bluuebunny/crossref_metadata_2025 huggingface dataset:
From Deep Holes to the Bigger Picture
Authors: Eberhardt Gisela
Published: November 2024

This chapter looks at the development and spread of archaeological field methods as reflected in the history of excavation layout. During the early nineteenth century, questions of chronology were initially in the foreground and could be answered by ordering the ancient finds—a targeted search for objects was thus appropriate as method. But holes and trenches proved to be insufficient at the latest when the notion of culture changed from general to particular. Instead of universally valid categories, the focus turned to the individual find site, which had to be carefully excavated, requiring increasingly large-scale excavation methods. Thus, the basic archaeological field methods were established by the first quarter of the twentieth century. In the process, the decidedly “Western” historical approach to the material and the associated ways of working had been spread around the world from Europe and the United States.
Reconceptualizing Altered States of Consciousness Using Network-Based Tools
Authors: Carranante Géraldine , van Elk Michiel
Published: November 2024

Progress in the scientific study of altered states of consciousness (ASCs) has been hindered by methodological and conceptual problems. At a methodological level there is a lack of agreement on the scales and instruments used to measure and categorize ASCs. At a conceptual level, existing typologies (such as trigger-based, phenomenology-based, attribution-based, neurobiological, and psychopathological approaches) face difficulties with demarcating different states and in organizing the field of investigation in a clear and productive way. The authors propose a new method of classification for this research field that will mitigate these problems by providing better typologies to study ASCs. In this chapter the authors lay out the epistemological foundations of such an approach, arguing that scientific progress can be made through an iterative process of conceptual refinement. On this approach, ASCs can be conceived of as a network of nodes, in which different clusters of states can be identified. At a methodological level, network-based models offer the potential to calculate network properties (e.g., centrality measures), while at a conceptual level they offer flexibility in terms of the nodes that can be included in the network (these could encompass features of experience, as well as contextual, social and biological features). The authors argue that a network-based model outperforms existing conceptual approaches for fostering current scientific research. By doing so, the authors also offer methodological tools to organize the research field of ASCs, which helps scientists to produce more precise scientific results and to foster interdisciplinary transmission of results.
Monsters of the Inner World
Authors: Apanomeritaki Eirini
Published: November 2024

Monsters of the ancient world often populate psychoanalytic thought. This chapter explores the relationship between monstrosity and psychoanalysis by offering a critical comparison of psychoanalytic theories on the monsters of classical myths. The first section discusses approaches to the Theban Sphinx by Sigmund Freud, Otto Rank, and Carl Gustav Jung. The second section considers Freud’s interpretation of Medusa and its effect on the formation of a psychoanalytic account that privileges male sexuality. After Freud, monstrosity is discussed in relation to maternity in the work of Cixous, Kristeva, and other theorists. The third section addresses the limited attention the Minotaur has received in psychoanalysis from the twentieth century onwards despite the interest in mythical monsters and archaeology. In exploring various approaches to monsters, the chapter highlights the affinity between monstrosity and the development of psychoanalytic thought.
Typhoeus, Agent of Disorder
Authors: Brockliss William
Published: November 2024

Typhoeus represents perhaps the most extreme instantiation of disorder of all monsters of the Greek and Roman tradition. The poets and artists of ancient Greece and Rome associate him with several related themes: disordered or otherwise unusual family relations, a disorderly body, disorderly sounds, and the capacity to engender disorder in the cosmos and on earth. Writers also draw on Typhoeus to illustrate disorder in human communities and the human soul, and to explore conceptual pairings important to their poems and treatises, such as reason and madness, music and noise. Nonetheless, for all Typhoeus’ disorderly qualities, some texts identify a more positive role for the forces associated with the monster. Nonnus, for instance, hints that a Typhoean soundscape can make a contribution to the poetics of the Dionysiaca.
Monsters and Disability
Authors: Silverblank Hannah , Ward Marchella
Published: November 2024

This chapter looks at the rhetorical constructions of monstrosity and disability in Aristotelian philosophy and Homer’s Odyssey Book 9—and proceeds by reading backwards in time, a methodology drawn from queer studies and disability studies. First, the chapter establishes some of the dangers of reading bodies for meaning in post-classical modernity. Then it contextualizes these physiognomic readings in Aristotelian interpretations of bodies (Parts of Animals, Physiognomonica, Generation of Animals). Finally, the chapter considers the role that these modes of monstering, and concomitant abdications of moral responsibility for violence, play in Odysseus’ encounter with the Cyclops Polyphemus. Odysseus’ rhetorical connection between disability and monstrosity can be dangerous and oppressive to people with non-normate bodies in the real world; but when read outside Odysseus’ interpretative lens, the monster becomes a spark for imagining alternative ways of living in multi-species community and interdependence.
Realism in the Global Age of Modernism in China and the United States
Authors: Chan Julia
Published: November 2024

If realism is often caught up in an oversimplified binary with modernism, what happens when modernist studies become increasingly expansive in geographical, temporal, and generic terms? This chapter reviews the recent critical approaches to reconfiguring the conventional narrative of nineteenth-century European realism’s demise and transition into modernism. Specifically, it traces the reification of the modernism/realism dichotomy back to Cold War ideologies, explores global modernist scholars’ turn toward the Soviet cultural system as an alternative model of world literature, and examines the tendencies in postcolonial and ethnic studies to read peripheral realist texts as ethnographic writing. Paradoxically, the attempt to recuperate realism (especially non-western or peripheral realisms) often ends up reaffirming the biases toward modernist modes of representation as more sophisticated and self-reflective. The second half of this chapter considers the material repercussions of this continual marginalization of realism. It includes a case study of Eileen Chang (Zhang Ailing, 1920–1995), whose celebration as a sinophone global modernist today has largely obscured her repeated attempts to pivot to anglophone realist writing from the 1950s onward. The rise and fall of Chang’s career as an émigré bilingual writer in the United States attests to a deeply politicized and deeply unequal international division of creative labor, in which non-western authors are often relegated to the role of the native informant. For the peripheral writer, realism is not necessarily an aesthetic choice but a political and artistic compromise they must make if they are to gain entry into the Euro-American “global” literary market.
On Assembly
Authors: Abu El-Haj Tabatha , Probert Thomas , Srinivasan Sharath
Published: November 2024

Introducing the Handbook, this chapter takes a fresh look at assembly, arguing it is central to the politics of our time. It begins by contending that a preoccupation with protest and the law surrounding it elides the fact that assembly is a far more extensive and significant phenomenon than its political protest form. Assembly lies at the heart of our existence as social beings, at the foundation of our communities and polities, and at the core of our collective capacity to reshape our lives and worlds. Furthermore, this chapter warns that studying and thinking about assembly only from the perspective of a ‘right’ to be enjoyed may ultimately reinforce a narrow conception of assembly and overemphasize the logics of regulation, thereby excessively taming the potential of assembly as a practice. Unfortunately, the particular way the right has been codified and practically implemented serves to enhance the legitimacy of the dominion of authorities over their subjects rather than enhancing the human freedom that makes assembly worthy of human rights protection in the first place. Taken together, the contributions to this Handbook place assembly front and centre, as a distinct social, political, legal, and managerial object of inquiry and develop a deeper understanding of the existing right, laying the groundwork for imagining a broader and more robust understanding of the phenomenon and construction of the right.
China
Authors: Zhang Qianfan
Published: November 2024

This chapter discusses the horizontal and vertical power structures in the current constitution of China and their relevance to the protection of constitutional rights. While the people’s congresses at the basic levels are supposed to be directly elected, the elections are tightly controlled by the Chinese Communist Party, making them “rubber stamp” legislatures. Constitutional enforcement and the rule of law are further weakened by a lack of judicial independence and a perplexing central–local relationship in which excessive centralization is made infeasible by the nation’s vast size and internal disparities. Ultimately, the best hope for constitutionalism lies in the people themselves, who must rise to safeguard their own rights.
Gender Recognition
Authors: Whittle Stephen
Published: November 2024

European human rights following the Second World War came about because of an urgent need for laws to protect minority groups from the type of systemic, institutional, or personal prejudices that led to the holocaust. The UNDHR and the European Convention on Human Rights were framed around the idea of preventing discrimination and were to form our understanding(s) of what citizenship is in modern Europe. Identity politics became a powerful force in Europe as minorities claimed their right not to experience discrimination. This chapter reviews the legal mechanisms of change on the road towards LGBTQI+ equality and finds they are a consequence of judicial decisions driving an equity agenda rather than the equality achievements of any particular social movement. Understanding why this is, and the processes behind change is essential when considering whether the progress achieved can be maintained. Well-funded, often religious, traditionalist populist movements have recently become a significant political force in Europe. In particular they are pushing back against transgender rights and autonomy. Challenging this opposition to transgender rights and autonomy has never been more important than now. The question of how is one of the biggest problems facing modern Europe as we watch the liberal post-Second World War democracies that are the foundation of modern Europe being eroded before our eyes.
Preventing Firearm Injuries and Deaths among Clients: An Action Plan Model for Social Workers
Authors: Conrick Kelsey M , McCollum Olivia , Porter Sarah F , St. Vil Christopher , Kanuha V Kalei , Rowhani-Rahbar Ali , Moore Megan
Published: November 2024

Social workers are uniquely positioned to support clients in crisis to reduce firearm access. However, many report needing support in navigating conversations and awareness of available options. Authors sought to understand the decision-making process social workers use, to choose which interventions (e.g., out-of-home storage) are appropriate to reduce firearm access for clients in crisis. Ten individual and group semistructured interviews were conducted with 29 social workers in Washington State; participants discussed experiences with clients at risk of harming themselves and/or others with a firearm and responded to two case examples. Grounded theory was used to develop an action plan model describing how social workers choose which interventions to pursue. Participants described two categories that influence their decision-making process for reducing firearm access for clients in crisis. The first category, sociopolitical context, included structural intersectionality, policies, professional ethics, workplace environment, and values. These influenced the second category, collaborative safety planning intervention for reducing firearm access, a process that included considering client factors, social worker actions, and options for reducing firearm access. This model can be used to develop trainings for social workers to educate them on processes to reduce firearm access for clients in crisis.
Personal data trusts in China: a balance between data sharing and privacy protection
Authors: Meng Zhen , Wang Lu
Published: November 2024

Compared with the traditional data protection models, data trusts can achieve long-term management of digital assets and promote the effective distribution of data rights. As for personal data trusts in China, the concept of data usufructuary rights can be introduced and combined with the tripartite allocation of data rights to explain the rationality of data trusts. In terms of the construction of China’s data trusts, a bottom-up model of data trusts should be adopted under government supervision; meanwhile, personal data should be divided into private data and public data for separate management.
Embedding cultural perspectives into animal welfare science education through study abroad opportunities
Authors: Makagon Maja M , Topczewska Jadwiga
Published: November 2024

Animal welfare is a global issue. The ability of our future workforce to solve global issues is contingent on their understanding of and ability to work with people from diverse cultural backgrounds. Study abroad programming can improve cross-cultural abilities of participating students. Therefore, study abroad opportunities in animal welfare education may be a particularly fruitful approach for preparing students to address animal welfare issues globally. We discuss the value of offering study abroad courses in animal welfare, detail one such course as a case study, and review pedagogical literature related to course design to guide the development of similar programs.
Cutaneous leishmaniasis: a neglected clinical manifestation among the tribal population in Nilambur, Kerala, India
Authors: Fathima P A , Shah Harish Kumar , Aiswarya R S , Ajithlal P M , Shailaja T V , Shubin C , Reena K J , Saini Prasanta
Published: November 2024

Background

Different clinical manifestations of leishmaniasis (cutaneous and visceral) caused by Leishmania donovani have been reported from Kerala, India. Leishmania donovani causing cutaneous leishmaniasis (CL) (also called atypical CL [ACL]) is one of the major health concerns in the Western Ghats belt of the state.

Methods

Skin biopsies of 20 patients with suspected CL from Nilambur, Kerala, were processed for CL diagnosis during the period 2022–2023. Parasite species were characterized using Leishmania-specific Internal Transcribed Spacer-Ⅰ (ITS-Ⅰ) PCR and ITS-Ⅰ RFLP analysis.

Result

A total of 18 cases were confirmed to be CL and the parasite was identified as L. donovani.

Conclusion

These indigenous ACL (CL due to L. donovani) reports from the small foci of Nilambur reveal an emerging endemic zone of leishmaniasis in the Western Ghats.
Regulation and Functions of Long Noncoding RNAs During Meloidogyne incognita Parasitism of Tomato
Authors: Ozdemir Selin , Zadegan Sobhan Bahrami , Sultana Mst Shamira , Coffey Nicole , Rice J. Hollis , Hewezi Tarek
Published: November 2024

Long noncoding RNAs (lncRNAs) are emerging as important regulators of various aspects of immune response and plant-pathogen interactions. However, the regulatory function of lncRNAs during plant-nematode interaction remains largely elusive. In this study, we investigated the differential regulation and function of lncRNAs during two different stages of tomato infection by the root-knot nematode Meloidogyne incognita. At the early stage of infection, 2,218 and 2,827 lncRNAs were regulated locally in the M. incognita–induced galls and systemically in the neighboring root cells, respectively. However, at the later stage of infection, the number of M. incognita–regulated lncRNAs was dramatically reduced, with only 49 lncRNAs being identified as differentially expressed. Differentially expressed lncRNAs were predicted to encode peptides with functionally annotated domains, providing insights into the potential roles of these peptides in regulating gene expression, RNA stability and splicing, and protein-protein-interactions. Among the differentially expressed lncRNAs, 55 were found to contain putative binding sites for 56 microRNAs (miRNAs). Overexpressing five of these lncRNAs significantly increased tomato resistance to M. incognita, supporting the functional importance of lncRNAs for establishing tomato- M. incognita interaction. Functional analysis of the target mimicry of lncRNAs towards miRNAs resulted in the identification of two novel regulatory modules involving miR47 and miR156e-5p and their targeted genes that regulate tomato responses to M. incognita parasitism. Taken together, our data provide novel insights into the transcriptional and posttranscriptional regulatory functions of lncRNA and open a new avenue to engineer crop plants with enhanced nematode resistance by leveraging the regulatory potential of lncRNAs.

[Formula: see text] Copyright © 2025 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Society for Maternal-Fetal Medicine Special Statement: Clinical Quality Measures in Obstetrics
Authors:   Society for Maternal-Fetal Medicine, Combs C.A. , Kern-Goldberger A. , Bauer S.T. ,   Patient Safety and Quality Committee
Published: November 2024

(Am J Obstet Gynecol. 2024;230(3):B2–B17. doi: 10.1016/j.ajog.2023.11.011)

The Society for Maternal-Fetal Medicine (SMFM) has issued a special statement on clinical quality measures (CQMs) for obstetrics. The statement is an update to a 2016 statement on the same topic.
Intrapartum Care: Updated Summary of NICE Guidance
Authors: Blackburn R. , Mehmeti A. , Russell S. , Rivers F. , Blott M.
Published: November 2024

(BMJ. 2024;384:p2885. doi: 10.1136/bmj.p2885)

In 2021, there were around 650,000 births in England and Wales, mostly from straightforward pregnancies without complications. The care and advice regarding the place of birth, pain relief, and labor management significantly affect women’s overall birth experiences and health outcomes. The National Institute for Health and Care Excellence (NICE) issued intrapartum care guidelines in 2014 that were then updated in 2017. This article summarizes new and updated recommendations in 2023, highlighting those based on new evidence and emphasizes shared decision-making between women and health care professionals. These guidelines apply to all pregnant or postpartum individuals, regardless of gender identity. Recommendations are derived from systematic reviews and cost-effectiveness considerations, using GRADE criteria to assess evidence certainty.
Ethical Principles Do Not Support Mandatory Preanesthesia Pregnancy Screening Tests: A Narrative Review
Authors: Jackson S. , Hunter J. , Van Norman G.A.
Published: November 2024

(Anesth Analg. 2024;138(5):980–991. doi: 10.1213/ANE.0000000000006669)

Informed consent has been required in the United States since 1914, though it has been presented with occasional challenging situations in the context of certain procedures or conditions. One of these occasions is increasing concerns surrounding maternal-fetal conflicts and the rights of pregnant patients to undergo elective anesthesia and surgery. This article is a narrative review that examines the ethical principles of pregnancy testing in preanesthesia patients.
Novice Learners’ Perspectives on Obstetric Airway Crisis Decision-Making Training Using Virtual Reality Simulation
Authors: Chan J , Chan C , Chia P , Goy R , Sng BL
Published: November 2024

(Int J Obstet Anesth. 2024;57:103926. https://doi.org/10.1016/j.ijoa.2023.103926)

The incidence of failed tracheal intubation during cesarean sections ranges from 1:238 to 1:808 and has not improved in 40 years despite advances in airway equipment and training. Most failures occur after hours with trainee anesthetists, leading to a mortality rate of 1 in 90. Over the past 3 decades, the preference for neuraxial over general anesthesia has increased due to better postoperative analgesia and fewer airway complications. Managing difficult airways in obstetrics is crucial but less common, reducing practice opportunities for trainees. Our curriculum includes didactic teaching and simulations, but current training may be insufficient. Virtual reality (VR) offers a potential solution by providing safe, immersive simulation training and enhancing technical and decision-making skills in managing difficult obstetric airways. The study aims to assess junior residents’ learning needs and perceptions of VR as a training tool.
Effects of Cumulative Duration of Repeated Anesthesia Exposure on Fetal Brain Development in the Ovine Model
Authors: Bleeser T. , Basurto D. , Russo F. , Vergote S. , Valenzuela  , Van den Broucke S. , Kunpalin Y. , Joyeux L. , Van der Veeken L. , Vally J.C. , Emam D. , Van der Merwe J. , Van de Velde M. , Devroe S. , Deprest J. , Rex S.
Published: November 2024

(J Clin Anesth. 2023;85:111050. https://doi.org/10.1016/j.jclinane.2022.111050)

During nonobstetric surgeries, general anesthesia is necessary in ∼1% of pregnant women. In a recent population cohort, 91% of these women underwent a single anesthesia exposure, averaging 89 minutes. However, 9% experienced multiple exposures. The duration of anesthesia varied: 29% had less than an hour, 49% had 1 to 2 hours, 12% had 2 to 3 hours, 6% had 3 to 5 hours, and 2% had 7 to 13 hours. The FDA issued a warning about potential fetal brain development impairment from repeated or prolonged anesthesia exposure (>3 h). A meta-analysis confirmed that in laboratory animals, repeated or prolonged exposure to general anesthesia results in neuronal injury and neurobehavioral impairments in fetuses. Short exposures (≤3 h) to ≤1 MAC of volatile anesthetics did not show significant neurodevelopmental impairments. Most studies were conducted in mice and rats, whose short gestation periods limit direct human comparisons. The 3-hour exposure in rodents equates to 40 to 47 hours in humans. A recent clinical study found no general population evidence linking prenatal anesthesia exposure to impaired neurodevelopment, though small sample sizes limited findings on prolonged exposure effects.
Neurodevelopmental Outcomes of Extremely Preterm Infants Fed Donor Milk or Preterm Infant Formula: A Randomized Clinical Trial
Authors: Colaizy T.T. , Poindexter B.B. , McDonald S.A. , Bell E.F. , Waldemar A.C. , Carlson S.J. , DeMauro S.B. , Kennedy K.A. , Nelin L.D. , Sanchez P.J. , Vohr B.R. , Johnson K.J. , Herron D.E. , Das A. , Crawford M.M. , Walsh M.C. , Higgins R.D. , Stoll B.J. ,   and the MILK Trial Investigators
Published: November 2024

(JAMA. 2024;331(7):582–591. doi: 10.1001/jama.2023.27693)

A large, nationwide, randomized clinical trial examining how donor milk and preterm infant formula affect neurodevelopment in premature infants has found that outcomes in both groups were similar. The double-blinded trial was conducted with 483 participants at 15 academic medical centers in the United States that are part of a National Institute of Child Health Neonatal Research Network. Previous studies have shown that preterm infants fed with maternal milk while hospitalized have better neurodevelopment outcomes.
Cosyntropin Prophylaxis With Intrathecal Saline: Impact on Postdural Puncture Headache and Epidural Blood Patch
Authors: Orbach-Zinger S. , Azem K. , Heesen P. , Frenkel A. , Binyamin Y.
Published: November 2024

(Anaesthesia. 2024;79(1):91–92. doi: 10.1111/anae.16139. PMID: 37816309)

One of the risks of neuraxial procedures for labor analgesia is accidental dural puncture (ADP), which may lead to further complications including postdural headache (PDPH). The most common treatment for PDPH is an epidural blood patch (EBP); however, this treatment is not infallible. An alternative approach includes the injection of prophylactic intravenous cosyntropin following the dural puncture, which may prevent PDPH or reduce the associated symptoms. Following ADP, anesthetists chose to either select a new site for the epidural or to place an intrathecal (IT) catheter. In this retrospective study, cases where an IT catheter was placed and either administration of intrathecal saline (predelivery) and/or prophylactic intravenous (IV) cosyntropin (postdelivery) occurred were examined to determine the impact on PDPH and EBP.
Surgical Sensation During Cesarean Section: A Qualitative Analysis
Authors: Jiang A. , Perry T. , Walker K. , Burfoot A. , Patterson L.
Published: November 2024

(Int J Obstet Anesth. 2024:57:103935. https://doi.org/10.1016/j.ijoa.2023.103935)

Cesarean section (CS) is a significant surgical procedure for young and generally healthy patients, marking a crucial emotional milestone. Neuraxial anesthesia (NA) is preferred for CS due to its safety advantages over general anesthesia, including reduced blood loss, improved postoperative pain control, and decreased neonatal exposure to drugs. While it allows patients and their partners to experience childbirth intimately, NA carries known risks such as hypotension, headache, and inadequate pain relief. Sedation is minimal during CS to ensure neonatal safety and preserve parental bonding. Preoperative anxiety affects postoperative outcomes and patient satisfaction, emphasizing the need for comprehensive patient education and counseling. However, there is limited recent data on patients’ perceptions of surgical sensations during CS under NA, highlighting the importance of this study’s detailed assessment to improve patient care and inform future research.
Postpartum Opioid Prescribing and Persistent Use in Western Countries
Authors: Poeran J. , Park C.H.
Published: November 2024

(Anesth Analg. 2024;138(5):967–969. doi: 10.1213/ANE.0000000000006953)

Pain during childbirth varies from person to person, but many women rate their pain as severe and persistent, with roughly 20% of individuals who underwent cesarean delivery reporting scar pain and ∼6% of individuals who had a vaginal delivery reporting perineal or vaginal pain 6 months after delivery. Due to this persistent and severe pain, prescription of opioids directly after birth is not uncommon, but many clinicians are concerned about persistent opioid use that affects up to 2% of those exposed to opioids during the postpartum period. In countries with high numbers of births annually, this translates to a large burden, and solutions are difficult to identify due to varying opioid use patterns across countries and unavailable data in many of them.
The Impact of Telehealth on Buprenorphine Prescribing at a Large Federally Qualified Health Center during COVID-19
Authors: Winters Ann , Walter Eve
Published: November 2024

Objectives

This study aims to explore the impact of telehealth on buprenorphine prescribing and retention in care for patients with opioid use disorder (OUD) seen at a large federally qualified health center (FQHC) the year prior to and following the start of the COVID-19 pandemic.

Methods

We conducted a retrospective study of patients with OUD and at least one medical visit to the FQHC between March 1, 2019, and February 28, 2021. This study utilized March 1, 2020, to delineate the beginning of COVID as the FQHC widely instituted telehealth during the month in response to the pandemic. We examined buprenorphine prescribing before and during year 1 of the pandemic; we applied logistic regression to estimate the association between telehealth and buprenorphine prescribing and we assessed buprenorphine retention through survival analysis.

Results

In the year before COVID, 24% of patients (502/2090) received buprenorphine compared with 31% (656/2110) during the first year of COVID (P < 0.01). Patients with at least one telehealth visit were three times more likely to receive buprenorphine compared to those without telehealth (odds ratio: 3.2, confidence interval: 2.1–5.0). Among those who received buprenorphine, those with at least one telehealth visit were retained in buprenorphine care longer (hazard ratio: 2.7, confidence interval: 1.8–3.9).

Conclusions

During the first year of COVID, telehealth was associated with increased likelihood that patients received buprenorphine; those who had telehealth remained in buprenorphine care longer compared to those who only had office-based visits. Increasing buprenorphine access through telehealth can play a significant role in retention in care for OUD.
Network Meta-Analysis and Trial Sequential Analysis of Randomised Controlled Trials Comparing Robotic, Laparoscopic, and Open Pancreatoduodenectomy
Authors: Joseph Nejo , Varghese Chris , Lucocq James , McGuinness Matthew J. , Tingle Samuel , Marchegiani Giovanni , Soreide Kjetil , Abu-Hilal Mohammed , Samra Jas , Besselink Marc , White Steve , Pandanaboyana Sanjay
Published: November 2024

Background:

The use of minimally invasive (laparoscopic and robotic) pancreatoduodenectomy (PD) is being increasingly adopted despite the lack of hard evidence to support its utilisation. With recent randomised controlled trials (RCTs) comparing open pancreatoduodenectomy (OPD) with robotic or laparoscopic pancreatoduodenectomy (RPD or LPD), we undertook a network meta-analysis (NMA) comparing all 3 approaches to evaluate comparative outcomes.

Methods:

A systematic search of MEDLINE, EMBASE, and Cochrane CENTRAL was conducted up to May 2024 and relevant RCTs were identified. A random-effects meta-analysis and trial sequential analysis (TSA) were conducted for primary outcomes, followed by a Bayesian NMA of length of stay (LOS), duration of surgery, intraoperative blood loss, and pancreas resection-related outcomes

Results:

Seven RCTs involving 1336 patients were included, 5 investigating LPD compared with OPD and 2 RPD to OPD. Pairwise meta-analysis indicated that LPD was associated with shorter hospital stay (mean difference [MD], −1.39; 95% confidence interval [CI], −2.33 to −0.45) and lower intraoperative blood loss compared with OPD (MD, −131; 95% CI, −146 to −117). However, LPD was associated with significantly longer operative duration (MD, 39.5; 95% CI, 34–45). TSA confirmed the robustness of the positive and negative findings on pairwise meta-analysis. In comparison, there were no significant differences between RPD and OPD in pairwise meta-analysis, which could not be confirmed by TSA. Network meta-analysis tended to favour LPD in most outcome parameters including LOS, duration of surgery, and pancreas resection-related outcomes.

Conclusions:

The current RCT evidence suggests potential better outcomes in LPD in comparison with RPD and OPD. However, few studies demonstrated robust statistical significance in outcome measures, suggesting an underpowered evidence base and possible selection bias. Hence, with current equivocal data, there is a need for ongoing RCTs to validate the role of minimally invasive approaches in PD.
Removal or Nonremoval of the Rib During a Direct Lateral Interbody Fusion Relative to Postoperative Pain
Authors: Littell Zane , Ablah Elizabeth , Okut Hayrettin , Dean Joey , Whitaker Camden
Published: November 2024

Study Design:

Retrospective chart review.

Objective:

To determine whether there was a difference in postoperative pain among patients undergoing direct lateral interbody fusion (DLIF) who had rib removal compared with those who did not.

Background:

DLIF is a minimally invasive, lateral transpsoas surgical approach for spinal fusion that has a lower 2-year pain rating when compared with an open procedure. However, the DLIF surgical approach of the L1/L2 spinal level can be obstructed by the ribs. It is unknown whether patients undergoing a DLIF with rib removal experience more pain than their counterparts without rib removal.

Methods:

Patients who underwent a DLIF from an individual spine surgeon at Wesley Medical Center between January 1, 2014 and December 31, 2018 were grouped by rib status: with removal versus without. Postoperative pain, measured by a 0 (no pain) to 10 (worst pain) Visual Analog Scale (VAS), was recorded on the day of discharge.

Results:

The analysis included data from 136 patients, 75 with removal and 61 without. Patient demographics did not differ significantly by age, sex, insurance, estimated blood loss, or length of stay. However, number of spinal levels fused was greater when rib removal occurred, 4.5 versus 3.5 (P = 0.008). The mean baseline VAS with rib removal was 6.6 (1.7) and at discharge it was 7.6 (2.1). The mean baseline VAS without removal was 6.7 (2.0) compared with 7.8 (1.8) at discharge. The multivariate model predicting discharge VAS indicated there was no difference in pain by rib removal status (P = 0.180). VAS at discharge was associated with positive morphine milligram equivalents; as the VAS pain score increased so did the morphine dose (P = 0.028).

Conclusion:

Patients undergoing a DLIF with rib removal expressed no difference in postoperative pain compared with patients without rib removal.
Effect and mechanism of endoclip papilloplasty in reducing the incidence of cholelithiasis
Authors: Li Yao , Lu Xiaofang , Wang Yingchun , Chang Hong , Zhang Yaopeng , Liu Wenzheng , Zheng Wei , Yan Xiue , Huang Yonghui
Published: November 2024

Background:

Endoscopic sphincterotomy (EST) is widely used to treat common bile duct stones (CBDS); however, long-term studies have revealed the increasing incidence of recurrent CBDS after EST. Loss of sphincter of Oddi function after EST was the main cause of recurrent CBDS. Reparation of the sphincter of Oddi is therefore crucial. This study aims to investigate the effectiveness and safety of endoclip papilloplasty (ECPP) for repairing the sphincter of Oddi and elucidate its mechanism.

Methods:

Eight healthy Bama minipigs were randomly divided into the EST group and the ECPP group at a 1:1 ratio, and bile samples were collected before endoscopy and 6 months later. All minipigs underwent transabdominal biliary ultrasonography for the diagnosis of cholelithiasis 6 months after endoscopy. The biliary microbiota composition and alpha and beta diversity were analyzed by 16S rRNA gene sequencing. Differential metabolites were analyzed by bile acid metabolomics to explore the predictive indicators of cholelithiasis.

Results:

Three minipigs were diagnosed with cholelithiasis in the EST group, while none in the ECPP group showed cholelithiasis. The biliary Firmicutes/Bacteroidota (F/B) ratio was increased after EST and decreased after ECPP. The Chao1 and observed species index significantly decreased 6 months after EST (P = 0.017 and 0.018, respectively); however, the biliary α-diversity was similar before and 6 months after ECPP. The β-diversity significantly differed in the EST group before and 6 months after EST, as well as in the ECPP group before and 6 months after ECPP (analysis of similarities [ANOSIM]: R = 0.917, P = 0.040; R = 0.740, P = 0.035; respectively). Glycolithocholic acid (GLCA) and taurolithocholic acid (TLCA) accumulated in bile 6 months after EST.

Conclusions:

ECPP has less impact on the biliary microenvironment than EST and prevents duodenobiliary reflux by repairing the sphincter of Oddi. The bile levels of GLCA and TLCA may be used to predict the risk of cholelithiasis.
Humoral immunity in HIV-1 post-treatment controllers
Authors: Mouquet Hugo
Published: November 2024

Purpose of review

Decoding the HIV-1 immune response, including its humoral arm, in post-treatment controllers (PTCs) is paramount to unveil immune correlates of viral control, which could help developing novel strategies towards HIV-1 remission. Here, we review novel findings on the humoral response to HIV-1 in PTCs.

Recent findings

New data reveal the heterogeneity of humoral immune profiles in PTCs, principally influenced by viral exposure and dynamics. Stably aviremic PTCs, akin early ART-treated individuals, show minimal antibody B-cell response. Conversely, virally exposed PTCs develop functionally coordinated and effective humoral responses to HIV-1. They can produce antibodies cross-neutralizing heterologous HIV-1 viruses, including broadly neutralizing antibodies (bNAbs) exerting selective immune pressure. PTCs also elicit neutralizing antibodies against contemporaneous autologous viruses presumed to play a major role in sustaining viral suppression.

The immune mechanisms underlying virologic control in PTCs likely involve various immune effectors. Notably, functional HIV-1 humoral responses can generate bNAbs and autologous neutralizing antibodies; however, their exact contribution to maintaining long-term control of plasma viremia and the precise mechanisms driving their induction require further investigation.
Long-acting preexposure prophylaxis: early data on roll-out in the United States
Authors: Koss Catherine A. , Parikh Urvi M.
Published: November 2024

Purpose of review

Long-acting preexposure prophylaxis (LA-PrEP), including cabotegravir (CAB-LA) and lenacapavir, could expand biomedical prevention coverage and reduce HIV incidence. This review describes LA-PrEP rollout in the United States, early clinical innovations in delivery, as well as opportunities and challenges for future delivery.

Recent findings

Although CAB-LA is approved in numerous countries, availability is limited outside of implementation studies. Data on CAB-LA rollout in routine care are mainly limited to the U.S at present. Early data indicate that oral PrEP far exceeds CAB-LA use and gaps exist between prescription and receipt of CAB-LA, with barriers including insurance coverage. Successful early clinic models include multidisciplinary staffing for benefits navigation, medication procurement, and injection provision, scheduling, and monitoring. Innovative models are being explored for community health worker delivery, low-barrier care for persons with psychosocial barriers, and telehealth and community-based models. Given persistent disparities in HIV diagnoses and oral PrEP use, there is a critical need for equitable implementation of CAB-LA and forthcoming products, including long-acting lenacapavir.

Gaps exist between the promise of LA-PrEP and actual use in US settings. To achieve population-level impact with LA-PrEP, there is an urgent need for greatly expanded access, clinical systems prepared for delivery, and a focus on LA-PrEP equity.
Transforming HIV prevention: the promise of long-acting preexposure prophylaxis in high HIV burden settings
Authors: Joseph Davey Dvora , Dadan Sumaya , Wara Nafisa
Published: November 2024

Purpose of review

Recent research on efficacy and safety of long-acting preexposure prophylaxis (PrEP) holds the promise to transform HIV prevention in high HIV burden settings. We review emerging findings regarding early end-user acceptability of long-acting PrEP modalities, feasibility of integrating long-acting PrEP into health systems, and considerations regarding drug resistance and cost.

Recent findings

Long-acting PrEP, particularly injectables, was found to be highly acceptable among individuals across key populations in high HIV burden settings. Concerns around use of long-acting PrEP highlight the importance of choice and ability to switch methods. Existing provider-level barriers to oral PrEP implementation (e.g., overburdened staff, training gaps) may impact long-acting PrEP rollout – however, utilization of PrEP implementation strategies such as task-shifting, timely PrEP training for all providers, differentiated service delivery, and integration with sexual health services, may mitigate barriers. Studies modeling injectable PrEP scale-up demonstrate substantial benefits in HIV mortality reduction, outweighing risks of increased integrase inhibitor resistance, but also highlight the urgency of pricing long-acting PrEP to ensure access and affordability.

Long-acting PrEP could be a game changer in HIV prevention in high burden settings. There is an urgent need for rapid scale production and price reductions to ensure access in high HIV burden settings. Implementation strategies are needed to address individual and provider-level barriers.
Future options for long-acting HIV treatment and prevention
Authors: Arens Yotam , Gulick Roy M.
Published: November 2024

Purpose of review

The aim of this review was to describe future options for long-acting HIV treatment and preexposure prophylaxis (PrEP) regimens featuring both innovations with currently approved antiretrovirals and a profile of investigational agents in the pipeline.

Recent findings

Newer formulations and modes of delivery for existing antiretroviral drugs and a number of investigational agents are under study for long-acting HIV treatment and PrEP. Regimens with weekly oral dosing for HIV treatment, monthly oral dosing for HIV PrEP, and injectable agents with longer dosing intervals (every 3 months or longer) for treatment and PrEP are in clinical development. Newer agents with novel mechanisms of action and newer modes of administration including vaginal rings, implants, patches, and rectal douches also are under investigation.

Despite the success of current antiretroviral therapy and PrEP with one-pill, once-daily regimens, there is a continuing need for new formulations, investigational agents, and novel modes of delivery to overcome barriers to implementation and ensure real-world effectiveness. Newer long-acting antiretroviral regimens for HIV treatment and PrEP using novel preparations and strategies will offer choice, enhance adherence, decrease toxicity, and improve patient and provider satisfaction.
Implementation of Volumetric Finger-Prick Self-Sampling for Therapeutic Drug Monitoring of Immunosuppressants After Kidney Transplantation: Lessons Learned From the Practice
Authors: Vethe Nils Tore , Åsberg Anders , Bergan Stein , Robertsen Ida , Midtvedt Karsten
Published: November 2024

Background:

Home-based hospital services are becoming increasingly popular, and the addition of remote outpatient appointments after kidney transplantation facilitates more practical and closer follow-up. In this context, finger-prick self-sampling is an important aspect of monitoring of immunosuppressants and biomarkers. Nevertheless, several issues must be addressed to ensure the feasibility and quality when implementing microsampling in clinical practice. We summarize our experiences and opinions in this field.

Methods:

This article is based on the authors' experience regarding the laboratory and clinical implementation of finger-prick self-sampling in kidney transplant recipients. The referenced literature is related to the authors' knowledge in this field.

Results:

We present considerations for the selection of relevant analytes, key characteristics of selected volumetric sampling tools (Mitra and Capitainer), and the associated sampling pitfalls. In addition, we address the requirements for patients performing finger-prick sampling, appropriate design of methods and workflow, critical points for validation, and aspects related to logistics and digital solutions.

Conclusions:

Volumetric finger-prick self-sampling is suitable for monitoring immunosuppressants and certain biomarkers that are relevant to outpatient follow-up after kidney transplantation. We believe that a carefully designed system for the entire workflow, including patient training, will be beneficial in enabling a safe experience for transplant recipients, as well as ensuring overall efficiency and adequate quality. In the future, a combination of immunosuppressants with a wide range of biomarkers has significant potential for use in at-home self-sampling after kidney transplantation.
Orbital Inflammatory Disease as a Presenting Symptom of Generalized Lipodystrophy in a Young Female
Authors: Shabto Julie M. , Shteyman Amy R. , Stevens Shanlee , Coombs Allison , Kazim Michael
Published: November 2024

We report the first case of generalized lipodystrophy with orbital inflammatory symptoms. A 6-year-old female with hypothyroidism who developed hepatosplenomegaly, lymphadenopathy, and progressive loss of subcutaneous fat. Following flu vaccination, she developed orbital inflammatory symptoms. Imaging of the orbits demonstrated a paucity of retrobulbar fat and fat stranding. Systemic workup revealed insulin resistance and hepatosteatosis, consistent with generalized lipodystrophy. We discuss the typical history and examination findings in generalized lipodystrophy and review the etiology, treatment options, and outcomes.
Tight junction regulation, intestinal permeability, and mucosal immunity in gastrointestinal health and disease
Authors: Saha Kushal , Zhou Yin , Turner Jerrold R.
Published: November 2024

Purpose of review

The contributions of intestinal barrier loss, that is, increased permeability, to multiple disorders, including inflammatory bowel disease (IBD), have been a topic of speculation for many years, and the literature is replete with conclusions based on correlation and speculation. The goal of this article is to critically review recent advances in mechanistic understanding of barrier regulation and the evidence for and against contributions of intestinal barrier loss to disease pathogenesis.

Recent findings

It is now recognized that intestinal permeability reflects the combined effects of two distinct routes across tight junctions, which form selectively permeable seals between adjacent epithelial cells, and mucosal damage that leads to nonselective barrier loss. These are referred to as pore and leak pathways across the tight junction and an unrestricted pathway at sites of damage. Despite advances in phenotypic and mechanistic characterization of three distinct permeability pathways, development of experimental agents that specifically target these pathways, and remarkable efficacy in preclinical models, pathway-targeted therapies have not been tested in human subjects.

After decades of speculation, therapeutic interventions that target the intestinal barrier are nearly within reach. More widespread use of available tools and development of new tools that discriminate between pore, leak, and unrestricted pathway permeabilities and underlying regulatory mechanisms will be essential to understanding the local and systemic consequences of intestinal barrier loss.