tbuckley/cabot-search huggingface dataset:
Loss of Subsidized Drug Coverage and Mortality among Medicare Beneficiaries
Authors: Eric T. Roberts, Jessica Phelan, Aaron L. Schwartz, Ellen Meara, Dominic Ruggiero, Lilly Estenson, Rachel M. Werner, José F. Figueroa
Journal: New England Journal of Medicine (2025)

A total of 14 million Medicare beneficiaries receive the Low-Income Subsidy (LIS), which reduces cost sharing in Medicare Part D. Losing the LIS may impede medication access and affect mortality. Using 2015-2023 Medicare data, we identified dual-eligible Medicare-Medicaid beneficiaries, who automatically receive the LIS, and calculated annual rates of Medicaid and LIS loss. To examine the relationship between LIS loss and mortality, we leveraged a natural experiment arising from the relationship between the timing of Medicaid disenrollment and subsequent LIS loss. We compared beneficiaries disenrolling from Medicaid in January through June, who kept the LIS through December (6 to 11 additional months), with those disenrolling in July through December, who kept the LIS through the following December (12 to 17 additional months). Among persons disenrolling from Medicaid during 2015-2017, we examined cumulative mortality 7 to 17 months after disenrollment, when those with earlier disenrollment were more likely to lose the LIS. The sample included 969,606 persons with early (January though June) Medicaid disenrollment and 920,158 with late (July though December) Medicaid disenrollment. Those with early Medicaid disenrollment averaged 13.6 cumulative months of the LIS in the 17 months after disenrollment, as compared with 15.3 months for those with late disenrollment. At 17 months after Medicaid disenrollment, cumulative mortality was higher among persons with early disenrollment (78.3 per 1000) than among those with late disenrollment (75.3 per 1000), a difference of 3.0 deaths per 1000 (95% confidence interval [CI], 2.1 to 3.9). Mortality differences between persons with early disenrollment and those with late disenrollment were amplified among those in the highest quintile of baseline Part D spending (5.6 deaths per 1000; 95% CI, 3.3 to 7.9) and users of medications for cardiovascular disease, chronic lung disease, or human immunodeficiency virus infection. Loss of drug subsidies after Medicaid disenrollment was associated with higher mortality among low-income Medicare beneficiaries. (Funded by the National Institute on Aging and others.).
Incomplete Team Staffing, Burnout, and Work Intentions Among US Physicians
Authors: Lisa S. Rotenstein, Purva Shah, Tait Shanafelt, Christine A. Sinsky
Journal: JAMA Internal Medicine (2025)

This cross-sectional study assesses the prevalence of incomplete team staffing in the post–COVID-19 pandemic health care landscape and its association with burnout and work intentions among US physicians.
Hypofractionated, Dose-Escalated Radiation Versus Conventionally Fractionated Radiation for Localized Prostate Cancer: Long-Term Update of a Phase III, Prospective, Randomized Controlled Trial
Authors: Comron Hassanzadeh, Deborah Kuban, Sarah Pasyar, Roland Bassett, Patricia Troncoso, Maheen Ansari, Pamela Schlembach, Sean McGuire, Quynh Nguyen, Steven Frank, Henry Mok, Osama Mohamad, Ryan Park, Chad Tang, Weiliang Du, Rajat Kudchadker, Seungtaek Choi, Karen Hoffman
Journal: Journal of Clinical Oncology (2025)

The MD Anderson dose-escalated, hypofractionated prostate radiation study was a phase III randomized trial comparing conventionally fractionated intensity-modulated radiation therapy (CIMRT, 75.6 Gy in 1.8-Gy fractions) with dose-escalated, hypofractionated intensity-modulated radiation (HIMRT, 72 Gy in 2.4-Gy fractions) in patients with localized prostate cancer, predominantly low-risk and intermediate-risk disease. The initial publication highlighted statistically fewer treatment failures in the HIMRT arm. We present long-term updated 13-year outcomes to determine whether cancer control benefit was maintained and to evaluate distant metastases post hoc. With a median follow-up of 13.2 years (IQR, 8.8-15.9 years), treatment failure occurred less frequently in men undergoing HIMRT (n = 13) compared with those undergoing CIMRT (n = 22), although the difference no longer meets statistical significance ( P = .08). Distant metastases were rare, and no statistically significant difference was noted ( P = .2). There remained no statistically significant difference in late GI 2+ (10-year 10% HIMRT v 4% CIMRT, P = .09) or genitourinary grade 2+ toxicity (10-year 26% v 23%, P = .5).
New IgG and IgA autoantibody specificities against DNA-binding and RNA-binding proteins discriminate systemic lupus erythematosus from health and non-lupus autoimmunity–could anti-LIN28A enhance precision in diagnostics?
Authors: Ioannis Parodis, Denis Lagutkin, Julius Lindblom, Helena Idborg, Lorenzo Beretta, Maria Orietta Borghi, Janique M Peyper, Guillermo Barturen, Per-Johan Jakobsson, Marta E Alarcón-Riquelme, Natalia Sherina, Dionysis Nikolopoulos
Journal: Annals of the Rheumatic Diseases (2025)

In response to the urgent unmet needs of heterogeneity, unpredictability, and diagnostic delay in systemic lupus erythematosus (SLE), we aimed to identify and validate new immunoglobulin (Ig)G and IgA autoantibody specificities. Using a KoRectly EXpressed technology-based microarrays (i-Ome Discovery; Sengenics), we screened for circulating IgG and IgA autoantibodies against 1609 proteins in 2 independent cohorts (discovery: NTC02890121; validation: NCT02890134) comprising patients with SLE (n = 199 and n = 30), primary Sjögren's disease (n = 115 and n = 31), and systemic sclerosis (n = 115 and n = 24), and healthy controls (HCs; n = 111 and n = 84), respectively. We identified and validated 5 IgG (anti-Lin-28 homolog A [LIN28A], anti-HNRNPA2B1, anti-HMG20B, anti-HMGB2, and anti-alpha-globin transcription factor CP2 [TFCP2]) and 4 IgA (anti-LIN28A, anti-HMG20B, anti-SUB1, and anti-TFCP2) autoantibodies that demonstrated high specificity for SLE (0.91-0.94), along with consistent and robust positivity (0.22-0.69) in differentially abundant autoantibody (daAAb) analysis between SLE and comparator groups. IgG and IgA anti-LIN28A levels varied over a 14-month follow-up in the validation cohort of newly diagnosed patients with SLE and exhibited metrics that outperformed those of traditional autoantibody markers such as anti-double-stranded DNA. Clustering of patients with SLE based on autoantibody positivity (levels above the HC median plus 2 IQRs in the discovery cohort) status revealed 1 subgroup demonstrating seroreactivity against multiple antigens, 3 exhibiting varying reactivity, and 1 showing no reactivity. In pathway analysis, daAAb targets pointed to DNA-binding and RNA-binding and transcription functions. Novel autoantibodies validated in this study may enhance diagnostics and molecular characterisation in SLE. The prominent IgA seroreactivity implicates important roles of mucosal tissues in SLE autoimmunity, warranting further investigation.
The comparative effectiveness and safety of fluticasone-salmeterol via metered-dose versus dry powder inhalers for COPD: A new user cohort study
Authors: Brandon J Demkowicz, Kevin Rader, Shirley V Wang, Aaron S Kesselheim, William B Feldman
Journal: PLoS Medicine (2025)

Background Fluticasone-salmeterol is available in both metered-dose and dry powder inhaler formulations for the treatment of chronic obstructive pulmonary disease (COPD). Metered-dose inhalers are associated with substantially higher greenhouse gas emissions than dry powder inhalers; however, data on their comparative effectiveness and safety in COPD remain limited. We aimed to compare the effectiveness and safety of fluticasone-salmeterol delivered via metered-dose inhaler (Advair HFA) versus dry powder inhaler (Advair Diskus) among patients with COPD treated in routine care. Methods and findings We conducted a retrospective cohort study using Optum’s de-identified Clinformatics DataMart (January 1, 2007 to November 30, 2023). The study included 202,052 commercially insured patients aged 40 years or older with COPD who had continuous insurance coverage for 180 days prior to cohort entry and had not initiated any inhaled corticosteroid–long-acting β₂-agonist during that period. Patients receiving fluticasone-salmeterol via a metered-dose inhaler (exposure) were compared to those receiving these drugs via a dry powder inhaler (referent), with stabilized inverse probability of treatment weighting applied for covariate adjustment. The primary effectiveness outcome was the incidence of first moderate or severe COPD exacerbation within 365 days of cohort entry. The primary safety outcome was the incidence of first pneumonia hospitalization during the same period. Use of fluticasone-salmeterol via metered-dose inhaler was associated with a similar hazard of first moderate or severe COPD exacerbation (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.99 to 1.08) and first pneumonia hospitalization (HR, 1.06; 95% CI, 0.98 to 1.14) compared to the dry powder inhaler. Primary study limitations include potential residual confounding despite weighting and short follow-up times. Conclusions In this cohort study comparing two brand-name fluticasone-salmeterol inhalers prescribed for COPD in routine clinical practice, effectiveness and safety outcomes were similar for patients receiving metered-dose and dry powder versions.
Sacral Hemangioma Mimicking Bone Metastasis on 18F-PSMA-1007 PET/CT
Authors: Xiaojun Man, Changming Dong, Xiandong Song, Aisheng Dong
Journal: Clinical Nuclear Medicine (2025)

A 74-year-old man with prostate cancer was referred for an 18 F-PSMA-1007 PET/CT scan for restaging due to a progressive rise in serum prostate–specific antigen levels. 18 F-PSMA-1007 PET/CT showed a focal intense activity in the left sacral ala. The sacral lesion corresponded to a hemangioma, which was initially detected on pelvic MRI 6 months ago and remained stable in size. A second 18 F-PSMA-1007 PET/CT performed 8 months after the first PET/CT showed no significant changes in size, density, and activity of the sacral lesion. This case indicates that hemangioma should be included in the differential diagnosis of PSMA-avid sacral lesions.
Bone Scintigraphy and Laboratory Clues to Osteomalacia in a Middle-Aged Man With Hip Fractures
Authors: Tzyy-Ling Chuang, Yuh-Feng Wang
Journal: Clinical Nuclear Medicine (2025)

A 43-year-old man with a 1-year history of bilateral hip pain, worsened by standing and walking, presented with a limping gait. x-rays showed diffuse osteoporosis (osteoblastic-lytic), and a bone scan revealed symmetric uptake in the costochondral junctions (rosary beads), femoral neck, proximal tibia, and feet, with no visualization of the kidneys, suggesting a metabolic disorder or neoplasm. Computed tomography revealed osteolytic lesions in multiple bones. Suspecting metabolic bone disease or metastasis, laboratory tests were conducted. Magnetic resonance imaging confirmed bilateral femoral neck fractures. He underwent open reduction internal fixation for the hip fractures. The imaging and laboratory findings suggest osteomalacia.
Efficacy of digital health technologies in the management of inflammatory bowel disease: an umbrella review
Authors: Marco Gasparetto, Priya Narula, Charlotte Wong, James Ashton, Jochen Kammermeier, Marieke Pierik, Uri Kopylov, Naila Arebi
Journal: The Lancet Digital Health (2025)

The use of digital health technology (DHT) is increasing worldwide. Clinical trials assessing available health tools for the management of patients with inflammatory bowel disease (IBD) are sparse, with limited evidence-based outcome data. In this umbrella review, we investigated the effectiveness of DHT in the care of patients with IBD and identified areas for future research following the Joanna Briggs Institute methodology. Systematic reviews published between January, 2012, and September, 2024, were identified through searches across nine databases (Ovid Embase, Ovid MEDLINE, ProQuest PsycINFO, Epistemonikos, Cochrane, Health Evidence, DoPHER, PROSPERO, and CINAHL via EBSCO), and the results were imported into Covidence software. Inclusion criteria included systematic reviews of randomised controlled trials (RCTs) involving patients of all ages with Crohn's disease or ulcerative colitis, using DHT for diagnostics, treatment support, monitoring, self-management, or increasing participation in research studies, compared with standard care or alternative interventions. Outcomes included the efficacy and effectiveness of digital interventions, as reported in the studies. The primary outcome was clinical efficacy reported as one or more of the following: clinical response or remission, disease activity, flare-ups or relapses, and quality of life. Secondary outcomes included medication adherence, number of health-care visits, patient engagement (satisfaction and adherence or compliance with interventions), attendance for all terms of engagement, rate of interactions, knowledge improvement, psychological outcomes, and cost or cost-time effectiveness. The review protocol was registered in PROSPERO (registration number: CRD42023417525). AMSTAR-2 was used for methodological quality assessment. Nine relevant reviews were included, including five with meta-analyses comprising 13-19 RCTs in each review; four reviews were rated as high quality and five as critically low quality. DHT was not directly beneficial in achieving or maintaining clinical remission in IBD. In four trials, DHT use was associated with a reduced number of hospital attendances and increased treatment adherence, supporting its role as an adjuvant to standard clinical practice in IBD. Although current evidence from several RCTs and systematic reviews does not indicate better clinical outcomes with DHT in maintaining IBD remission and reducing relapse rates, DHT could be used as an adjuvant resource contributing towards treatment adherence and reducing hospital visits.
Addressing the growing burden of musculoskeletal diseases in the ageing US population: challenges and innovations
Authors: Andrew Nguyen, Philip Lee, Edward K Rodriguez, Karen Chahal, Benjamin R Freedman, Ara Nazarian
Journal: The Lancet Healthy Longevity (2025)

The prevalence of musculoskeletal diseases such as osteoarthritis, osteoporosis, sarcopenia, and rheumatoid arthritis is rising sharply with global ageing, increasing disability rates among older adults (aged ≥60 years), diminishing quality of life, and burdening health-care systems. Current musculoskeletal care for older adults faces multiple limitations, including comorbidities, frailty, and fragmented care. High osteoarthritis prevalence in individuals older than 55 years, the mounting economic burden of osteoporotic fractures, the growing concern of muscle mass decline, and insufficient guideline implementation collectively underscore these challenges. In the USA, musculoskeletal diseases affect over 121 million people and account for the highest rate of disability among all disease groups, underscoring the need for targeted strategies. Although promising solutions encompassing advanced pharmacological therapies, regenerative medicine, and digital health technologies (including artificial intelligence) are available, they remain underutilised in existing care models. This Personal View discusses the need for personalised, multidisciplinary approaches to address these issues, advocating for collaboration among the orthopaedic, geriatric, and health-care sectors in the USA. We propose that prevention of musculoskeletal diseases is key to its effective management in ageing populations, alongside a holistic, scalable approach that integrates diagnostics, therapy, and telemedicine. Early intervention, interdisciplinary collaboration, and personalised care are essential to improving patient outcomes and addressing the growing musculoskeletal disease burden in the USA.
Prognostic Value of Gait Speed and Handgrip Strength in Patients With Advanced Systolic Heart Failure
Authors: Tejus Satish, Nicholas S Hendren, Jennifer Thibodeau, Sarah Godfrey, Melanie Sulistio, Maryjane Farr, Mark H Drazner, W H Wilson Tang, Justin L Grodin
Journal: JACC Heart Failure (2025)
Prevalence of Heart Failure With Preserved Ejection Fraction in Patients Referred for Atrial Fibrillation Ablation
Authors: Jan Riess, Julius Obergassel, Nils Pohlmann, Moritz Nies, Marc Lemoine, Ilaria My, Bruno Reißmann, Andreas Metzner, Paulus Kirchhof, Andreas Rillig
Journal: JACC Heart Failure (2025)
Carvedilol as Single Therapy for Heart Failure With Improved Ejection Fraction
Authors: Deborah de Sá Pereira Belfort, Edimar Alcides Bocchi, Caio Rebouças Fonseca Cafezeiro, Mauro R B Wanderley, Vera Maria Cury Salemi, Camila Rocon, Robinson Tadeu Munhoz, Paulo Roberto Chizzola, Bruno Biselli, Diógenes Amauri Gonçalves Furlan, Silvia Moreira Ayub-Ferreira
Journal: JACC Heart Failure (2025)
The Underrepresentation of Women Among Cardiac Imagers
Authors: Maria Alwan, Ahmed Sayed, Nadeen N. Faza, Chiara Bucciarelli-Ducci, Panithaya Chareonthaitawee, Ahmad El Yaman, Asim Shaikh, Mahmoud Al Rifai, Mouaz H. Al-Mallah
Journal: JACC. Cardiovascular imaging (2025)
Valve Area Planimetry on 4D-CT for Significant Aortic Stenosis
Authors: Aro Daniela Arockiam, Akiva Rosenzveig, Tiffany Dong, Elio Haroun, Ankit Agrawal, Joseph El Dahdah, Rishabh Khurana, Aritra Paul, Odette Iskandar, Bianca Honnekeri, Jaideep Singh Bhalla, Agam Bansal, Serge Harb, Zoran Popovic, Leonardo Rodriguez, Brian Griffin, Samir Kapadia, Tom Kai Ming Wang
Journal: JACC. Cardiovascular imaging (2025)
Longitudinal Assessment of Spot Urinary Sodium as Predictor of Clinical Outcomes in Chronic Heart Failure
Authors: Miguel Lorenzo, Eduardo Núñez, Rafael de la Espriella, Arturo Carratalá, Enrique Rodríguez, Jose Luis Górriz, Neus Valls, Antoni Bayés-Genís, Juan Sanchis, Julio Núñez
Journal: JACC Heart Failure (2025)
Statin Therapy Persistence Following Opportunistic Screening for Coronary Artery Calcium on Nongated Chest CTs
Authors: Sarkis G. Bouladian, Summer Ngo, Domenico Mastrodicasa, David Eng, Nishith Khandwala, Doug Sousa, Akshay S. Chaudhari, David J. Maron, Fatima Rodriguez, Alexander T. Sandhu
Journal: JACC. Cardiovascular imaging (2025)
Clemastine fumarate accelerates accumulation of disability in progressive multiple sclerosis by enhancing pyroptosis
Authors: Joanna Kocot, Peter Kosa, Shinji Ashida, Nicolette A Pirjanian, Raphaela Goldbach-Mansky, Karin Peterson, Valentina Fossati, Steven M Holland, Bibiana Bielekova
Journal: Journal of Clinical Investigation (2025)

Multiple sclerosis (MS) is an immune-mediated demyelinating disease of the CNS. Clemastine fumarate, the over-the-counter antihistamine and muscarinic receptor blocker, has remyelinating potential in MS. A clemastine arm was added to an ongoing platform clinical trial, targeting residual activity by precision, biomarker-guided combination therapies of multiple sclerosis (TRAP-MS) (ClinicalTrials.gov NCT03109288), to identify a cerebrospinal fluid (CSF) remyelination signature and to collect safety data on clemastine in patients progressing independently of relapse activity (PIRA). The clemastine arm was stopped per protocol-defined criteria when 3 of 9 patients triggered individual safety stopping criteria. Clemastine-treated patients had significantly higher treatment-induced disability progression slopes compared with the remaining TRAP-MS participants. Quantification of approximately 7,000 proteins in CSF samples collected before and after clemastine treatment showed significant increases in purinergic signaling and pyroptosis. Mechanistic studies showed that clemastine with sublytic doses of extracellular adenosine triphosphate (ATP) activates inflammasome and induces pyroptotic cell death in macrophages. Clemastine with ATP also caused pyroptosis of induced pluripotent stem cell-derived human oligodendrocytes. Antagonist of the purinergic channel P2RX7, which is strongly expressed in oligodendrocytes and myeloid cells, blocked these toxic effects of clemastine. Finally, reanalysis of published single-nucleus RNA-Seq (snRNA-Seq) studies revealed increased P2RX7 expression and pyroptosis transcriptional signature in microglia and oligodendrocytes in the MS brain, especially in chronic active lesions. The CSF proteomic pyroptosis score was increased in untreated MS patients, was higher in patients with progressive than relapsing-remitting disease, and correlated significantly with the rates of MS progression. Collectively, this identifies pyroptosis as a likely mechanism of CNS injury underlying PIRA even outside of clemastine toxicity.
Metabolic dysfunction–associated steatotic liver disease and pregnancy
Authors: Monika Sarkar, Tatyana Kushner
Journal: Journal of Clinical Investigation (2025)

Metabolic dysfunction-associated steatotic liver disease (MASLD) is rising among reproductive-aged individuals and in pregnancy. MASLD in pregnancy does increase such risks as gestational diabetes, preeclampsia, and preterm birth. Although routine screening for MASLD has not been established in pregnancy, individuals with metabolic comorbidities, such as type 2 diabetes mellitus, should be evaluated by liver imaging and liver panel. Preconception counseling should address potential risks as well as need for optimized metabolic health before and during pregnancy. Fibrosis assessment should ideally be completed before pregnancy, to identify cases of cirrhosis that may warrant additional preconception management, such as variceal screening, as well as comanagement with maternal-fetal medicine specialists. In patients with MASLD, aspirin is advised at 12 weeks of gestational age to lower preeclampsia risk. In the absence of cirrhosis, no additional blood test monitoring is needed. In the general population, breastfeeding has beneficial effects on metabolic health in birthing parents and offspring and thus should be encouraged in the setting of MASLD, including access to enhanced lactation support. Research needs include evaluation of the long-term risks of MASLD in pregnancy on metabolic health in birthing parents and infants, as well as safety data for MASLD-directed therapies during pregnancy and lactation.