systems such as supportive structures and supportive persons. These systems may be ideal mechanisms through which to support nurses in the future
Infection prevention processes implemented at a children\u27s hospital during a community measles outbreak, 2025.
No full textBACKGROUND: Measles, a highly infectious virus, can cause outbreaks in low-vaccinated communities. In January 2025, a community-wide outbreak in the South Plains of Texas prompted a hospital serving pediatric and women\u27s patients to rapidly develop and implement infection prevention protocols to treat measles patients while protecting patients, visitors, and staff within the hospital. This article explains infection prevention and control strategies utilized by the hospital during a community-wide measles outbreak and processes implemented to mitigate exposures.
METHODS: A multidisciplinary team collaborated to educate staff on the Centers for Disease Control and Prevention (CDC) measles infection prevention guidance and ensured access to necessary resources for protection. The hospital temporarily converted rooms to negative pressure, constructed a screening shed for patients arriving at the emergency department, developed signage to direct measles patients, provided roving fit testing, and worked with public health officials.
RESULTS: Ninety-eight patients presented to the hospital for measles. Fifty eight were confirmed via reverse transcription-polymerase chain reaction or IgM tests, and 9 were diagnosed clinically. There were 810 patients hospitalized simultaneously with the measles patients, and none returned or were reported as secondary cases linked to hospital exposure.
CONCLUSIONS: The implemented interventions successfully prevented measles secondary cases associated with the hospital
Real-World Data: Critical Evidence to Better Understanding Kidney Benefits with Sodium-Glucose Cotransporter 2 Inhibitors.
No full textDetection and Impact of Staphylococcus aureus Small Colony Variants in Chronic Wounds: A Pilot Study
No full textA unique phenotype of S. aureus called S. aureus small-colony variants (SA-SCVs) are a consequential contributor to multiple infectious processes. SA-SCVs are distinguishable from wild-type S. aureus (WT-SA) by their small size, slowed growth rate, and altered biochemical reactions; these changes make SA-SCV more difficult to detect from clinical specimens using routine diagnostics. While the clinical environment of chronic wound infections has the potential to stimulate the production of SA-SCVs, studies investigating detection of SA-SCVs in chronic wounds have not been previously conducted. Chronic wound specimens found to harbor S. aureus via qPCR screening, and screened for recent aminoglycoside treatment and/or co-infected with Pseudomonas aeruginosa, were collected from a specialty wound care clinic in April 2019. In-house enrichment methods alongside culture-dependent and independent diagnostics were utilized to recover and identify SA-SCVs from these chronic wounds. Our investigation determined difficulties in recovering and identifying SA-SCVs during routine diagnostic procedures, and the potential clinical impact of wounds harboring SA-SCVs related to antimicrobial susceptibility
Analysis of clinical, single cell, and spatial data from the Human Tumor Atlas Network (HTAN) with massively distributed cloud-based queries.
No full textCancer research increasingly relies on large-scale, multimodal datasets that capture the complexity of tumor ecosystems across diverse patients, cancer types, and disease stages. The Human Tumor Atlas Network (HTAN) generates such data, including single-cell transcriptomics, proteomics, and multiplexed imaging. However, the volume and heterogeneity of the data present challenges for researchers seeking to integrate, explore, and analyze these datasets at scale. To this end, HTAN developed a cloud-based infrastructure that transforms clinical and assay metadata into aggregate Google BigQuery tables, hosted through the Institute for Systems Biology Cancer Gateway in the Cloud (ISB-CGC). This infrastructure introduces two key innovations: (1) a provenance-based HTAN ID table that simplifies cohort construction and cross-assay integration, and (2) the novel adaptation of BigQuery\u27s geospatial functions for use in spatial biology, enabling neighborhood and correlation analysis of tumor microenvironments. We demonstrate these capabilities through R and Python notebooks that highlight use cases such as identifying precancer and organ-specific sample cohorts, integrating multimodal datasets, and analyzing single-cell and spatial data. By lowering technical and computational barriers, this infrastructure provides a cost-effective and intuitive entry point for researchers, highlighting the potential of cloud-based platforms to accelerate cancer discoveries
An evolving role in the NICU: a study of the tasks, knowledge, skills, and practice demographics of the neonatal therapist.
No full textObjectives: To describe current practice and roles of the neonatal therapist.
Study design: A Neonatal Therapy Practice Analysis was distributed to neonatal therapists (physical therapists, occupational therapists, and speech-language pathologists) in 2019-2020 via social media, email, newsletters, and conference materials.
Results: There were 1,313 respondents from 1,110 different hospitals. 41.7% (n = 277) were occupational therapists, 29.3% (n = 195) were physical therapists, and 29.0% (n = 193) were speech-language pathologists. 760 (59.1%) worked in level III NICUs, while 248 (19.3%) worked in level II NICUs and 273 (21.2%) in level IV NICUs. 166 (28.1%) of respondents were Certified Neonatal Therapists (CNTs), which was related to higher number of full-time equivalent (FTE) positions per bed (β = 1.066, SE = 0.478, p = 0.026) and higher percentage of infants served in the NICU (β = -3.2, SE = 0.589, p \u3c 0.001). We observed a median of one therapy FTE per 17 NICU beds (range of 1 FTE per 10-200 beds). Higher acuity NICU levels (β = 2.23, SE = 0.197, p \u3c 0.001) and NICUs with higher number of beds (β = 2.497, SE = 0.285, p \u3c 0.001) had more neonatal therapy FTEs. Survey respondents reported working with a median of 76.0% of infants in their respective NICUs (IQR 65%-90%, range 1%-100%). There was a higher percentage of infants served in higher acuity NICUs (β = 4.358, SE = 1.517, p = 0.004), in NICUs with a higher number of beds (β = 0.058, SE = 0.029, p = 0.047), when there was a productivity standard (β=11.47, SE = 1.9, p \u3c 0.001), and where there was a higher number of neonatal therapy FTEs (β = 1.0, SE = 0.239, p \u3c 0.001). 294 (46%) of respondents reported having standing orders, which was related to a higher percentage of infants served in the NICU (β = -1.109, SE = 0.393, p \u3c 0.001) and to having a productivity standard (β = -0.467, SE = 0.139, p \u3c 0.001). 65.3% (n = 415) of respondents reported having productivity standards to meet each day, with a range between 50%-80%.
Conclusion: This practice analysis provides insights into the changing landscape of neonatal therapy
Radiation therapy causes a STING and MyD88-independent upregulation of CD80 and CD86 in macrophages and monocytes that limits tumor control.
No full textIn preclinical models, optimum tumor control by radiation therapy incorporates CD8 T cell control of residual cancer cells. Tumor control by these CD8 T cells is negatively regulated by myeloid and T regulatory cell expansions in the tumor following radiation treatment. We demonstrate using ex vivo 3D tumor models and novel in vivo cell tracking models that radiation results in upregulation of the costimulatory molecules CD80 and CD86 on tumor macrophages and on monocytes that enter the tumor following radiation. This regulation of CD80 is not dependent on adjuvant signaling via MyD88 or STING in the myeloid cells. While we would anticipate that CD80 and CD86 would have a positive impact on anti-tumor immunity, we demonstrate that blockade of CD80 and CD86 signaling limits CD4 infiltrates in tumors and prevents the Treg expansion caused by radiation treatment. Importantly, this treatment results in improved tumor control following radiation therapy. These data link the inflammatory activation of myeloid cells in irradiated tumors to the Treg expansion following radiation and ensuing suppression of anti-tumor immunity