bluuebunny/crossref_metadata_2025 huggingface dataset:
Fatal Human Rabies Infection With Suspected Host-Mediated Failure of Post-Exposure Prophylaxis Following a Recognized Zoonotic Exposure—Minnesota, 2021
Authors: Holzbauer Stacy M , Schrodt Caroline A , Prabhu Rajesh M , Asch-Kendrick Rebecca J , Ireland Malia , Klumb Carrie , Firestone Melanie J , Liu Gongping , Harry Katie , Ritter Jana M , Levine Min Z , Orciari Lillian A , Wilkins Kimberly , Yager Pamela , Gigante Crystal M , Ellison James A , Zhao Hui , Niezgoda Michael , Li Yu , Levis Robin , Scott Dorothy , Satheshkumar Panayampalli S , Petersen Brett W , Rao Agam K , Bell W Robert , Bjerk Sonja M , Forrest Sara , Gao Wangcai , Dasheiff Richard , Russell Kari , Pappas Melissa , Kiefer Jessica , Bickler Wesley , Wiseman Anthony , Jurantee Joel , Reichard R Ross , Smith Kirk E , Lynfield Ruth , Scheftel Joni , Wallace Ryan M , Bonwitt Jesse
Published: March 2023

Background

No human rabies post-exposure prophylaxis (PEP) failure has been documented in the United States using modern cell culture–based vaccines. In January 2021, an 84-year-old male died from rabies 6 months after being bitten by a rabid bat despite receiving timely rabies PEP. We investigated the cause of breakthrough infection.

Methods

We reviewed medical records, laboratory results, and autopsy findings and performed whole-genome sequencing (WGS) to compare patient and bat virus sequences. Storage, administration, and integrity of PEP biologics administered to the patient were assessed; samples from leftover rabies immunoglobulin were evaluated for potency. We conducted risk assessments for persons potentially exposed to the bat and for close patient contacts.

Results

Rabies virus antibodies present in serum and cerebrospinal fluid were nonneutralizing. Antemortem blood testing revealed that the patient had unrecognized monoclonal gammopathy of unknown significance. Autopsy findings showed rabies meningoencephalitis and metastatic prostatic adenocarcinoma. Rabies virus sequences from the patient and the offending bat were identical by WGS. No deviations were identified in potency, quality control, administration, or storage of administered PEP. Of 332 persons assessed for potential rabies exposure to the case patient, 3 (0.9%) warranted PEP.

Conclusions

This is the first reported failure of rabies PEP in the Western Hemisphere using a cell culture–based vaccine. Host-mediated primary vaccine failure attributed to previously unrecognized impaired immunity is the most likely explanation for this breakthrough infection. Clinicians should consider measuring rabies neutralizing antibody titers after completion of PEP if there is any suspicion for immunocompromise.
GBScleanR: robust genotyping error correction using a hidden Markov model with error pattern recognition
Authors: Furuta Tomoyuki , Yamamoto Toshio , Ashikari Motoyuki
Published: March 2023

Reduced-representation sequencing (RRS) provides cost-effective and time-saving genotyping platforms. Despite the outstanding advantage of RRS in throughput, the obtained genotype data usually contain a large number of errors. Several error correction methods employing the hidden Markov model (HMM) have been developed to overcome these issues. These methods assume that markers have a uniform error rate with no bias in the allele read ratio. However, bias does occur because of uneven amplification of genomic fragments and read mismapping. In this paper, we introduce an error correction tool, GBScleanR, which enables robust and precise error correction for noisy RRS-based genotype data by incorporating marker-specific error rates into the HMM. The results indicate that GBScleanR improves the accuracy by more than 25 percentage points at maximum compared to the existing tools in simulation data sets and achieves the most reliable genotype estimation in real data even with error-prone markers.
An ecosystem-wide approach for assessing the spatialized cumulative effects of local and global changes on coastal ecosystem functioning
Authors: Nogues Quentin , Bourdaud Pierre , Araignous Emma , Halouani Ghassen , Ben Rais Lasram Frida , Dauvin Jean-Claude , Le Loc'h François , Niquil Nathalie
Published: March 2023

Coastal ecosystems are subjected to an increasing number of anthropogenic drivers, including marine renewable energies and climate change (CC). These drivers can interact in complex ways, which may lead to cumulative effects (CEs) whose potential consequences on the ecosystems need to be addressed. We used a holistic approach—ecological network analysis (ENA)—coupled with a two-dimensional food web model—Ecospace—to conduct an ecosystem study of the CEs of CC plus the operation of an offshore wind farm on ecosystem functioning in the extended Bay of Seine (English Channel). Mapped ENA indices showed that CEs were not restricted to the wind farm area, i.e. where anthropogenic drivers are concomitant. CEs varied both in space and among ecosystem properties, displaying that ENA indices can distinguish between different cumulative pathways that modify ecosystem functioning in multiple ways. Moreover, the effects seemed to be tied to the structuring role of CC, and differed under the 2050 and 2100 conditions. Such changes resulted in stronger loss of ecosystem resilience under the 2100 conditions despite the benefits of the reef and reserve effects of the wind farm.
Cremona Groups Over Finite Fields, Neretin Groups, and Non-Positively Curved Cube Complexes
Authors: Genevois Anthony , Lonjou Anne , Urech Christian
Published: March 2023

We show that plane Cremona groups over finite fields embed as dense subgroups into Neretin groups, that is, groups of almost automorphisms of rooted trees. We also show that if the finite base field has even characteristic and contains at least four elements, then the permutations induced by birational transformations on rational points of regular projective surfaces are even. In a second part, we construct explicit locally compact CAT(0) cube complexes, on which Neretin groups act properly. This allows us to recover in a unified way various results on Neretin groups such as that they are of type $F_{\infty }$. We also prove a new fixed-point theorem for CAT(0) cube complexes without infinite cubes and use it to deduce a regularization theorem for plane Cremona groups over finite fields.
More than Extraction: Rethinking Data's Colonial Political Economy
Authors: Gray Catriona
Published: March 2023

This article offers a novel conceptual framework to enable empirical investigation and analysis of the different ways in which contemporary data practices are entangled with colonialism. Departing from recent theorizations of the politics and political economy of data and data-driven technologies, including the theory of so-called data colonialism, I argue for a historicized and differentiated account of the colonial processes of dispossession at stake in datafication and the proliferation of data-dependent technologies. By undertaking a broad engagement with decolonial thinking, I demonstrate the need to move beyond an examination of how everyday life is datafied to be extracted like a natural resource. I show that such analogies are inapt and occlude colonial relations reproduced through datafication. Our understanding of these processes would find a firmer footing not in historical analogy, but in our colonial present. I propose that the modality of data's power lies not in the extraction of value as such, but in the interaction of orders of knowledge with orders of value. This reordering both acts as a motor of further colonial epistemic violence and creates the conditions for a new apparatus of racialized dispossession. Giving examples from migration governance, I set out its targets, objects, and operations.
Thinking beyond otorhinolaryngology in patients presenting with bilateral vocal cord paresis
Authors: Usman Hamza , Protts Faith , Fathers Edward , Chisholm Edward
Published: March 2023

Anti-immunoglobulin-like cell adhesion molecule 5 (IGLON5), a disease first described in 2014 by Sabater et al., is characterised by dysphonia, dysphagia, stridor and dysautonomia. We discuss the case of a patient presenting to the emergency department with anti-IGLON5 associated airway compromise following progressive reduced vocal cord movement requiring a surgical tracheostomy. We discuss the outpatient and emergency presentation of this case along with the available literature on anti-IGLON5. We aim to remind ENT practitioners to look beyond the common diagnoses and consider the diagnosis of anti-IGLON5 disease when faced with the symptoms listed above.
How to leverage intelligent agents and complex event processing to improve patient monitoring
Authors: De Lauretis Lorenzo , Persia Fabio , Costantini Stefania , D’Auria Daniela
Published: March 2023

This paper describes an intelligent ecosystem that can continuously monitor patients’ health conditions, whether at home, at work or during recreational activities, by leveraging a creative blend of wearable medical devices, intelligent agents (IA) and complex event processing (CEP). With the help of a smart application, linking wearable devices and the power of IA and CEP, patients will be constantly and actively supervised during their daily activities. This can even save their lives in case they experience sudden or gradual problems. Thanks to our system, patients with chronic illnesses that are not serious but potentially unstable will no longer overburden first aid services. This is also helpful in containing the spread of COVID-19. Specifically, in this paper, we focus on automatic monitoring of vital parameters, electrocardiogram analysis and psoriasis detection. Experimental results conducted on real patients show how promising our approach is.
Complex Systems Approaches to Psychopathology
Authors: Bringmann Laura , Helmich Marieke , Eronen Markus , Voelkle Manuel
Published: March 2023

Clinical research and practice are permeated by complexity. In recent years, researchers have witnessed a sharp increase in scientific studies that acknowledge this complexity and approach psychopathology from the perspective of complex systems. In this chapter, the authors provide an introduction to the complex systems approaches that have received the most attention in psychopathology. They begin by discussing the general idea of complexity and complex systems and then turn to the framework of complex dynamic system models and how they have been applied to psychopathology. After this, the authors discuss early warning signals, which hold the promise of using insights from complexity science to enable personalized prediction and timely intervention. Finally, the authors go through the recently popular network approach to psychopathology and how it is related to the broader framework of complex systems. Throughout the chapter, the authors discuss the applications, challenges, and limitations of these approaches.
Generalized Anxiety Disorder, Panic Disorder, Social Anxiety Disorder, and Specific Phobia
Authors: Zinbarg Richard E. , Williams Alexander L. , Kramer Amanda M. , Schmidt Madison R.
Published: March 2023

This chapter covers the anxiety disorders: generalized anxiety disorder, panic disorder, social anxiety disorder, and SP. The authors review leading perspectives on the epidemiology, etiology, and maintenance of each of the major anxiety disorders and cover leading factor analytic models of anxiety, from the tripartite model to the tri-level model. The chapter includes an overview of the prevalence and typical course of these disorders and reviews major contributing factors. The authors discuss temperament and personality factors, such as neuroticism, behavioral inhibition, anxiety sensitivity, and positive emotionality; summarize biological perspectives on anxiety disorder etiology; and describe information-processing biases that may also play etiological or maintaining roles. They also discuss vulnerability and contextual variables related to conditioning from direct, vicarious, and interoceptive conditioning to the role of uncontrollability and unpredictability, social reinforcement, and more. Finally, the authors discuss the interpersonal factors at play in the anxiety disorders, including attachment, interpersonal conflict, and expressed emotion.
Posttraumatic Stress Disorder and Dissociative Disorders
Authors: McNally Richard J.
Published: March 2023

This chapter has two major sections, one on posttraumatic stress disorder (PTSD) and the other on dissociative disorders. In addition to reviewing the nosological history of these syndromes and their epidemiology, the chapter covers landmark studies and recent research, especially work concerning the cognitive (attention, memory) and biological (genetic, neuroscientific, psychophysiological) aspects of these disorders. Although clinicians have long recognized that traumatic events can produce psychiatric symptoms in previously well-adjusted individuals, prevailing opinion held that stress-induced symptoms were transient and that persistent symptoms implied the presence of another neurotic or characterological disturbance. The psychiatric sequelae of the Vietnam War altered this view. Many veterans reported chronic symptoms, often long after reentering civilian life. Instead of viewing these men as suffering from preexisting conditions worsened by the war, clinicians concluded that combat itself could cause lasting psychiatric disability. The author then discusses certain controversies that have embroiled both syndromes over the years.
Sexual Dysfunction
Authors: Meston Cindy M. , Freihart Bridget K. , Stanton Amelia M.
Published: March 2023

Sexual problems can be broadly conceptualized as the inability to exhibit a sexual response or experience sexual pleasure. For such problems to be diagnosed as a sexual dysfunction, the concerns need to be further identified as personally distressing. The DSM-5 recognizes seven sexual problems: female interest/arousal disorder, male hypoactive sexual desire disorder, erectile disorder, premature (early) ejaculation, delayed ejaculation, female orgasmic disorder, and genito-pelvic pain/penetration disorder. Although individuals may present with a range of sexual problems, DSM-5 recognizes only three major categories of sexual dysfunction: interest/arousal, orgasm, and pain. This chapter reviews each sexual dysfunction, with a specific focus on the diagnostic criteria and prevalence rates, as well as known psychological and biological etiological factors.
Functional Somatic Symptoms
Authors: Henningsen Peter , Bouman Theo K. , Hausteiner-Wiehle Constanze
Published: March 2023

Every individual experiences subjective somatic symptoms that might or might not be explained by a known medical condition. Some of these symptoms disappear quickly, whereas others persist. This chapter focuses mostly on symptoms that cannot be easily understood from a solely biomedical perspective, the so-called functional somatic symptoms (FSS). The symptoms referred to as FSS are comprised of varying combinations of pain in different parts of the body, functional disturbances attributed to organs like cardiovascular or gastrointestinal dysfunctions or dizziness, and symptoms surrounding fatigue. Their main characteristics, pathophysiology, and etiology are briefly discussed. In addition, the authors discuss the relation between FSS and the current DSM classification of somatic symptom disorder and other related diagnostic categories.
Comparison Between Neuroscience- and DIRFloortime®-Informed Approaches Within Music Therapy: A Descriptive Case Study
Authors: Shinn Haley , Lagasse A Blythe
Published: March 2023

Music therapists practice from different clinical approaches; however, these approaches have not been compared in a research study. The purpose of this descriptive case study was to examine differences in behaviors for one participant on the autism spectrum and their therapist practicing from two different clinical approaches. We examined five videos where treatment was delivered in a neuroscience-informed approach and five videos in a DIRFloortime®-informed approach. We used observational behavioral coding for three nonmusical social skill behaviors, three musical social skill behaviors, and four therapist behaviors. We also examined the presence of critical elements of each approach within the videos. Results indicated that the therapist overall showed the critical elements for each approach within the examined videos. Targeted participant social behaviors were present in each of the approaches; however, the manner in which they were facilitated was different. Descriptive statistics and visual analysis were used to show similarities and differences between the approaches. Further studies are needed to explore different approaches in music therapy clinical practice.
Citizen science photographs indicate different timing and location use of migrating adult and juvenile Whimbrels
Authors: Hines Chance , Duval Laura , Watts Bryan D , Van Horn Grant , Miller Eliot
Published: March 2023

It is imperative to identify factors that influence population trends for declining species, but demographic parameters can be especially challenging to quantify for birds, such as Whimbrels (Numenius phaeopus), that breed in locations that are logistically difficult to access. At least two disjunct Whimbrel populations breed in remote and difficult to access northern latitudes but migrate through the heavily populated North American Atlantic Coast during autumn migration. Here, we capitalize on the Whimbrel migrations through the more populated coastal areas to age Whimbrels in photographs uploaded to the citizen science website, eBird, to identify the timing and location of juvenile Whimbrels staging for trans-Atlantic migratory flights. Mean photograph dates for adult migration were synchronous with reported dates for the Mackenzie Delta population that breeds along the northern coast of Northwest Territories, Canada, and stages in Atlantic Canada and for the Hudson Bay population that stages along the South Atlantic USA coast. However, the mean dates of juvenile photographs were 29–41 days later than adult dates, depending on the region. Space use by juveniles along the coast also differed from that reported for adults. Adults primarily depend on Atlantic Canada and the South Atlantic USA coast during fall migration. The percentage of juveniles was greater outside these two primary staging locations. Region-specific juvenile photograph dates suggest that juveniles may drift farther south than the majority of adults from their respective populations. The percentage of juvenile photos collected better predicted the percentage of adult photos 3 years later than 1 and 2 years later which is consistent with Whimbrel’s delayed reproductive strategy and provides validation for using photographs to obtain age ratios. As photograph uploads become more commonplace, this and similar analyses may be used to obtain information that would normally be logistically difficult with traditional field methods.
Rare-earth control of phase transitions in infinite-layer nickelates
Authors: Zhang Yajun , Zhang Jingtong , He Xu , Wang Jie , Ghosez Philippe
Published: March 2023

Perovskite nickelates RNiO3 (R = rare-earth ion) exhibit complex rare-earth ion dependent phase diagram and high tunability of various appealing properties. Here, combining first- and finite-temperature second-principles calculations, we explicitly demonstrate that the superior merits of the interplay among lattice, electron, and spin degrees of freedom can be passed to RNiO2, which recently gained significant interest as superconductors. We unveil that decreasing the rare-earth size directly modulates the structural, electronic, and magnetic properties and naturally groups infinite-layer nickelates into two categories in terms of the Fermi surface and magnetic dimensionality: compounds with large rare-earth sizes (La, Pr) closely resemble the key properties of CaCuO2, showing quasi-two-dimensional (2D) antiferromagnetic (AFM) correlations and strongly localized dx2−y2 orbitals around the Fermi level; the compounds with small rare-earth sizes (Nd–Lu) are highly analogous to ferropnictides, showing three-dimensional (3D) magnetic dimensionality and strong kz dispersion of d3z2−r2 electrons at the Fermi level. Additionally, we highlight that RNiO2 with R = Nd–Lu exhibit on cooling a structural transition with the appearance of oxygen rotation motion, which is softened by the reduction of rare-earth size and enhanced by spin-rotation couplings. The rare-earth control of kz dispersion and structural phase transition might be the key factors differentiating the distinct upper critical field and resistivity in different compounds. The established original phase diagram summarizing the temperature and rare-earth controlled structural, electronic, and magnetic transitions in RNiO2 compounds provides rich structural and chemical flexibility to tailor the superconducting property.
mHealth hyperspectral learning for instantaneous spatiospectral imaging of hemodynamics
Authors: Ji Yuhyun , Park Sang Mok , Kwon Semin , Leem Jung Woo , Nair Vidhya Vijayakrishnan , Tong Yunjie , Kim Young L
Published: March 2023

Hyperspectral imaging acquires data in both the spatial and frequency domains to offer abundant physical or biological information. However, conventional hyperspectral imaging has intrinsic limitations of bulky instruments, slow data acquisition rate, and spatiospectral trade-off. Here we introduce hyperspectral learning for snapshot hyperspectral imaging in which sampled hyperspectral data in a small subarea are incorporated into a learning algorithm to recover the hypercube. Hyperspectral learning exploits the idea that a photograph is more than merely a picture and contains detailed spectral information. A small sampling of hyperspectral data enables spectrally informed learning to recover a hypercube from a red–green–blue (RGB) image without complete hyperspectral measurements. Hyperspectral learning is capable of recovering full spectroscopic resolution in the hypercube, comparable to high spectral resolutions of scientific spectrometers. Hyperspectral learning also enables ultrafast dynamic imaging, leveraging ultraslow video recording in an off-the-shelf smartphone, given that a video comprises a time series of multiple RGB images. To demonstrate its versatility, an experimental model of vascular development is used to extract hemodynamic parameters via statistical and deep learning approaches. Subsequently, the hemodynamics of peripheral microcirculation is assessed at an ultrafast temporal resolution up to a millisecond, using a conventional smartphone camera. This spectrally informed learning method is analogous to compressed sensing; however, it further allows for reliable hypercube recovery and key feature extractions with a transparent learning algorithm. This learning-powered snapshot hyperspectral imaging method yields high spectral and temporal resolutions and eliminates the spatiospectral trade-off, offering simple hardware requirements and potential applications of various machine learning techniques.
Non-alcoholic fatty liver and fibrosis is associated with cardiovascular structure and function in young adults
Authors: Tang Rosalind , Abeysekera Kushala W. M. , Howe Laura D. , Hughes Alun D. , Fraser Abigail
Published: March 2023

Background:

Non-alcoholic fatty liver disease shares many risk factors with other metabolic disorders. We sought to establish whether non-alcoholic fatty liver disease may be associated with cardiovascular health independently of other known risk factors.

Methods:

In this prospective, population-based cohort of young adults, controlled attenuation parameter-defined liver steatosis, transient elastography-defined liver fibrosis, echocardiography, carotid ultrasonography, and pulse wave analysis were assessed at age 24 years. We examined associations between liver and cardiovascular measures, with and without accounting for demographics, body mass index, alcohol, smoking, blood pressure, lipidemia, glycemia, and inflammation.

Results:

We included 2047 participants (mean age 24.4 y; 36.2% female): 212 (10.4%) had steatosis, whereas 38 (1.9%) had fibrosis. Steatosis was associated with cardiovascular measures after adjusting for demographics, but with more comprehensive adjustment, steatosis only remained associated with stroke index [β (95% CI) of −1.85 (−3.29, −0.41) mL/m2] and heart rate [2.17 (0.58, 3.75) beats/min]. Fibrosis was associated with several measures of cardiovascular structure and function after full adjustment for risk factors, including left ventricular mass index [2.46 (0.56, 4.37) g/m2.7], E/A ratio [0.32 (0.13, 0.50)], tricuspid annular plane systolic excursion [0.14 (0.01, 0.26) cm], carotid intima-media thickness [0.024 (0.008, 0.040) mm], pulse wave velocity [0.40 (0.06, 0.75) m/s], cardiac index [−0.23 (−0.41, −0.06) L/min⋅m2], and heart rate [−7.23 (−10.16, −4.29) beats/min].

Conclusions:

Steatosis was not associated with measures of cardiovascular structure and function nor with subclinical atherosclerosis after adjusting for known cardiovascular risk factors. Fibrosis, however, was associated with several cardiovascular measures, including indicators of subclinical atherosclerosis, even after full adjustment. Further follow-up will help determine whether cardiovascular health worsens later with steatosis alone.
Acute severe hepatitis as a presenting symptom in clinically stable patients admitted with SARS-CoV-2 Omicron infection
Authors: Swain Liam A. , Ambasta Anshula , Munhoz Erika Prando , Omodon Onyebuchi , Urbanski Stefan J. , Nguyen Henry H.
Published: March 2023

Background:

Suggested mechanisms for SARS-CoV-2 direct liver infection have been proposed by others to involve both cholangiocytes and hepatocytes. Early clinical studies have highlighted abnormal liver biochemistry with COVID-19 infection as often not being severe, with elevated liver enzymes <5X the upper limit of normal.

Methods:

Liver enzymes were evaluated and compared in patients admitted with a diagnosis of COVID-19 in a deidentified Internal Medicine-Medical Teaching Unit/hospitalist admission laboratory database. Comparisons in the incidence of severe liver injury (alanine aminotransferase >10 times upper limit of normal) were made for patients with pre-Omicron SARS-CoV-2 (November 30, 2019, to December 15, 2021) and Omicron SARS-CoV-2 (December 15, 2021, to April 15, 2022). Comprehensive hospital health records were also reviewed for the 2 patient cases discussed. One patient had a liver biopsy that was evaluated with H&E and immunohistochemistry staining using an antibody against COVID-19 spike protein.

Results:

The evaluation of a deidentified admissions laboratory database found the incidence of severe liver injury was 0.42% with Omicron versus 0.30% with pre-Omicron variants of COVID-19. In both patient cases discussed, abnormal liver biochemistry and a negative comprehensive workup strongly suggest COVID-19 as the cause of severe liver injury. In the one patient with liver biopsy, immunohistochemistry staining suggests SARS-CoV-2 presence in the portal and lobular spaces in association with immune cell infiltration.

Conclusions:

The Omicron variant of SARS-CoV-2 should be considered in the differential diagnosis of severe acute liver injury. Our observation suggests that this new variant, either through direct liver infection and/or mediating immune dysfunction, can result in severe liver injury.
RETINAL ISCHEMIA AFTER FOCAL CEREBRAL ARTERIOPATHY IN A YOUNG GIRL
Authors: Benvenuto Franco , Colorado-Zavala Maria F. , Ruiz-Lozano Raul E. , Gonzalez-Dutra Maria L. , Kadzielski Carina , Ancona-Lezama David
Published: March 2023

Purpose:

We present a case of an ischemic retinopathy with severe vision loss secondary to a childhood stroke.

Methods:

Case report.

Results:

An otherwise healthy 9-year-old girl presented with a 1-day history of impaired gait and speech. After performing computed tomography and magnetic resonance imaging, thrombosis of the left internal carotid artery was observed and a diagnosis of ischemic stroke was established. Serological autoimmune, coagulation, and viral panels were unrewarding. Cardiac, inflammatory, and coagulation disorders were ruled out. The cause was attributed to a focal cerebral arteriopathy, a common cause of childhood stroke. The patient was treated with mechanical thrombectomy followed by anticoagulation. The day after, the patient referred vision loss of 20/100 in the left eye. Fundus evaluation of the left eye depicted diffuse intraretinal hemorrhages and cotton-wool spots and there was retinal whitening at the posterior pole. Six weeks after, VA dropped to counting fingers.

Conclusion:

A macular optical coherence tomography revealed diffuse atrophic changes in the inner retinal layers at the macula, and the angio-optical coherence tomography showed an enlarged foveal avascular zone. We propose ischemia-reperfusion as the primary explanation of this unusual event.
“Factors Associated with Court Outcomes of Medical Malpractice Litigations involving Breast Reductions: 1990-2020”
Authors: Gong Jung Ho , Kim Daniel D , King Victor A , Mehrzad Raman
Published: March 2023

Background:

7.4% of physicians in the United States face risk of undergoing medical malpractice litigations each year. Breast reduction surgeries are performed often, but specific factors of breast reduction malpractice litigations associated with the outcome and indemnity payments to plaintiffs are unknown.

Methods:

Using the Westlaw legal database, we analyzed plaintiff and defendant characteristics, alleged reasons for malpractice, case outcomes, and payments to plaintiffs among medical malpractice lawsuits involving breast reductions with final jury verdicts or settlements using logistic regressions.

Results:

96 malpractice litigations with jury verdicts or settlements involving breast reduction surgeries between 1990 and 2020 met out inclusion/exclusion criteria. The average reported plaintiff age was 39 years (SD, 15). A total of 28 (29.2%), 48 (50.0%), and 20 (20.8%) cases occurred in the 1990-1999, 2000-2009, and 2010-2020 periods, respectively. 15 (15.6%) cases were held in New York. Most cases were in favor of defendants (N=65, 67.7%). Among 14 (14.6%) cases with nipple malpositioning as a sustained injury, 8 (57.1%) of them were ruled in favor of plaintiffs. Nipple malpositioning had increased odds of plaintiff verdict or settlement vs defendant verdict (OR, 1.33 [95% CI, 1.03 to 1.74]; P=0.03). Median payment to plaintiffs were $221,348 (range, $4,375 to $3,500,000) for plaintiff verdicts and $650,000 (range, $250,000 to $750,000) for settlements.

Conclusions:

Most breast reduction malpractice litigations were ruled in favor of defendants. Nipple positioning should be taken into high consideration by plastic surgeons performing breast reductions to avoid malpractice litigations and indemnity payments.
Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma Etiology and Epidemiology (PROFILE): Updated Report 2012 – 2020
Authors: McCarthy Colleen M. , Roberts John , Mullen Erin , Loyo-Berrios Nilsa , Clemens Mark W. , Yoon Sung W. , Levinson Howard , Sommers Katie , Hume Keith , Carr Logan
Published: March 2023

Introduction:

In January 2011, the FDA released a safety communication regarding the potential association between breast implants and anaplastic large cell lymphoma (BIA-ALCL). In 2012, the American Society of Plastic Surgeons, The Plastic Surgery Foundation, and the FDA signed a cooperative research and development agreement to develop a patient registry entitled the " Patient Registry and Outcomes F or breast Implants and anaplastic large cell Lymphoma etiology and Epidemiology" or “PROFILE" Registry.

Methods:

This is an updated report of registry findings.

Results:

From August 2012 to August 2020, 330 unique, suspected or confirmed cases of BIA-ALCL in the US were reported to PROFILE. This includes 144 cases newly reported since the 2018 publication. Median time from implantation of any device to BIA-ALCL diagnosis was 11 years (range 2 - 44 years). At the time of presentation, 91% of cases had local symptoms and 9% had concurrent systemic symptoms. The most common local symptom was seroma seen in 79% of patients. All patients had a history of a textured device; there were no patients who had a confirmed smooth-only device history. Approximately, 11% of the reported cases were diagnosed with Stage 1A disease (TNM Staging Classification).

Conclusions:

The PROFILE Registry continues to be an essential tool in unifying the collection of granular level data pertaining to BIA-ALCL. This data emphasizes the critical importance of detailed tracking of BIA-ALCL cases and will contribute significantly to our understanding of the relationship between breast implants and ALCL.
“The Resting Angle Suture”
Authors: Finocchi Valerio , Todaro Mattia , Çakir Bariş , Cervelli Daniele
Published: March 2023

The goal of every rhinoplasty surgeon is the creation of both a functionally and aesthetically pleasing nose. The lateral crura resting angle is a key concept that has recently emerged, we believe that it should always be taken into consideration to achieve a satisfactory result.

In this paper, we describe a novel technique: the resting angle suture, the idea for this suture comes from the inversion suture used to correct ectropion deformity in lower eyelid surgery.
What We Talk About When We Talk About Coping
Authors: Bamdad Michaela C. , Vitous Crystal Ann , Rivard Samantha J. , Anderson Maia , Lussiez Alisha , De Roo Ana , Englesbe Michael J. , Suwanabol Pasithorn A.
Published: March 2023

Objective:

To explore how surgery residents cope with unwanted patient outcomes including postoperative complications and death.

Background:

Surgery residents face a variety of work-related stressors that require them to engage in coping strategies. Postoperative complications and deaths are common sources of such stressors. Although few studies examine the response to these events and their impacts on subsequent decision-making, there has been little scholarly work exploring coping strategies among surgery residents specifically.

Methods:

This study investigated the ways, in which general surgery residents cope with unwanted patient outcomes, including complications and deaths. Mid-level and senior residents (n = 28) from 14 academic, community, and hybrid training programs across the United States participated in exploratory semistructured interviews conducted by an experienced anthropologist. Interview transcripts were analyzed iteratively, informed by thematic analysis.

Results:

When discussing how they cope with complications and deaths, residents described both internal and external strategies. Internal strategies included a sense of inevitability, compartmentalization of emotions or experiences, thoughts of forgiveness, and beliefs surrounding resilience. External strategies included support from colleagues and mentors, commitment to change, and personal practices or rituals, such as exercise or psychotherapy.

Conclusions:

In this novel qualitative study, general surgery residents described the coping strategies that they organically used after postoperative complications and deaths. To improve resident well-being, it is critical to first understand the natural coping processes. Such efforts will facilitate structuring future support systems to aid residents during these difficult periods.
Association of Intellectual Disability with Delayed Presentation and Worse Outcomes in Emergency General Surgery
Authors: Zondlak Allyse N. , Oh Esther J. , Neiman Pooja U. , Fan Zhaohui , Taylor Kathryn K. , Sangji Naveen F. , Hemmila Mark R. , Scott John W.
Published: March 2023

Objective:

To examine the association between intellectual disability and both severity of disease and clinical outcomes among patients presenting with common emergency general surgery (EGS) conditions.

Background:

Accurate and timely diagnosis of EGS conditions is crucial for optimal management and patient outcomes. Individuals with intellectual disabilities may be at increased risk of delayed presentation and worse outcomes for EGS; however, little is known about surgical outcomes in this population.

Methods:

Using the 2012-2017 Nationwide Inpatient Sample, we conducted a retrospective cohort analysis of adult patients admitted for 9 common EGS conditions. We performed multivariable logistic and linear regression to examine the association between intellectual disability and the following outcomes: EGS disease severity at presentation, any surgery, complications, mortality, length of stay, discharge disposition, and inpatient costs. Analyses were adjusted for patient demographics and facility traits.

Results:

Of 1,317,572 adult EGS admissions, 5,062 (0.38%) patients had a concurrent ICD-9/-10 code consistent with intellectual disability. EGS patients with intellectual disabilities had 31% higher odds of more severe disease at presentation compared with neurotypical patients (aOR 1.31; 95% CI 1.17–1.48). Intellectual disability was also associated with a higher rate of complications and mortality, longer lengths of stay, lower rate of discharge to home, and higher inpatient costs.

Conclusion:

EGS patients with intellectual disabilities are at increased risk of more severe presentation and worse outcomes. The underlying causes of delayed presentation and worse outcomes must be better characterized to address the disparities in surgical care for this often under-recognized but highly vulnerable population.
Selecting DCD Recipients Using Predictive Indices
Authors: Ganni Saif , Handing Greta , Anand Adrish , Barrett Spencer , Galvan Nhu Thao Nguyen , O’Mahony Christine , Goss John A. , Cotton Ronald T. , Rana Abbas
Published: March 2023

Background.

Donation after circulatory death (DCD) allografts might represent one of the largest untapped sources of liver allografts. Our aim was to identify independent recipient risk factors that predict mortality in DCD allograft recipients to preselect optimal candidates for successful transplantation. Furthermore, we compared the application of our newly constructed DCD Recipient Selector Index (RSI) score to previously developed models to determine superiority in predicting recipient survival.

Methods.

Using the Organ Procurement and Transplantation Network database, we performed univariate and multivariate retrospective analyses on 4228 DCD liver allograft recipients.

Results.

We identified 8 significant factors and incorporated them into the weighted RSI to predict 3-mo survival following DCD liver transplantation with a C-statistic of 0.6971. The most significant recipient risk factors were recipient serum sodium levels >150 mEq/L at transplant, recipient albumin <2.0 g/dL at transplant, and a history of portal vein thrombosis. Because Model for End-Stage Liver Disease (MELD) score components were included as individual predictors, the DCD RSI predicts survival independently of MELD. Upon comparison with 3 previous recipient risk scores—Balance of Risk, Renal Risk Index, Patient-Survival Outcomes Following Liver Transplantation—the DCD RSI was determined to be superior at selecting optimal candidates pre-DCD transplantation, yielding a C-statistic of 0.6971.

Conclusions.

After verifying the performance of predictive indices for selection of DCD recipients, the DCD RSI is best used to preselect patients for optimized outcomes after DCD transplantation. This can increase utilization of DCD donors by improving outcomes.
Insights From Chronic ECoG by RNS
Authors: Traner Christopher B. , King-Stephens David
Published: March 2023

The NeuroPace responsive neurostimulation system (RNS) has revolutionized the care of patients suffering from focal epilepsy since its approval in 2014. One major advantage of this device is its innate ability to gather long-term electrocorticographic (ECoG) data that the device uses in its novel closed-loop treatment paradigm. Beyond the standard stimulation treatments, which have been demonstrated to be safe and well-tolerated, the data collected by the RNS provide valuable information, such as the long-term circadian and ultradian variations that affect seizure risk, obtained under naturalistic conditions. Additionally, these data inform future surgical procedures, supplementing clinically reported seizures by patients, assessing the response to newly added anti-seizure medications, helping to forecast the risk of future seizures, and understanding the mechanisms of certain long-term outcomes in patients with postsurgical epilepsy. By leveraging these data, the delivery of high-quality clinical care for patients with epilepsy can only be enhanced. Finally, these data open significant avenues of research, including machine learning and artificial intelligence algorithms, which may also translate to improved outcomes in patients who struggle with recurrent seizures.
Structural basis of CHMP2A-CHMP3 ESCRT-III polymer assembly and membrane cleavage
Authors: Azad Kimi , Guilligay Delphine , Boscheron Cecile , Maity Sourav , De Franceschi Nicola , Sulbaran Guidenn , Effantin Gregory , Wang Haiyan , Kleman Jean-Philippe , Bassereau Patricia , Schoehn Guy , Desfosses Ambroise , Weissenhorn Winfried
Published: March 2023

The endosomal sorting complex required for transport (ESCRT) is a highly conserved protein machinery that drives a divers set of physiological and pathological membrane remodeling processes. However, the structural basis of ESCRT-III polymers stabilizing, constricting and cleaving negatively curved membranes is yet unknown. Here we present cryo electron microscopy structures of membrane-coated CHMP2A-CHMP3 filaments of two different diameters at 3.3 and 3.6 Å resolution. The structures reveal helical filaments assembled by CHMP2A-CHMP3 heterodimers in the open ESCRT-III conformation, which generates a partially positive charged membrane interaction surface, positions short N-terminal motifs for membrane interaction and the C-terminal VPS4 target sequence towards the tube interior. Inter-filament interactions are electrostatic, which facilitate filament sliding upon VPS4-mediated polymer remodeling. Fluorescence microscopy as well as high speed atomic force microscopy imaging corroborate that CHMP2A-CHMP3 polymers and VPS4 can constrict and cleave narrow membrane tubes, thus acting as a minimal membrane fission machinery.
Hepatic IRE1 Protects Against Septic Cardiac Failure
Authors: Li Mark , Berton Roger R. , Qian Qingwen , Maschek J. Alan , Chen Biyi , Barroso Elizabeth , Rauckhorst Adam J. , Griffith Thomas S. , Taylor Eric B. , Badovinac Vladimir P. , Hotamisligil Gökhan S. , Song Long-Sheng , Yang Ling
Published: March 2023

SUMMARY

Metabolic reprogramming in response to infection plays a critical role for septic survival. During a septic episode, the heart heavily relies on hepatic lipid particles to prevent heart damage and failure. Inositol- Requiring Enzyme 1 (IRE1) is the most conserved unfolded protein response (UPR) regulator that governs homeostasis of the endoplasmic reticulum (ER), the major site for lipid synthesis and processing. Here we show that hepatocyte IRE1 is indispensable for protecting against septic mortality in two different rodent models of experimental sepsis. The protective effect of hepatic IRE1 was not attributed to the inflammatory response since hepatic IRE1 deletion did not alter hepatic or systemic cytokine response. However, loss of IRE1 in the liver significantly augmented septic cardiac dysfunction in part due to a skewed immune-metabolic balance. Lipidomic and metabolomic analyses further revealed that loss of IRE1 in the liver compromised adaptive intrahepatic and circulating lipid reprogramming, including VLDL, in response to septic challenge. Furthermore, we identified that the protective effects against septic mortality are mediated by a non-canonical IRE1-dependent mechanism. Together, our study provides the first insight into how a disruption of hepatic ER-mediated lipid metabolic regulation promotes sepsis-associated cardiac immuno-metabolic imbalance.
Multi-ancestry meta-analysis of tobacco use disorder prioritizes novel candidate risk genes and reveals associations with numerous health outcomes
Authors: Toikumo Sylvanus , Jennings Mariela V , Pham Benjamin K , Lee Hyunjoon , Mallard Travis T , Bianchi Sevim B , Meredith John J , Vilar-Ribó Laura , Xu Heng , Hatoum Alexander S , Johnson Emma C , Pazdernik Vanessa , Jinwala Zeal , Pakala Shreya R , Leger Brittany S , Niarchou Maria , Ehinmowo Michael ,   Penn Medicine BioBank, Million Veteran Program,   Psychemerge Substance Use Disorder Workgroup, Jenkins Greg D , Batzler Anthony , Pendegraft Richard , Palmer Abraham A , Zhou Hang , Biernacka Joanna M , Coombes Brandon J , Gelernter Joel , Xu Ke , Hancock Dana B , Nancy Cox J , Smoller Jordan W , Davis Lea K , Justice Amy C , Kranzler Henry R , Kember Rachel L , Sanchez-Roige Sandra
Published: March 2023

Tobacco use disorder (TUD) is the most prevalent substance use disorder in the world. Genetic factors influence smoking behaviors, and although strides have been made using genome-wide association studies (GWAS) to identify risk variants, the majority of variants identified have been for nicotine consumption, rather than TUD. We leveraged five biobanks to perform a multi-ancestral meta-analysis of TUD (derived via electronic health records,EHR) in 898,680 individuals (739,895 European, 114,420 African American, 44,365 Latin American). We identified 88 independent risk loci; integration with functional genomic tools uncovered 461 potential risk genes, primarily expressed in the brain. TUD was genetically correlated with smoking and psychiatric traits from traditionally ascertained cohorts, externalizing behaviors in children, and hundreds of medical outcomes, including HIV infection, heart disease, and pain. This work furthers our biological understanding of TUD and establishes EHR as a source of phenotypic information for studying the genetics of TUD.