Citations

Abstract Unvetted scientific claims about vaccines can spread rapidly and undermine decades of progress in immunization and public trust. A recent non-peer-reviewed analysis, promoted at political hearings, in the documentary “An Inconvenient Study,” and on social media, has been used to suggest that vaccinated children experience higher rates of chronic illness than unvaccinated peers. Despite standard regression models, critical flaws - uncontrolled confounding, exposure misclassification, unequal follow-up, and outcome multiplicity, invalidate causal inference. An independent group of international experts critically appraises this analysis and contrast its claims with the consistent evidence confirming vaccine safety and effectiveness. We also show how poorly designed studies can distort public discourse, amplify misinformation, and fuel vaccine hesitancy. We outline actions to strengthen research integrity, such as transparent data sharing, labeling of non-peer-reviewed content, and evidence-based communication. Safeguarding public health demands that vaccine evidence be methodologically sound, reviewed, and interpreted by qualified experts.

ABSTRACT Context effects are ubiquitous across sensory systems and reflect a general encoding principle for both simple and complex stimuli. One simple context effect, contraction bias, manifests in two-interval perception tasks as a bias of the perceived magnitude of the first stimulus toward the center of the overall magnitude range. The underlying cause of contraction bias is unclear. One explanation is that a listener’s magnitude estimate of the first stimulus is combined with a perceptual anchor, usually the mean stimulus magnitude, biasing it toward the anchor (sensory model). An alternative explanation is that a listener’s response criterion shifts, based on the magnitude of the stimulus pair, relative to the mean magnitude of the stimuli range (decision model). Two pitch-discrimination experiments were performed to test these hypotheses in the auditory domain. The first was a forced-choice discrimination task, where listeners were asked to identify the higher or lower tone in a pair. The second was a same-different task where listeners indicated whether or not the two tones in a pair differed in frequency. Contraction bias was observed in the higher-lower discrimination task, even after extensive perceptual training with feedback. In contrast, no contraction bias was observed in the same-different task. Computational models of the sensory and decision hypotheses were fit to data from both experiments. The sensory model captured the pattern of results the higher-lower experiment but erroneously predicted a contraction bias in the same-different task. The decision model produced similar predictions to the sensory model in the higher-lower task but correctly predicted no contraction bias in the same-different task, and produced lower prediction errors and more stable parameter estimates in both paradigms. Overall, the results suggest that the underlying nature of the contraction bias may reflect decision, rather than sensory, biases based on the context. AUTHOR SUMMARY Every day, people combine experiential knowledge of the world and incoming sensory information to assess their environment. Interestingly, the environment itself can substantially alter how incoming sensory information is processed and perceived. These so-called context effects occur in all sensory modalities. Here, we examine one such context effect, known as “contraction bias”, in a simple pitch-discrimination task. Prior work argued that the contraction bias occurs because observers make biased estimates of stimulus magnitudes due to the influence of recent stimulus history. By combining behavioral data and computational modeling, we offer a different explanation, more consistent with the available data, which posits that the bias can be accounted for by systematic shifts in observers’ response strategies with changes in relative stimulus magnitudes. The results shed light onto how humans compare and process sensory features within their environment.

Patients with plasma cell leukemia (PCL) are generally excluded from pivotal T-cell redirecting bispecific antibody (BsAb) trials. We evaluated real-world outcomes in a multicenter retrospective study of 122 patients with primary or secondary PCL across 15 academic centers, categorized as 'active' (≥5% circulating plasma cells within 30 days of BsAb initiation) or 'historical'. In a heavily pretreated population, patients received teclistamab (37%), elranatamab (11%), talquetamab as a line of therapy (Tal LOT, 42%), or talquetamab as bridging therapy to CAR-T (Tal Bridge, 11%). Cytokine release syndrome (CRS) was grade 1-2 in 56% and grade 3-4 in 4%, whereas neurotoxicity was grade 1-2 in 16% and grade 3-4 in 5%. Among 110 evaluable patients, the overall response rate (ORR) was 55%, including 61% with Tal LOT, 58% with Tal Bridge, 46% with elranatamab, and 33% with teclistamab. With a median follow-up of 8.3 months, talquetamab demonstrated superior survival. Tal LOT showed a median progression-free survival (mPFS) of 5.5 months and a median overall survival (mOS) of 11.5 months, and both were unreached in the Tal Bridge cohort. In contrast, teclistamab and elranatamab showed a mPFS of 1.2 and 1.6 months and mOS of 8.1 and 3.6 months, respectively (P=0.007, P=0.023). In active PCL, Tal LOT achieved mPFS/mOS of 6.9/12.2 months versus 0.7/1.4 months with teclistamab and 1.0/3.1 months with elranatamab, respectively (P<0.001, P=0.002). Multivariable analysis associated active PCL with worse survival and Tal LOT with improved outcomes. BsAbs were safe in PCL, with talquetamab showing superior outcomes compared with BCMA-directed BsAbs.

BACKGROUND: Aortic enlargement is a powerful predictor of dissection and rupture, yet it is rarely evaluated during routine myocardial perfusion imaging, despite the widespread availability of computed tomography (CT) attenuation correction scans. The aim of this study was to determine whether fully automated, opportunistically derived, artificial intelligence-based aortic measurements from myocardial perfusion imaging CT attenuation correction scans are associated with adverse outcomes in a large multicenter cohort. METHODS: CT attenuation correction scans from patients undergoing positron emission tomography/CT and single-photon emission CT/CT myocardial perfusion imaging across 10 centers were included. A deep learning model automatically segmented the thoracic aorta, and a postprocessing algorithm extracted maximum ascending and descending diameters. The aortic size index was calculated by indexing the diameter to body surface area. RESULTS: A total of 29 339 patients (56% men; median age, 66 years [interquartile range, 58–75 years]) were included. Over a median follow-up of 3.5 years (interquartile range, 1.9–5.0 years), 5083 (17.3%) patients died. Median ascending and descending aortic size index values were 1.8 cm/m 2 (interquartile range, 1.6–2.0) and 1.5 cm/m 2 (interquartile range, 1.4–1.6), respectively, with an increase with age and higher values in females. Elevated aortic size index thresholds (ascending >2.2 cm/m 2 ; descending >1.6 cm/m 2 ) were significantly associated with increased all-cause mortality (ascending: adjusted hazard ratio, 1.16 [95% CI, 1.07–1.26], P <0.001; descending: adjusted hazard ratio, 1.23 [95% CI, 1.14–1.31]; P <0.001). Notably, the prognostic value of an abnormal aortic size index persisted independent of age, sex, and perfusion abnormalities. CONCLUSIONS: Artificial intelligence can unlock previously unused information within routine myocardial perfusion imaging CT attenuation correction scans by rapidly and automatically quantifying aortic size at scale. Opportunistic aortic measurements derived from CT attenuation correction may serve as an adjunctive risk biomarker and could add prognostic value to standard myocardial perfusion imaging without additional imaging or radiation.

Abstract: Heart valve abnormalities are present in 30% of congenital heart defects. Additionally, there are acquired conditions like rheumatic heart disease. They often require surgery, and in complex cases, valve replacement becomes unavoidable. The current valve replacement options, either mechanical, bioprosthetic, homografts, or autografts, lack key properties for pediatric patient needs: availability, durability, and the ability to grow. Our goal is to review 2 clinically relevant innovations: tissue-engineered heart valves (TEHVs) and partial heart transplantation (PHT). We conducted searches in electronic databases covering the past 25 years using the terms “partial heart transplantation,” “tissue-engineered heart valves,” and their combinations. Decellularized pulmonary homografts outperform cryopreserved homografts and bovine jugular vein conduits in pulmonary valve replacement, showing less stenosis and no infective endocarditis. The European Clinical Study for the Application of Regenerative Heart Valves trial confirmed decellularized pulmonary homograft safety, demonstrating 97.5% freedom from explantation at 5 years. Decellularized aortic homografts showed excellent 97.8% 5-year survival and low endocarditis rates, though increases in transvalvular gradient and regurgitation occurred. Partial heart transplantation uses living valves from donor hearts and accommodates somatic growth. Postoperative immunosuppression in PHT is required but may be limited, as children and valve tissues may possess immune privilege, as evidenced by limited valve injury even in failed orthotopic heart transplants. In a pilot study of 19 infants, with a median follow-up of 26 weeks, increases in annular diameter and leaflet length were observed. Both PHT and TEHVs are promising valve replacement options. While PHT provides a growth-adaptive capability, TEHVs hold the potential for off-the-shelf solutions with minimal immunogenicity.

ABSTRACT This review examines physiological limits, longitudinal projections, and best practices for muscle hypertrophy with a focus on bodybuilding and physique sport. Recurring body composition assessments using multicompartment models are recommended for monitoring short-term fat-free mass (FFM) changes and long-term muscular development. Normative data indicate that drug-free male athletes typically gain roughly 1.4 kg of FFM over 12 weeks of resistance training, with an interquartile range of 1–2 kg. A practical upper limit for FFM index in drug-free male athletes is approximately 28.5, although higher values have been observed in the context of elevated adiposity or anabolic androgenic steroid use. Female athletes tend to have roughly 70% less FFM at baseline but make proportionally similar FFM gains in response to resistance training. The present review models plausible short-term and long-term growth trajectories for both male and female lifters. Training practices that optimize hypertrophy include moderate loads (6–12 repetition maximum), training near muscular failure, and sufficient weekly volume (12–30 fractional sets per muscle group). Nutritional factors include maintaining modest caloric surpluses (0.1–0.25% body weight gain weekly), adequate protein intake (1.6–2.2 g/kg/d), sufficient carbohydrate intake (≥3 g/kg/d), and moderate fat intake (0.5–1.5 g/kg/d). Creatine and protein supplementation provide established hypertrophic benefits, while evidence for other supplements remains inconclusive.

Background: Hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), and preterm delivery are associated with higher long-term cardiovascular, metabolic, and kidney disease risk. Their implications for living kidney donation remain uncertain. Methods: We conducted a retrospective cohort study of 498 female living kidney donors (2000–2017) from the Mayo Clinic Living Donor Program with documented pregnancy histories, pre-donation CT angiography, implantation kidney biopsy, and measured GFR. Donors with prior HDP (n=45), GDM (n=18), or preterm delivery (n=65) were compared with donors without adverse pregnancy outcomes (APO; n=385). Kidney morphometry, histology, and function were analyzed with adjustment for age at donation and first pregnancy, parity, and hypertension. Post-donation kidney outcomes were assessed using surveys and medical record review. Results: Donors with prior HDP and GDM had higher BMI at donation (+7.9% and +8.9%; p=0.006 and 0.04), whereas donors with preterm delivery had lower BMI (−4.8%; p=0.03) compared with donors with no APO. After adjustment, donors with HDP showed no differences in kidney volumes, biopsy features, or kidney function at donation or during follow-up. Donors with GDM had larger total and cortical kidney volumes (9.5–10%), less arterial luminal stenosis, and higher 5-year post-donation eGFR (+15%; p=0.03). Donors with preterm delivery had a lower risk of eGFR <45 mL/min/1.73 m 2 (HR 0.28; p=0.03). Conclusions: Prior adverse pregnancy outcomes were not associated with adverse kidney structure at donation or accelerated kidney function decline post-donation. These findings support that APO history alone should not preclude living kidney donation when other eligibility criteria are met.

Aims Reverse shoulder arthroplasty (RSA) after prior rotator cuff repair (RCR) is commonly performed for recurrence of pain and arthritic progression; however, the influence of prior RCR timing and technique on outcomes of RSA has not been adequately explored. Our primary aim was to evaluate the relationship between the postoperative American Shoulder and Elbow Surgeons (ASES) score, whether prior RCR was performed open or arthroscopic, and the time interval between RSA and prior RCR. Secondary outcomes were forward elevation (FE) and external rotation (ER). Methods A prospectively collected single-institution shoulder arthroplasty database was queried to identify patients undergoing primary RSA after prior RCR between 2004 and 2022 for non-tumour and non-fracture indications with minimum two-year follow-up. We evaluated the relationship between the postoperative ASES score, FE, and ER stratified by prior RCR approach (open vs arthroscopic) and time between RSA and RCR. Multivariable analysis was used to adjust for potential confounders. Results We included 104 RSAs (99 patients) with a mean 8.8 years (SD 7.3) after RCR and a mean age of 68 years (SD 8.3). Prior RCR was performed arthroscopically in 40 RSAs (38%). Mean follow-up was 4.8 years (SD 2.8). On multivariable analysis, arthroscopic RCR was independently associated with a 13-point greater postoperative ASES score (p = 0.008), 14° greater forward elevation (p = 0.011), and 8° greater external rotation (p = 0.018) compared with open RCR. A ten-year increase in time between RCR and RSA was associated with a seven-point greater postoperative ASES score (p = 0.029) and 5° greater external rotation (p = 0.015). Conclusion A greater time interval between prior RCR and RSA, as well as arthroscopic techniques, is associated with improved outcomes after primary RSA in patients with prior RCR. Cite this article: Bone Joint J 2026;108-B(7):928–935.