Publications by Year: 2026

Stress has profound effects on health, yet how it damages tissues remains poorly understood. Here, we show that acute stress triggers rapid hair loss and initiates autoimmunity. Under stress, hyperactivated sympathetic nerves release excessive norepinephrine, causing necrosis in rapidly dividing hair follicle transit-amplifying cells (HF-TACs) while sparing most hair follicle stem cells (HFSCs). This differential sensitivity stems from differences in cell death pathways, metabolic strategies, and calcium homeostasis, which render HF-TACs more susceptible to norepinephrine-induced calcium surges. HF-TAC necrosis releases cellular debris that triggers macrophage-mediated clearance and dendritic cell activation, ultimately leading to the activation and amplification of autoreactive T cells that can attack the hair follicle under inflammatory insults. Our findings reveal mechanistically how stress causes immediate tissue damage in highly proliferative HF-TACs via sympathetic nerve-induced necrosis, which in turn fuels the activation of autoreactive T cells capable of mounting future attacks against the same tissue.

OBJECTIVE: To evaluate whether a history of sexual violence is associated with differences in postoperative opioid use following laparoscopic hysterectomy for benign, non-pain-related, indications.

DESIGN: Retrospective cohort study.

SETTING: Multisite academic health system in a large metropolitan region.

PATIENTS: A total of 753 adult patients who underwent elective minimally invasive laparoscopic hysterectomy from 2013 to 2023, among whom 66 (8.8 %) had a documented history of sexual violence Patients were stratified by history of sexual violence. Demographics, perioperative variables and postoperative morphine equivalent dose (MED) were compared.

INTERVENTIONS: None.

RESULTS: Patients with a history of sexual violence had higher mean MED at discharge (194.5 vs 13.96 mg, p = 0.08) and at six months (511.3 vs 127.9 mg, p = 0.10), although these differences were not statistically significant after adjustment. In multivariable analysis, non-steroidal anti-inflammatory drug allergy or intolerance (β = 208.9; 95 % CI, 88.6-329.4) and history of illicit substance use (β = 80.4; 95 % CI, 4.0-156.8) were independently associated with increased postoperative opioid use.

CONCLUSIONS: A history of sexual violence was associated with a trend towards increased postoperative opioid use but was not an independent predictor after adjustment. Non-steroidal anti-inflammatory allergy or intolerance and history of illicit substance use were the strongest predictors of increased opioid use. These findings support the need for trauma-informed postoperative care in gynecologic surgery.

BACKGROUND: Although extended operative duration increases risks in other surgeries, its impact on breast reduction outcomes remains unclear. This retrospective cohort study investigated the relationship between operative time and postoperative morbidity in breast reduction.

METHODS: The ACS-NSQIP database (2008-2022) was queried to identify adult female patients who underwent elective breast reduction. Preoperative, intraoperative, and postoperative parameters, including 30-day complications, were assessed. Multivariable logistic regression was used to evaluate the impact of operative time on postoperative outcomes, analyzing it as both a continuous and dichotomous variable.

RESULTS: A total of 45,143 patients were included. Overall complications occurred in 6.4% (n=2870), with reoperation required in 1.8% (n=825) and readmission in 1.1% (n=516). Surgical complications were observed in 4.3% (n=1930), primarily superficial incisional infections (n=1466, 3.2%). Multivariable analysis demonstrated a nuanced association between operative time and complications: For every 1-h increase in operative time, the risk of any complication and surgical complications decreased by 11.4% (OR=0.998, p<0.0001) and 17.4% (OR=0.997, p<0.0001), respectively, whereas the risk of medical complications increased by 19.2% (OR=1.003, p=0.0009). Threshold analyses revealed that operative times >145 min and >147 min were associated with a significantly lower risk of any (OR=0.792, p<0.0001) and surgical complication (OR 0.708, p<0.0001), respectively. Conversely, operative times >156 min correlated with significantly higher odds of medical complications (OR=1.473, p=0.005).

CONCLUSION: Operative time impacts postoperative outcomes in breast reduction surgery. Longer procedures are linked to lower surgical risks but higher medical complications. Further research is needed to validate these findings and explore the underlying mechanisms.

BACKGROUND: Many reports associate particular phases of the human reproductive cycle with psychiatric symptoms including depression, although details of associations of morbidity of depressive, bipolar, and anxiety disorders with pre-, peri-, and post-menopausal phases require further clarification. This naturalistic study evaluated the timing of onset and morbidity of mood and anxiety disorders in women during these menopausal phases.

METHODS: Women (N = 928) with a primary diagnosis of BD type I or II (BD1 or BD2), major depressive disorder (MDD) or an anxiety disorder were clinically evaluated after menopause to determine the onset of affective illness during the pre, peri-, or post-menopausal phases. Psychometric scales were used to assess affective illness and multivariable regression modeling was used to compare menopausal phases.

RESULTS: Many descriptive and clinical measures differed significantly with illnesses starting in the three menstrual phases. Women with onset of affective illness in the perimenopause phase spent 1.33 more time ill than those starting in the premenopausal phase and 1.46 more time ill than women with postmenopausal onset, with corresponding differences in illness episodes/year as well as suicidal risks.

CONCLUSIONS: Study findings are consistent with the view that onset in the peri-menopausal phase may be associated with an excess of affective morbidity in both MDD and BD and that the post-menopausal phase may involve less morbidity.

BACKGROUND: The aim of this analysis was to quantify and compare the frequency of transfusion-related adverse events (TRAE) in adult patients with myocardial infarction transfused with a restrictive versus liberal transfusion strategy from the Myocardial Ischemia and Transfusion (MINT) trial.

STUDY DESIGN AND METHODS: Clinical sites reported TRAE. Major TRAE were transfusion-related acute lung injury, transfusion-associated circulatory overload, acute hemolytic transfusion reaction, anaphylactic transfusion reaction, and transfusion-associated sepsis. TRAE rates per transfusion arm per patient and per 100 units of red blood cells (RBC) transfused were calculated.

RESULTS: There were nine site-reported events in the restrictive transfusion arm and 49 events in the liberal transfusion arm with an overall event rate of 0.51 in the restrictive transfusion arm, and 2.80 in the liberal transfusion arm per 100 patients, rate difference -2.29; 95% confidence interval [CI], -3.12,-1.44.. The rate of major TRAE was 0.51 in the restrictive arm and 1.99 in the liberal arm per 100 patients, rate difference -1.48 (95% CI, -2.21, -0.74). When the rates were normalized per 100 units of RBC transfused, the rate difference of major TRAE was -0.08 (95% CI, -0.63, 0.46) and rate ratio was 0.90 (95% CI, 0.43, 1.87).

CONCLUSION: The rate of major TRAE was low, albeit increased in the liberal transfusion arm proportional to the number of RBC units transfused. The higher rate of major TRAE in the liberal arm was not sufficient to offset the increased rates of myocardial infarction or death at 30 days observed in patients assigned to the restrictive transfusion arm.

In addition to dementia, Alzheimer's patients suffer from sleep impairments and aberrations in sleep-dependent brain rhythms. Deficits in inhibitory GABAergic interneuron function disrupt one of those rhythms, slow oscillation in particular, and actively contribute to Alzheimer's progression. The degree to which transplantation of healthy donor interneuron progenitors restores slow oscillation rhythm in young APP/PS1 mice is tested. Medial ganglionic eminence (MGE) progenitors are harvested from mouse embryos and transplanted them into host APP/PS1 mutant cortices. 3D light-sheet and structured illumination microscopy revealed that transplanted MGE progenitors survived and matured into healthy interneurons. In vivo multiphoton calcium imaging and voltage-sensitive dye imaging showed functional integration and slow oscillation rescue in the absence or presence of optogenetic stimulation. The work provides proof-of-concept evidence that stem cell therapy may serve as a viable strategy to rescue functional impairments in cortical circuits of APP/PS1 mice and potentially those of Alzheimer's patients.

AIMS: Low-income adults face barriers to diabetes prevention and self-management, especially healthy eating. This study assessed factors associated with diet quality in low-income adults with prediabetes or type 2 diabetes (T2D), particularly modifiable factors that could be targeted in diabetes self-management education and support (DSMES).

METHODS: This secondary analysis of a cohort of low-income health center patients in Boston, Massachusetts determined the association between diet quality and sociodemographic (e.g., race/ethnicity, social support) and behavioral (e.g., depression) factors in adults with prediabetes or T2D. Primary outcome was Healthy Eating Index-2020 (HEI; range 0-100, higher=healthier). Random forests, interpreted using Shapley Additive Explanation values, were fit to determine relative importance of factors in predicting HEI.

RESULTS: Of 278 participants, 42 % had prediabetes and 58 % had T2D. Median age (IQR) was 52 (43, 57); 58 % were Hispanic. Top factors associated with higher HEI were older age, female gender, and Hispanic ethnicity; other important factors were non-smoking, greater dietary variety, less time sitting, higher sleep quality, lower stress, more social support, and fewer depression symptoms.

CONCLUSION: Modifiable factors for low diet quality, such as dietary variety, social support, and stress, could be emphasized in diabetes prevention and DSMES programs tailored for low-income populations.

Mortality remains a key indicator for the assessment of care quality in medicine. In neonatology, mortality rates are highly variable, both across units and over time. Comparison of crude mortality rates, however, are insufficient for benchmarking, as they fail to account for differences in population case mix and severity of illness. Risk adjustment using artificial intelligence (AI) and machine learning (ML) has emerged as a promising tool to facilitate meaningful comparisons and drive improvement. This review seeks to examine the state of the current literature on the use of AI/ML-based models to predict mortality in the neonatal intensive care unit (NICU). We identified 37 studies describing 242 models. Most studies developed models using single-center data and frequently lacked external validation. Similarly, reporting of performance metrics was heterogenous, limiting evaluation. As a result, further work is necessary before AI/ML-enabled risk adjustment is feasible.

BACKGROUND: Adults with transposition of the great arteries (TGA) and systemic morphologic right ventricle (SRV) have a high prevalence of SRV failure with accompanying tricuspid valve regurgitation (TR). It is unknown if tricuspid valve surgery (TVS) impacts clinical outcomes in this setting.

METHODS: Data were gathered from an international cohort of patients with TGA and SRV. From this group, patients who had previously undergone tricuspid valve surgery (TVS) were propensity matched with patients who had not undergone surgery and followed for 10.5 ± 4.6 years. The impact of surgery on the probability of the combined endpoint of death/transplant/MCS was investigated. Variables associated with favorable outcomes were explored.

RESULTS: Among 2562 patients with TGA and SRV, 140 patients with prior TVS were propensity matched to 140 controls without previous TVS. In the TVS group, primary end point was noted in 20 cases with 15 deaths (10.7 %), 3 transplant listings (2.1 %) and 5 MCS implants (3.6 %). Among controls, primary end point occurred in 23 patients (16.4 %) with 15 deaths (10.7 %), 7 transplant listings (5.0 %) and 2 MCS implants (1.4 %). There was no difference between groups in event free survival. Lower rates of combined endpoint were observed in TVS group with moderate-severe TR and mild-moderate SRV dysfunction. Sensitivity analyses to address potential immortal-time bias were performed in the subset who underwent surgery during the observation period and produced similar results. Among patients with severe SRV dysfunction there was no difference in primary outcome between groups. Similarly, no difference in outcomes was observed between congenitally corrected (ccTGA) and atrial corrected transposition of the great arteries (acTGA) patients.

CONCLUSIONS: For acTGA and ccTGA patients with SRV and moderate-severe TR, surgical intervention prior to development of severe RV dysfunction is recommended. More data are required to determine those with severe SRV dysfunction who may benefit most.