tbuckley/cabot-search huggingface dataset:
Urban Heat and Burden of Hyponatremia
Authors: Monika Prpic, Christina Hoffmann, Wolfgang Bauer, Peter Hoffmann, Kai Kappert
Journal: JAMA Network Open (2024)

Importance Hyponatremia (sodium level &amp;amp;lt;135 mEq/L), the most prevalent electrolyte disorder in clinical practice, is associated with considerable clinical and economic burdens. Despite its recognized effect and indication of seasonal patterns, there is a research gap regarding heat-related hyponatremia. Addressing this issue is crucial, especially regarding projected increases in environmental temperature, particularly in urban areas. Objective To comprehensively analyze the association of heat in an urban setting with hyponatremia prevalence. Design, Setting, and Participants This cross-sectional study using retrospective time series analysis was conducted among all adult patients (age ≥18 years) presenting to the Charité–Universitätsmedizin Berlin between March 1, 2000, and August 31, 2023, with a blood sodium measurement. Exposure The daily heat index, which accounts for both outdoor air temperature and relative humidity. Main Outcomes and Measures The primary outcome measure was the daily number of hyponatremia cases, further categorized by severity. Differences in prevalence across age groups (adult patients, aged 18-65 years; and older patients, aged &amp;amp;gt;65 years) and sexes were also examined. Results A total of 7 135 688 sodium measurements from 2 028 537 hospital visits were analyzed. The mean (SD) age at admission was 57.8 (17.8) years, and 51.7% of patients were male. A clear seasonal pattern of heat-related hyponatremia was evident among older patients, especially for moderate (sodium level, 125-129 mEq/L) and severe hyponatremia (sodium level, &amp;amp;lt;125 mEq/L), where the cumulative risk over a lag period of 5 days reached a maximum relative risk (RR) of 1.26 (95% CI, 1.07-1.48) when the heat index reached 30 °C, compared with the temperature at which hyponatremia occurred least frequently. Older women were disproportionately more likely to experience hyponatremia compared with older men, with a cumulative RR of 1.10 (95% CI, 1.03-1.18) at a heat index of 26 °C. The highest RR was on lag day 0 for all subgroups (older patients: RR, 1.04 [95% CI, 1.00-1.08]; moderate and severe hyponatremia in older patients: RR, 1.05 [1.01-1.10]; and older women: RR, 1.07 [95% CI, 1.01-1.12]) and significantly increased when the heat index exceeded 15 °C (RR, 1.01 [95% CI, 1.00-1.02]). Conclusions and Relevance This cross-sectional study of patients with sodium measurements suggests that older people, especially women, were vulnerable to heat-related hyponatremia. Environmental heat was associated with an immediate exacerbation of hyponatremia. This finding highlights the importance of implementing prevention strategies to mitigate heat-related hyponatremia, as an increased burden in the future due to climate change is likely.
Rethinking Palliative Interventions in Critical Care—When More Is Not Better
Authors: Kieran L. Quinn, Rebecca Rodin, James Downar
Journal: JAMA Internal Medicine (2024)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast JAMA+ AI Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2024 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
Adenoma Detection Rates by Physicians and Subsequent Colorectal Cancer Risk
Authors: Nastazja D. Pilonis, Piotr Spychalski, Mette Kalager, Magnus Løberg, Paulina Wieszczy, Joanna Didkowska, Urszula Wojciechowska, Jaroslaw Kobiela, Jaroslaw Regula, Thomas Rösch, Michael Bretthauer, Michal F. Kaminski
Journal: JAMA (2024)

Importance Patients of physicians with higher adenoma detection rates (ADRs) during colonoscopy have lower colorectal cancer (CRC) risk after screening colonoscopy (ie, postcolonoscopy CRC). Among physicians with an ADR above the recommended threshold, it is unknown whether improving ADR is associated with a lower incidence of CRC in their patients. Objective To determine the association of improved ADR in physicians with a range of ADR values at baseline with CRC incidence among their patients. Design, Setting, and Participants A total of 789 physicians in the Polish Colonoscopy Screening Program were studied between 2000 and 2017, with final follow-up on December 31, 2022. Joinpoint regression analyses were used to identify trends between changes in ADR and postcolonoscopy CRC incidence. Rates of CRC after colonoscopy were compared between physicians whose ADR improved and those without improvement. ADR improvement was defined as either an improvement by at least 1 ADR sextile category or remaining in the highest category. Exposure Physician ADR. Main Outcomes and Measures Association of improved ADR with postcolonoscopy CRC incidence. Results Of 485 615 patients (mean [SD] age, 57 [5.41] years; 60% female), 1873 CRC diagnoses and 474 CRC-related deaths occurred during a median follow-up of 10.2 years. Among individual physicians at baseline, median (IQR) ADR was 21.8% (15.9%-28.2%) and maximum ADR was 63.0%. Joinpoint regression showed a change in CRC incidence trends at an ADR level of 26%, corresponding to a CRC incidence of 27.1 per 100 000 person-years. Patients of physicians whose ADR was less than 26% at baseline and improved during follow-up had a postcolonoscopy CRC incidence of 31.8 (95% CI, 29.5-34.3) per 100 000 person-years, compared with 40.7 (95% CI, 37.8-43.8) per 100 000 person-years for patients of physicians with an ADR of less than 26% at baseline who did not improve during follow-up (difference, 8.9/100 000 person-years [95% CI, 5.06-12.74]; P &amp;amp;lt; .001). Patients of physicians whose ADR was above 26% at baseline and improved during follow-up had a postcolonoscopy CRC incidence of 23.4 (95% CI, 18.4-29.8) per 100 000 person-years, compared with 22.5 (95% CI, 18.3-27.6) for patients of physicians whose ADR was above 26% at baseline and did not improve during follow-up (difference, 0.9/100 000 person-years [95% CI, −6.46 to 8.26]; P = .80). Conclusions and Relevance In this observational study, improved ADR over time was statistically significantly associated with lower CRC risk in patients who underwent colonoscopy compared with absence of ADR improvement, but only among patients whose physician had a baseline ADR of less than 26%.
Early Screening for Latent Autoimmune Diabetes in Adults to Improve Care—Beyond the Routine
Authors: Camryn L. Keller, Ankita Yelamanchili, Bruno Álvarez Concejo
Journal: JAMA Internal Medicine (2024)

This Teachable Moment describes a man in his 30s who presented with a right diabetic foot ulcer and hyperglycemia and was assumed to have type 2 diabetes and was subsequently diagnosed with latent autoimmune diabetes in adults.
Coronary Microvascular Dysfunction Years After Cessation of Anabolic Androgenic Steroid Use
Authors: Yeliz Bulut, Jon Jarløv Rasmussen, Niels Brandt-Jacobsen, Jan Frystyk, Mario Thevis, Morten Schou, Finn Gustafsson, Philip Hasbak, Caroline Kistorp
Journal: JAMA Network Open (2024)

Long-term use of anabolic androgenic steroids (AASs) is associated with a high risk of left ventricular hypertrophy, heart failure with reduced systolic function, and early sudden death, with the mechanism of progression being understudied. Early and persistent impaired myocardial microcirculation could be of clinical importance and a potential underlying mechanism of frequent and early cardiac disease among individuals with AAS use and a future potential target for intervention.
Focusing on Systems and Policies to Solve the Kidney Transplant Equity Crisis
Authors: L. Ebony Boulware, Dinushika Mohottige, Tanjala S. Purnell
Journal: JAMA Internal Medicine (2024)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast JAMA+ AI Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2024 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
Experience of Older Adults and Their Family Members in the Kidney Transplant Evaluation
Authors: Catherine R. Butler, Olivia A. Gaughran, Janelle S. Taylor, Patrick O. Gee, Ann M. O’Hare
Journal: JAMA Internal Medicine (2024)

Importance Transplant can be a valuable treatment option for older adults with kidney failure, and recent initiatives encourage more frequent referral to transplant centers. However, the evaluation process can be challenging, and most older adults do not ultimately receive a kidney. Objective To elucidate the perspectives and experiences of older adults with advanced kidney disease and their family members regarding the kidney transplant evaluation process. Design, Setting, and Participants This qualitative study, conducted between December 19, 2022, and February 5, 2024, included adults aged 65 years or older with advanced kidney disease (estimated glomerular filtration rate ≤20 mL/min/1.73 m 2 , receiving dialysis, or with a functioning kidney transplant) and their family members in Seattle, Washington. Main Outcomes and Measures Perspectives and experiences of patients and family members, identified through inductive thematic analysis of semi-structured interviews. Results A total of 26 older adults (16 [61.5%] men; median age, 68 years [range, 65-74 years]) with advanced kidney disease and 7 of their family members (4 [57.1%] women; median age, 65 years [range, 36-75 years]) were interviewed. Three dominant themes pertaining to the kidney transplant evaluation process were identified: (1) committed to transplant, (2) a complex and protracted process, and (3) responsibility without power. Because receiving a kidney was such an important priority, most participants were willing to engage in what could be a demanding process of testing and treatment narrowly focused on this future goal. However, the transplant evaluation could be lengthy, demanding, opaque, and fragmented, and patients often put other aspects of their lives on hold while awaiting an uncertain result. Patients and families often felt personally responsible for navigating and completing the transplant evaluation despite having little power to shape this process. Feeling responsible for the continued progress of a high-stakes evaluation process while remaining dependent on clinical teams and family members for support could strain relationships. Conclusions and Relevance This qualitative study found that older adults with advanced kidney disease and their family members were highly motivated to receive a kidney transplant but engagement in an evaluation process, over which they had little control, could have far-reaching implications for patients and families. These findings underline the importance of making the transplant evaluation process more transparent and person centered and of helping patients and families who are contemplating or engaged in the process to understand what to expect.
Effect of Community-Based Integrated Care for Patients With Diabetes and Depression (CIC-PDD) in China: A Pragmatic Cluster-Randomized Trial
Authors: Yanshang Wang, Dan Guo, Yiqi Xia, Mingzheng Hu, Ming Wang, Qianqian Yu, Zhansheng Li, Xiaoyi Zhang, Ruoxi Ding, Miaomiao Zhao, Zhenyu Shi, Dawei Zhu, Ping He
Journal: Diabetes Care (2024)

OBJECTIVE To develop a care model for patients with both diabetes and depression and assess the model’s effectiveness. RESEARCH DESIGN AND METHODS In this pragmatic cluster randomized trial, we allocated eight community health centers into two groups: the enhanced usual care group and the intervention group. A comprehensive care plan was developed for the intervention group based on the integrated care model. We recruited individuals aged ≥18 years with type 2 diabetes and depression (Patient Health Questionnaire-9 score ≥10). The primary outcome was the between-group difference in the percentage of patients who had at least a 50% reduction in depressive symptoms and a reduction of at least 0.5 percentage points in HbA1c. The outcome analysis was conducted within the intention-to-treat population; missing data were multiply imputed. RESULTS We enrolled 630 participants, with 275 in the intervention group and 355 in the control group. A significantly greater percentage of patients in the intervention group met the primary outcome at 12 months (for depressive symptoms: risk difference [RD] 31.03% [62.06% vs. 31.02%, respectively; 95% CI 21.85–40.21]; for HbA1c: RD 19.16% [32.41% vs. 13.25%, respectively; 95% CI 11.35–26.97]). The patients in the intervention group showed significant enhancements in mental quality of life (mean difference [MD] 6.74 [46.57 vs. 39.83, respectively; 95% CI 3.75–9.74]), diabetes self-care activities (MD 0.69 [3.46 vs. 2.78, respectively; 95% CI 0.52–0.86]), medication adherence (MD 0.72 [6.49 vs. 5.78, respectively; 95% CI 0.37–1.07]), and experience of care (MD 0.89 [3.84 vs. 2.95, respectively; 95% CI 0.65–1.12]) at 12 months. Rural participants benefited more from the intervention. CONCLUSIONS The implementation strategy can serve as a valuable blueprint for the identification and treatment of patients with physical and mental multimorbidity in primary health care settings.
Pivotal role of exogenous pyruvate in human natural killer cell metabolism
Authors: Nicolas Kern Coquillat, Louis Picq, Ameline Hamond, Pierre Megy, Sarah Benezech, Annabelle Drouillard, Nina Lager-Lachaud, Edern Cahoreau, Marielle Moreau, Lucie Fallone, Anne-Laure Mathieu, Floriant Bellvert, Carine Nizard, Anne-Laure Bulteau, Thierry Walzer, Antoine Marçais
Journal: Nature Metabolism (2025)
Aortic Stenosis and Coronary Artery Disease: Decision-Making Between Surgical and Transcatheter Management
Authors: Daijiro Tomii, Thomas Pilgrim, Michael A. Borger, Ole De Backer, Jonas Lanz, David Reineke, Matthias Siepe, Stephan Windecker
Journal: Circulation (2024)

Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist and share pathophysiological mechanisms. The proportion of patients with AS and CAD requiring revascularization varies widely because of uncertainty about best clinical practices. Although combined surgical aortic valve replacement and coronary artery bypass grafting has been the standard of care, management options in patients with AS and CAD requiring revascularization have expanded with the advent of transcatheter aortic valve replacement (TAVR). Potential alternative treatment pathways include revascularization before TAVR, concomitant TAVR and percutaneous coronary intervention, percutaneous coronary intervention after TAVR and deferred percutaneous coronary intervention or hybrid procedures. Selection depends on underlying disease severity, antithrombotic treatment strategies, clinical presentation, and symptom evolution after TAVR. In patients undergoing surgical aortic valve replacement, the addition of coronary artery bypass grafting has been associated with improved long-term mortality, especially if CAD is complex. although it is associated with higher periprocedural risk. The therapeutic impact of percutaneous coronary intervention in patients with TAVR is less well-established. The multitude of clinical permutations and remaining uncertainties do not support a uniform treatment strategy for patients with AS and CAD. Therefore, to provide the best possible care for each individual patient, heart teams need to be familiar with the available data on AS and CAD. Herein, we provide an in-depth review of the evidence supporting the decision-making process between transcatheter and surgical approaches and the key elements of treatment selection in patients with AS and CAD.
Co-targeting of the thymic stromal lymphopoietin receptor to decrease immunotherapeutic resistance in CRLF2-rearranged Ph-like and Down syndrome acute lymphoblastic leukemia
Authors: Tommaso Balestra, Lisa M Niswander, Asen Bagashev, Joseph P Loftus, Savannah L Ross, Robert K Chen, Samantha M McClellan, Jacob J Junco, Diego A Bárcenas López, Karen R. Rabin, Terry J Fry, Sarah K Tasian
Journal: Leukemia (2024)

Abstract CRLF2 rearrangements occur in &gt;50% of Ph-like and Down syndrome (DS)-associated B-acute lymphoblastic leukemia (ALL) and induce constitutive kinase signaling targetable by the JAK1/2 inhibitor ruxolitinib under current clinical investigation. While chimeric antigen receptor T cell (CART) immunotherapies have achieved remarkable remission rates in children with relapsed/refractory B-ALL, ~50% of CD19CART-treated patients relapse again, many with CD19 antigen loss. We previously reported preclinical activity of thymic stromal lymphopoietin receptor-targeted cellular immunotherapy (TSLPRCART) against CRLF2 -overexpressing ALL as an alternative approach. In this study, we posited that combinatorial TSLPRCART and ruxolitinib would have superior activity and first validated potent TSLPRCART-induced inhibition of leukemia proliferation in vitro in CRLF2- rearranged ALL cell lines and in vivo in Ph-like and DS-ALL patient-derived xenograft (PDX) models. However, simultaneous TSLPRCART/ruxolitinib or CD19CART/ruxolitinib treatment during initial CART expansion diminished T cell proliferation, blunted cytokine production, and/or facilitated leukemia relapse, which was abrogated by time-sequenced/delayed ruxolitinib co-exposure. Importantly, ruxolitinib co-administration prevented fatal TSLPRCART cytokine-associated toxicity in ALL PDX mice. Upon ruxolitinib withdrawal, TSLPRCART functionality recovered in vivo with clearance of subsequent ALL rechallenge. These translational studies demonstrate an effective two-pronged therapeutic strategy that mitigates acute CART-induced hyperinflammation and provides potential anti-leukemia ‘maintenance’ relapse prevention for CRLF2 -rearranged Ph-like and DS-ALL.
THE OPTIMAL DURATION OF pH-MONITORING: TESTING THE VALIDITY OF LYON 2.0 RECOMMENDATIONS FOR WIRELESS pH MEASUREMENT
Authors: Radu I Rusu, Mark R Fox, Rami Sweis, Sebastian Zeki, Jason M Dunn, Angela Anggiansah, Jafar Jafari, Annastazia Learoyd, Terry Wong
Journal: Clinical Gastroenterology and Hepatology (2024)
Functional Lumen Imaging Probe Provides an Accurate Assessment of Esophageal Diameter in Patients with Eosinophilic Esophagitis
Authors: Ronak V Patel, Dustin A Carlson, Angelika Zalewski, Nirmala Gonsalves, John Pandolfino, Ikuo Hirano
Journal: Clinical Gastroenterology and Hepatology (2024)
Efficacy and Safety of Budesonide Orodispersible Tablets for Eosinophilic Esophagitis up to 3 Years: an Open-Label Extension Study
Authors: Luc Biedermann, Christoph Schlag, Alex Straumann, Alfredo J Lucendo, Stephan Miehlke, Michael Vieth, Cecilio Santander, Constanza Ciriza de Los Rios, Christoph Schmöcker, Ahmed Madisch, Petr Hruz, Jamal Hayat, Ulrike von Arnim, Albert Jan Bredenoord, Stefan Schubert, Mike Halstead, Sabrina Pfurr, Ralph Mueller, Alain M Schoepfer, Stephen Attwood
Journal: Clinical Gastroenterology and Hepatology (2024)

Budesonide orodispersible tablets (BOT) have been shown to be safe and effective in phase 3 double-blind trials of induction and 48-week maintenance therapy of eosinophilic esophagitis (EoE). We now analyzed the long-term efficacy and safety of BOT in a 96-week open-label extension (OLE) study. All EoE patients in the 48-week double-blind maintenance study were eligible to receive BOT treatment for up to 96 weeks. Dosage was 0.5 or 1.0 mg BOT, twice daily, at investigator's discretion. Clinical, histologic, endoscopic, quality of life, and safety measures were assessed. A total of 186 patients participated in the OLE up to 96 weeks. At week 96, 81.9% of patients had clinical remission, defined as an EoE Symptom Activity Index (EEsAI) score of ≤ 20, versus 77.7% at OLE baseline. A further 80.1% of patients were in histologic remission, defined as peak eosinophils per high-power field of <5, at week 96 versus 91.8% at OLE baseline. Mean EoE endoscopic reference scores (EREFS) were 1 at all time points measured. Mean EoE Quality of Life (EoE-QoL-A) Scale scores improved from 3.3 at OLE baseline to 3.5 at week 96. No new safety concerns were observed across 96 weeks of treatment. Suspected symptomatic candidiasis occurred at similar rates to prior BOT studies, and was predominantly mild and resolved with treatment. Clinical and histological remission of EoE could be maintained with BOT in a large majority of patients for up to 96 weeks, and for up to 144 weeks in patients with uninterrupted BOT therapy across all trials. No additional safety concerns were identified with long-term BOT treatment. (ClinicalTrials.gov, Number: NCT02493335).
HIGH RISK OF DIGESTIVE CANCERS IN PATIENTS WITH CELIAC DISEASE: A NATIONWIDE CASE CONTROL COHORT STUDY
Authors: Anne-Sophie Jannot, Yannick Girardeau, Stanislas Chaussade, Romain Coriat, Nadine Cerf-Bensussan, Georgia Malamut
Journal: Clinical Gastroenterology and Hepatology (2024)
In situ blockade of TNF-TNFR2 axis via oncolytic adenovirus improves antitumor efficacy in solid tumors
Authors: Xiaozhen Kang, Yifeng Han, Mengdi Wu, Yuxin Li, Peng Qian, Chuning Xu, Zhengyun Zou, Jie Dong, Jiwu Wei
Journal: Molecular Therapy (2024)
Endoscopic sleeve gastroplasty plus lifestyle intervention in patients with MASH: a multicentre, sham-controlled, randomized trial.
Authors: Javier Abad, Elba Llop, María Teresa Arias-Loste, Diego Burgos-Santamaría, José Luis Martínez Porras, Paula Iruzubieta, Javier Graus, Belén Ruiz-Antoran, María Rosario Sánchez Yuste, Manuel Romero-Gómez, Agustin Albillos, Javier Crespo, José Luis Calleja
Journal: Clinical Gastroenterology and Hepatology (2024)
Global Distribution of Colorectal Cancer Staging at Diagnosis: An Evidence Synthesis
Authors: Lanwei Guo, Le Wang, Lin Cai, Yuelun Zhang, Xiaoshuang Feng, Chenxin Zhu, Wendong Gao, Rafael Cardoso, Haiyan Yang, Min Dai, Hermann Brenner, Hongda Chen
Journal: Clinical Gastroenterology and Hepatology (2024)
Predictors of Post-ERCP Pancreatitis: A Comprehensive Systematic Review and Meta-Analysis
Authors: Azizullah Beran, Tarek Aboursheid, Adel Hajj Ali, Tarek Nayfeh, Hashem Albunni, Alejandra Vargas, Mouhand F Mohamed, Khaled Elfert, Mohammad Shaear, Ite Obaitan, Nasir Saleem, Awais Ahmed, Mark A Gromski, John M DeWitt, Mohammad Al-Haddad, James L Watkins, Evan Fogel, Jeffrey J Easler
Journal: Clinical Gastroenterology and Hepatology (2024)