bluuebunny/crossref_metadata_2025 huggingface dataset:
Absence of long-term structural and functional cardiac abnormalities on multimodality imaging in a multi-ethnic group of COVID-19 survivors from the early stage of the pandemic
Authors: Sewanan Lorenzo R , Di Tullio Marco R , Laine Andrew F , D’Souza Belinda , Leb Jay , Mironov Alexander , Khan Ahsan , Stanger Dylan E , Konofagou Elisa E , Goldsmith Rochelle L , Jambawalikar Sachin R , Hirschfeld Cole B , Castillo Michelle , Durkin Kathleen J , Dashnaw Stephen , Thomas Vaughan J , Einstein Andrew J
Published: October 2023

Aims

Many patients with coronavirus disease-2019 (COVID-19), particularly from the pandemic’s early phase, have been reported to have evidence of cardiac injury such as cardiac symptoms, troponinaemia, or imaging or ECG abnormalities during their acute course. Cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE) have been widely used to assess cardiac function and structure and characterize myocardial tissue during COVID-19 with report of numerous abnormalities. Overall, findings have varied, and long-term impact of COVID-19 on the heart needs further elucidation.

Methods and results

We performed TTE and 3 T CMR in survivors of the initial stage of the pandemic without pre-existing cardiac disease and matched controls at long-term follow-up a median of 308 days after initial infection. Study population consisted of 40 COVID-19 survivors (50% female, 28% Black, and 48% Hispanic) and 12 controls of similar age, sex, and race-ethnicity distribution; 35% had been hospitalized with 28% intubated. We found no difference in echocardiographic characteristics including measures of left and right ventricular structure and systolic function, valvular abnormalities, or diastolic function. Using CMR, we also found no differences in measures of left and right ventricular structure and function and additionally found no significant differences in parameters of tissue structure including T1, T2, extracellular volume mapping, and late gadolinium enhancement. With analysis stratified by patient hospitalization status as an indicator of COVID-19 severity, no differences were uncovered.

Conclusion

Multimodal imaging of a diverse cohort of COVID-19 survivors indicated no long-lasting damage or inflammation of the myocardium.
Machine learning–based feature selection to search stable microbial biomarkers: application to inflammatory bowel disease
Authors: Lee Youngro , Cappellato Marco , Di Camillo Barbara
Published: October 2023

Background

Biomarker discovery exploiting feature importance of machine learning has risen recently in the microbiome landscape with its high predictive performance in several disease states. To have a concrete selection among a high number of features, recursive feature elimination (RFE) has been widely used in the bioinformatics field. However, machine learning–based RFE has factors that decrease the stability of feature selection. In this article, we suggested methods to improve stability while sustaining performance.

Results

We exploited the abundance matrices of the gut microbiome (283 taxa at species level and 220 at genus level) to classify between patients with inflammatory bowel disease (IBD) and healthy control (1,569 samples). We found that applying an already published data transformation before RFE improves feature stability significantly. Moreover, we performed an in-depth evaluation of different variants of the data transformation and identify those that demonstrate better improvement in stability while not sacrificing classification performance. To ensure a robust comparison, we evaluated stability using various similarity metrics, distances, the common number of features, and the ability to filter out noise features. We were able to confirm that the mapping by the Bray–Curtis similarity matrix before RFE consistently improves the stability while maintaining good performance. Multilayer perceptron algorithm exhibited the highest performance among 8 different machine learning algorithms when a large number of features (a few hundred) were considered based on the best performance across 100 bootstrapped internal test sets. Conversely, when utilizing only a limited number of biomarkers as a trade-off between optimal performance and method generalizability, the random forest algorithm demonstrated the best performance. Using the optimal pipeline we developed, we identified 14 biomarkers for IBD at the species level and analyzed their roles using Shapley additive explanations.

Conclusion

Taken together, our work not only showed how to improve biomarker discovery in the metataxonomic field without sacrificing classification performance but also provided useful insights for future comparative studies.
The chromosome-level genome of Chinese praying mantis Tenodera sinensis (Mantodea: Mantidae) reveals its biology as a predator
Authors: Yuan Ruizhong , Zheng Boying , Li Zekai , Ma Xingzhou , Shu Xiaohan , Qu Qiuyu , Ye Xiqian , Li Sheng , Tang Pu , Chen Xuexin
Published: October 2023

Background

The Chinese praying mantis, Tenodera sinensis (Saussure), is a carnivorous insect that preys on a variety of arthropods and small vertebrates, including pest species. Several studies have been conducted to understand its behavior and physiology. However, there is limited knowledge about the genetic information underlying its genome evolution, digestive demands, and predatory behaviors.

Findings

Here we have assembled the chromosome-level genome of T. sinensis, representing the first sequenced genome of the family Mantidae, with a genome size of 2.54 Gb and scaffold N50 of 174.78 Mb. Our analyses revealed that 98.6% of BUSCO genes are present, resulting in a well-annotated assembly compared to other insect genomes, containing 25,022 genes. The reconstructed phylogenetic analysis showed the expected topology placing the praying mantis in an appropriate position. Analysis of transposon elements suggested the Gypsy/Dirs family, which belongs to long terminal repeat (LTR) transposons, may be a key factor resulting in the larger genome size. The genome shows expansions in several digestion and detoxification associated gene families, including trypsin and glycosyl hydrolase (GH) genes, ATP-binding cassette (ABC) transporter, and carboxylesterase (CarE), reflecting the possible genomic basis of digestive demands. Furthermore, we have found 1 ultraviolet-sensitive opsin and 2 long-wavelength-sensitive (LWS) opsins, emphasizing the core role of LWS opsins in regulating predatory behaviors.

Conclusions

The high-quality genome assembly of the praying mantis provides a valuable repository for studying the evolutionary patterns of the mantis genomes and the gene expression profiles of insect predators.
Radioelement abundances and heat production in the Paleoarchaean and early Neoarchaean granitoids of the Singhbhum Craton, eastern India: Thermal and geodynamic implications
Authors: Ray Labani , Dey Sukanta , Chopra Nishu
Published: October 2023

Distributions of long-lived radioelements (Th, U and K) in the upper crust play a vital role in lithospheric thermal modelling and understanding of underlying geodynamic processes. In the present study, we report abundances of Th, U, K and radiogenic heat production (A) in Paleoarchaean and early Neoarchaean granitoids from the Singhbhum Craton, located in the eastern part of the Indian shield, for the first time in a systematic way, using laboratory gamma-ray spectrometric set-up. We have studied 204 samples consisting of Paleoarchaean gneiss, three phases of Paleoarchaean Singhbhum Granite and early Neoarchaean granitoid. Th, U, K and A in the Paleoarchaean Singhbhum Granite are found to be marginally higher (10.8 ppm, 1.4 ppm, 2.4 per cent and 1.3 μWm−3) than the Paleoarchaean gneiss (9.6 ppm, 1.7 ppm, 1.8 per cent and 1.3 μWm−3). In comparison, such values are much higher in the early Neoarchaean granitoid (31.1 ppm, 4.2 ppm, 3.9 per cent, and 3.6 μWm−3). The surface heat production (1.36 μWm−3) of this craton is comparatively low compared to most cratons worldwide. In addition, it has the lowest average crustal heat production (0.42 µWm−3), due to which it will contribute little to the observed surface heat flow. Moreover, Th is a dominant component in heat production, followed by U and K in these granitoids. Spatially, radioelement ratios Th/U and K/U show similar trends as the radioelements, indicating systematic depletion of Th and U, compared to K. The study also indicates that the spatially separated coeval granitoids are formed from different magma sources in the heterogeneous crust that prevailed during the Archaeans. The lower radioelement abundances in the Paleoarchaean granitoids mostly resulted from the partial melting of mafic sources, whereas higher radioelement abundances in the early Neoarchaean granitoids resulted from the partial melting of the felsic source.
The burden of very early dropout in infertility care: a nationwide population-based cohort study
Authors: Ben Messaoud Khaoula , Bouyer Jean , Guibert Juliette , de La Rochebrochard Elise
Published: October 2023

STUDY QUESTION

What is the frequency and the associated factors of very early dropout following unsuccessful clomiphene citrate (CC)/gonadotropin treatment in the context of full coverage of treatment cost.

SUMMARY ANSWER

Despite free treatment, almost one in four women had a very early dropout following unsuccessful CC/gonadotropin treatment, with patients below the poverty line being more likely to drop out early.

WHAT IS KNOWN ALREADY

Success of infertility care is tarnished by very high dropout rates. Infertility care dropout has been considered as resulting principally from financial barriers because of the high cost of treatment. Nearly all previous work addressed dropout following IVF/ICSI. Factors associated with dropout following CC/gonadotropins may be different and also need to be investigated.

STUDY DESIGN, SIZE, DURATION

Nationwide population-based cohort study.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Using the French national health insurance and hospital databases, we included in the cohort 27 416 women aged 18–49 years unsuccessfully treated with CC/gonadotropins in 2017. The main outcome was very early dropout, defined as discontinuation of all infertility treatment after unsuccessful treatment for 1–3 months. Very early treatment dropout was analysed by multivariate logistic regression.

MAIN RESULTS AND THE ROLE OF CHANCE

Among women unsuccessfully treated with CC/gonadotropins, 22% dropped out of infertility care within 3 months. In multivariate analysis, higher early dropout following unsuccessful CC/gonadotropin treatment was associated with older and younger ages (≥35 and <25 years), being below the poverty line, being treated with CC prescribed by a general practitioner and lack of infertility tests or monitoring.

LIMITATIONS, REASONS FOR CAUTION

This study is based on health administrative data that do not include reasons for dropout and record only a limited amount of information. It is thus not possible to analyse the reason for early dropout.

WIDER IMPLICATIONS OF THE FINDINGS

Despite full coverage of all infertility treatment, women under the poverty line have a higher risk of very early dropout following unsuccessful CC/gonadotropin treatment. Better understanding is needed of the non-financial barriers and difficulties faced by these patients. To address disparities in infertility treatment, practitioner training could be reinforced to adapt to patients from different social and cultural backgrounds.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by the ANR StimHo project, grant ANR-17-CE36-0011-01 from the French Agence Nationale de la Recherche. The authors have no conflict of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.
Strategies for smoothing power fluctuations in lithium-ion battery–supercapacitor energy storage systems
Authors: Liu Zenglei , Lu An
Published: October 2023

Onshore wind power has received attention from governments, including China and Europe, as a renewable energy generation technology. Still, it is highly influenced by weather factors and often requires energy storage systems to smooth its power. The hybrid energy storage system (HESS), comprising a lithium-ion battery and a supercapacitor (SC), fully uses the advantages of both the lithium-ion battery and SC with high energy and high power density. The contribution of this paper is to give a control strategy for internal power coordination and smoothing power fluctuation in HESS. For internal power coordination, when the state of charge (SOC) of a lithium-ion battery and SC are not in the normal range simultaneously, the lithium-ion battery power limit must be adjusted to regulate their SOC. In contrast, for smoothing power fluctuation, a low-pass filter is used to reduce the charge/discharge depth of the lithium-ion battery and maintain the SOC of SC. The trigonometric factor is used to optimize the particle swarm optimization (PSO) to obtain a better power distribution value. The proposed strategy is optimized using onshore wind power generation and load 1-day power variation, and the results achieve the desired goal with superior application.
Prevalence of antibiotic prescribing in COVID-19 patients in China and other low- and middle-income countries during the pandemic (December 2019—March 2021): a systematic review and meta-analysis
Authors: Cong Wenjuan , Cheng Hung-Yuan , Stuart Beth , Liu Binjuan , Tang Yunyi , Wang Yi , AIhusein Nour , Wang Hexing , Manchundiya Amit , Lambert Helen
Published: October 2023

Objectives

Low- and middle-income countries (LMICs) are particularly vulnerable to the threat of antimicrobial resistance (AMR). Use of antibiotics to treat COVID-19 patients during the pandemic may have contributed to increasing the AMR burden, but systematic evidence is lacking.

Methods

We searched Web of Science, EMBASE, PubMed, China National Knowledge Infrastructure (CNKI) and VIP databases from 1 December 2019 to 31 March 2021. Interventional and observation studies across all settings that reported antibiotic use in at least 10 COVID-19 patients were included. We restricted publications to English and Chinese languages. Screening and data extraction were undertaken by at least two independent reviewers. Results were synthesized using random-effects meta-analyses. Subgroup analyses and meta-regression were used to explore heterogeneities. This review was registered with PROSPERO (CRD42021288291).

Results

We included 284 studies involving 210 611 participants in 19 countries. The antibiotic prescribing rates (APRs) in COVID-19 inpatients were 71.7% (95% CI 66.7%–76.5%) in China and 86.5% (77.1%–93.9%) in other LMICs, respectively. APR was lower in mild/moderate cases in China [66.9% (57.9%–75.4%) compared with 91.8% (71.4%–100%) in other LMICs]. High APRs were found among pregnant women and the elderly in China. Disparities in APRs of other patient groups were identified. In studies reporting bacterial infections, the prevalence was 17.3% (10.0%–25.9%) in China and 24.9% (0.1%–68.8%) in other LMICs. Several antibiotics on the WHO ‘Watch’ and ‘Reserve’ lists were prescribed frequently in LMICs.

Conclusions

Inappropriate antibiotic use and high prevalence of antibiotic prescribing were found in COVID-19 inpatients in many LMICs.
Prediction of short-acting beta-agonist usage in patients with asthma using temporal-convolutional neural networks
Authors: Hirons Nicholas , Allen Angier , Matsuyoshi Noah , Su Jason , Kaye Leanne , Barrett Meredith A
Published: October 2023

Objective

Changes in short-acting beta-agonist (SABA) use are an important signal of asthma control and risk of asthma exacerbations. Inhaler sensors passively capture SABA use and may provide longitudinal data to identify at-riskpatients. We evaluate the performance of several ML models in predicting daily SABA use for participants with asthma and determine relevant features for predictive accuracy.

Methods

Participants with self-reported asthma enrolled in a digital health platform (Propeller Health, WI), which included a smartphone application and inhaler sensors that collected the date and time of SABA use. Linear regression, random forests, and temporal convolutional networks (TCN) were applied to predict expected SABA puffs/person/day from SABA usage and environmental triggers. The models were compared with a simple baseline model using explained variance (R2), as well as using average precision (AP) and area under the receiving operator characteristic curve (ROC AUC) for predicting days with ≥1–10 puffs.

Results

Data included 1.2 million days of data from 13 202 participants. A TCN outperformed other models in predicting puff count (R2 = 0.562) and day-over-day change in puff count (R2 = 0.344). The TCN predicted days with ≥10 puffs with an ROC AUC score of 0.952 and an AP of 0.762 for predicting a day with ≥1 puffs. SABA use over the preceding 7 days had the highest feature importance, with a smaller but meaningful contribution from air pollutant features.

Conclusion

Predicted SABA use may serve as a valuable forward-looking signal to inform early clinical intervention and self-management. Further validation with known exacerbation events is needed.
Understanding the Drivers of Cost and Length of Stay in a Cohort of 21,875 Patients with Severe Burn
Authors: Hauc Sacha C , Stögner Viola Antonia , Ihnat Jacqueline M , Hosseini Helia , Huelsboemer Lioba , Kauke-Navarro Martin , Rivera Jean C , Williams Mica , Glahn Joshua Z , Savetamal Alisa , Pomahac Bohdan
Published: October 2023

Burn management has significantly advanced in the past 75 years, resulting in improved mortality rates. However, there are still over one million burn victims in the United States each year, with over 3,000 burn-related deaths annually. The impacts of individual patient, hospital, and regional demographics on length of stay (LOS) and total cost have yet to be fully explored in a large nationally representative cohort. Thus, this study aimed to examine various hospital and patient characteristics using a sample of over 20,000 patients. Inpatient data from the National Inpatient Sample from 2008 to 2015 were analyzed, and only patients with an ICD-9 code for second- or third-degree burns were included. In addition, a major operating room procedure must have been indicated on the discharge summary for patients to be included in the final dataset, ensuring that only severe burns requiring complex care were analyzed. Analysis of covariance models was used to evaluate the impact of various patient, hospital, and regional variables on both LOS and cost. The study found that skin grafts and fasciotomy significantly increased the cost of hospitalization. Having burns on the face, neck, and trunk significantly increased costs for patients with second-degree burns, while burns on the trunk resulted in the longest LOS for patients with third-degree burns. Infections in the hospital and additional procedures, such as flaps and skin grafts, also led to longer stays. The study also found that the prevalence of postoperative complications, such as electrolyte imbalance, was high among patients with burn surgery.
Loss of the vitamin D receptor triggers senescence in chronic myeloid leukemia via DDIT4-mediated DNA damage
Authors: Xu Yan , Qi Wentao , Zheng Chengzu , Li Yuan , Lu Zhiyuan , Guan Jianmin , Lu Chunhua , Zhao Baobing
Published: October 2023

Chronic myeloid leukemia (CML) is a hematopoietic malignancy driven by the fusion gene BCR::ABL1. Drug resistance to tyrosine kinase inhibitors (TKIs), due to BCR::ABL1 mutations and residual leukemia stem cells (LSCs), remains a major challenge in CML treatment. Here, we revealed the requirement of the vitamin D receptor (VDR) in the progression of CML. VDR was upregulated by BCR::ABL1 and highly expressed in CML cells. Interestingly, VDR knockdown inhibited the proliferation of CML cells driven by both BCR::ABL1 and TKI-resistant BCR::ABL1 mutations. Mechanistically, VDR transcriptionally regulated DDIT4 expression; reduced DDIT4 levels upon VDR knockdown triggered DNA damage and senescence via p53 signaling activation in CML cells. Furthermore, VDR deficiency not only suppressed tumor burden and progression in primary CML mice but also reduced the self-renewal capacity of CML-LSCs. Together, our study demonstrated that targeting VDR is a promising strategy to overcome TKI resistance and eradicate LSCs in CML.
Asymptomatic colo-ovarian fistula amidst acute psychosis: a case report
Authors: Mansour Meghan R , Kessler Steven A , Khreisat Ali , Skrzynski Justin K
Published: October 2023

This paper presents a rare case of an asymptomatic colo-ovarian fistula in a 45-year-old female with acute psychosis and a history of bipolar disorder, seizure disorder and substance misuse. The intricate diagnostic challenges arising from the patient’s complex medical history underscore the significance of a multidisciplinary approach. The absence of typical gastrointestinal symptoms and the presence of a tubo-ovarian abscess complicated the diagnosis of acute on chronic sigmoid diverticulitis and colo-ovarian fistula. Surgical intervention, including sigmoid resection, anastomosis and left salpingo-oophorectomy, led to successful resolution. This case highlights the need for further understanding of colo-ovarian fistula pathophysiology, improved diagnostic strategies, and the nuanced interplay between medical and psychiatric conditions in complex clinical scenarios.
Case report: repair of eventration of the diaphragm in an octogenarian
Authors: Forter-Chee-A-Tow Ninon , Smith Alan
Published: October 2023

Eventration of the diaphragm is a cephalad displacement of the diaphragm because of congenital or acquired causes. The diaphragm maintains its anatomical continuity and normal attachments. It may be partial or complete and unilateral or bilateral. Most adult presentations are asymptomatic, but patients may present with respiratory, gastrointestinal, or cardiac symptoms. Surgical repair is indicated in the symptomatic patient with the most common being diaphragmatic plication. We present surgical repair of a symptomatic left diaphragmatic eventration in an octogenarian.
Location: root architecture structures rhizosphere microbial associations
Authors: Galindo-Castañeda Tania , Hartmann Martin , Lynch Jonathan P
Published: October 2023

Root architectural phenotypes are promising targets for crop breeding, but root architectural effects on microbial associations in agricultural fields are not well understood. Architecture determines the location of microbial associations within root systems, which, when integrated with soil vertical gradients, determines the functions and the metabolic capability of rhizosphere microbial communities. We argue that variation in root architecture in crops has important implications for root exudation, microbial recruitment and function, and the decomposition and fate of root tissues and exudates. Recent research has shown that the root microbiome changes along root axes and among root classes, that root tips have a unique microbiome, and that root exudates change within the root system depending on soil physicochemical conditions. Although fresh exudates are produced in larger amounts in root tips, the rhizosphere of mature root segments also plays a role in influencing soil vertical gradients. We argue that more research is needed to understand specific root phenotypes that structure microbial associations and discuss candidate root phenotypes that may determine the location of microbial hotspots within root systems with relevance to agricultural systems.
Liver regeneration
Authors: Humar Bostjan , Humar Rok
Published: October 2023

The liver is the only mammalian organ capable of complete recovery following major tissue loss. Intense research has revealed the profound complexity behind liver regeneration, rightly considered to be one of the most intriguing processes within the human body. This chapter provides a concise overview of key findings, interpreted to highlight the general principles that underlie the restoration of liver mass. Following a descriptive view of the regenerative process, mechanistic insights are given on priming, progression, vascular reconstitution, and termination—the major phases of liver regeneration. Given the central tasks of the liver, metabolic disturbances arising following tissue loss are emerging as crucial regulators of regeneration and are likewise discussed. The chapter closes with three pressing medical issues (post-hepatectomy liver failure, steatosis, and fibrosis) that compromise successful recovery, describing potential causes associated with the underlying pathobiology.
Perioperative management and nutrition in patients with liver and biliary tract disease
Authors: Rajakumar Akila , Kaliamoorthy Ilankumaran , Kanagavelu Rathnavel G.
Published: October 2023

Patients with liver and biliary tract disease present unique critical challenges to the perioperative physician. Involvement of a multidisciplinary team with expertise in handling critically ill patients with cirrhosis, a thorough understanding and evaluation of the altered pathophysiology in this cohort of patients, and meticulous planning of timing and other perioperative strategies can help to achieve better outcomes during patients’ perioperative course. Risk minimization with attempts to optimize inherent conditions in various organ systems should be performed whenever possible, especially for elective surgeries. It is also important to decide when to defer surgery and the patient’s family should be involved in making an informed decision.
Modern management of liver trauma
Authors: Müller Philip C. , Neuhaus Valentin , Pfammatter Thomas , Petrowsky Henrik
Published: October 2023

Following trauma, the liver is one of the organs of the abdominal cavity which is most often injured. Historically, liver trauma was associated with a high morbidity and mortality mainly from an aggressive surgical approach. During the last 25 years, however, there has been a paradigm shift away from aggressive surgical techniques towards damage control surgery. With the introduction of computed tomography, non-operative management has become the standard of care for blunt liver trauma in haemodynamically stable patients. Still, surgeons often face demanding challenges in the hostile environment of actively bleeding livers, while resection techniques as in elective hepatic surgery cannot be applied. This chapter presents the current approach to hepatic trauma, describing its pathophysiology, classification, diagnostic workup, non-operative management, and surgical management.
Cholangiocarcinoma
Authors: Rela Mohamed , Reddy Mettu Srinivas
Published: October 2023

Cholangiocarcinomas are a group of malignancies originating from the biliary epithelium. They are classified according to their location of origin into intrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma, and distal cholangiocarcinoma. Cholangiocarcinomas are slow-growing tumours, seen after the sixth decade of life, which usually present late in their natural history. Surgery with negative margins is the only treatment option which is potentially curative, though less than a third of these tumours are resectable at presentation. Recent advances in preoperative optimization techniques, aggressive surgery with vascular resection, and better postoperative management has improved their resection rates and overall survival.
Secondary neoplasms of the liver
Authors: Line Pål-Dag
Published: October 2023

Secondary liver tumours are metastases from primary tumours elsewhere and constitute the largest group of malignant hepatic tumours. The liver involvement dictates survival probability in the majority of patients, and surgical resection is the only potential curative therapeutic option. Colorectal liver metastasis is the most common type. Liver resection is the standard of care for colorectal liver metastasis and overall 5-year survival following resection is about 42%, dependent on a range of prognostic factors. Metastases from neuroendocrine tumours may be treated by hepatic resection with a 5-year survival of 50–75%. Liver transplantation is an option for carefully selected patients with non-resectable liver metastases from neuroendocrine tumours with 5-year survival of greater than 80% and a low risk of recurrence. For other types of metastases, like breast cancer, urological and gynaecological cancer, gastrointestinal stromal tumours, and sarcomas, surgical therapy may be efficacious, particularly in young patients with oligometastatic disease, long disease-free interval, and favourable tumour biology.
Paediatric liver transplantation
Authors: Kasahara Mureo
Published: October 2023

Living donor liver transplantation (LDLT) was introduced in Japan in 1989 as a life-saving procedure for paediatric patients with post-Kasai biliary atresia due to the absolute scarcity of organs available for deceased donor transplantation. The shortage of deceased organ donors led to the development of unique technical, logistical, and physiological innovations in LDLT. Experience and technical improvements in living donor surgery have led to the general acceptance of paediatric LDLT, and even adult LDLT, with excellent long-term patient and graft outcomes. As LDLT has been revealed to increase the donor pool and decrease paediatric waiting list mortality, LDLT and deceased donor liver transplantation should not be mutually exclusive—LDLT should be a complementary procedure to save the children with end-stage liver disease. It is hoped that the refinement of procedures and immunosuppression protocols will lead to the further improvement of long-term outcomes and quality of life in patients undergoing liver transplantation for paediatric liver diseases. It should always be remembered that the aim is to obtain excellent long-term outcomes in paediatric liver transplant recipients with a favourable quality of life for all who are involved in the process.
Long-term outcomes following liver surgery
Authors: Iwao Yasuhito , Heaton Nigel D.
Published: October 2023

The first anatomical liver resection was performed more than 130 years ago; however, liver surgery has only developed properly over the past 60 years, following advances in the understanding of liver anatomy, anaesthetic and intensive care, technical aspects of liver surgery, and advances in the understanding of haemostasis. There has been continuous improvement in perioperative mortality and long-term survival over this time. A number of factors have contributed to this including improved pre-and perioperative imaging, patient selection, and perioperative management. The development of anatomical resections and the introduction of effective systemic therapies have also contributed to a decline in early recurrence of cancer. In the West, liver surgery has been developed primarily as a treatment for colorectal liver secondaries, in contrast to the East where the focus has been on hepatocellular carcinoma associated with hepatitis B and C. Liver surgery remains a technically demanding procedure with specific complications which differ from those encountered with other forms of surgery. Postoperative complications vary depending on the cancer, presence of underlying liver disease and extent of liver resection, and in considering survival beyond 3 months the tumour biology and impact of systemic therapies. In addition, locoregional therapies including microwave ablation, irreversible electroporation, and radiotherapy are being utilized in place of surgery or as an adjuvant treatment. Therefore, long-term outcomes following liver surgery will be reviewed in this chapter along with the history of liver resection, the impact of early mortality and morbidity, extent of liver resection, and underlying cancer type. Little has been published on specific long-term complications after hepatectomy other than on a focus on disease recurrence and patient survival.
Percutaneous biliary imaging and interventions
Authors: Vermersch Mathilde , Denys Alban , Violi Naik Vietti
Published: October 2023

Percutaneous bile duct imaging and intervention can be performed for various patient conditions. When it is needed, preoperative planning is required in order to define the access and type of intervention required for each particular situation. Post-intervention follow-up is mandatory in order to depict complications. According to the patient condition, intervention could include bile duct biopsy, drainage, and dilatation with or without stent placement which will be detailed in this chapter. Additionally, specific bile duct interventions in case of malignant biliary obstruction including need for biopsy, preoperative drainage, or when the tumour is inoperable will be discussed. Benign biliary obstruction includes a large spectrum of diseases such as benign bile duct stricture, stones, chronic pancreatitis, primary sclerosing cholangitis, immunoglobulin G4-related sclerosing cholangitis, post-liver translation complications, infection, iatrogenic injures, and gall bladder drainage that are all covered in this chapter.
Pathogenesis and natural history of gallstones
Authors: Bheeman Veena , Vincent Royce P. , Patel Ameet G.
Published: October 2023

Gallstone disease affects up to 20% of the world’s population. Its complications account for a significant burden of disease both in the acute and chronic clinical settings, from the occasional episode of biliary colic, to devastating gallstone pancreatitis and its myriad complications. The laparoscopic cholecystectomy has become one of the most common procedures performed today in addressing acute and chronic presentations of gallstone diseases. In addition, advances in endoscopic techniques have added to the options available in their management. This has created a scenario where gallstones are dealt with across many specialties at various levels of expertise. Therefore, understanding and recognizing the aetiopathogenesis and natural history is imperative to guiding the best treatment strategy in deciding when to intervene, how to intervene, and, most importantly, when not to intervene.
Benign and malignant lesions of the gall bladder
Authors: Agarwal Anil K. , Kalayarasan Raja
Published: October 2023

Gall bladder cancer (GBC) is the most common malignancy of the biliary tract. Traditionally, it was regarded as a lethal tumour with a dismal prognosis. However, advancements in surgical techniques and perioperative care have improved the outcomes in the last two decades. While curative surgery remains the mainstay of therapy, several aspects of surgical management are still controversial. Gall bladder (GB) polyps are the most common benign GB lesions. While the majority of the polyps are benign, a small proportion are premalignant and early GBC may present as polypoidal lesions. The challenge is to differentiate a true polyp from a pseudopolyp and not miss an early GBC. This chapter aims to review the current surgical management of GB polyps and GBC with a particular focus on some of the debated aspects, including the extent of resection and lymphadenectomy, and management of incidental GBC.
Medical and innovative therapies for biliary malignancies
Authors: Kodali Sudha , Nolte Fong Joy V. , Ghobrial R. Mark
Published: October 2023

Cholangiocarcinoma is a malignancy arising from varying locations of the biliary tree with cholangiocyte differentiation. Though surgical resection and liver transplantation with neoadjuvant chemoradiation provide the best long-term outcomes for all three subtypes of cholangiocarcinoma, advanced disease at presentation and higher rates of recurrence may preclude surgical candidacy. In these unresectable cases, various modalities to control the disease include chemotherapy, locoregional options, and external or internal radiation. Furthermore, combinations of chemotherapy or chemotherapy plus locoregional therapy have shown improvement in overall and progression-free survival. This chapter on medical and innovative therapies for biliary malignancies describes the various treatment options for the three subtypes of cholangiocarcinoma, currently available therapies, and future directions for medical management options.
Thrombosis on foreign surfaces and devices
Authors: Geisler Tobias
Published: October 2023

Thrombosis on artificial surfaces is a crucial condition and dependent on the material properties of the device and patient adherent factors. This chapter discusses the pathophysiology of device-related thrombosis and gives an overview of the clinical relevance and diagnostic and treatment algorithms.
Forthcoming oral factor XIa and factor XIIa inhibitors
Authors: Fredenburgh James C. , Weitz Jeffrey I.
Published: October 2023

Oral anticoagulants are a mainstay for the prevention and treatment of arterial and venous thrombosis. Direct oral anticoagulants (DOACs) have replaced vitamin K antagonists for many indications. Currently available DOACs include dabigatran, which inhibits thrombin, and apixaban, edoxaban, and rivaroxaban, which inhibit factor (F)-Xa. A new class of DOACs is under development. These new DOACs, which include asundexian and milvexian, inhibit FXIa, which is positioned in the intrinsic pathway of coagulation. Anticoagulants that target FXIa have the potential to be safer than the current DOACs because there is emerging evidence that FXI is essential for thrombosis but mostly dispensable for haemostasis. In addition to the oral inhibitors of FXIa, parenteral inhibitors also are under development. These include fesomersen, an antisense oligonucleotide that reduces the hepatic synthesis of FXI, abelacimab, an antibody that binds FXI and blocks its activation, and osocimab, an FXIa inhibitory antibody. FXII inhibitors, which may be even safer than those that target FXI, are at an earlier stage of development. Focusing on these new agents, this chapter (1) describes the unmet needs in oral anticoagulation therapy, (2) explains why FXI and FXII are promising targets for new oral anticoagulants, (3) reviews the clinical data with the new agents, and (4) provides perspective on the opportunities and challenges for oral FXIa and FXIIa inhibitors.
Delusional Beliefs and Thought Insertion
Authors: Humpston Clara , Broome Matthew
Published: October 2023

This chapter considers thought insertion (TI) in relation to other kinds of delusional beliefs often observed in schizophrenia-spectrum psychoses. TI is compared with the more common delusional beliefs, such as delusions of persecution and reference, and evaluate whether TI is better conceptualized as a delusional belief in its entirety or as a near-sensory experience of passivity and thought interference which is often accompanied by a delusional elaboration. Considering historical and contemporary literature on the nature of delusions, it is argued that TI, at least on some levels, is fundamentally different, both phenomenologically and clinically, from many of the other delusional beliefs found in schizophrenia and other psychoses. The chapter concludes with recommendations for future research and practice and emphasize that not all experiences of TI are of the same psychopathological nature or best understood as delusional beliefs.
Soundless Voices and Inserted Thoughts
Authors: Wilkinson Sam
Published: October 2023

Several theorists have argued that voices and inserted thoughts are the same phenomena described differently. However, given this purported similarity, such theorists have not, accounted for why some experiences are reported as soundless voices while others as inserted thoughts. This chapter examines some alternatives for this problem and ends reflecting on what these might say about the mechanisms underlying these experiences. Specifically, it is explored whether these experiences are linguistic or imagistic; the type of speech act; the mode of address; the transparency or opacity of the experience; contextual coherence; degree and agentive representation; and shows how digging deeper into these more fine-grained and nuanced distinctions can yield clues for future investigation.
On Philosophy and Schizophrenia
Authors: Feyaerts Jasper , Kusters Wouter
Published: October 2023

Philosophers have often turned towards schizophrenic experience as a way to empirically substantiate philosophical assumptions regarding the essential nature of selfhood. In this context, the phenomenon of thought insertion (TI) has served as a particularly privileged example, as it is assumed to reveal, in a pathological or negative way, the nature of ordinary self-experience. In this chapter, we critically discuss one such philosophical account that attempts to explain TI as involving a loss of a ‘sense of agency’ that is presumed to characterize ordinary thinking. In the second part, we furthermore critically revisit the more general assumption that schizophrenia can be understood as a ‘via negativa’ into overlooked evidences and experiences that would permeate ordinary life. Instead, we advance the idea that both philosophy and schizophrenia share a basic kind of hyper-reflexive attitude towards ordinary life. In conclusion, we detail the implications of this idea for current accounts of TI and sketch the general lines of an alternative model that puts more emphasis on the shared nature of philosophical and schizophrenic reflection, and the dialectical paradoxes that may arise in such reflection.
Thought Insertion and Auditory Hallucinations
Authors: Cazimir Catherine , Powers Albert R.
Published: October 2023

Thought insertion (TI) and auditory verbal hallucinations (AVH) are respectively defined as thoughts present in one’s mind that appear to emanate from elsewhere and a percept-like experience of a voice without a corresponding external stimulus. This chapter explores the common and distinct phenomenological, perceptual, and neural aspects of TI and AVH with the hope of understanding and contributing to future work in treating these phenomena, both independently and as they relate to psychotic illness. Future research to compare TI and AVH in help-seeking and non-help-seeking populations using the emerging methods of computational psychiatry is warranted and may aid in definitively understanding how these phenomena relate to each other.
Experimental Approaches to Understanding Thought Insertion
Authors: Brann Elisa , Walsh Eamonn , Mehta Mitul A. , Oakley David A. , Deeley Quinton
Published: October 2023

Thought insertion (TI) is a distressing alteration of self-experience occurring in schizophrenia and related psychoses. Despite its prevalence across human populations, TI has been almost untouched by experimental science. Experimental approaches to investigating alterations in experience complement phenomenological approaches such as descriptive psychopathology. Experiments can produce alterations in experience under controlled conditions which when accompanied by measurement of brain activity can help identify underlying brain processes. Consequently, experimentally produced alterations in experience resembling symptoms of psychopathology can provide insights into relevant brain processes. We open this chapter by exploring why TI has been little studied, discussing the principal challenges of investigating TI experimentally and suggesting how effective experimental paradigms can be designed. We then review a series of experiments that have employed experimental suggestion in hypnosis to model experiences of TI in healthy individuals, along with related alterations in self-experience such as alien control of movement. Some first-person descriptions of the types of experience elicited by experimental suggestion are provided. We then discuss brain measurement studies of these phenomena and how they inform theoretical accounts of TI. We consider the forward model, a computational model of voluntary motor control, and the role of the supplementary motor area (SMA) in the sense of control and ownership of mental contents and actions. Finally, the limitations of the experimental use of direct verbal suggestion are considered, and other possible avenues of investigation are highlighted for the future development of the field.
Generalized Internal Model of Mental Representations
Authors: Hiromitsu Kentaro , Asai Tomohisa
Published: October 2023

The current literature agrees that the internal model theory explains precision motor control. However, this theory applies to any neural representation of the external world, even our own mental states. This generalized hypothesis provides an analogy between controlled body movements and the manipulation of mental activities; that is, both models are presumably embedded within the cerebellum (reduced dimensions), but the cerebral cortex is more oriented toward the actual sensorium (higher dimensions). The following chapter thus contains three parts, including mental agency among healthy persons (e.g., Bayesian causal inference), thought insertion and psychosis (i.e., the loss of agency), and the aftereffects of cortical lesions (e.g., disturbed models and psychotic-like experiences). An exploration of the shared mechanism between these factors indicates that the generalized theory of thought insertion is associated with the internal model principle.
Thought Insertion and the Ontology of Thinking
Authors: Roessler Johannes
Published: October 2023

On what it will be called the No Subject view, there is a sense in which one may be aware of a thought, conceived as an event in one’s stream of consciousness, without being aware of oneself thinking something. Philosophical work on the delusion of thought insertion is one of the areas in which the No Subject view has been highly influential: the view has framed what, in the philosophy of mind, has become the standard interpretation of the delusion. Here a challenge is presented to the No Subject view, developing from reflection on the ontology of thinking. It will be also considered how, if the standard interpretation fails, thought insertion should be understood. In particular, it will be suggested that the widespread assumption that understanding the delusion has to be a matter of making sense of it should be questioned.
Expectations
Authors: Juhl Lunde Sigrid , Kirsch Irving , Bingel Ulrike , Büchel Christian , Vase Lene
Published: October 2023

Expectations are generally thought to be a key determinant of placebo effects. Yet, there is no consensus on how expectations should be defined, and placebo studies differ greatly on how—and if—they take measures of expectations into account. This chapter summarizes current approaches for the conceptualization and assessment of expectations, and presents new frameworks related to treatment expectations and prediction that may entail both conscious and unconscious aspects. These frameworks add to our understanding of expectations as complex, dynamic structures and may help to clarify when and how expectations contribute—not only to placebo effects, but also to treatment effects in general.
New translational opportunities for placebo research
Authors: Alter Ben , Leibowitz Kari , Crum Alia , Peciña Marta
Published: October 2023

Despite a significant understanding of the neurobiological mechanisms implicated in placebo effects, research to date has yet to be translated into placebo-based clinical interventions. In this chapter, we review the current state of placebo research as the first step to justifying placebo-based clinical interventions. We provide evidence to demonstrate how placebo-based paradigms can be used to improve patient satisfaction (e.g., reduced side effects) and health outcomes. We argue that the first step toward this aim is to train clinical healthcare providers and the broader healthcare staff to deliberately and effectively leverage the psychological and social forces underlying the placebo effect to improve patient satisfaction and health outcomes. In particular, we review interventions focused on empowering patients to establish more adaptive mindsets as they progress through treatment. Ultimately, we aim to leverage new frontiers for placebo research that will significantly affect clinical practice.