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This report concerns an autopsy case of amyotrophic lateral sclerosis (ALS) with circumscribed temporal atrophy. The patient was a Japanese woman without hereditary burden who was 71-year-old at the time of death. She developed dysarthria and gait disturbance at age 69, followed by dysphagia. A neurological examination about 1 year 11 months after the onset of the disease revealed absence of character change and of dementia. Neuroradiological examination disclosed circumscribed atrophy of the anterior part of the right temporal lobe. The patient died of respiratory failure 2 years after the disease onset. No respirator administration was performed throughout the clinical course. Macroscopically, neuropathological examination showed circumscribed atrophy of the right first temporal gyrus. Histologically, there was neuronal loss in the cerebral cortex, including the first temporal gyrus, the parahippocampal gyrus, subiculum, amygdala, substantia nigra, brain stem motor nuclei, and anterior horns of the spinal cord, in addition to loss of Betz cells, obvious degeneration of the pyramidal tracts, and the presence of Bunina bodies. Ubiquitin-immunoreactive intraneuronal inclusions were present in the hippocampal dentate granular cells, frontotemporal cortical layer II neurons, and motor neurons in the brain stem and spinal cord. Based on these clinicopathological findings and a review of the literature, we concluded that our case was atypical ALS without dementia, showing temporal lobe atrophy macroscopically, in addition to pathological hallmarks compatible with ALS with dementia. We also note the possibility that there is a forme fruste of ALS with dementia showing no overt dementia clinically. [ABSTRACT FROM AUTHOR]

The distribution of the basal ganglia lesions, including the amygdala, striatum, and pallidum, were investigated neuropathologically in eight Japanese autopsy cases of Pick’s disease with Pick bodies. The lesions were classified as mild, moderate or severe. The degree and distribution of basal ganglia lesions in all eight cases were uniform: the amygdala showed severe to moderate lesions, the caudate nucleus and putamen showed moderate to mild lesions, and the pallidum showed mild lesions. Furthermore, the lesions in the amygdala were more prominent in the basolateral group than in the corticomedial group. In Pick’s disease with Pick bodies, the degree and distribution of the lesions within the basal ganglia differs from those reported in both ‘Pick’s disease without Pick bodies’ and corticobasal degeneration (CBD), in which severe lesions were present in the pallidum. These neuropathological findings may contribute to the morphological differential diagnosis among Pick’s disease with Pick bodies, ‘Pick’s disease without Pick bodies’, and CBD. [ABSTRACT FROM AUTHOR]

While the impact of spirituality as it relates to quality of life post-liver transplant (LT) has been studied, there are limited data showing how religious affiliation impacts objective measures such as survival. The aim of the study is to investigate whether LT recipients who identified as having a religious affiliation had better clinical outcomes when compared to LT recipients who did not. Religious affiliation is obtained as part of general demographic information for patients within our institution (options of "choose not to disclose" and "no religious affiliation" are available). Subjects in this retrospective cohort study which conformed with the Declarations of Helsinki and Istanbul were separated into cohorts: LT recipients who self-reported religious affiliation and LT recipients who did not. All LT recipients between March 2007 and September 2018 who had available information regarding their reported religion were included. Excluded patients included those who received a multi-organ transplant, underwent re-transplantation, received a partial liver graft, and identified as agnostic. Outcomes included 30-day readmission, death, and the composite outcome of re-transplantation/death. In an unadjusted analysis of 378 patients, there were no statistically significant differences between the two groups for 30-day readmission (OR=1.15, P=0.71), death (HR=0.63, P=0.19), or re-transplantation/death (HR=0.90, P=0.75). In multivariable analysis, adjusting for age at transplant and hospital admittance status when called for transplant, results were similar. We found no statistically significant difference in the outcomes measured between patients with and without self-reported religious affiliation. Further studies into the role of participation in religious activity and the impact of engagement with a religious community should be conducted in the future., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board of Mayo Clinic issued approval 22-006393. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Prier et al.)

Introduction: Successful mentorship programs in academic medicine correlate with increased achievement in scholarly activities, leadership, and academic advancement for faculty members, as well as reduced burnout. Despite these benefits, the traditional mentorship model may be underutilized due to challenges of time constraints and alignment in goals. Furthermore, women and underrepresented in medicine (UriM) physicians are less likely to have mentorship, perpetuating the gap in the diversity of academic faculty in leadership and career advancement. To address this, we created an innovative mentorship model for busy academic faculty physicians using a virtual academic asynchronous mentoring video platform.  Methods: A series of videos were created by interviewing 10 identified mentors (four male, six female) from various medical specialties at a national academic institution. The mentors included nine physician faculty with the academic rank of Associate Professor or full Professor and one Research Administrator. Key learning points shared by mentors included topics on academic advancement, mentorship development, leadership development, and research resources., Results: Between March 2020 and September 2023, the Virtual Academic Asynchronous Mentoring (VAAM) Video Series garnered 182 unique viewers, received 2,107 visits, and accumulated 1,871 total minutes of viewing time. All viewers were surveyed, with an 11% survey response rate received. Fifty-two percent of survey respondents reported that the video content was excellent and 43% reported very good. Seventy-six percent of respondents thought the video series had the potential to enhance their professional development and academic productivity., Conclusion: The VAAM Video Platform offers a novel approach to academic mentoring for faculty physicians which eliminates limitations of traditional mentorship models in a convenient and cost-effective way. VAAM offers an egalitarian starting point for all junior faculty who have not yet established a mentoring relationship to seek information and resources on academic advancement and career development., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Yin et al.)

Use of the synthetic opioid fentanyl increased ~300% in the last decade, including among women of reproductive ages. Adverse neonatal outcomes and long-term behavioral disruptions are associated with perinatal opioid exposure. Our previous work demonstrated that perinatal fentanyl exposed mice displayed enhanced negative affect and somatosensory circuit and behavioral disruptions during adolescence. However, little is known about molecular adaptations across brain regions that underlie these outcomes. We performed RNA sequencing across three reward and two sensory brain areas to study transcriptional programs in perinatal fentanyl exposed juvenile mice. Pregnant dams received 10 μg/ml fentanyl in the drinking water from embryonic day 0 (E0) through gestational periods until weaning at postnatal day 21 (P21). RNA was extracted from nucleus accumbens (NAc), prelimbic cortex (PrL), ventral tegmental area (VTA), somatosensory cortex (S1) and ventrobasal thalamus (VBT) from perinatal fentanyl exposed mice of both sexes at P35. RNA sequencing was performed, followed by analysis of differentially expressed genes (DEGs) and gene co-expression networks. Transcriptome analysis revealed DEGs and gene modules significantly associated with exposure to perinatal fentanyl in a sex-wise manner. The VTA had the most DEGs, while robust gene enrichment occurred in NAc. Genes enriched in mitochondrial respiration were pronounced in NAc and VTA of perinatal fentanyl exposed males, extracellular matrix (ECM) and neuronal migration enrichment were pronounced in NAc and VTA of perinatal fentanyl exposed males, while genes associated with vesicular cycling and synaptic signaling were markedly altered in NAc of perinatal fentanyl exposed female mice. In sensory areas from perinatal fentanyl exposed females, we found alterations in mitochondrial respiration, synaptic and ciliary organization processes. Our findings demonstrate distinct transcriptomes across reward and sensory brain regions, with some showing discordance between sexes. These transcriptome adaptations may underlie structural, functional, and behavioral changes observed in perinatal fentanyl exposed mice., (© 2023. The Author(s), under exclusive licence to American College of Neuropsychopharmacology.)

Objective: Delirium is a clinical diagnosis that can occur frequently in hospitalized patients. A retrospective study was completed to identify the incidence of patients aged greater than 65 developing delirium during hospitalization., Methods: This study was conducted at a single tertiary care teaching hospital. Charts of discharged patients from November to December 2018 were evaluated and patients less than age 65 or with delirium present on admission were excluded. The search terms altered, delirium, encephalopathy, and confusion were used to identify patients who developed delirium during the hospitalization. Characteristics of the patients with delirium were also collected., Results: The incidence of new-onset delirium in patients over age 65 during hospitalization was 10%. Patients who developed delirium during their hospital stay were found to have a higher risk of mortality ( p  = 0.0028) and severity of illness ( p  = 0.014). A strong correlation between the length of stay (LOS) and incidence of delirium was also noted., Conclusion: The strong correlation between a longer LOS and a higher incidence of delirium should guide the development of new innovative strategies to shorten the LOS and thus reduce the risk of delirium, in high-risk older hospitalized patients.

Introduction: This study evaluated patient preference of physician attire both before and after the coronavirus disease 2019 (COVID-19) global pandemic began. The primary outcome was patient preference of physician attire in 2017 compared to 2022 survey cohorts. Methods: An observational cross-sectional study performed at a single-site academic institution in the United States using patient survey materials. In total, 339 patients were included in the study, 161 from 2017 and 178 from 2022. Key Points: There was a statistically significant decrease in patient preference for formal attire in the clinical settings of primary care, hospital, and overall. Male patient preference for formal attire declined in primary care, emergency room, and overall; whereas female patient preference for formal attire declined in the hospital setting. For all genders, the odds ratio was statistically significantly lower in the settings of primary care clinic, hospital, and overall clinical settings. Conclusions: Patient preference for physicians wearing formal attire has decreased significantly since the COVID-19 global pandemic began., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Nonnutritive sweeteners (NNSs) and low-calorie sweeteners (LCSs) are commonly used as sugar substitutes. Many popular media Web sites caution against the use of these sweeteners because of their potential adverse effects such as inflammation; however, there are limited supporting data. A Medline search of articles published between 2010 and 2020 was conducted, resulting in 833 articles, of which 12 relevant studies were included in this review. Acute adverse effects associated with the consumption of NNSs and LCSs are rare. A few studies cite reports of acute adverse effects, including mild gastrointestinal disturbance, headaches, lightheadedness, hypersensitivity reactions, impaired spatial orientation, depression, and pain. Little scientific evidence has been reported in the literature since 2010 to support these warning statements to consumers about acute adverse effects to NNSs and LCSs.

Built environment stocks have attracted much attention in recent decades because of their role in material and energy flows and environmental impacts. Spatially refined estimation of built environment stocks benefits city management, for example, in urban mining and resource circularity strategy making. Nighttime light (NTL) data sets are widely used and are regarded as high-resolution products in large-scale building stock research. However, some of their limitations, especially blooming/saturation effects, have hampered performance in estimating building stocks. In this study, we experimentally proposed and trained a convolution neural network (CNN)-based building stock estimation (CBuiSE) model and applied it to major Japanese metropolitan areas to estimate building stocks using NTL data. The results show that the CBuiSE model is capable of estimating building stocks at a relatively high resolution (approximately 830 m) and reflecting spatial distribution patterns, although the accuracy needs to be further improved to enhance the model performance. In addition, the CBuiSE model can effectively mitigate the overestimation of building stocks arising from the blooming effect of NTL. This study highlights the potential of NTL to provide a new research direction and serve as a cornerstone for future anthropogenic stock studies in the fields of sustainability and industrial ecology.

Objectives: Our aim was to identify self-reported stressors and coping mechanisms during the 2020-2021 application cycle by dermatology residency applicants. We hypothesized that coronavirus disease 2019 (COVID-19) would be the most reported stressor., Methods: During the 2020-2021 application season, the Mayo Clinic Florida Dermatology residency program sent a supplemental application to each applicant requesting that they describe a challenging life situation and how they handled it. Comparisons of self-reported stressors and self-expressed coping mechanisms according to sex, race, and geographic region were performed., Results: The most common stressors reported were academic (18.4%), family crisis (17.7%), and COVID-19 (10.5%). The most frequent coping mechanisms expressed were perseverance (22.3%), seeking community (13.7%), and resilience (11.5%). The coping mechanism of diligence was observed more often in females than in males (2.8% vs 0.0%, P = 0.045). First in medicine was more often observed in Black or African American students (12.5% vs 0%, P = 0.001), immigrant experience was more often observed in Black or African American and Hispanic students (16.7% and 11.8% vs 3.1%, P = 0.021), and natural disaster was reported more often in Hispanic students (26.5% vs 0.5%, P < 0.001) as compared with White applicants. By geography, applicants in the northeastern United States were more likely to report the COVID-19 pandemic as a stressor (19.5%, P = 0.049), and the natural disaster stressor was more often reported by applicants from outside the continental United States (45.5%, P < 0.001)., Conclusions: Stressors reported by dermatology applicants in the 2020-2021 cycle included academic, family crisis, and the COVID-19 pandemic. The type of stressor reported varied by race/ethnicity and geographic location of the applicant.

Background: Surgical management of tumor thrombus extending to the major vascular system for children with hepatoblastoma is challenging and insufficiently discussed., Methods: We conducted a retrospective review of hepatoblastoma with tumor thrombus extending to the major vascular system (inferior vena cava, 3 hepatic veins, and portal vein trunk) treated at our center between May 2010 and June 2021. We describe our preoperative assessment, surgical strategies, and outcomes., Results: We identified 9 patients (median age at the diagnosis: 3.4 years). All patients received chemotherapy before liver surgery. At the time of the diagnosis, tumor thrombus extended to the portal vein trunk (n = 6), inferior vena cava (n = 3), and 3 hepatic veins (n = 2). Among the 9 patients, 4 underwent liver resection. Liver transplantation was performed in 5 patients. The inferior vena cava wall was circumferentially resected for tumor removal in 1 patient and partially resected in 2 patients. One patient underwent liver transplantation using veno-venous bypass. Patients with tumor thrombus extending to the portal vein trunk were more likely to be managed by liver transplantation in comparison to those with tumor thrombus spreading to the inferior vena cava. The median follow-up period was 5.5 years. One patient underwent transhepatic balloon dilatation for biliary stricture after liver resection. Tumor recurrence was seen in 3 patients (33.3%; lung, n = 2; lymph node and liver, n = 1). No patients died during the follow-up period., Conclusion: Surgical intervention for pediatric hepatoblastoma with tumor thrombus extending into the major vascular system is safe, feasible, and achieves excellent outcomes., (Copyright © 2022 Elsevier Inc. All rights reserved.)