Publications

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Prim Care Companion CNS Disord 2026;28(1):25f04082. Author affiliations are listed at the end of this article.

BACKGROUND: Solid organ transplantation has evolved globally as an established and life-saving treatment for patients with end-stage organ failure.

METHODS: Since 2007, the Global Observatory on Donation and Transplantation (GODT), an initiative of the World Health Organization in collaboration with the Organización Nacional de Trasplantes (Spain), collects data and reports on the activity of World Health Organization member states in regard to solid organ donation, transplantation, and waitlisting. This ongoing effort provides insights into transplant activities in countries with different healthcare systems and practices, economic and cultural contexts, and local disease burdens.

RESULTS: This annual report presents activities for the year 2024 and summarizes the developments from a global, regional, and country-specific perspective. This report includes information from 92 countries that submitted their data to the GODT by October 29, 2025. Descriptive statistics were applied to analyze and present key indicators.

CONCLUSIONS: A record 173 727 solid organ transplants were performed worldwide in 2024, representing the highest number ever reported to the GODT. This corresponds to a 2% global increase compared with 2023, largely driven by a rise in deceased donations, particularly the expansion of donations after the circulatory determination of death, which accounted for 28% of all deceased donation activity in 2024 (total deceased donations: 47 180). Despite these achievements on a global scale, the data also indicate that major challenges persist, including a continued shortage of organs and pronounced geographical disparities in access to transplantation.

BACKGROUND: Home blood pressure (BP) monitoring (HBPM) is increasingly used as an alternative to office BP. However, factors influencing agreement between office and home BP among very old adults remain unclear.

METHODS: During ARIC (Atherosclerosis Risk in Communities) visit 10, participants underwent 3 automated office BP (AOBP) measurements using an Omron HEM-907XL and performed HBPM twice daily for 8 days using an Omron BP7450. Discordance was defined as a systolic BP difference of ±10 mm Hg between mean AOBP and HBPM. Multivariable regression models evaluated demographic, anthropometric, and clinical factors associated with discordance.

RESULTS: Among 792 participants (58% female; mean age, 84±3.7 years), mean systolic BP was 130.6 mm Hg (AOBP) and 129.6 mm Hg (HBPM). Despite a minimal average difference (1.0±15.7 mm Hg), 49% had ≥10 mm Hg systolic BP discordance. Higher AOBP was associated with greater discordance. Compared with females, males had lower AOBP relative to HBPM (-4.69 mm Hg [95% CI, -6.86 to -2.51]). Smaller arm circumference was associated with higher discordance (β=14.4 mm Hg [95% CI, 4.78-24.04]). Frail adults had lower AOBP relative to HBPM (β, -5.1 mm Hg [95% CI, -11.0 to 0.9]). Baseline AOBP systolic BP ≥140 mm Hg strongly predicted discordance ≥+10 mm Hg (odds ratio, 8.27 [95% CI, 5.52-12.40]). Participants aged 91 to 100 years had lower AOBP than those aged 78 to 80 years (β, -5.0 mm Hg [95% CI, -10.06 to 0.001]).

CONCLUSIONS: Among very old adults, substantial BP discordance between AOBP and HBPM was common and influenced by higher BP, age, male sex, arm circumference, and frailty.

BACKGROUND: This pilot study evaluated the feasibility of integrating an immunosuppressant area under the concentration-time curve (AUC) monitoring for tacrolimus and mycophenolic acid (MPA) into pediatric kidney transplantation care.

METHODS: Dedicated test codes, an AUC requisition form, and a coordinated laboratory sampling process were established for tacrolimus and MPA AUC. AUC was calculated using the ISBA 3.0 Bayesian pharmacokinetic platform. AUC results were correlated with doses, trough concentrations (C0), 3 h post-dose concentrations (C3h), and clinical outcomes.

RESULTS: The AUC protocol was successfully integrated into the routine clinical workflow. Tacrolimus AUC showed correlations with dose (r = 0.85) and C0 (r = 0.82); similarly, MPA AUC showed correlation with dose (r = 0.61) and C3h (r = 0.65). Of the 21 Tacrolimus AUC measurements, 76% were within the target range, and 24% were below the range. For MPA AUC measurements, 65% (13/20) were within the target range, 5% (1/20) were below the range, and 30% (6/20) were above the range. Following individual AUC measurements, the tacrolimus dose was adjusted after 43% (9/21) of measurements, and the mycophenolate mofetil (MMF) dose was adjusted after 50% (10/20) of measurements.

CONCLUSION: This AUC pilot study demonstrated the feasibility of integrating AUC-guided monitoring into the routine management of pediatric kidney transplant recipients.

Ultrasound-guided nerve blocks (USGNBs) are increasingly used in the emergency department (ED) as a safe and effective part of multimodal pain management. Their use has been shown to reduce reliance on opioids and procedural sedation, improve pain scores, and enhance functional outcomes for patients. Additionally, USGNBs in the ED have a complication rate of 0.4%, markedly lower than procedural sedation (4-11%), and they significantly reduce opioid requirements, which is critical considering the current opioid epidemic and the risks of persistent opioid use and overdose. Despite these benefits, relevant concerns about medicolegal liability, informed consent, evolving standards of care, may still influence the adoption of USGNBs in clinical practice. To address these issues, this review examines the legal risks associated with USGNBs by drawing on current clinical literature, closed claims data, and case law. We highlight common adverse events such as peripheral nerve injury and local anesthetic systemic toxicity and assess their legal implications. Potential legal risk including liability related to alternatives like opioid use and procedural sedation, are discussed. While the risk of litigation remains low when best practices are followed, failing to offer a USGNB when clearly indicated may increasingly be viewed as a liability if preventable complications occur. This article aims to provide a practical, interdisciplinary framework, including legal risk assessment, training, credentialing, and risk mitigation, to help clinicians, educators, and hospital administrators safely and confidently integrate USGNBs into ED practice.

Plant cell surface pattern recognition receptors (PRRs) perceive non- or altered-self elicitors to induce immune responses. PRRs relay information across the plasma membrane and trigger downstream signalling via receptor-like cytoplasmic kinases such as BOTRYTIS-INDUCED KINASE 1 (BIK1). BIK1 associates with several PRRs and acts as a key executor of immune responses through the phosphorylation of substrate proteins. However, a comprehensive understanding of how BIK1 targets specific substrates and a full repertoire of these substrates are lacking. Here we defined the substrate specificity of BIK1 and used these data to predict candidate substrates in Arabidopsis. Using high-throughput biochemical and genetic screening of these candidates, we confirmed many as direct BIK1 substrates in vitro and novel regulators of plant immunity. Among the BIK1 substrates identified are MULTIPLE C2 DOMAIN AND TRANSMEMBRANE REGION PROTEIN 3, which we reveal regulates flagellin 22 (flg22)-induced plasmodesmata closure and immunity, and members of the largely uncharacterized CYCLIN-DEPENDENT KINASE-LIKE family, which we uncover as novel negative regulators of immunity. In parallel, we interrogated intracellular NUCLEOTIDE-BINDING LEUCINE-RICH REPEAT (NLR) immune receptors for potential BIK1 phosphorylation motifs and identified multiple NLRs as direct BIK1 substrates. We reveal that BIK1 phosphorylation regulates NLR oligomerization, thus controlling a key activation step for these immune receptors. Together, our unbiased biochemical screens shed light on the central role of BIK1 as a key kinase shaping multiple layers of plant immune signalling.

The last four decades have led to a clarification of the clinical deficits exhibited by cerebellar patients and a set of reliable and valid clinical ataxia rating scales are now available for both the assessment and follow-up of cerebellar ataxias. Cerebellar syndrome is now divided into three principal categories: the cerebellar motor syndrome (CMS), the vestibulo-cerebellar syndrome (VCS), and the cerebellar cognitive affective syndrome/ Schmahmann syndrome (CCAS/SS). CMS corresponds to motor impairments, including dysmetria, kinetic tremor, asynergia, dysdiadochokinesia, and dyschronometria. VCS includes oculomotor disturbances, such as saccadic dysmetria, jerky pursuit, downbeat nystagmus, and gaze-evoked nystagmus. CCAS/SS includes a spectrum of cognitive and affective deficits targeting executive functions, spatial cognition, language processing, and emotional regulation. The International Cooperative Ataxia Rating Scale (ICARS) was developed as an objective quantitative measure of cerebellar ataxias and assesses CMS and VCS, while the more streamlined Scale for the Assessment and Rating of Ataxia (SARA) was introduced specifically for the evaluation of motor deficits corresponding to the CMS. The Brief Ataxia Rating Scale (BARS) has also been proposed as a concise yet effective alternative, demonstrating enhanced efficiency and significant correlations with established cerebellar syndrome subtypes CMS/VCS. Furthermore, the Scale for Oculomotor Disorders in Ataxia (SODA) assesses the VCS, and the CCAS/Schmahmann Scale (CCAS-SS) and the Cerebellar Neuropsychiatric Rating Scale (CNRS and CNRS-2) assess the cognitive and emotional impairments in the CCAS/SS. Together with the Patient-Reported Outcome Measure of Ataxia (PROM-Ataxia) that covers all of these domains, the recognition of the three types of cerebellar syndrome and the application of validated clinician-administered and patient-completed rating scales represent a key step forward in the practice of ataxiology and training of students.

IntroductionPersonality assessments have been widely used in business to identify leadership potential and enhance team performance; however, their integration into surgical education remains limited. This study evaluated surgeons' personality profiles using the PRISM assessment and compared them with those of other health care professionals to guide the design of leadership development curricula for surgical training.MethodsA total of 199 surgeons (residents, fellows, and faculty) across multiple academic medical centers completed the PRISM personality assessment as part of structured leadership development programs. Data were compared with a normative cohort of 5887 health care professionals from the SurePeople database. Primary and under-pressure personality profiles were analyzed using chi-square and Fisher's exact tests, with significance set at P < .05.ResultsNo significant differences were found between surgeons and other health care professionals in primary personality distributions. Under-pressure profiles, however, revealed a greater proportion of surgeons classified as the Navigator type (22% vs 14%; P = .05), reflecting tendency towards higher decisiveness and structure in stressful conditions. Personality distributions were similar across residents, fellows, and attending surgeons.DiscussionAlthough surgeons' baseline personalities mirror those of other health care professionals, their stress-related behavioral tendencies demonstrate a unique shift toward structured, action-oriented responses. Incorporating personality assessments such as PRISM into leadership curricula may enhance self-awareness, emotional intelligence, and team performance.ConclusionIntegrating structured personality assessment into surgical leadership education provides valuable insight into behavioral responses under stress and supports the development of adaptive, emotionally intelligent leaders who foster effective and collaborative surgical teams.

Human leukocyte antigen (HLA)-bound tumor peptides can be routinely isolated from cancer samples and identified using mass spectrometry (MS). However, MS approaches can be stochastic or rely on spectral libraries, which are not customarily available for individual-specific peptides, thus limiting the ability to discover novel peptides. Here, we introduce Pepyrus, which generates user-defined, individual-specific or disease-specific peptide libraries in Escherichia coli to improve the sensitivity and confidence of MS peptide identification, including lowly abundant neoantigens. Using Pepyrus-generated peptide libraries paired with an HLA-specific data-independent acquisition strategy, we recover >75% of the expected sequences per single injection for libraries of >10,000 peptides and identify 0.1 fmol of spiked-in peptides in a complex background. We apply Pepyrus to create personalized libraries, facilitating identification of clinically relevant HLA peptides, including several novel peptides from cell lines derived from persons with melanoma and renal cell carcinoma. Pepyrus enables identification of rare HLA-bound peptides and provides the ability to generate large training datasets to improve spectra, retention time and ion mobility prediction tools.