tbuckley/cabot-search huggingface dataset:
Hypertensive Disorders and Cardiovascular Severe Maternal Morbidity in the US, 2015-2019
Authors: Isabelle Malhamé, Kara Nerenberg, Kelsey McLaughlin, Sonia M. Grandi, Stella S. Daskalopoulou, Amy Metcalfe
Journal: JAMA Network Open (2024)

Importance The incidence of severe maternal morbidity (SMM)—and particularly cardiovascular SMM (cvSMM), the first cause of pregnancy-related mortality—has been rising in North America. Although hypertensive disorders of pregnancy (HDP) are common, their association with cvSMM specifically remains unclear. Objective To assess the association between individual subtypes of HDP and cvSMM, in addition to overall SMM, in a large, nationally representative sample. Design, Setting, and Participants A population-based cohort study using the United States National Inpatient Sample was conducted. Individuals with obstetric deliveries between 2015 and 2019 were included. Data analysis was performed from October 2023 to February 2024. Exposure HDP subtypes included gestational hypertension, chronic hypertension, preeclampsia without severe features, severe preeclampsia, and HELLP (hemolysis, elevated liver enzymes, and low platelet) syndrome. Main Outcomes and Measures The primary outcome was a composite of cvSMM (including conditions such as pulmonary edema, stroke, and acute myocardial infarction) and the secondary outcome was a composite of overall SMM (including cvSMM and other conditions such as respiratory failure, severe postpartum hemorrhage, and sepsis). Adjusted risk ratios (aRRs) for the association between HDP subtypes and the outcomes were estimated using modified Poisson regression models adjusted for demographic and clinical characteristics. Results Among 15 714 940 obstetric deliveries, 2 045 089 (13.02%) had HDP, 23 445 (0.15%) were affected by cvSMM, and 282 160 (1.80%) were affected by SMM. The mean (SD) age of the cohort was of 29 (6) years. The incidence of cvSMM was higher in participants with HDP than those without HDP (0.48% [9770 of 2 045 089] vs 0.10% [13 680 of 13 669 851]; P &amp;amp;lt; .001). Participants with HELLP syndrome had the highest risk for cvSMM (aRR, 17.55 [95% CI, 14.67-21.01]), followed by severe preeclampsia (aRR, 9.11 [95% CI, 8.26-10.04]), and chronic hypertension (aRR, 3.57 [95% CI, 3.15-4.05]). Although HDP subtypes were also associated with overall SMM, the association with HELLP syndrome (aRR, 9.94 [95% CI, 9.44-10.45]), severe preeclampsia (aRR, 3.66 [95% CI, 3.55-3.78]), and chronic hypertension (aRR, 1.96 [95% CI, 1.88-2.03]) was attenuated compared with cvSMM. Conclusions and Relevance In this cohort study, a graded relationship by severity characterized the association between HDP and cvSMM. Although all HDP subtypes were associated with an increased risk of overall SMM, the risk was more pronounced for cvSMM.
Prevalence and Factors Associated With Prostate Cancer Among Transgender Women
Authors: Celeste Manfredi, Antonio Franco, Francesco Ditonno, Eugenio Bologna, Leslie Claire Licari, Costantino Leonardo, Alessandro Antonelli, Cosimo De Nunzio, Edward E. Cherullo, Marco De Sio, Riccardo Autorino
Journal: JAMA Oncology (2024)

Importance Evidence on prostate cancer (PCa) in transgender women is very limited; data are needed to reduce gender disparities in both PCa knowledge and health care. Objective To evaluate the prevalence of PCa among transgender women in the US and assess the factors associated with PCa, and factors associated with biochemical recurrence (BCR) and bone metastases (BM) secondary to PCa in the transgender population. Design, Setting, and Participants A retrospective cohort study was conducted in October 2023, covering the period between 2011 and 2022 (12-year analysis). The study was based on a large, all-payer claims, deidentified, US database (PearlDiver Mariner). Transgender women who were identified as male before assignment of transsexual status codes were included. Patients with PCa were detected in the transgender women population. Main Outcomes and Measures PCa diagnosis was selected as primary outcome; BCR and BM were chosen as secondary outcomes. Results A total of 95 460 transgender women with a mean (SD) age of 52.5 (9.4) years were included. PCa was diagnosed in 589 individuals with a mean (SD) age of 66.8 (10.0) years (estimated prevalence, 0.62%; 95% CI, 0.54%-0.77%). Age (adjusted odds ratio [OR], 1.10; 95% CI, 1.08-1.12; P &amp;amp;lt; .001) and family history (adjusted OR, 2.27; 95% CI, 1.60-4.92; P &amp;amp;lt; .001) were positively associated with PCa in transgender women. Gender-affirming hormone therapy (GAHT) was negatively associated with PCa in transgender women (OR, 0.60; 95% CI, 0.56-0.89; P &amp;amp;lt; .001) but positively associated with BCR (OR, 1.83; 95% CI, 1.21-2.86; P &amp;amp;lt; .001) and BM (OR, 3.96; 95% CI, 1.50-9.99; P &amp;amp;lt; .001) in the transgender population with PCa. Conclusions and Relevance This cohort study found that PCa appeared to be relatively uncommon in transgender women. GAHT may reduce the risk of PCa in transgender patients, but it may also increase the risk of BCR and BM in transgender women with PCa. Further studies are needed to confirm our findings.
Reactive microglia partially envelop viable neurons in prion diseases
Authors: Natallia Makarava, Tarek Safadi, Olga Bocharova, Olga Mychko, Narayan P Pandit, Kara Molesworth, Simone Baiardi, Li Zhang, Piero Parchi, Ilia V Baskakov
Journal: Journal of Clinical Investigation (2024)

Microglia are recognized as the main cells in the central nervous system responsible for phagocytosis. The current study demonstrated that in prion disease, microglia effectively phagocytose prions or PrPSc during early preclinical stages. However, a critical shift occured in microglial activity during the late preclinical stage, transitioning from PrPSc uptake to establishing extensive neuron-microglia body-to-body cell contacts. This change was followed by a rapid accumulation of PrPSc in the brain. Microglia that enveloped neurons exhibited hypertrophic, cathepsin D-positive lysosomal compartments. However, most neurons undergoing envelopment were only partially encircled by microglia. Despite up to 40% of cortical neurons being partially enveloped at clinical stages, only a small percentage of envelopment proceeded to full engulfment. Partially enveloped neurons lacked apoptotic markers but showed signs of functional decline. Neuronal envelopment was independent of the CD11b pathway, previously associated with phagocytosis of newborn neurons during neurodevelopment. This phenomenon of partial envelopment was consistently observed across multiple prion-affected brain regions, various mouse-adapted strains, and different subtypes of sporadic Creutzfeldt-Jakob disease (sCJD) in humans. The current work describes a new phenomenon of partial envelopment of neurons by reactive microglia in the context of an actual neurodegenerative disease, not a disease model.
Biomarkers to Inform Prognosis and Treatment for Unresectable or Metastatic GEP-NENs
Authors: Jonathan M. Loree, David Chan, Jennifer Lim, Heather Stuart, Nicolas Fidelman, Jonathan Koea, Jason Posavad, Meredith Cummins, Sarah Doucette, Sten Myrehaug, Boris Naraev, Dale L. Bailey, Andrew Bellizzi, David Laidley, Veronica Boyle, Rachel Goodwin, Jaydi del Rivero, Michael Michael, Janice Pasieka, Simron Singh
Journal: JAMA Oncology (2024)

Importance Evidence-based treatment decisions for advanced gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) require individualized patient-centered decision-making that accounts for patient and cancer characteristics. Objective To create an accessible guidance document to educate clinicians and patients on biomarkers informing prognosis and treatment in unresectable or metastatic GEP-NENs. Methods A multidisciplinary panel in-person workshop was convened to define methods. English language articles published from January 2016 to January 2023 in PubMed (MEDLINE) and relevant conference abstracts were reviewed to investigate prognostic and treatment-informing features in unresectable or metastatic GEP-NENs. Data from included studies were used to form evidence-based recommendations. Quality of evidence and strength of recommendations were determined using the Grading of Recommendations, Assessment, Development and Evaluations framework. Consensus was reached via electronic survey following a modified Delphi method. Findings A total of 131 publications were identified, including 8 systematic reviews and meta-analyses, 6 randomized clinical trials, 29 prospective studies, and 88 retrospective cohort studies. After 2 rounds of surveys, 24 recommendations and 5 good clinical practice statements were developed, with full consensus among panelists. Recommendations focused on tumor and functional imaging characteristics, blood-based biomarkers, and carcinoid heart disease. A single strong recommendation was made for symptomatic carcinoid syndrome informing treatment in midgut neuroendocrine tumors. Conditional recommendations were made to use grade, morphology, primary site, and urinary 5-hydroxyindoleacetic levels to inform treatment. The guidance document was endorsed by the Commonwealth Neuroendocrine Tumour Collaboration and the North American Neuroendocrine Tumor Society. Conclusions and Relevance The study results suggest that select factors have sufficient evidence to inform care in GEP-NENs, but the evidence for most biomarkers is weak. This article may help guide management and identify gaps for future research to advance personalized medicine and improve outcomes for patients with GEP-NENs.
Differences in COVID-19 Outpatient Antiviral Treatment Among Adults Aged ≥65 Years by Age Group — National Patient-Centered Clinical Research Network, United States, April 2022–September 2023
Authors: Claire M. Quinlan, Melisa M. Shah, Carol E. DeSantis, J. Bradford Bertumen, Christine Draper, Faraz S. Ahmad, Jonathan Arnold, Kenneth H. Mayer, Thomas W. Carton, Lindsay G. Cowell, Samantha Smith, Sharon Saydah, Jefferson M. Jones, Pragna Patel, Melissa Briggs Hagen, Jason Block, Emily H. Koumans
Journal: MMWR Morbidity and Mortality Weekly Report (2024)

Adults aged ≥65 years experience the highest risk for COVID-19-related hospitalization and death, with risk increasing with increasing age; outpatient antiviral treatment reduces the risk for these severe outcomes. Despite the proven benefit of COVID-19 antiviral treatment, information on differences in use among older adults with COVID-19 by age group is limited. Nonhospitalized patients aged ≥65 years with COVID-19 during April 2022-September 2023 were identified from the National Patient-Centered Clinical Research Network. Differences in use of antiviral treatment among patients aged 65-74, 75-89, and ≥90 years were assessed. Multivariable logistic regression was used to estimate the association between age and nonreceipt of antiviral treatment. Among 393,390 persons aged ≥65 years, 45.9% received outpatient COVID-19 antivirals, including 48.4%, 43.5%, and 35.2% among those aged 65-75, 76-89, and ≥90 years, respectively. Patients aged 75-89 and ≥90 years had 1.17 (95% CI = 1.15-1.19) and 1.54 (95% CI = 1.49-1.61) times the adjusted odds of being untreated, respectively, compared with those aged 65-74 years. Among 12,543 patients with severe outcomes, 2,648 (21.1%) had received an outpatient COVID-19 antiviral medication, compared with 177,874 (46.7%) of 380,847 patients without severe outcomes. Antiviral use is underutilized among adults ≥65 years; the oldest adults are least likely to receive treatment. To prevent COVID-19-associated morbidity and mortality, increased use of COVID-19 antiviral medications among older adults is needed.
Socioeconomic Status and Major Adverse Transplant Events in Pediatric Heart Transplant Recipients
Authors: Christina Hartje-Dunn, Kimberlee Gauvreau, Heather Bastardi, Kevin P. Daly, Elizabeth D. Blume, Tajinder P. Singh
Journal: JAMA Network Open (2024)

Importance Low socioeconomic status (SES) has been associated with higher risk of rejection and graft loss in pediatric heart transplant (HT) recipients. The association of SES with other posttransplant morbidities is unknown. Objective To assess whether low SES is associated with higher risk of a major adverse transplant event (MATE) among pediatric HT recipients. Design, Setting, and Participants Retrospective single-center cohort study at a children’s hospital in Boston with consecutive primary HT recipients from 2006 to 2019 and follow-up through 2022. Data were analyzed from June 2023 to March 2024. Exposure Very low or low, moderate, and high or very high Childhood Opportunity Index (COI) for neighborhood (census tract) of patient residence. Main Outcomes and Measures Primary outcome was 3-year MATE-6 score assessed in 6-month survivors as cumulative burden of acute cellular rejection, antibody-mediated rejection, coronary vasculopathy, lymphoproliferative disease, kidney dysfunction, and infection, each as an ordinal score from 0 to 4 (24 for death or retransplant). Secondary outcomes were freedom from rejection during first 6 months, freedom from death or retransplant, MATE-3 score for events 1 to 3 (under immune suppression) and events 4 to 6 (chronic immune suppression effects), and each MATE component. Results Of 153 children analyzed, the median (IQR) age at HT was 7.2 (1.5-14.8) years, 99 (65%) were male, 16 (10%) were Black, 17 (11%) were Hispanic, and 106 (69%) were White. Fifty patients (33%) lived in very low or low, 17 (11%) in moderate, and 86 (56%) in high or very high COI neighborhoods. There was no significant group difference in mean (SD) 3-year MATE-6 score (very low or low COI, 3.4 [6.5]; moderate COI, 2.4 [6.3]; and high or very high COI, 4.0 [6.9]). Furthermore, there was no group difference in mean (SD) MATE-3 scores for underimmune suppression (very low or low COI, 1.9 [3.5]; moderate COI, 1.2 [3.2]; and high or very high COI, 2.2 [3.6]), chronic immune suppression effects (very low or low COI, 1.6 [3.3]; moderate COI, 1.1 [3.2]; and high or very high COI, 1.8 [3.6]), individual MATE components, rejection during the first 6 months, or death or retransplant. Conclusions and relevance In this cohort study of pediatric HT recipients, there was no difference in posttransplant outcomes among recipients stratified by SES, a notable improvement from prior studies. These findings may be explained by state-level health reform, standardized posttransplant care, and early awareness of outcome disparities.
Mismatch Repair and Microsatellite Testing for Individuals With Colorectal Cancer
Authors: Totadri Dhimal, Fernando Colugnati, Bailey K. Hilty Chu, Anthony Loria, Paula Cupertino, Daniel Mulkerin, Fergal J. Fleming
Journal: JAMA Oncology (2024)

This cohort study examines the institution-level and patient-level factors associated with mismatch repair and microsatellite testing for individuals with colorectal cancer.
Fungal Lung Disease
Authors: Tavleen Kaur Jaggi, Ritesh Agarwal, Pei Yee Tiew, Anand Shah, Emily C Lydon, Chadi A Hage, Grant W Waterer, Charles R Langelier, Laurence Delhaes, Sanjay H Chotirmall
Journal: European Respiratory Journal (2024)

Fungal lung disease encompasses a wide spectrum of organisms and associated clinical conditions presenting a significant global health challenge with type and severity determined by underlying host immunity and infecting fungal strain. The most common group of diseases are associated with the filamentous fungus
USPSTF Colorectal Cancer Screening Recommendation and Uptake for Individuals Aged 45 to 49 Years
Authors: Sunny Siddique, Rong Wang, Faiza Yasin, Jacquelyne J. Gaddy, Lan Zhang, Cary P. Gross, Xiaomei Ma
Journal: JAMA Network Open (2024)

Importance In May 2021, the US Preventive Services Task Force (USPSTF) issued a grade B recommendation encouraging colorectal cancer (CRC) screening among average-risk individuals aged 45 to 49 years. The patterns of screening uptake and possible socioeconomic disparities in screening in this age group remain unknown. Objective To evaluate changes in CRC screening uptake among average-risk individuals aged 45 to 49 years after the USPSTF recommendation was issued in 2021. Design, Setting, and Participants This retrospective cohort study used deidentified claims data from commercially insured Blue Cross Blue Shield beneficiaries aged 45 to 49 years across the US between January 1, 2017, and December 31, 2022. Exposure Publication of the May 2021 USPSTF CRC screening recommendation for adults aged 45 to 49 years. Main Outcomes and Measures Absolute and relative changes in screening uptake were compared between a 20-month period preceding (May 1, 2018, to December 31, 2019) and a 20-month period following (May 1, 2021, to December, 31, 2022) the USPSTF recommendation. Interrupted time-series analysis and autoregressive integrated moving average models were used to evaluate changes in screening rates, adjusting for temporal autocorrelation and seasonality. Results In this cohort study of 10 221 114 distinct beneficiaries aged 45 to 49 years (mean [SD] age, 47.04 [1.41] years; 51.04% female), bimonthly mean (SD) numbers of average-risk beneficiaries were 3 213 935 (31 508) and 2 923 327 (105 716) in the prerecommendation and postrecommendation periods, respectively. Mean (SD) screening uptake increased from 0.50% (0.02%) to 1.51% (0.59%) between the 2 periods ( P &amp;amp;lt; .001), representing an absolute change of 1.01 percentage points (95% CI, 0.62-1.40 percentage points) but no significant relative change (202.51%; 95% CI, −30.59% to 436.87%). Compared with average-risk beneficiaries residing in areas with the lowest socioeconomic status (SES), those residing in areas with the highest SES experienced the largest absolute change in screening (1.25 [95% CI, 0.77-1.74] percentage points vs 0.75 [95% CI, 0.47-1.02] percentage points), but relative changes were not significant (214.01% [95% CI, −30.91% to 461.15%] vs 167.73% [95% CI, −16.30% to 352.62%]). After the recommendation was issued, the screening uptake rate also increased fastest among average-risk beneficiaries residing in the areas with highest SES (0.24 [95% CI, 0.23-0.25] percentage points every 2 months) and metropolitan areas (0.20 [95% CI, 0.19-0.21] percentage points every 2 months). Conclusions and Relevance This study found that among privately insured beneficiaries aged 45 to 49 years, CRC screening uptake increased after the USPSTF recommendation, with potential disparities based on SES and locality.
Clinical Effectiveness and Safety of Dupilumab in Chronic Obstructive Pulmonary Disease Patients: A 7-Year Population-based Cohort Study
Authors: Chuan-Yen Sun, Yohannes Tesfaigzi, Gin-Yi Lee, Yi-Hsuan Chen, Scott T Weiss, Kevin Sheng-Kai Ma
Journal: Journal of Allergy and Clinical Immunology (2024)
<i>Burkholderia multivorans</i> Infections Associated with Use of Ice and Water from Ice Machines for Patient Care Activities ― Four Hospitals, California and Colorado, 2020–2024
Authors: Axel A. Vazquez Deida, Kevin B. Spicer, Kiara X. McNamara, Matthew J. Arduino, Paige Gable, Alison L. Halpin, Lindsay J. Caverly, John J. LiPuma, Braden Bardach, Cayla Mayle, Samuel N. Baird, Christopher A. Czaja, Raymond Chinn, Jane D. Siegel, Kiran M. Perkins
Journal: MMWR Morbidity and Mortality Weekly Report (2024)

Ice machines can harbor water-related organisms, and the use of ice or tap water for clinical care activities has been associated with infections in health care settings. During 2021-2022, a total of 23 cases of infection by Burkholderia multivorans (sequence type ST659) were reported at two southern California hospitals and linked to contaminated ice and water from ice machines. In addition to these 23 cases, this report also includes 23 previously unreported cases of B. multivorans ST659 infections that occurred during 2020-2024: 13 at a northern California hospital, eight at a hospital in Colorado, and two additional cases at one of the southern California hospitals. The same brand of ice machine and brands of filters, descaling, and sanitizing products were used by all four hospitals; B. multivorans was isolated from samples collected from ice machines in two of the hospitals. Whole genome sequencing indicated that all clinical and ice machine isolates were highly genetically similar (0-14 single nucleotide variant differences across 81% of the selected reference genome). Recommendations from public health officials to halt the outbreak included avoiding ice and tap water during clinical care activities. An investigation is ongoing to determine possible sources of ice machine contamination. During outbreaks of water-related organisms in health care facilities, health care personnel should consider avoiding the use of tap water, including ice and water from ice machines, for patient care.
The McMaster Cough Severity Questionnaire (MCSQ): a cough severity instrument for patients with refractory chronic cough
Authors: Elena Kum, Gordon H Guyatt, Rayid Abdulqawi, Peter Dicpinigaitis, Lieven Dupont, Stephen K Field, Cynthia L French, Peter G Gibson, Richard S Irwin, Faye Johnston, Lorcan McGarvey, Robert Newman, Nada Popovic, Jaclyn A Smith, Woo-Jung Song, Paul M O'Byrne, Imran Satia
Journal: European Respiratory Journal (2024)

Cough severity represents an important endpoint to assess the impact of therapies for patients with refractory chronic cough (RCC).
Lung Structure and Longitudinal Change in Cardiac Structure and Function: The MESA COPD Study
Authors: Emilia A Hermann, Yifei Sun, Eric A Hoffman, Norrina B Allen, Bharath Ambale-Venkatesh, David A Bluemke, J Jeffrey Carr, Steven M Kawut, Martin R Prince, Sanjiv J Shah, Benjamin M Smith, Karol E Watson, Joao A C Lima, R Graham Barr
Journal: European Respiratory Journal (2024)

Lung structure and cardiac structure and function are associated cross-sectionally. The classic literature suggests relationships of airways disease to cor pulmonale and emphysema to reduced cardiac output (CO) but longitudinal data are lacking.
COVID-19–Associated Hospitalizations Among U.S. Adults Aged ≥18 Years — COVID-NET, 12 States, October 2023–April 2024
Authors: Christopher A. Taylor, Kadam Patel, Huong Pham, Pam Daily Kirley, Breanna Kawasaki, James Meek, Lucy Witt, Patricia A. Ryan, Libby Reeg, Kathy Como-Sabetti, Adrienne Domen, Bridget Anderson, Sophrena Bushey, Melissa Sutton, H. Keipp Talbot, Emma Mendez, Fiona P. Havers, Jeremey Roland, Nisha Alden, Daewi Kim, Kyle P. Openo, Maya L. Monroe, Val Tellez Nunez, Erica Bye, Dominic Solhtalab, Grant Barney, Christina B. Felsen, Nasreen Abdullah, William Schaffner, Isabella Reyes
Journal: MMWR Morbidity and Mortality Weekly Report (2024)

Among adults, COVID-19 hospitalization rates increase with age. Data from the COVID-19-Associated Hospitalization Surveillance Network were analyzed to estimate population-based COVID-19-associated hospitalization rates during October 2023-April 2024 and identify demographic and clinical characteristics of adults aged ≥18 years hospitalized with COVID-19. Adults aged ≥65 years accounted for 70% of all adult COVID-19-associated hospitalizations, and their COVID-19-associated hospitalization rates were higher than those among younger adult age groups. Cumulative rates of COVID-19-associated hospitalization during October 2023-April 2024 were the lowest for all adult age groups during an October-April surveillance period since 2020-2021. However, hospitalization rates among all adults aged ≥75 years approached one COVID-19-associated hospitalization for every 100 persons. Among adults hospitalized with COVID-19, 88.1% had not received the 2023-2024 formula COVID-19 vaccine before hospitalization, 80.0% had multiple underlying medical conditions, and 16.6% were residents of long-term care facilities (LTCFs). Guidance for adults at high risk for severe COVID-19 illness, including adults aged ≥65 years and residents of LTCFs, should continue to focus on adopting measures to reduce risk for contracting COVID-19, advocating for receipt of recommended COVID-19 vaccinations, and seeking prompt outpatient antiviral treatment after receipt of a positive SARS-CoV-2 test result.