M E Shapiro

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This study analyzed data from over 15 years of the National Violent Death Reporting System to compare female military veterans who died by firearm suicide with those who used other methods. Women who used firearms were less likely to have been in mental health or substance use treatment and less likely to have made prior suicide attempts. This means many at-risk women are not being reached by healthcare, and firearm safety conversations need to happen outside clinical settings.

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This review examines how mathematical modeling and simulation techniques — collectively called Model-Informed Drug Development — can be applied to improve the design and testing of mRNA-based medicines delivered via lipid nanoparticles, such as COVID-19 vaccines. The authors survey approaches including pharmacokinetic modeling, systems pharmacology, and population-level analysis, and compare them with methods used for similar gene therapy platforms. Better use of these modeling tools could accelerate development and strengthen the safety and effectiveness assessment of mRNA therapeutics.

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This study measured grip strength in general surgery residents and asked them about difficulty using surgical instruments and pain while operating. Grip strength was not associated with how hard residents found instruments to use, but two-thirds reported difficulty with at least one instrument and a third reported pain. The findings suggest that instruments need to be redesigned to fit a wider range of hand sizes, and that grip strength alone is not a useful guide for evaluating surgical ergonomics.

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Researchers built a mathematical model of mucus clearance in the lung that can estimate how well different regions of the airway clear mucus using nuclear imaging data. Applied to healthy volunteers and people with cystic fibrosis, the model found that mucus clearance was most impaired in the lower lobes in cystic fibrosis, and that inhaling hypertonic saline improved clearance across all regions. This tool could help researchers measure how well mucus-clearing treatments work in specific parts of the lung.

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A trauma center tracked every patient seen by its emergency general surgery service over a year and found that 60% never had an operation — a group almost entirely absent from existing research and databases. Insurance status and race differed between the surgical and non-surgical groups, pointing to potential inequities. The findings show that registries must capture non-operative patients to accurately measure the true workload and needs of emergency surgery services.

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Researchers took nasal cells from people with cystic fibrosis, healthy volunteers, and carrier parents, grew them in the lab, and measured how well those cells predicted lung function and response to treatment. The stickiness of the fluid layer on the nasal cells — measured by how quickly small particles could diffuse through it — was the best predictor of how much someone's mucus clearance improved after inhaling hypertonic saline. This means lab-grown nasal cells could be used to identify which patients are most likely to respond to mucus-hydrating therapies before treating them.

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Using a national surgical database of over 267,000 cases, researchers identified factors that predict a longer-than-usual hospital stay after emergency abdominal surgery. Older age, Black race, high blood pressure, sepsis, and cancer were independently associated with extended stays across all four major procedure types studied. These findings can help hospitals identify high-risk patients early and allocate resources more effectively.

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This study reviewed 135 surgeries performed during humanitarian missions in Ghana and Peru between 2017 and 2019, comparing cases where a surgery resident assisted versus a second attending surgeon. Resident involvement did not increase operation time or complication rates, and all complications that did occur were minor. The findings support including surgical trainees in international humanitarian surgical programs without concern that their participation harms patients.

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This article examines the ethical and practical challenges that arise when a patient with a Do Not Resuscitate order needs surgery, where the line between routine anesthetic management and resuscitation is blurry. It reviews the history of DNR policies, the reasons a care team might suspend or maintain a DNR order perioperatively, and emphasizes that the decision should flow from a thorough discussion of the patient's goals. A clear understanding of what the patient wants — not a blanket policy — should guide how the surgical team proceeds.

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Scientists used nasal airway cells grown in the lab from cystic fibrosis and healthy donors to measure how fluid and small molecules move across the airway surface, then built a computational model to explain the results. The model showed that cystic fibrosis cells allow more water to pass through their membranes and absorb small molecules differently than healthy cells, consistent with the fluid depletion seen in cystic fibrosis airways. This platform provides a quantitative tool for testing how drug candidates might restore normal airway hydration.

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Researchers tested two food enrichment devices on three lemur species in captivity and recorded how their behavior changed. Each species responded differently depending on its natural movement patterns and feeding habits, and the two devices produced different behavioral effects even within the same species. The study demonstrates that effective enrichment for captive animals must be tailored to the specific biology of each species rather than applied uniformly.

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This analysis examines whether the criteria and timing used to declare death during lethal injection executions in China meet accepted medical standards for death. Based on the timeline of drug administration and documented thiopental levels from U.S. executions, the authors argue that death is declared before cardiopulmonary or brain death criteria are met, and that the paralytic agent used could mask pain during organ removal if anesthesia is inadequate. The authors call for China to revise its death-determination standards to ensure biological death before any pronouncement.

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This report describes a new surgical technique for repairing a blocked ureter in children who had previously failed one or more repairs, using a small patch of tissue taken from the inside of the cheek to reconstruct the narrowed segment with robotic assistance. Three pediatric patients underwent the procedure, all remained symptom-free at follow-up of up to 26 months, and imaging showed stable or improved results. The approach appears safe and feasible for children with difficult recurrent blockages, though longer follow-up is needed.

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This paper reviews evidence that China continues to procure organs from executed prisoners and prisoners of conscience despite official announcements to the contrary, and argues that this practice violates international human rights and medical ethics standards. The analysis shows that no legal changes were made following China's 2014 announcement, meaning prisoner organ use remains legal with claimed consent. The authors call on the international transplant community to require verifiable legislative reform and independent oversight before accepting organ transplant data from China.

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Researchers used CT scanning and 3D surface modeling to derive a more accurate formula for estimating body surface area in ferrets, which is used to calculate chemotherapy doses. CT-derived measurements were reliable, and the new ferret-specific formula produced values very similar to the formula currently borrowed from cats. The practical difference in calculated drug doses between the old and new formulas is small enough that most veterinarians will not need to change their current approach.

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This paper argues that China's 2014 announcement to stop using organs from executed prisoners did not change the underlying law or practice, because no new legislation was enacted and officials continued to describe prisoner donations as voluntary. The authors contend that relabeling prisoner organs as voluntary citizen donations obscures ongoing ethical violations. They recommend that China enact explicit laws banning prisoner organ use and open its transplant system to international inspection before sanctions are lifted.

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Researchers compared two surgical techniques for pancreas transplants that differ in how they connect the new organ's blood vessels—one drains blood through the portal vein (which goes to the liver) and the other drains it into the general circulation. After reviewing 15 studies involving hundreds of patients, they found that both techniques produced nearly identical results: patients survived equally well, their grafts functioned equally well, and they had similar rates of complications. The only measurable difference was that portal vein drainage patients needed slightly less insulin, but this didn't translate to better blood sugar control or cholesterol levels overall. This means doctors can choose either technique based on other practical factors, since the two approaches deliver equivalent outcomes for patients.

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This study examined whether cognitive reserve — built through education and reading ability — protects against apathy in 116 HIV-positive patients. Higher cognitive reserve predicted lower apathy levels, and this protective effect was especially strong in patients who had experienced the most severe immune suppression. The findings suggest that building cognitive reserve may help buffer HIV patients against motivational decline, particularly after significant disease progression.

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Researchers measured apathy in 116 HIV-positive patients and found it was linked to worse cognitive performance, higher HIV viral load, and greater difficulty with daily activities. Patients with higher apathy also showed a stronger interaction between age and processing speed, meaning apathy amplifies age-related cognitive slowing in this population. The study highlights apathy as a clinically important marker of neurological and functional decline in HIV.

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This paper argues that the U.S. kidney allocation system should explicitly incorporate recipient age to better match the expected functional lifespan of a donated kidney to the expected lifespan of the recipient. The current system often allocates long-functioning kidneys to older patients and shorter-functioning kidneys to younger ones, wasting potential years of organ function. Adjusting for age in allocation calculations would increase total life-years gained from transplantation while raising fairness questions that the author addresses directly.

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This commentary argues that the transplant community must take a clear and active stance against China's practice of using organs from executed prisoners, which violates international ethical standards. The author presents two policy options — refusing to engage with any Chinese transplant data until practices change, or carefully evaluating individual studies — and discusses the trade-offs of each approach. The author recommends concrete steps that individual clinicians and professional societies can take to push for reform.

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This study identified flotillin-1 as a key molecular player in how a cell-surface protein called SALM4 stimulates hippocampal neurons to grow more branches. Blocking flotillin-1 prevented SALM4 from triggering neurite branching, while increasing flotillin-1 enhanced branching through a pathway involving lipid raft membrane domains, actin regulators, and machinery that delivers new membrane to growing tips. Understanding this pathway could help clarify how normal brain wiring develops and what goes wrong in developmental disorders.

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Scientists discovered that flotillin-1, a protein found in specialized regions of cell membranes, promotes the formation of glutamate-releasing synapses in hippocampal neurons without affecting inhibitory synapses. When flotillin-1 levels were increased, the frequency of excitatory signals between neurons went up; the protein was also physically found at these excitatory connections. Because synapse formation problems underlie conditions like autism, flotillin-1 is a candidate protein worth investigating in neurodevelopmental disease.

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This study reviewed 39 live kidney donor surgeries performed laparoscopically in cases where the blood vessels supplying the kidney had unusual anatomy, including multiple arteries, multiple veins, or abnormal venous paths. Despite the added complexity, operation times, blood loss, and hospital stays were comparable to standard cases, and kidney function in recipients remained stable at two-year follow-up. Laparoscopic donor surgery is safe even with complex vascular anatomy and can expand the donor pool.

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Researchers showed that the NR2A and NR2B subunits of NMDA receptors — which are central to learning and memory — physically bind to flotillin-1, a lipid raft protein, at specific regions on their tails. The interaction is stronger with flotillin-1 than with the related flotillin-2, and occurs at synapses in hippocampal neurons. This connection between NMDA receptors and lipid raft proteins may help explain how these receptors are organized and stabilized at the synapse.

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Researchers surveyed patients at three primary care clinics in the Bronx about their experiences with arrest and incarceration and found that over half had a personal or family history of involvement with the criminal justice system. Clinicians who asked about incarceration reported that it did not damage the patient relationship, suggesting it is a feasible topic to raise in primary care. The findings highlight how common incarceration is as a social determinant of health in urban patient populations.

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This review describes the problems with the existing U.S. kidney allocation system — particularly that it fails to match kidney longevity to recipient longevity — and explains the rationale behind a proposed overhaul based on "life years from transplant." The new model would predict how many additional years a patient would gain from a transplant versus staying on dialysis and allocate accordingly, generally favoring younger recipients. The author acknowledges the equity concerns this raises and presents the ethical arguments for and against prioritizing life-years gained.

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A controlled trial tested whether giving fish oil supplements (containing omega-3 fatty acids) to kidney transplant patients starting several months after surgery could reduce rejection and protect kidney function. Fish oil did not improve kidney function or prevent rejection at that stage, though it did lower diastolic blood pressure modestly. Based on this and prior work, omega-3 fatty acids appear more beneficial when started immediately after transplantation rather than months later.

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Researchers tested pancreas transplant recipients at two time points — shortly after transplant and one year later — to see how well the transplanted pancreas responded to a glucose challenge. Insulin secretion was initially much higher than normal but normalized over two years, and glucose handling became more similar to that of healthy volunteers. The results show that even a transplanted, denervated pancreas can restore near-normal blood sugar regulation over time despite the effects of anti-rejection drugs.

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Researchers analyzed kidney transplant biopsies by measuring gene activity for several immune molecules and found that a gene expressed specifically by cytotoxic T cells — a type of immune cell that kills targets directly — was strongly associated with active rejection. Genes associated with a different type of immune response were found in both rejecting and non-rejecting biopsies, suggesting they are always present but not specific to rejection. Detecting this cytotoxic T cell gene could serve as a more precise diagnostic marker for kidney rejection.

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This study tested whether a cognitive assessment tool developed for adult psychiatric patients — the Allen Cognitive Level Test — could be applied to emotionally disturbed children aged 8 to 15. The test showed moderate correlation with visual-motor skills but little correlation with perceptual memory, and scores were related to age. The findings suggest the tool has some utility in children but that cognitive function in this age group is complex and occupational therapy planning should not rely on a single measure.

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A randomized trial tested whether adding an antibody that blocks the IL-2 receptor — a key signal for immune cell activation — could reduce kidney transplant rejection when used alongside lower doses of standard drugs. Patients who received the antibody had significantly fewer rejection episodes in the first 10 days after surgery, and the time to first rejection was longer. Despite this early benefit, overall kidney and patient survival at up to two years were the same between groups.

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This case report describes a kidney transplant patient who developed a dangerous arterial tear during a balloon procedure intended to treat high blood pressure, which suddenly cut off blood flow to the transplanted kidney. Blood flow was restored using a catheter designed to keep vessels open while the patient was prepared for corrective surgery, saving the kidney. The report highlights this type of catheter as a useful emergency tool that had not previously been described in the radiology literature for this situation.

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Researchers tested a synthetic retinoid compound called RO 23-6457 in mouse, rat, and monkey transplant models to see if it could prevent rejection. The compound extended graft survival in mice and primates but caused significant toxicity resembling vitamin A overdose, especially when given under the skin. Results support further testing and efforts to make the compound less toxic before clinical use.

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This paper reports interim results of a clinical trial testing anti-Tac, an antibody that blocks a key immune activation signal, for preventing rejection after cadaveric kidney transplantation. Patients who received the antibody had fewer and later rejection episodes than controls, while kidney function and infection rates were similar between groups. The antibody appeared to work by transiently blocking immune cell growth during its administration without causing lasting immune suppression.

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This paper describes how a primate kidney transplant model in cynomolgus monkeys was used to test two antibodies targeting the IL-2 receptor, a molecule needed for immune cell proliferation. One of the antibodies, anti-Tac, extended transplant survival in the monkeys and was subsequently moved forward for human trials. The authors explain how this non-human primate model bridges laboratory findings and clinical application for new immunosuppressive therapies.