Recovery after Low-Impact Laparoscopic Hysterectomy: A Randomized Controlled Clinical Trial.

Background: Low-impact laparoscopy (LIL), a surgical protocol using mini-laparoscopic instruments and low-and-stable pneumoperitoneal pressure, was developed as a minimally invasive approach to mitigate local and systemic effects of laparoscopy. However, its real clinical impact is still poorly documented.

Objective: To evaluate LIL impact on the postoperative recovery quality 6 hours after laparoscopic hysterectomy (henceforth 6H postsurgery) compared to conventional laparoscopy.

Weakly Supervised Deep Learning for Monitoring Sleep Apnea Severity Using Coarse-grained Labels.

Sleep apnea, a prevalent sleep-related breathing disorder, often remains undiagnosed and untreated in a large patient population due to the need of extensive manual annotations on various physiological signals for clinical diagnosis. Despite the surge of interest in applying machine learning to automate apnea detection, the effectiveness of existing techniques highly relies on strongly supervised learning that requires massive finely labeled training data for sufficiently short time intervals - a requirement often unmet due to the prohibitively high cost of manual labeling in clinical practice. In this article, we incorporate clinical knowledge to establish a weakly supervised deep learning framework for automatically estimating the latent fine-grained apnea severity when only coarse-grained labels indicating apnea presence are available in the training data.

Auto-adjusting positive airway pressure: the fine line between engineering and medicine.

Auto-adjusting positive airway pressure (APAP), unlike continuous PAP (CPAP), dynamically adjusts treatment pressure in response to events detected automatically from a derived flow signal. Introduced in the 90's, APAP quickly became a key tool in sleep clinics, initially serving as a faster alternative to manual titration for patients with obstructive sleep apnea (OSA), and later also as a long-term treatment option to expedite follow-up visits. APAP and CPAP are overall comparable in terms of adherence, efficacy and control of symptoms.

Enhancing anti-tumor immunity of natural killer cells through targeting IL-15R signaling.

Interleukin-15 receptor (IL-15R) agonists induce anti-tumor immunity in pre-clinical models. However, dose-limiting toxicity has hampered their clinical development. We performed genome-wide CRISPR screens to reveal the complete IL-15R signaling mechanism in natural killer (NK) cells and discovered that ubiquitin-dependent IL-15R degradation is the dominant mechanism restraining IL-15R signaling.

Force control deficits in rapid eye movement behavior disorder and Parkinson's disease.

Objective: This study aimed to determine if there are deficits in force variability, force increase, force decrease and force errors in rapid eye movement behavior disorder (RBD) using established force control paradigms.

Methods: A cohort of 27 controls, 37 RBD and 37 early-stage Parkinson's disease (PD) were investigated. Individuals completed constant force and ballistic force control for the finger and ankle.

Structure and mechanism of the Zorya anti-phage defence system.

Zorya is a recently identified and widely distributed bacterial immune system that protects bacteria from viral (phage) infections. Three Zorya subtypes have been identified, each containing predicted membrane-embedded ZorA-ZorB (ZorAB) complexes paired with soluble subunits that differ among Zorya subtypes, notably ZorC and ZorD in type I Zorya systems. Here we investigate the molecular basis of Zorya defence using cryo-electron microscopy, mutagenesis, fluorescence microscopy, proteomics and functional studies.

Direct recognition of an intact foreign protein by an αβ T cell receptor.

αβ T cell receptors (αβTCRs) co-recognise antigens when bound to Major Histocompatibility Complex (MHC) or MHC class I-like molecules. Additionally, some αβTCRs can bind non-MHC molecules, but how much intact antigen reactivities are achieved remains unknown. Here, we identify an αβ T cell clone that directly recognises the intact foreign protein, R-phycoerythrin (PE), a multimeric (αβ)γ protein complex.

A case of central sleep apnea associated with chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids.

Unlabelled: A 78-year-old man with history of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids syndrome, moderate persistent asthma, pansinusitis, and upper airway cough syndrome presented to the sleep medicine clinic for evaluation of sleep-disordered breathing. Brain magnetic resonance imaging showed lesions in the pons and midbrain. Diagnostic polysomnography was remarkable for central sleep apnea.

Optimisation of a primary human CAR-NK cell manufacturing pipeline.

Objectives: Autologous chimeric antigen receptor (CAR) T-cell therapy of B-cell malignancies achieves long-term disease remission in a high fraction of patients and has triggered intense research into translating this successful approach into additional cancer types. However, the complex logistics involved in autologous CAR-T manufacturing, the compromised fitness of patient-derived T cells, the high rates of serious toxicities and the overall cost involved with product manufacturing and hospitalisation have driven innovation to overcome such hurdles. One alternative approach is the use of allogeneic natural killer (NK) cells as a source for CAR-NK cell therapy.

Diverse cytomegalovirus US11 antagonism and MHC-A evasion strategies reveal a tit-for-tat coevolutionary arms race in hominids.

Recurrent, ancient arms races between viruses and hosts have shaped both host immunological defense strategies as well as viral countermeasures. One such battle is waged by the glycoprotein US11 encoded by the persisting human cytomegalovirus. US11 mediates degradation of major histocompatibility class I (MHC-I) molecules to prevent CD8+ T-cell activation.

A new class of biological ion-driven rotary molecular motors with 5:2 symmetry.

Several new structures of three types of protein complexes, obtained by cryo-electron microscopy (cryo-EM) and published between 2019 and 2021, identify a new family of natural molecular wheels, the "5:2 rotary motors." These span the cytoplasmic membranes of bacteria, and their rotation is driven by ion flow into the cell. They consist of a pentameric wheel encircling a dimeric axle within the cytoplasmic membrane of both Gram-positive and gram-negative bacteria.

Accrual and retention of diverse patients in psychosocial cancer clinical trials.

Background: Minority and older adult patients remain underrepresented in cancer clinical trials (CCTs). The current study sought to examine sociodemographic inequities in CCT interest, eligibility, enrollment, decline motivation, and attrition across two psychosocial CCTs for gynecologic, gastrointestinal, and thoracic cancers.

Methods: Patients were approached for recruitment to one of two interventions: (1) a randomized control trial (RCT) examining effects of a cognitive-behavioral intervention targeting sleep, pain, mood, cytokines, and cortisol following surgery, or (2) a yoga intervention to determine its feasibility, acceptability, and effects on mitigating distress.

Detection of Common Arrhythmias by the Watch-PAT: Expression of Electrical Arrhythmias by Pulse Recording.

Background: The WatchPAT (WP) device was shown to be accurate for the diagnosis of sleep apnea and is widely used worldwide as an ambulatory diagnostic tool. While it records peripheral arterial tone (PAT) and not electrocardiogram (ECG), the ability of it to detect arrhythmias is unknown and was not studied previously. Common arrhythmias such as atrial fibrillation (AF) or premature beats may be uniquely presented while recording PAT/pulse wave.

A transition to the American Academy of Sleep Medicine-recommended hypopnea definition in adults: initiatives of the Hypopnea Scoring Rule Task Force.

Unlabelled: The American Academy of Sleep Medicine (AASM) recommends that hypopneas be identified using a definition that is based on a ≥ 30% decrease in airflow associated with a ≥ 3% reduction in the oxygen saturation or an arousal (H3A) for diagnosis of obstructive sleep apnea (OSA) in adults. This conflicts with the Centers for Medicare & Medicaid Services definition, which requires a ≥ 4% decrease in the oxygen saturation to identify a hypopnea (H4) and does not acknowledge arousals. In 2018, the AASM Board of Directors constituted a Hypopnea Scoring Rule Task Force with a mandate to "create a strategy for adoption and implementation of the AASM recommended adult hypopnea scoring criteria among members, payers and device manufacturers.

Incorporation of Polymer-Grafted Cellulose Nanocrystals into Latex-Based Pressure-Sensitive Adhesives.

While the improvement of water-based adhesives with renewable additives is important as industry shifts toward more sustainable practices, a complete understanding of how the compatibility between additives and polymers affects adhesive performance is currently lacking. To elucidate these links, cellulose nanocrystals (CNCs) were first functionalized via surface-initiated atom-transfer radical polymerization with the hydrophobic polymers poly(butyl acrylate) (PBA) and poly(methyl methacrylate) (PMMA) to facilitate their incorporation into latex-based pressure-sensitive adhesives (PSAs). Next, PBA latexes were synthesized using seeded semibatch emulsion polymerization with unmodified or polymer-grafted CNCs added in situ at a loading of 0.

Recognition of the antigen-presenting molecule MR1 by a Vδ3 γδ T cell receptor.

Unlike conventional αβ T cells, γδ T cells typically recognize nonpeptide ligands independently of major histocompatibility complex (MHC) restriction. Accordingly, the γδ T cell receptor (TCR) can potentially recognize a wide array of ligands; however, few ligands have been described to date. While there is a growing appreciation of the molecular bases underpinning variable (V)δ1 and Vδ2 γδ TCR-mediated ligand recognition, the mode of Vδ3 TCR ligand engagement is unknown.

Elucidation of obstructive sleep apnoea related blood pressure surge using a novel continuous beat-to-beat blood pressure monitoring system.

Background: Obstructive sleep apnoea (OSA) episode related blood pressure (BP) surge may mediate the association of OSA with cardiovascular disease. However, BP is not measured during a clinical sleep study.

Method: We tested the feasibility of incorporating the Caretaker physiological monitor, which utilizes a novel continuous beat-to-beat (b-b) BP monitoring technology, into polysomnography (PSG) and aimed to characterize BP surges related to obstructive respiratory events.

Elucidating the Motif for CpG Oligonucleotide Binding to the Dendritic Cell Receptor DEC-205 Leads to Improved Adjuvants for Liver-Resident Memory.

DEC-205 is a cell-surface receptor that transports bound ligands into the endocytic pathway for degradation or release within lysosomal endosomes. This receptor has been reported to bind a number of ligands, including keratin, and some classes of CpG oligodeoxynucleotides (ODN). In this study, we explore in detail the requirements for binding ODNs, revealing that DEC-205 efficiently binds single-stranded, phosphorothioated ODN of ≥14 bases, with preference for the DNA base thymidine, but with no requirement for a CpG motif.

Optimal NIV Medicare Access Promotion: Patients With Central Sleep Apnea: A Technical Expert Panel Report From the American College of Chest Physicians, the American Association for Respiratory Care, the American Academy of Sleep Medicine, and the American Thoracic Society.

This document summarizes suggestions of the central sleep apnea (CSA) Technical Expert Panel working group. This paper shares our vision for bringing the right device to the right patient at the right time. For patients with CSA, current coverage criteria do not align with guideline treatment recommendations.