tbuckley/cabot-search huggingface dataset:
Hemodynamic Impact of Cipepofol vs Propofol During Anesthesia Induction in Patients With Severe Aortic Stenosis
Authors: Tingting Ni, Xiaoxia Zhou, Shuguang Wu, Tao Lv, Yujiao Hu, Qi Gao, Ge Luo, Chen Xie, Jingcheng Zou, Yuexiu Chen, Linqian Zhao, Jie Xiao, Xincheng Tao, Yu Yi, Zhili Xu, Tingting Wang, Junyu Zhou, Yuanyuan Yao, Min Yan
Journal: JAMA Surgery (2025)

Importance Postinduction hemodynamic instability is a frequent complication among patients with severe aortic stenosis (AS). Using cipepofol as the anesthesia agent may reduce the incidence and severity of hemodynamic instability. Objective To assess whether cipepofol outperforms propofol in maintaining postinduction hemodynamic stability in patients with AS. Design, Setting, and Participants This single-center, randomized clinical trial was conducted from June 29, 2023, to July 8, 2024, at the Second Affiliated Hospital of Zhejiang University School of Medicine in China. Patients with AS scheduled for transcatheter aortic valve replacement (TAVR) were eligible for inclusion. Interventions Participants were randomized 1:1 to receive either cipepofol or propofol as anesthesia induction agents at equipotent doses. Main Outcomes and Measures The primary outcome was the area under the curve (AUC) of the mean arterial pressure (MAP) difference from baseline during the initial 15 minutes postinduction. Results A total of 124 patients with AS scheduled for TAVR were randomized into either the cipepofol group (n = 62) or the propofol group (n = 62). Of 124 patients randomized, 1 patient from each group was excluded due to ineligibility for the TAVR procedure, and data were analyzed for 122 patients (61 patients per group) based on the intention-to-treat principle. Among 122 total patients, mean (SD) age was 72.2 (5.0) years, and 53 patients (43.4%) were female. The cipepofol group exhibited a significantly smaller median (IQR) AUC (−8505.0 mm Hg · s [−12 402.8 to −5130.0]) compared with the propofol group (−13 189.0 mm Hg · s [−17 006.7 to −7593.3]; P &amp;amp;lt; .001). Moreover, compared with the propofol group, the cipepofol group demonstrated a significantly lower incidence of postinduction hypotension (70.5% vs 88.5%; P = .01) and required a smaller median (IQR) dose of norepinephrine during the first 15 minutes postinduction (6.0 μg [0.0-10.0] vs 10.0 μg [5.0-20.0]; P = .006). Additionally, the 2 groups’ bispectral indices were comparable. Conclusions and Relevance In this randomized clinical trial, cipepofol provided superior hemodynamic stability as an induction agent compared to propofol at equipotent doses and similar anesthesia depths for patients with AS. Therefore, cipepofol could serve as an alternative induction agent to propofol for patients at high cardiovascular risk. Trial Registration ClinicalTrials.gov Identifier: NCT05881291
Transcranial direct current stimulation combined with motor training for motor symptoms in Parkinson's disease: a systematic review and meta-analysis
Authors: Joon Ho Lee, Jin-Sun Jun, Nyeonju Kang, Ryul Kim, Beom Jin Choi, Kyeongho Byun, Kiwon Park, Jee-Young Lee, Beomseok Jeon
Journal: Ageing Research Reviews (2025)
Remestemcel-L-rknd for Steroid-Refractory Acute Graft-vs-Host Disease in Pediatric Patients
Authors: Upendra Mahat, Donna Przepiorka, Lola A. Fashoyin-Aje
Journal: JAMA (2025)

This JAMA Insights discusses the FDA approval of remestemcel-L-rknd to treat graft-vs-host disease in children and provides regulatory considerations for this approval.
Experiences With VA-Purchased Community Care for US Veterans With Mental Health Conditions
Authors: Megan E. Vanneman, Eric T. Roberts, Yaming Li, Florentina E. Sileanu, Utibe R. Essien, Maria K. Mor, Michael J. Fine, Carolyn T. Thorpe, Thomas R. Radomski, Katie J. Suda, Walid F. Gellad
Journal: JAMA Network Open (2025)

Importance Veterans with mental health conditions (MHC) face unique challenges obtaining high-quality, coordinated health care. With a growing number of veterans receiving VA-purchased community care (CC) provided outside the Veterans Health Administration (VA), evidence is needed on how veterans in this high-prevalence, marginalized subgroup experience CC. Objective To compare experiences with CC over time for US veterans with and without MHC. Design, Setting, and Participants This retrospective, cross-sectional survey study analyzed responses to the Survey of Healthcare Experiences of Patients–Community Care Survey (SHEP-CCS) from 2016 to 2021. Ratings of CC were examined across 9 domains and compared for veterans with and without MHC, adjusting for differences in baseline characteristics using regression models. Data were analyzed from March 2023 to September 2024. Exposure Diagnosis of MHC, defined as bipolar disorder, major depression, posttraumatic stress disorder, schizophrenia, or psychosis. Main Outcomes and Measures Veterans’ ratings of CC across 9 domains, overall satisfaction, overall clinician rating, clinician communication, eligibility determination, first appointment access, recent appointment access, nonappointment access, care coordination, and billing, were assessed on a scale of 1 to 100. Unadjusted annual ratings of care experiences were analyzed by survey domain. A series of 4 respondent-level linear regression models were examined for each domain and survey responses were pooled to test for differences in experiences between veterans with vs without MHC. Results This study included 231 869 veterans, including 62 911 veterans with MHC (27.1%) and 168 958 without MHC (72.9%). Veterans with MHC had a mean (SD) age of 55.8 (14.7) years, 8327 were female (18.5%), and 24 792 had 3 or more comorbidities (29.9%). Veterans without MHC had a mean (SD) age of 62.5 (15.2) years, 11 277 were female (11.0%), and 49 689 had 3 or more comorbidities (24.0%). In fully adjusted models, veterans with vs without MHC had lower adjusted overall satisfaction with CC by −1.8 (95% CI, −2.3 to −1.3) points ( P &amp;amp;lt; .001). Ratings in all domains were lower for veterans with vs without MHC (−0.09 to −0.05 SDs of domain scores) ( P &amp;amp;lt; .001 for all comparisons). Although ratings improved from 2016 to 2021, significant differences persisted over time for veterans with vs without MHC for all domains. Conclusions and Relevance In this survey study of veterans receiving CC from 2016 to 2021, those diagnosed with MHC reported lower ratings of CC across all measured domains, and these differences persisted over time. These findings highlight where focused care coordination and quality improvement efforts could improve CC experiences for this vulnerable subpopulation of veterans.
Finerenone in Heart Failure With Improved Ejection Fraction
Authors: Maria A. Pabon, Orly Vardeny, Muthiah Vaduganathan, Akshay S. Desai, Brian L. Claggett, Ian J. Kulac, Pardeep S. Jhund, Carolyn S. P. Lam, Michele Senni, Sanjiv J. Shah, Adriaan A. Voors, Faiez Zannad, Bertram Pitt, Clara I. Saldarriaga, Mark C. Petrie, Béla Merkely, Maria Borentain, Katharina Mueller, Prabhakar Viswanathan, Flaviana Amarante, Alanna Morris, John J. V. McMurray, Scott D. Solomon
Journal: JAMA Cardiology (2025)

Importance Patients with chronic heart failure (HF) and left ventricular ejection fraction (LVEF) less than 40% who experience LVEF improvement to 40% or higher (HFimpEF) may still face residual risks. Objective To assess the clinical profiles, risk, and treatment response to finerenone in participants with HFimpEF. Design, Setting, and Participants A total of 6001 patients with HE, LVEF of 40% or higher, New York Heart Association class II to IV symptoms, and elevated natriuretic peptide levels, were enrolled between September 14, 2020, and January 10, 2023. Patients with a prior history of LVEF less than 40% were included. Data analysis was conducted between September 1 to December 10, 2024. Intervention Participants received finerenone (titrated to 20 mg or 40 mg) or placebo. Main Outcomes and Measures The primary end point was the composite of cardiovascular (CV) death and total (first and recurrent) worsening HF events. Results Of the 6001 participants (mean [SD] age, 72 [9.7], years; 3269 male [55%]), 273 (5%) had a prior LVEF less than 40%. Among those with a prior LVEF of less than 40%, the median recorded prior LVEF was 35% [IQR, 30%-37%], with a median improvement of 12% [IQR, 8%-17%]. Over a median follow-up of 2.6 years, those with a history of LVEF of less than 40% experienced higher rates of the primary outcome of a composite of CV death and worsening of HF events (21.4 per 100 patient-years vs 16.0 per 100 patient-years) than did those whose LVEF was consistently 40% or higher. After adjustment for clinically relevant covariates; however, this rate ratio (RR) was not statistically different (absolute RR, 1.13; 95% CI, 0.85-1.49, P = .39). The treatment effect of finerenone on the primary outcome was consistent among those with a history of LVEF less than 40% and those with LVEF that was consistently 40% or higher ( P for interaction = .36). Owing to higher baseline risk, the absolute risk reduction was greater among those with HFimpEF (9.2 vs 2.5 per 100 patient-years). Patients with HFimpEF tended to develop more hypotension with finerenone treatment, but otherwise, the safety profile of finerenone was similar in patients with and without previous LVEF less than 40%. Conclusions and Relevance In this prespecified analysis of a randomized clinical trial, patients with HFimpEF remained at high risk of CV events, underscoring the need for continued management despite LVEF improvement. The treatment benefits of finerenone observed among the overall population of patients with HF with preserved EF were consistent among patients with HFimpEF. Trial Registration ClinicalTrials.gov Identifier: NCT04435626
Access to Information Cited in National Organization for Rare Disorders Reports
Authors: Mengyuan Fu, Kexin Ling, Xinyi Zhou, Sneha Dave, Can Li, Luwen Shi, Xiaodong Guan, Joseph S. Ross
Journal: JAMA Network Open (2025)

This cross-sectional study describes the availability and access cost to the public of research findings and other clinical insights relevant to rare diseases.
Private Equity Among US Psychiatric Hospitals
Authors: Morgan C. Shields, Yuanyuan Yang, Susan H. Busch
Journal: JAMA Psychiatry (2025)

Importance Private equity (PE) ownership in health care has increased, but evidence for its association with health care quality is mixed. Moreover, there is no evidence regarding inpatient psychiatric hospitals, despite considerable patient vulnerabilities. Objective To describe trends in PE ownership of psychiatric hospitals from 2013 through 2021 and the cross-sectional association between PE ownership and hospital staffing and quality. Design, Setting, and Participants In this cross-sectional study, a novel dataset of PE ownership of psychiatric hospitals in the US was constructed using industry sources and web searches. Characteristics of 87 PE-owned psychiatric hospitals in 2021 were compared with 530 non–PE-owned psychiatric hospitals. Regression models were used to estimate adjusted differences in hospital staffing and quality. Participants included all Medicare-participating freestanding psychiatric hospitals in the US (N = 617). These data were analyzed from September 2023 to October 2024. Exposure PE ownership. Main Outcomes and Measures Main outcomes were staffing ratios, national quality measures (restraint and seclusion rates, 7- and 30-day follow-up rates, postdischarge medication continuation, and 30-day all-cause readmission rates). Other studied characteristics included institutional characteristics (region, number of beds), services provided, measures of case mix (populations served, hospital average Diagnosis Related Group score among Medicare beneficiaries), occupancy rates, and average length of stay. Results By 2021, of the 617 freestanding psychiatric hospitals in the US, 87 (14.10%), representing 4660 beds (6.30%), were PE owned, with two-thirds of PE-owned facilities in the southern US (63.22%). In adjusted models, PE ownership was associated with significantly lower staff per patient day among registered nurses (0.12 vs 0.15; P = .048 and medical social workers (0.02 vs 0.04; P = .005). Yet, PE-owned facilities performed better on quality measures, including lower reported hours of restraint use (0.03 vs 0.24 hours per 1000 patient hours; P &amp;amp;lt; .001), 30-day readmissions (19.40% vs 20.16%; P = .047), and higher 7-day (29.34% vs 26.28%; P = .03) and 30-day (52.92% vs 49.08%; P = .01) follow-up visits. Conclusions and Relevance PE ownership of psychiatric hospitals is growing rapidly. In 2021, these facilities had significantly lower staffing ratios, even after controlling for observable case-mix factors. No evidence of lower quality among PE-owned facilities was found, although existing measures are limited. Expansions of US Centers for Medicare &amp;amp;amp; Medicaid Services quality measures to include patient experiences will provide information on new dimensions of quality in these facilities.
Polygenic Prediction of Peripheral Artery Disease and Major Adverse Limb Events
Authors: Alyssa M. Flores, Yunfeng Ruan, Anika Misra, So Mi Jemma Cho, Margaret S. Selvaraj, Tiffany R. Bellomo, Tetsushi Nakao, Kenneth Rosenfield, Matthew Eagleton, Whitney Hornsby, Aniruddh P. Patel, Pradeep Natarajan
Journal: JAMA Cardiology (2025)

Importance Peripheral artery disease (PAD) is a heritable atherosclerotic condition associated with functional decline and high risk for limb loss. With growing knowledge of the genetic basis for PAD and related risk factors, there is potential opportunity to identify individuals at high risk using polygenic risk scores (PRSs). Objective To develop a novel integrated, multiancestry polygenic score for PAD (PRS-PAD) and evaluate its risk estimation for PAD and major adverse limb events in 3 populations. Design, Setting, and Participants This longitudinal cohort study was conducted among individuals with genotyping and electronic health record data in the UK Biobank (2006-2021), All of Us (AoU, 2018-2022), and the Mass General Brigham Biobank (MGBB, 2010-2023). Data were analyzed from July 2023 to February 2025. Exposures PRS-PAD, previously published PAD polygenic scores, and clinical risk factors. Main Outcomes and Measures The primary outcomes were PAD and major adverse limb events, defined as a surrogate of major amputation and acute limb ischemia. Results The study populations included 400 533 individuals from the UK Biobank (median [IQR] age, 58.2 [45.0-71.4] years; 216 215 female participants [53.9%]), 218 500 from AoU (median [IQR] age, 53.6 [37.7-65.0] years; 132 647 female participants [60.7%]), and 32 982 from MGBB (median [IQR] age, 56.0 [32.0-80.0] years; 18 277 female participants [55.4%]). In the UK Biobank validation cohort, PRS-PAD was associated with an odds ratio [OR] per SD increase of 1.63 (95% CI, 1.60-1.68; P &amp;amp;lt; .001). After adjusting for clinical risk factors, the OR for the top 20% of PRS-PAD was 1.68 (95% CI, 1.62-1.74; P &amp;amp;lt; .001) compared to the remainder of the population. Among PAD cases without a history of diabetes, smoking, or chronic kidney disease (n = 3645), 1097 individuals (30.1%) had a high PRS-PAD (top 20%). In incident disease analysis, PRS-PAD improved discrimination (C statistic, 0.761), which was nearly equivalent to the performances of diabetes (C statistic, 0.760) and smoking (C statistic, 0.765). Among individuals with prevalent PAD, high PRS-PAD was associated with an increased risk of incident major adverse limb events in the UK Biobank (hazard ratio [HR], 1.75; 95% CI, 1.18-2.57; P = .005), MGBB (HR, 1.56; 95% CI, 1.06-2.30; P = .02), and AoU (HR, 1.57; 95% CI, 1.06-2.33; P = .03). Conclusions and Relevance This cohort study develops a new PRS that stratifies risk of PAD and adverse limb outcomes. Incorporating polygenic risk into PAD care warrants further investigation to guide screening and tailor management to prevent major adverse limb events.
Local Anesthetics Adulterating the Illicit Fentanyl Supply
Authors: Joseph J. Palamar, Joshua S. DeBord, Alex J. Krotulski, Bruce A. Goldberger
Journal: JAMA Psychiatry (2025)

This Viewpoint examines the use of local anesthetics to adulterate synthetic opioids, particularly illicitly manufactured fentanyl, and the dangers associated with exposure to these drugs.
Clinical Outcomes of Laparoscopic vs Robotic-Assisted Cholecystectomy in Acute Care Surgery
Authors: Nathnael Abera Woldehana, Andrew Jung, Brett Colton Parker, Alisa Mae Coker, Elliott Richard Haut, Gina Lynn Adrales
Journal: JAMA Surgery (2025)

Importance The use of robotic-assisted cholecystectomy in acute care surgery is increasing, but its safety and efficacy compared with laparoscopic cholecystectomy remain unclear. Objective To compare clinical outcomes and bile duct injury rates between robotic-assisted cholecystectomy and laparoscopic cholecystectomy in acute care surgery. Design, Setting, and Participants This was a retrospective cohort study using patient data from a commercial claims and encounter database from 2016 to 2021. Included in the study were adult patients undergoing robotic-assisted cholecystectomy or laparoscopic cholecystectomy in acute care surgery. Data were analyzed from January to October 2024. Exposures Robotic-assisted or laparoscopic cholecystectomy in acute care surgery. Main Outcomes and Measures The primary outcome was bile duct injury. Results A total of 844 428 patients (mean [SD] age, 45.6 [12.5] years; 547 665 female [64.9%]) were included in this analysis. After propensity score matching, robotic-assisted cholecystectomy (n = 35 037) and laparoscopic cholecystectomy (n = 35 037) had similar bile duct injury rates (0.37% [128 of 35 037] vs 0.39% [138 of 35 037]; odds ratio [OR], 0.93; 95% CI, 0.73-1.18; P = .54). Robotic-assisted cholecystectomy had higher major postoperative complications (8.37% [2934 of 35 037] vs 5.50% [1926 of 35 037]; OR, 1.57; 95% CI, 1.48-1.67; P &amp;amp;lt; .001), more postoperative drain use (0.63% [219 of 35 037] vs 0.48% [132 of 35 037]; OR, 1.66; 95% CI, 1.34-2.07; P &amp;amp;lt; .001), and longer median (IQR) hospital length of stay (3 [2-4] days vs 2 [1-4] days; P &amp;amp;lt; .001). Conclusions and Relevance In this large, propensity-matched cohort analysis of acute care surgery cholecystectomy, robotic-assisted and laparoscopic cholecystectomy had similar bile duct injury rates, but robotic-assisted cholecystectomy was associated with higher postoperative complications, longer hospital stays, and increased drain use. Further research is needed to optimize the use of robotic-assisted cholecystectomy for acute gallbladder disease. These findings suggest that, under current practice conditions, robotic-assisted cholecystectomy may not offer clear benefits compared with the standard, established laparoscopic cholecystectomy approach.
Melatonin receptor 1a alleviates sleep fragmentation-aggravated testicular injury in T2DM by suppression of TAB1/TAK1 complex through FGFR1
Authors: Xiaohui Zhang, Xinyu Tang, Ting Gao, Yuanfang Guo, Guangping Lu, Qingbo Liu, Jiahao Li, Jie Wang, Mingrui Liu, Dongmei Zhang, Yufeng Tang, Junlian Gu
Journal: Acta Pharmaceutica Sinica B (2025)
Harnessing PD-1-overexpressing Macrophage Membrane for Preparation of Lenvatinib-loaded Vesicles to Boost Immunotherapy against HCC Recurrence after Radiofrequency Ablation
Authors: Huanling Guo, Guangliang Huang, Haiyi Long, Wenxin Wu, Ke Lin, Bin Qiao, Nan Zhang, Tongyi Huang, Yang Tan, Qi Zhang, Minru Zhang, Xiaoyan Xie, Xintao Shuai, Ming Xu, Chunyang Zhang
Journal: Biomaterials (2025)
Comparison of Temperature‐Mortality Associations Across the Middle East Using Different Exposure Estimation Approaches
Authors: Yazan Alwadi, Barrak Alahmad, Marc G. Weisskopf, Petros Koutrakis
Journal: Environmental Health Perspectives (2025)

Traditional temperature-health studies have predominantly relied on temperature measurements from stations or modelled spatial averages from gridded temperature datasets. It has been suggested that population-weighted spatial averages would perform better in remote regions with large temperature and population variability. This would be particularly true in regions other than North America and Europe where outcome data is often only available on a crude spatial scale, but no studies have examined this in such regions, where temperatures can be particularly hot. Using the Middle East as a climate hotspot, our objective was to illustrate the utility of population weighting temperature exposures in understudied regions with large health data aggregation areas. We used a daily 1km × 1km temperature dataset for 152 administrative regions in 12 Middle Eastern countries. From 2003 to 2020, for each administrative region, we computed daily minimum and maximum population-weighted and unweighted spatial average temperatures. To illustrate, we examined temperature-mortality associations in two countries: Kuwait and Jordan. We used distributed lag non-linear models to estimate the daily timeseries temperature-mortality associations in using three temperature exposure measurement approaches: station temperatures, unweighted spatial averages, and population-weighted temperatures. For each scenario, we fitted country-specific optimized parameters and compared them using three metrics: 1) exposure-response relationships, 2) minimum mortality temperatures and 3) attributable mortality estimates. The study region had geographically sporadic yet densely populated areas within each country. In both Kuwait and Jordan, population-weighted and unweighted spatial average temperatures resulted in fairly similar exposure-response curves, whereas both were notably different from station temperatures. Minimum mortality temperatures were 30.2, 28.6, and 28.3°C in Kuwait for station, unweighted spatial average, and population-weighted temperatures, respectively. In Jordan, the corresponding temperatures were 20.6, 20.9, and 20°C. Heat attributable mortality calculated using population-weighted temperatures increased by 15% compared to the traditionally used station temperatures in Kuwait and Jordan, respectively, and -0.4% and 5% compared to unweighted spatial average temperatures. Spatial averaging, whether weighted or unweighted, is a valuable tool for estimating heat-attributable mortality. This is especially true in regions like the Middle East, where granular temperature data are often unavailable and health studies are urgently needed. Population-weighted temperatures may better capture localized exposures in areas with significant population clustering, though their exact added effect on top of unweighted spatial averages remains a tentative conclusion.. https://doi.org/10.1289/EHP16010.
Outcomes and Mortality in Calciphylaxis: A Multicenter Update
Authors: Colleen M Glennon, Joyce Xia, Lindsay Strowd, Arturo R Dominguez, Dylan Haynes, Jesse Keller, Joseph J Locascio, Robert G Micheletti, Alex G Ortega Loayza, Helena B Pasieka, Michi M Shinohara, Alice J Tan, Sagar U Nigwekar, Daniela Kroshinsky
Journal: Journal of the American Academy of Dermatology (2025)