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Objective: To review the literature comparing functional endoscopic sinus surgery to dupilumab for the treatment of chronic rhinosinusitis with nasal polyps, in terms of symptom control, cost-effectiveness and complications. Method: A literature review was conducted using PubMed, ScienceDirect and Cochrane databases. Data were extracted manually. Results: A total of six papers relevant to the main objective were found. Conclusion: Chronic rhinosinusitis with nasal polyps has a significant impact on patients' quality of life. Both functional endoscopic sinus surgery and dupilumab achieve comparable disease control and result in good symptom relief. Dupilumab is far more expensive than functional endoscopic sinus surgery and is not considered cost-effective for the time being. This is expected to change after 10 years when the drug patent expires. More research is needed to compare the complications of both treatment modalities. [ABSTRACT FROM AUTHOR]

Introduction: There is limited experience transplanting kidneys from either expanded criteria donors (ECD) or donation after circulatory death (DCD) deceased donors with terminal acute kidney injury (AKI). Methods: AKI kidneys were defined by a donor terminal serum creatinine level >2.0 mg/dL whereas non‐ideal deceased donor (NIDD) kidneys were defined as AKI/DCD or AKI/ECDs. Results: From February 2007 to March 2023, we transplanted 266 single AKI donor kidneys including 29 from ECDs, 29 from DCDs (n = 58 NIDDs), and 208 from brain‐dead standard criteria donors (SCDs). Mean donor age (43.7 NIDD vs. 33.5 years SCD), KDPI (66% NIDD vs. 45% SCD), and recipient age (57 NIDD vs. 51 years SCD) were higher in the NIDD group (all p <.01). Mean waiting times (17.8 NIDD vs. 24.2 months SCD) and dialysis duration (34 NIDD vs. 47 months SCD) were shorter in the NIDD group (p <.05). Delayed graft function (DGF, 48%) and 1‐year graft survival (92.7% NIDD vs. 95.9% SCD) was similar in both groups. Five‐year patient and kidney graft survival rates were 82.1% versus 89.9% and 82.1% versus 75.2% (both p = NS) in the NIDD versus SCD groups, respectively. Conclusions: The use of kidneys from AKI donors can be safely liberalized to include selected ECD and DCD donors. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has presented unpreceded challenges to conventional surveillance systems, including high day-to-day reporting variability, timeliness, cost, manpower, and interpretability of large-volume data. A review of the advantages and limitations across common visual surveillance approaches to SARS-CoV-2/COVID-19 disease progression are discussed. A novel surveillance methodology using a two-month moving locally estimated scatterplot smoothing (LOESS) procedure, laid out in a small-multiple panel format, was successfully able to address many surveillance issues that occurred with onset of the COVID-19 pandemic. This surveillance system was used throughout the COVID-19 response by the state of Texas to detect daily incidence trends across disparate regions. The LOESS panel methodology can be applied to daily new cases or other variables of interest across multiple levels of aggregated regions for COVID-19 or other diseases. Use-case testing indicated the LOESS strikes a successful balance between daily variability versus early detection of true change in overall country and regional COVID-19 trends beyond that of a weekly moving average. In sum, the paneled LOESS smoothing methodology described herein presents a highly useful addition to other conventional methods of trend detection. This approach can be applied to COVID-19 and other rapidly spreading infectious diseases across multiple regions of interest and could be an additional highly accessible tool available for utilization by many state and regional jurisdictions. [ABSTRACT FROM AUTHOR]

Across much of the South, digital technologies are increasingly central to the expansion of state social protection systems. Supported by major development agencies, many of these distributive technologies are developed and implemented by financial technology companies with the specific aim of accelerating financial inclusion. While researchers have documented the influence of these financial actors and logics over social policy, we know less about how these interventions are transforming the experience of receiving social protection. Based on qualitative and observational research with social grant recipients in South Africa, this research demonstrates how digital and financial technologies produce confusion, informational opacities and new forms of exclusion among grant recipients. It suggests that the increasingly prominent role of financial technologies in the delivery of social protection undermines state capacity and further entrenches the influence of neoliberal logics over social policy. Finally, the article suggests that these technologies may be transforming the nature of social citizenship in South Africa, undermining efforts to advance universal and redistributive social protection policies. [ABSTRACT FROM AUTHOR]

Research on youth unemployment in South Africa has largely been dominated by quantitative accounts that highlight skills' mismatches, educational levels and industrial transformations. Missing from these is a sense of how youth navigate labour markets and why they might choose to abandon the job search. Based on qualitative interviews with youth from an urban township, this article examines the obstacles they face searching for stable employment and their experiences of the labour market itself. It calls attention to two significant, and largely unexplored, issues affecting young people's relationship to labour markets. First is the role of place-based identities and the stigmatisation associated with representations of place. Second is how low-wage, insecure work acts as a disincentive for remaining in the labour market. For many young people, wage work is rarely experienced as dignified or fulfiling, nor does it provide the resources required for transitions to adulthood. Building on Kathi Weeks's concept of "anti-work politics," it proposes improvements to the quality of existing work and the need to expand social protections to young people. It contributes to a broader geographical literature on labour market segmentation, by highlighting how cultural representations of place affect young people's employment prospects and work identities. [ABSTRACT FROM AUTHOR]

For many veterans returning from wars in Iraq and Afghanistan, homecoming is an encounter with an unrecognisable former homeland that has become a place of uncertainty and confounding moral landscapes. Within the liminal space of combat deployment, occupying soldiers cross thresholds which confound established moral worlds and problematise notions of purpose. Through acts of transgression, temporality and ratiocination are challenged and reconfigured. Applying the analytic of 'thresholds' to theorise about these encounters, this paper draws from 18 months of fieldwork with repatriated American veterans as well as my own experience as a veteran of the war in Afghanistan. As a concept, thresholds elucidate the intensity and permanence of the embodied phenomenological encounters that epitomise contemporary wartime soldiering. [ABSTRACT FROM AUTHOR]

This article provides an analysis of South Africa's #FeesMustFall protests focusing on young people's concerns around debt, family obligations and social mobility. While the protests have popularly been understood as a generational revolt, there has been insufficient attention paid to the role of debt in young people's lives and how this affects aspirations towards collective social mobility. Drawing on ethnographic fieldwork with students from a black working-class township, this article suggests that education reconfigures kinship bonds, generating expectations to support family members by paying a so-called 'black tax'. Drawing on the concept of 'debt ecologies', I highlight how debt articulates with other forms of social inequality, racialized poverty in particular, and can also act as a source of politicization. Finally, I call for greater attention to the role of debt in young people's lives and how it impacts their economic agency, their role in care and familial networks and ability to imagine the future. [ABSTRACT FROM AUTHOR]

Corns are a common foot problem accounting for nearly half of all problems seen within podiatry and chiropody clinics. Hard corns are concentrated areas of hyperkeratosis within the stratum corneum, typically found on the weight-bearing (plantar) surfaces of the feet. For many patients, they are a source of pain and have been shown to negatively affect a patient's activity and quality of life. Most of the currently available treatments are short-lived in their effectiveness, with corns frequently being recurrent, requiring repeated visits to remove the painful lesions. The use of handheld microwave devices indicated for surface applications has demonstrated effectiveness in clearing recalcitrant plantar warts and significantly reducing the pain associated with them. The authors report 2 cases of patients with persistent and painful plantar corns who underwent microwave treatment of their plantar corns with a successful, lasting reduction in pain levels after the intervention. Further work is required to fully assess the potential of this treatment modality in the management of painful plantar corns. [ABSTRACT FROM AUTHOR]

South Africa's #FeesMustFall protests have widely been seen as a reckoning with the limitations of post‐apartheid citizenship and young people's frustrations over the slow pace of socio‐economic transformation. This paper seeks to analyse how working‐class students from one township community interpreted these protests. It argues that the protests reflected collective aspirations toward social mobility among working‐class students and concerns over the threat that high levels of future debt posed to this mobility. It contributes to geographical research on young people's experiences of debt by highlighting how the burden of debt intersects with experiences of racialised poverty and inequality. It suggests that young people's aspirations, even in the context of neoliberalism, frequently focused on collective social mobility and family well‐being. Finally, it proposes global comparative research on young people's experiences of debt and economic uncertainty in order to understand this increasingly globalised phenomenon and its political consequences. This article seeks to analyze how working‐class students from one township community interpreted South Africa's #FeesMustFall protests. It argues that the protests reflected collective aspirations toward social mobility among working‐class students and concerns over the threat that high levels of future debt posed to this mobility. It contributes to geographic research on young people's aspirations and experiences of debt in contexts of economic uncertainty and inequality. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to utilize the data generated by the City of Toronto, Street Needs Assessment conducted in 2021 to explore the prevalence, causes, experiences, and characteristics of 2-spirit, lesbian, gay, bisexual, transgender, queer, and questioning (2SLGBTQ+) individuals experiencing homelessness in Toronto, Ontario, Canada. Methods: Data was collected by the City of Toronto during its Street Needs Assessment in April 2021. The Street Needs Assessment is a needs assessment survey and Point-in-Time count of people experiencing homelessness across the city of Toronto. Homelessness included any individual who was sleeping outdoors or staying in City-administered emergency/transitional shelters and shelter motels/hotels on the night of data collection. The Street Needs Assessment survey was administered to clients by trained shelter and outreach staff using a computer or mobile device. To ensure that survey questions were 2SLGBTQ+ inclusive, questions on sexual orientation, gender identity, and 2SLGBTQ+ identity were included in the survey. Results: Two hundred and eighty-eight 2SLGBTQ+ individuals completed the survey. Compared to non-2SLGBTQ+ individuals experiencing homelessness, 2SLGBTQ+ respondents were younger at the time of survey completion and when they first experienced homelessness, were more likely to have been in foster care or a group home, reported higher rates of conflict with and/or abuse by a parent/guardian as their main pathway into homelessness, and were more likely to experience chronic homelessness. Conclusion: Our study results demonstrate that Street Needs Assessments and Point-in-Time counts can be used to examine homelessness in marginalized populations, including 2SLGBTQ+ individuals and that sexual orientation and gender identity questions need to be included on future government surveys. The consistency of findings from this study and previous research suggests that 2SLGBTQ+ individuals experience a significant need for population-based housing and social support services aimed at meeting the needs of 2SLGBTQ+ populations. [ABSTRACT FROM AUTHOR]

A major goal for the revision of the International Classification of Diseases and Related Health Problems, Tenth Edition (ICD-10) is to increase the clinical utility of the diagnostic system. Schizoaffective disorder has a history of poor diagnostic reliability due to the similarities and overlap in symptoms that it shares with other disorders, especially primary psychotic and mood disorders. The present study was part of the case-controlled field trials for ICD-11 and examines how the proposed changes for schizoaffective disorder may improve differential diagnosis and diagnostic accuracy. Clinicians from around the globe (n = 873) were provided with either ICD-10 or ICD-11 diagnostic guidelines and asked to apply them to case vignettes comparing schizoaffective disorder to schizophrenia and mood disorders with psychotic symptoms. Participants were asked to respond to follow-up diagnostic questions to determine which components of the diagnostic guidelines affected diagnostic accuracy. Overall, clinicians showed small improvements in accurately diagnosing vignettes using ICD-11 over ICD-10. Results suggest the discrepancy in diagnosing schizoaffective disorder is related primarily to the presence of mood symptoms and discrepancies about whether those symptoms are more consistent with schizoaffective disorder or a mood disorder diagnosis. Continuing to identify ways to more accurately capture this symptom picture will be important in the future as well as systematic efforts to educate clinicians about differential diagnosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Functional gallbladder disorder is most commonly defined by biliary colic and low ejection fraction (EF) on cholescintigraphy. Biliary hyperkinesia is a controversial type of functional gallbladder disorder, and its definition and the role of cholecystectomy in treating functional gallbladder disorder remains unclear. STUDY DESIGN: We conducted a retrospective review of patients who underwent cholecystokinin-stimulated cholescintigraphy and cholecystectomy at 3 Mayo Clinic sites between 2007 and 2020. Eligible patients were 18 years or older, presented with symptoms of biliary disease, had an EF greater than 50%, underwent cholecystectomy, and had no evidence of acute cholecystitis or cholelithiasis on imaging. We used receiver operating characteristics curve analysis to identify the optimal cutoff value that predicted symptom resolution within 30 days of cholecystectomy. RESULTS: A total of 2,929 cholecystokinin-stimulated cholescintigraphy scans were performed during the study period; the average EF was 67.5% and the median EF was 77%. Analyzing those with EFs greater than or equal to 50% yielded 1,596 patients with 141 (8.8%) going on to have cholecystectomy. No significant differences were found in age, sex, BMI, final pathology between patients with and without pain resolution. Using a cutoff EF of 81% was significantly associated with pain resolution after cholecystectomy (78.2% for EF greater than or equal to 81% vs 60.0% for EF less than 81%, p = 0.03). Chronic cholecystitis was found in 61.7% of the patients on final pathology. CONCLUSIONS: We determined that an EF cutoff of 81% is a reasonable upper limit of normal gallbladder EF. Patients with biliary symptoms and an EF greater than 81% but no evidence of biliary disease on ultrasound or scintigraphy can be classified as having biliary hyperkinesia. Based on our findings, we recommend cholecystectomy for this patient population. [ABSTRACT FROM AUTHOR]

Background: To assess the relationship between self-reported and performance-based visual impairment (VI) and lower extremity physical function.Methods: Cross-sectional analysis of 2219 Health ABC participants who completed vision testing and the Short Physical Performance Battery (SPPB). Linear regression models used either self-reported (weighted visual function question (VFQ) score)) or performance-based (visual acuity (VA), log contrast sensitivity (LCS), Frisby stereoacuity (SA)) to predict SPPB or its components-gait speed, chair stands, or standing balance-with and without covariate adjustment.Results: Mean age was 73.5 years (range 69-80); 52.4% were female and 37.4% African American. All VI measures were strongly associated with SPPB in unadjusted and adjusted models (p<0.001). A self-reported VFQ score 1 standard deviation lower than the mean (mean 87.8 out of 100) demonstrated a -0.241(95% CI:-0.325, -0.156) adjusted difference in SPPB. After controlling for covariates, VA of <20/40 (41%) demonstrated a -0.496(-0.660, -0.331) lower SPPB score while SA score>85 arcsec (30%) had a -0.449(-0.627, -0.271) adjusted SPPB score versus those with better visual function. LCS<1.55 (28.6%) was associated with a -0.759(-0.938, -0.579) lower and LCS≤1.30 (8%) with a -1.216(-1.515, -0.918) lower adjusted SPPB score relative to better LCS. In a final multivariable model containing multiple vision measures, LCS remained independently associated with SPPB and all components, while SA remained associated with balance (all p<0.05).Conclusions: Both self-reported and performance-based VI are strongly associated with poor lower extremity physical function. These findings may identify a subgroup of older adults with co-existing visual and physical dysfunction who may benefit from targeted screening and intervention to prevent disability. [ABSTRACT FROM AUTHOR]

Objective: Research suggests sleep disturbance plays a role in depression and risk for suicidal behavior (i.e., ideation, attempts, death by suicide). How sleep disturbance affects suicide risk is unclear and one's ability to perform activities of daily living (ADLs) may help explain this relation. This study examined associations between sleep problems, ADLs, and either depressive symptoms or suicide risk among older adults. We hypothesized that ADLs would mediate relations between sleep problems and depressive symptoms and suicide risk. Method: Participants (N = 134; age ≥65) were recruited through Amazon's Mechanical Turk. Participants completed questionnaires that assessed insomnia symptoms, nightmares, ADLs, depressive symptoms, and suicidal behaviors. Results: Nightmares were associated with depressive symptoms and suicide risk but not independently associated with ADLs. Insomnia symptoms were associated with depressive symptoms, suicide risk, and ADLs. ADLs mediated the relation between insomnia symptoms and depressive symptoms. The insomnia symptom--suicidal behavior relation and the nightmare--suicidal behavior relation were significantly mediated by a pathway containing ADLs and depressive symptoms. Discussion: ADLs help explain how insomnia symptoms and nightmares confer suicide risk among older adults, either independently or in association with depressive symptoms. Clinical Implications: Practitioners should attend to ADL performance when treating older adults with insomnia and depression. [ABSTRACT FROM AUTHOR]

This study examined whether schemas formed during training (graduate coursework, clinical supervision, etc.) are responsible for the tendency of clinicians to experience higher rates of false recall for clinical case details when compared with novices. Participants in this study were recruited from a general psychology class to limit preexisting knowledge of psychological disorders. Half of the participants were trained to recognize features of generalized anxiety disorder (GAD) with the purpose of forming a schema for that disorder, whereas the other half were not. Participants' memories for diagnostic and nondiagnostic details within a hypothetical case vignette were tested using a free recall prompt followed by a yes-no recognition test. Trained participants falsely recognized the diagnostic detail "restlessness" and falsely recalled the diagnostic detail "uncontrollable worry" at a significantly higher rate than controls, suggesting that the training successfully formed a schema for GAD symptoms. Graduate training programs should consider incorporating training about false memories in students' coursework as one mechanism for mitigating these errors. [ABSTRACT FROM AUTHOR]

Acquired Hemophilia A (AHA) is a rare autoimmune disorder associated with the development of autoantibodies against factor VIII (FVIII). Although obtaining hemostatic control through the use of recombinant factor VIIa, activated prothrombin complex concentrate and recombinant porcine FVIII are cornerstones in the clinical management of AHA, these therapies have several disadvantages, including a higher risk for the development of thromboembolic events, unpredictable efficacy and short half-lives. While emicizumab has been FDA licensed for use in bleeding prophylaxis for patients with Congenital Hemophilia A (CHA) with and without inhibitors, it has not been approved for use in AHA, with only a few reports describing its use in this context. We report our experience with the use of emicizumab in an 83-year old male with AHA, complicated by the onset of atrial fibrillation following admission, drug-induced thrombocytopenia, infectious complications, and the identification of a low-grade lymphoproliferative disorder, in which emicizumab prophylaxis was used for bleeding prophylaxis in the context of persistently elevated inhibitor titers without evidence of thrombotic events or thrombotic microangiopathy. [ABSTRACT FROM AUTHOR]

The advent of a dimensional model of personality disorder included in DSM-5 has necessitated the development of a new measurement scheme, specifically a self-report questionnaire termed the Personality Inventory for DSM-5 (PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012). However, there are many threats to the validity of a self-report measure, including response inconsistency. This study outlines the development of an inconsistency scale for the PID-5. Across both college student and clinical samples, the inconsistency scale was able to reliably differentiate real from random responding. Random responses led to increased scores on the PID-5 facets, indicating the importance of detecting inconsistent responding prior to test interpretation. Thus, this inconsistency scale could be of use to researchers and clinicians in detecting inconsistent responses to this new personality disorder measure. [ABSTRACT FROM AUTHOR]

Objective This study examined the role of expertise in clinicians' memory for case details. Clinicians' diagnostic formulations may afford mechanisms for retaining and retrieving information. Method Experts ( N = 41; 47.6% males, 23.8% females; 28.6% did not report gender; age: mean [ M] = 54.69) were members of the American Board of Professional Psychologists. Lay judges ( N = 156; 25.4% males, 74.1% females; age: M = 18.85) were undergraduates enrolled in general psychology. Three vignettes were presented to each group, creating a 2 (group: expert, lay judge) x 3 (vignettes: simple, complex-coherent, complex-incoherent) mixed factorial design. Recall accuracy for vignette details was the dependent variable. Results Data analyses used multivariate analyses of variance to detect group differences among multiple continuous variables. Experts recalled more information than lay judges, overall. However, experts also exhibited more false memories for the complex-incoherent case because of their schema-based knowledge. Conclusions This study supported clinical expertise as beneficial. Nonetheless, negative influences from experts' schema-based knowledge, as exhibited, could adversely affect clinical practices. [ABSTRACT FROM AUTHOR]

Neurological injuries following peripheral nerve blocks are a relatively rare yet potentially devastating complication depending on the type of lesion, affected extremity, and duration of symptoms. Medical management continues to be the treatment modality of choice with multimodal nonopioid analgesics as the cornerstone of this therapy. We report the case of a 28-year-old man who developed a clinical common peroneal and lateral sural cutaneous neuropathy following an uncomplicated popliteal sciatic nerve block. Workup with electrodiagnostic studies and magnetic resonance neurography revealed injury to both the femoral and sciatic nerves. Diagnostic studies and potential mechanisms for nerve injury are discussed. [ABSTRACT FROM AUTHOR]

Use of adductor canal blocks and catheters for perioperative pain management following total knee arthroplasty is becoming increasingly common. However, the optimal equipment, timing of catheter insertion, and catheter dislodgement rate remain unknown. A previous study has suggested, but not proven, that non-tunneled stimulating catheters may be at increased risk for catheter migration and dislodgement after knee manipulation. We designed this follow-up study to directly compare tip migration of two catheter types after knee range of motion exercises. In a male unembalmed human cadaver, 30 catheter insertion trials were randomly assigned to one of two catheter types: flexible or stimulating. All catheters were inserted using an ultrasound-guided short-axis in-plane technique. Intraoperative knee manipulation similar to that performed during surgery was simulated by five sequential range of motion exercises. A blinded regional anesthesiologist performed caliper measurements on the ultrasound images before and after exercise. Changes in catheter tip to nerve distance ( p = 0.547) and catheter length within the adductor canal ( p = 0.498) were not different between groups. Therefore, catheter type may not affect the risk of catheter tip migration when placed prior to knee arthroplasty. [ABSTRACT FROM AUTHOR]

Thoracic endometriosis syndrome is a relatively uncommon disorder characterized by recurrent pneumothoraces, hemothorax, chest pain, dyspnea, and hemoptysis within 48 to 72 hours of menstruation. A 34 year old, ASA physical status 2 woman with recurrent catamenial pneumothoraces due to thoracic endometriosis syndrome is presented. After treatment with video-assisted thoracoscopic surgery, she underwent successful elective diagnostic abdominal laparoscopy without incident. The presence of parenchymal injury and damage predisposes these patients to ventilator-induced lung injury. Postponement of surgery until the intermenstrual period, with lung protective ventilation, allows patients with this disease to successfully undergo general anesthesia and surgery. [ABSTRACT FROM AUTHOR]

Dexmedetomidine is an a2-receptor agonist commonly used for sedation and analgesia in ICU patients. Dexmedetomidine is known to provide sympatholysis and also to have direct atrioventricular and sinoatrial node inhibitory effects. In rare instances, orthotopic lung transplantation has been associated with disruption of autonomic innervation of the heart. The combination of this autonomic disruption and dexmedetomidine may be associated with severe bradycardia and/or asystole. Since orthotopic lung transplant patients with parasympathetic denervation will not respond with increased heart rate to anticholinergic therapy, bradyarrhythmias must be recognized and promptly treated with direct acting beta agonists to avoid asystolic cardiac events. [ABSTRACT FROM AUTHOR]

Physical hydraulic scale models are valuable tools for engineers to use when solving complex hydraulic problems. Several manuals exist to aid engineers in appropriately modelling a hydraulic structure; however, information on modelling hydraulic roughness in the current literature is scattered and incomplete. To assist the engineers in properly representing hydraulic roughness from a prototype to a scale model, a systematic approach was compiled from the available literature. A thorough literature search demonstrated that some important information was presently not available. This study investigates the hydraulic roughness scaling equations for Manning's n, focusing on accuracy and the limitations of these equations. The results of this study show that the use of these roughness scaling equations is limited to cases where prototype and model operate in the fully rough flow regime. Additionally, a procedure was developed to predict the hydraulic roughness coefficient of artificial roughness materials used in physical models. [ABSTRACT FROM AUTHOR]

Context.—Pituitary adenomas are relatively rare occurrences in the pediatric population, and there are few studies documenting the profile of these tumors in this age group. Objective.—To study the clinical and pathologic features of pediatric pituitary adenomas in conjunction with a review of the available literature. Design.—A retrospective clinicopathologic review of 20 pediatric patients (younger than 20 years of age) with pituitary adenomas resected during a 24.5-year period (1981-2005). Results.—A total of 20 patients, including 12 females and 8 males, comprise the study group. Mean age at onset of symptoms was 14.0 years (range, 5-18 years). Four patients had onset of symptoms before the age of 12 years. The majority of patients presented with headaches (n = 12), visual disturbances (n = 12) or, in females, menstrual dysfunction (n = 9/12). Tumor size based on radiographic data was known for 19 tumors; 12 adenomas were greater than 1 cm in greatest dimension, and 7 were less than 1 cm. On follow-up, 2 patients with total gross tumor resections had recurrent adenomas; time to recurrence was 5 months and 17 months, respectively. Nine adenomas stained solely for prolactin, 5 for adrenocorticotropic hormone, and 3 for growth hormone. Two stained for growth hormone and prolactin. One did not stain with hormone antibodies. Conclusions.—Most pediatric pituitary adenomas present after the onset of puberty and present with frequent headaches, changes in visual acuity and, in females, menstrual dysfunction. Most (19/20) were secretory, with prolactinomas being the most common type. [ABSTRACT FROM AUTHOR]

Although the catalytic subunit of the Schizosaccharomyces pombe telomerase holoenzyme was identified over ten years ago, the unusual heterogeneity of its telomeric DNA made it difficult to identify its RNA component. We used a new two-step immunoprecipitation and reverse transcription–PCR technique to identify the S. pombe telomerase RNA, which we call TER1. TER1 RNA was 1,213 nucleotides long, similar in size to the Saccharomyces cerevisiae telomerase RNA, TLC1. TER1 RNA associated in vivo with the two known subunits of the S. pombe telomerase holoenzyme, Est1p and Trt1p, and neither association was dependent on the other holoenzyme component. We present a model to explain how telomerase introduces heterogeneity into S. pombe telomeres. The technique used here to identify TER1 should be generally applicable to other model organisms. [ABSTRACT FROM AUTHOR]

Discrete sequence elements known as exonic splicing enhancers (ESEs) have been shown to influence both the efficiency of splicing and the profile of mature mRNAs in multicellular eukaryotes. While the existence of ESEs has not been demonstrated previously in unicellular eukaryotes, the factors known to recognize these elements and mediate their communication with the core splicing machinery are conserved and essential in the fission yeast Schizosaccharomyces pombe. Here, we provide evidence that ESE function is conserved through evolution by demonstrating that three exonic splicing enhancers derived from vertebrates (chicken ASLV, mouse IgM, and human cTNT) promote splicing of two distinct S. pombe pre-messenger RNAs (pre-mRNAs). Second, as in extracts from mammalian cells, ESE function in S. pombe is compromised by mutations and increased distance from the 3'-splice site. Third, three-hybrid analyses indicate that the essential SR (serine/arginine-rich) protein Srp2p, but not the dispensable Srplp, binds specifically to both native and heterologous purine-rich elements; thus, Srp2p is the likely mediator of ESE function in fission yeast. Finally, we have identified five natural purine-rich elements from S. pombe that promote splicing of our reporter pre-mRNAs. Taken together, these results provide strong evidence that the genesis of ESE-mediated splicing occurred early in eukaryotic evolution. [ABSTRACT FROM AUTHOR]

The small subunit of U2AF, which functions in 3' splice site recognition, is more highly conserved than its heterodimeric partner yet is less thoroughly investigated. Remarkably, we find that the small subunit of Schizosaccharomyces pombe U2AF (U2AFSM) can be replaced in vivo by its human counterpart, demonstrating that the conservation extends to function. Precursor mRNAs accumulate in S. pombe following U2AFSM depletion in a time frame consistent with a role in splicing. A comprehensive mutational analysis reveals that all three conserved domains are required for viability. Notably, however, a tryptophan in the pseudo-RNA recognition motif implicated in a key contact with the large subunit by crystallographic data is dispensable whereas amino acids implicated in RNA recognition are critical. Mutagenesis of the two zinc-binding domains demonstrates that they are neither equivalent nor redundant. Finally, two- and three-hybrid analyses indicate that mutations with effects on large-subunit interactions are rare whereas virtually all alleles tested diminished RNA binding by the heterodimer. In addition to demonstrating extraordinary conservation of U2AF smallsubunit function, these results provide new insights into the roles of individual domains and residues. [ABSTRACT FROM AUTHOR]

Paravertebral blocks are becoming increasingly utilized for breast surgery with studies showing improved postoperative pain control, decreased need for opioids, and less nausea and vomiting. We describe the anesthetic management of an otherwise healthy woman who was 12 weeks pregnant presenting for treatment of her breast cancer. For patients undergoing breast mastectomy and reconstruction with tissue expanders, paravertebral blocks offer an anesthetic alternative when general anesthesia is not desired. [ABSTRACT FROM AUTHOR]

Background: Plasma exchange (PLEX) therapy is indicated for several disorders. The 5% albumin is often used as a sole replacement fluid during most PLEX. However, each 1.0 plasma volume exchange depletes coagulation factors by ~65%. Although most coagulation factors recover to hemostatic levels within 24 h post‐PLEX, fibrinogen requires 48–72 h to recover. Fibrinogen is the key coagulation protein for hemostasis. Therefore, fibrinogen is often monitored during the acute course of PLEX, and plasma is supplemented to prevent bleeding if fibrinogen is <100 mg/dL. Study Design and Methods: We conducted a prospective, single‐center, observational study to evaluate bleeding risk in adults who received an acute course of PLEX with a fibrinogen level of 80–100 mg/dL without plasma supplementation during the procedure or before central venous catheter removal. The study group was compared to patients with plasma fibrinogen >100 mg/dL. Results: Among the 275 patients who received 1406 PLEXes, 62 patients (23%) who underwent 323 PLEXes met the inclusion criteria, and only 2 (3%) patients had bleeding while on oral anticoagulants. In contrast, out of 275 patients, 143 (52%) with fibrinogen levels >100 mg/dL received 751 PLEX treatments, and bleeding occurred in 2 (1%) while on low‐molecular‐weight heparin. Conclusions: Our findings suggest that a pre‐procedure fibrinogen threshold of 80–100 mg/dL without plasma supplementation does not increase bleeding risk unless patients were on anticoagulation. See editorial on page 959–962, in this issue [ABSTRACT FROM AUTHOR]

Introduction: The study aim was to analyze the presentation, management, and follow-up of renal transplant patients developing bladder calculi. Methods: Patients who underwent renal transplant with postoperative follow-up at our institution were retrospectively analyzed (1984–2023) to assess for the development of posttransplant bladder stones. All bladder stones were identified by computerized tomography imaging and stone size was measured using this imaging modality. Results: The prevalence of bladder calculi post-renal transplantation during the study window was 0.22% (N = 20/8,835) with a median time to bladder stone diagnosis of 13 years posttransplant. Of all bladder stone patients, 6 (30%) received deceased donor and 14 (70%) living donor transplants. There were 11 patients with known bladder stone composition available; the most common being calcium oxalate (N = 6). Eleven (55%) patients had clinical signs or symptoms (most commonly microhematuria). Fourteen of the bladder stone cohort patients (70%) underwent treatment including cystolitholapaxy in 12 subjects. Of these 14 patients, 9 (64%) were found to have nonabsorbable suture used for their ureteroneocystostomy closure. Conclusions: The prevalence of bladder stones post-renal transplant is low. The utilization of nonabsorbable suture for ureteral implantation was the main risk factor identified in our series. This technique is no longer used at our institution. Other factors contributing to bladder stone formation in this population warrant identification. [ABSTRACT FROM AUTHOR]

BACKGROUND: The nonuse rate for kidneys recovered from deceased donors is increasing, rising to 27% in 2023. In 10% of these cases, 1 kidney is transplanted but the mate kidney is not. STUDY DESIGN: We conducted a retrospective, single-center cohort study from December 2001 to May 2023 comparing single kidneys transplanted at our center (where the contralateral kidney was not used) to kidneys where both were transplanted separately, at least 1 of which was at our center. RESULTS: We performed 395 single deceased-donor kidney transplants in which the mate kidney was not transplanted. Primary reasons for mate kidney nonuse were as follows: no recipient located or list exhausted (33.4%), kidney trauma or injury or anatomic abnormalities (18.7%), biopsy findings (16.7%), and poor renal function (13.7%). Mean donor and recipient ages were 51.5 ± 14.2 and 60 ± 12.6 years, respectively. Mean kidney donor profile index was 73% ± 22%, and 104 donors (26.3%) had kidney donor profile index >85%. Mean cold ischemia was 25.6 ± 7.4 hours, and 280 kidneys (70.7%) were imported. Compared with 2,303 concurrent control transplants performed at our center, primary nonfunction or thrombosis (5.1% single vs 2.8% control) and delayed graft function (35.4% single vs 30.1% control) were greater with single-kidney use (both p < 0.05). Median patient and death-censored graft survival were shorter in the single group (11.6 vs 13.5 years, p = 0.03 and 11.6 vs 19 years, p = 0.003), although the former was at least double median survival on the waiting list. In patients with functioning grafts in the single-kidney group, 1-year mean serum creatinine was 1.77 ± 0.8 mg/dL and estimated glomerular filtration rate was 44.8 ± 20 mL/min/1.73 m². CONCLUSIONS: These findings suggest that many mate kidneys are being inappropriately rejected, given the acceptable outcomes that can be achieved by transplanting the single kidney in appropriately selected recipients. [ABSTRACT FROM AUTHOR]

Background: Some patients with end stage renal disease are or will become narcotic‐dependent. Chronic narcotic use is associated with increased graft loss and mortality following kidney transplantation. We aimed to compare the efficacy of continuous flow local anesthetic wound infusion pumps (CFLAP) with patient controlled analgesia pumps (PCA) in reducing inpatient narcotic consumption in patients undergoing kidney transplantation. Materials and Methods: In this single‐center, retrospective analysis of patients undergoing kidney transplantation, we collected demographic and operative data, peri‐operative outcomes, complications, and inpatient oral morphine milligram equivalent (OME) consumption. Results: Four hundred and ninety‐eight patients underwent kidney transplantation from 2020 to 2022. 296 (59%) historical control patients received a PCA for postoperative pain control and the next 202 (41%) patients received a CFLAP. Median age [53.5 vs. 56.0 years, p =.08] and BMI [29.5 vs. 28.9 kg/m2, p =.17] were similar. Total OME requirement was lower in the CFLAP group [2.5 vs. 34 mg, p <.001]. Wound‐related complications were higher in the CFLAP group [5.9% vs. 2.7%, p =.03]. Two (.9%) patients in the CFLAP group experienced cardiac arrhythmia due to local anesthetic toxicity and required lipid infusion. Conclusions: Compared to PCA, CFLAP provided a 93% reduction in OME consumption with a small increase in the wound‐related complication rate. The utility of local anesthetic pumps may also be applicable to patients undergoing any unilateral abdominal or pelvic incision. [ABSTRACT FROM AUTHOR]

Digital rectal examination revealed frank blood and investigations revealed a coagulopathy with a prolonged prothrombin time of 115 sec, international normalized ratio of 14.7 and activated partial thromboplastin time of 222.5 sec with normal hemoglobin concentration (125 g/L) and platelet count (199 k/uL [199 × 10 SP 9 sp /L]). Her coagulation profile showed a prolonged thrombin time (>60 sec) and less prolonged prothrombin time (28.9 sec), international normalized ratio (2.9), and partial thromboplastin time (61.3 sec). Had the activated partial thromboplastin time and thrombin time been normal, management would have differed as the focus would have turned to non-anticoagulant etiologies of bleeding. [Extracted from the article]

Background To evaluate whether contrast sensitivity is associated with lower extremity physical function in cognitively intact older adults. Methods Cross-sectional analysis of the relationship of binocular and worse eye log contrast sensitivity (LCS) to expanded Short Physical Performance Battery (eSPPB) and its components (gait speed, narrow walking speed, chair stand pace, and balance) in 192 cognitively healthy older adults. The association of LCS with postural sway and gait was also tested with tasks that further challenged functional reserve. Results Mean age was 76.4 years with 56% identifying as female and over 98.5% having good corrected visual acuity. Lower LCS was significantly associated with worse performance on the eSPPB, 4-M gait speed, narrow walking speed, and balance time in unadjusted and adjusted models. The relationship between worse eye LCS and larger postural sway was 3 times greater on a foam surface (beta 1.07, 95% CI [0.35, 1.80]) than a firm surface (beta 0.35, 95% CI [0.05, 0.65]), and both were robust to adjustment for confounders; similar findings were observed with binocular LCS. Lower binocular LCS had a greater decremental effect on gait velocity during the fast pace (beta −0.58, 95% CI [−0.90, −0.27]) than the usual pace (Beta −0.39 [−0.63, −0.15]) gait task. Conclusions These findings suggest that cognitively unimpaired older adults without significant visual acuity impairment can have subtle preclinical deficits in contrast sensitivity and physical function that could place them at risk of mobility and balance issues. Future studies should determine whether this subset of older adults may benefit from targeted intervention to prevent disability. [ABSTRACT FROM AUTHOR]

Aim: The influence of dialysis modality and duration on outcomes following simultaneous pancreas‐kidney transplantation (SPKT) remains uncertain. Methods: We performed a single‐center retrospective review in 255 SPKT recipients according to dialysis modality (55 preemptive/no dialysis‐ND, 70 peritoneal dialysis–PD, 130 hemodialysis–HD) and duration (55 none, 137 < 2 years, 41 2‐4 years, 22 > 4 years). Results: Mean follow‐up was 9.4 years (median 9.2 years). Early (3‐month) relaparotomy rate (20% ND vs. 36% PD/HD, p =.03) was lower in ND patients. There were no differences in early graft loss, patient survival, overall or death‐censored kidney or pancreas graft survival rates (GSR) at 1 or 10 years follow‐up. When analyzing dialysis duration, there were no differences in rates of pancreas thrombosis or early pancreas graft loss. Kidney delayed graft function (DGF) was lower in the ND/short dialysis groups combined (1.0%), compared to the intermediate/long dialysis groups combined (9.5%, p =.003). Early relaparotomy rates were higher with longer duration of dialysis (p =.045 between ND and >4 years of dialysis). Patient survival in the long dialysis group was 50% compared to 69.5% in the other three groups combined (p =.09). However, both overall and death‐censored kidney and pancreas GSR were comparable. Conclusions: Preemptively transplanted patients had a lower incidence of kidney DGF and relaparotomy whereas patient survival was slightly lower with longer dialysis vintage prior to SPKT. Dialysis modality and duration did not influence either overall or death‐censored pancreas or kidney GSR in patients with short waiting times, low KDPI donor organs, and dialysis duration up to 4 years. [ABSTRACT FROM AUTHOR]

Introduction: Long‐term outcomes of kidney transplantation from deceased donors (DDKTs) with terminal acute kidney injury (AKI) are not well defined. Methods: Single center retrospective review of DDKTs from 1/31/07‐12/31/19. AKI kidneys were defined by a doubling of the donor's admission serum creatinine (SCr) level AND a terminal SCr ≥2.0 mg/dl. Results: A total of 188 AKI DDKTs were performed, including 154 from brain‐dead standard criteria donors (SCD). Mean donor age was 36 years and mean Kidney Donor Profile Index was 50%; mean admission and terminal SCr levels were 1.3 and 3.1 mg/dl, respectively. With a mean follow‐up of 94 months (median 89 months), overall patient (both 71.3%) and graft survival (54% AKI vs. 57% non‐AKI) rates were comparable to concurrent DDKTs from brain‐dead non‐AKI SCDs (n = 769). Delayed graft function (DGF) was higher in AKI kidney recipients (47% vs. 20% non‐AKI DDKTs, p <.0001). DGF was associated with lower graft survival in recipients of both AKI and non‐AKI SCD kidneys but the impact was earlier and more pronounced in non‐AKI recipients. Conclusions: Despite having more than twice the incidence of DGF, kidneys from deceased donors with terminal AKI have long‐term outcomes comparable to non‐AKI SCD kidneys and represent a safe and effective method to expand the donor pool. [ABSTRACT FROM AUTHOR]

The telomerase protein Est1 exists in multiple organisms, including Schizosaccharomyces pombe, humans, and Saccharomyces cerevisiae, but its function has only been closely examined in S. cerevisiae, where it is a recruiter/activator of telomerase. Here, we demonstrate that S. pombe Est1 was required for the telomere association of the telomerase holoenzyme, suggesting that it too has a recruitment role. I ts association with telomeres was dependent on Trt1, the catalytic subunit, and Ccq1, a telomeric protein. Surprisingly, Est1 telomere binding was only partially dependent on TER1, the telomerase RNA, even though Est1 bound nucleotides 415-507 of TER1. A ter1-Δ415-507 strain had short telomeres and very low Est1 and Trt1 telomere association in late S phase but did not senesce. An unbiased search for mutations that reduced Est1-TER1 interaction identified mutations only in the Est1 14-3-3-like domain, a phosphoserine-binding motif, the first example of a 14-3-3-like domain with RNA-binding activity. These mutations also reduced Est1-Ccq1 binding. One such mutant prevented Est1 telomere association and caused telomere loss and slow senescence, similar to ccq1Δ. We propose that the Est1-Ccq1 interaction is critical for telomerase recruitment, while the Est1-TER1 interaction acts downstream from Ccq1-mediated recruitment to stabilize the holoenzyme at the telomere. [ABSTRACT FROM AUTHOR]