tbuckley/cabot-search huggingface dataset:
Active Treatment vs Expectant Management of Patent Ductus Arteriosus in Preterm Infants
Authors: Santosi Buvaneswarran, Yi Ling Wong, Shen Liang, Swee Chye Quek, Jiun Lee
Journal: JAMA Pediatrics (2025)

Importance Recent evidence suggests that expectant management of hemodynamically significant patent ductus arteriosus (PDA) may confer better outcomes. Objective To assess clinical outcomes of active treatment vs expectant management of hemodynamically significant PDA in preterm infants. Data Sources The PubMed (MEDLINE), Embase, and Cochrane Library databases were searched for randomized clinical trials (RCTs) published between January 1, 2010, and July 31, 2024. Study Selection RCTs were included if they enrolled preterm infants born before 33 weeks of gestation and had 2 groups comparing active treatment with expectant management. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed. Data were extracted by 2 independent reviewers. The Cochrane Risk of Bias tool was used to assess study quality. A random-effects model was used to estimate the pooled effects. Main Outcomes and Measures The primary outcomes were a composite of death at 36 weeks’ postmenstrual age or at discharge (whichever occurred later) or moderate to severe bronchopulmonary dysplasia (BPD), death at 36 weeks, and moderate to severe BPD. Secondary outcomes included intraventricular hemorrhage, periventricular leukomalacia (PVL), retinopathy of prematurity, and necrotizing enterocolitis. Results This meta-analysis included 10 RCTs involving 2035 infants. There were 1018 infants in the active treatment group (510 female [50.1%]) and 1017 infants (551 male [54.2%]) in the expectant management group. The mean (SD) gestational age was 26.2 (1.7) weeks vs 26.3 (1.7) weeks, and the mean (SD) birth weight was 874.7 (222.1) g vs 897.7 (216.5) g, respectively. The incidence of the composite outcome (death at 36 weeks or at discharge or moderate to severe BPD) was higher in the active treatment group vs the expectant management group (516 of 918 [56.2%] vs 465 of 915 [50.8%]; relative risk [RR], 1.10 [95% CI, 1.01-1.19]; P = .02). Deaths at 36 weeks were higher in the active treatment group (139 of 974 [14.3%] vs 109 of 969 [11.2%]; RR, 1.27 [95% CI, 1.01-1.61]; P = .04). There were nonsignificant increases in moderate to severe BPD (372 of 785 [47.4%] vs 349 of 806 [43.3%]; RR, 1.08 [95% CI, 0.95-1.23]; P = .25) and PVL (52 of 913 [5.7%] vs 32 of 908 [3.5%]; RR, 1.50 [95% CI, 0.98-2.30]; P = .06) in the active treatment group vs the expectant management group. Conclusions and Relevance This meta-analysis found that active treatment of hemodynamically significant PDA during the first 2 weeks of life was associated with a significantly higher incidence of death or moderate to severe BPD and with increased mortality compared with an expectant management approach. Further research is needed for revision of protocols for PDA management.
Weight Loss in Midlife, Chronic Disease Incidence, and All-Cause Mortality During Extended Follow-Up
Authors: Timo E. Strandberg, Arto Y. Strandberg, Satu Jyväkorpi, Annele Urtamo, Solja T. Nyberg, Philipp Frank, Jaana Pentti, Kaisu H. Pitkälä, Mika Kivimäki
Journal: JAMA Network Open (2025)

Importance Few studies have examined long-term health benefits among individuals with sustained weight loss beyond its association with decreased diabetes risk. Objective To examine the long-term association of body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) changes during healthy midlife (ages 40-50 years) with later-life morbidity and mortality. Design, Setting, and Participants This cohort study analyzed data from 3 cohorts that included repeated height and weight measurements: the Whitehall II study (WHII; baseline, 1985-1988), Helsinki Businessmen Study (HBS; baseline, 1964-1973), and Finnish Public Sector study (FPS; baseline, 2000). Participants were categorized into 4 groups based on their first 2 weight assessments and followed up for morbidity and mortality outcomes. Data analyses were conducted between February 11, 2024, and February 20, 2025. Exposures Midlife BMI change was categorized as persistent BMI less than 25, BMI change from 25 or greater to less than 25, BMI change from less than 25 to 25 or greater, and persistent BMI of 25 or greater. Main Outcomes and Measures Incident chronic disease, including type 2 diabetes, myocardial infarction, stroke, cancer, asthma, or chronic obstructive pulmonary disease, was assessed in WHII and FPS, and all-cause mortality was assessed in HBS. These outcomes were obtained from linked electronic health records in national health registries. Results There were 23 149 participants, including 4118 men and women (median [IQR] age at first visit, 39 [37-42] years; 2968 men [72.1%]) from WHII, 2335 men (median [IQR] age at first visit, 42 [38-45] years) from HBS, and 16 696 men and women (median [IQR] age at first visit, 39 [34-43] years; 13 785 women [82.6%]) from FPS. During a median (IQR) follow-up of 22.8 (16.9-23.3) years, after adjusting for smoking, systolic blood pressure, and serum cholesterol at the first evaluation, WHII participants with weight loss had a decreased risk of developing chronic disease (hazard ratio [HR], 0.52; 95% CI, 0.35-0.78) compared with participants with persistent overweight. This finding was replicated after excluding diabetes from the outcome (HR, 0.58; 95% CI, 0.37-0.90). The corresponding HR in FPS was 0.43 (95% CI, 0.29-0.66) over a median (IQR) follow-up of 12.2 (8.2-12.2) years. In HBS, weight loss was associated with decreased mortality (HR, 0.81; 95% CI, 0.68-0.96) during an extended follow-up (median [IQR], 35 [24-43] years). Conclusions and Relevance In this study, conducted when surgical and pharmacological weight-loss interventions were nearly nonexistent, sustained midlife weight loss compared with persistent overweight was associated with a decreased risk of chronic diseases beyond type 2 diabetes and decreased all-cause mortality.
Asian American Female Residents’ Perceptions of Facilitators and Barriers to Leadership in Medicine
Authors: Sarah J. Ho, Jasmine W. Jiang, Catherine T. Yu, Emily Xu, Eunice Y. Yuen
Journal: JAMA Network Open (2025)

Importance When their proportion of faculty positions are accounted for, Asian American women are the most underrepresented group among academic medicine leadership. Despite the importance of diversity and representation in academic medicine leadership, no study to date has explored the specific factors that hinder or support Asian American women’s advancement to leadership roles in academic medicine. Objective To characterize perceptions of facilitators and barriers to academic medicine leadership for Asian American women. Design, Setting, and Participants In this qualitative study, Asian American female residents were interviewed between December 1, 2023, and April 30, 2024, using an online video platform. Data were analyzed using thematic content analysis. Eligible participants were recruited through word of mouth, social media groups, cold emailing, and snowball sampling. A purposive sampling strategy ensured diversity in ethnicity, geographic locations of past and current institutions, postgraduate years, and specialties. Main Outcomes and Measures Key themes related to the perceptions of Asian American female residents on facilitators and barriers to leadership in academic medicine. Results Fifteen participants (age range, 25-32 years) who self-identified as female and Asian American (3 [20%] Asian Indian, 6 [40%] Chinese, 2 [13%] Korean, 1 [7%] Punjabi, 1 [7%] Taiwanese, and 2 [13%] Vietnamese) were interviewed. Participants were enrolled in residency programs geographically distributed across the US. Training levels ranged from postgraduate year 1 to postgraduate year 6, spanning 9 residency program specialties. This analysis revealed 4 key themes: (1) role models of leadership, especially the representation of Asian American women in leadership positions; (2) multifactorial development of professional identity, specifically through peers, mentors, and formalized institutional programming; (3) the othering nature of workplaces and institutional cultures, including the exclusionary “boys’ club,” discrimination from patients and colleagues, and burden of familial responsibilities imposed on women; and (4) leadership discordance, including differing ideas of leadership and sociocultural perceptions of Asian American women influencing perceptions of leadership potential. Conclusions and Relevance This qualitative study of Asian American female resident physicians’ perceptions of facilitators and barriers to academic medicine leadership found 4 key themes and identified opportunities for intervention, paving the way for enhanced representation of Asian American women in academic medicine leadership.
Risk of Parkinson Disease in Individuals With Autism Spectrum Disorder
Authors: Weiyao Yin, Abraham Reichenberg, Michal Schnaider Beeri, Stephen Z. Levine, Jonas F. Ludvigsson, Martijn Figee, Sven Sandin
Journal: JAMA Neurology (2025)

Importance Recent research suggests a plausible biological link between autism spectrum disorder (ASD) and Parkinson disease (PD). Nonetheless, large longitudinal studies examining the risk of PD following ASD are lacking. Objective To examine the association between ASD and future PD risk. Design, Setting, and Participants A nationwide population-based prospective cohort study was performed using data from Swedish national registers. All individuals born in Sweden from 1974 to 1999 with follow-up from age 20 years until December 31, 2022, and with complete covariate data were included. The analysis was completed in August 2024. Exposures Diagnoses of ASD as a time-varying exposure obtained from the National Patient Register. Main Outcomes and Measures Diagnoses of PD were obtained from the National Patient Register through 2022. The relative risk (RR) of PD was quantified using incidence rate ratios with 95% CIs from Poisson regression. Preterm birth, depression, antidepressant use, and antipsychotic exposure over time were potentially modifying life events. Results The study included 2 278 565 individuals (median [IQR] age at exit, 34 [29-42] years; 1 106 772 female [48.6%]), contributing 33 858 476 person-years. PD occurred in 438 of 2 226 611 individuals without ASD (0.02%; 1.3 cases/100 000 person-years) and 24 of 51 954 individuals with ASD (0.05%; 3.9 cases/100 000 person-years) (RR, 4.43 [95% CI, 2.92-6.72]). The risk estimates were similar after adjusting for sex, socioeconomic status, family history of mental illness, family history of PD, and age at ASD diagnosis. Preterm or early-term birth was not associated with and did not modify the PD risk. Depression and antidepressant use (present in 24 257 individuals with ASD [46.7%]) were associated with increased risk of PD (RR, 2.01 [95% CI, 1.40-2.88]), independent of ASD. Antipsychotic exposure (present in 16 387 individuals with ASD [31.5%]) reduced but did not fully attenuate the association (RR, 2.00 [95% CI, 1.27-3.14]) and showed no interaction with ASD on PD risk. Conclusions and Relevance ASD was associated with increased risk of PD, even after adjusting for depression or antidepressant use and antipsychotic exposure. These findings suggest a potential shared etiology between neurodevelopmental disorders and PD, and a heightened awareness of long-term neurological conditions in individuals with ASD may be warranted.
Core GRADE 6: presenting the evidence in summary of findings tables
Authors: Gordon Guyatt, Liang Yao, M Hassan Murad, Monica Hultcrantz, Thomas Agoritsas, Hans De Beer, Stefan Schandelmaier, Alfonso Iorio, Linan Zeng, Manya Prasad, Per Olav Vandvik, Reem A Mustafa, Arnav Agarwal, Tahira Devji, Ivan D Florez, Benjamin Djulbegovic, Derek K Chu, Bram Rochwerg, Victor M Montori, Romina Brignardello-Petersen
Journal: BMJ (2025)
Adverse Social Exposome During the Life Course and Vascular Brain Injury
Authors: Sarah A. Keller, Amanda DeWitt, W. Ryan Powell, Frederick B. Ketchum, Robert A. Rissman, Barbara B. Bendlin, Amy J. H. Kind
Journal: JAMA Network Open (2025)

Importance The adverse social exposome, the entirety of harmful lifetime social-environmental exposures, is associated with Alzheimer disease and related dementias (ADRD) risk and may be key to informing modifiable systemic and behavioral risk interventions. With increasing emphasis to understand lifetime risk, methods are needed to measure and study social exposome relative to ADRD-related biological processes, including cerebrovascular disease. Objective To evaluate the association between adverse social exposome and the burden of vascular brain injury (VBI) post mortem. Design, Setting, and Participants This retrospective cohort study analyzed brain bank donors from 2 Alzheimer Disease Research Centers. Donations occurred between January 5, 2000, and August 5, 2018. Analysis was performed between January 13 and July 20, 2023. Exposures Adverse social exposome, via geo-linked, time-concordant Area Deprivation Index (ADI) rankings for each year of a donor’s lifetime. Main Outcomes and Measures The main outcome consisted of the presence or absence of VBI indicators: infarcts, microinfarcts, hemorrhages, and white matter rarefaction. Association between cumulative or change in life-course ADI and VBI burden was evaluated using multivariate logistic regression models adjusted for sex and age at death. Results The sample included 740 donors (417 female [56.4%]; mean [SD] age at death, 81.5 [10.3] years; mean [SD] VBI score, 0.7 [1.0]; and median life course ADI, 7.08 [IQR, 4.33-9.83]), with residential years spanning 1905 to 2018. In adjusted models, living more years in a county with an ADI ranked above the study population median was associated with increased VBI odds (adjusted odds ratio [AOR], 1.04; 95% CI, 1.03-1.05). Greater odds of VBI were identified in those with increasing ADI between youth and adulthood (AOR, 3.67; 95% CI, 3.65-3.70) and youth and older adulthood (AOR, 12.02; 95% CI, 7.87-18.35). Increased odds were found in groups with stable high median ADI from youth to adulthood (AOR, 3.08; 95% CI, 3.01-3.14) and youth to older adulthood (AOR, 8.46; 95% CI, 8.04-8.90). Conclusions and Relevance In this cohort study of 740 brain bank donors, an association between ADI and the presence of VBI was indicated, when considering the full life course as well as specific life course periods. These results show promise for identifying geographic areas in need of targeted interventions to reduce cerebrovascular disease and ADRD risk factors.
Prevalence of Diagnosed Fetal Alcohol Spectrum Disorder in Children and Adolescents
Authors: Xiaodong Zang, Wei Bao, Yuxiao Wu, Sidong Li, Mingwu Chen, Guifeng Xu
Journal: JAMA Pediatrics (2025)

This survey study estimated the prevalence of diagnosed fetal alcohol spectrum disorder in US children and adolescents using nationally representative data from the 2022 to 2023 National Survey of Children’s Health.
Hydrocortisone and Risk Factors for Kidney Replacement Therapy in Septic Shock
Authors: Lachlan H. Donaldson, Anthony Devaux, Kyle C. White, Dorrilyn Rajbhandari, Jeremy Cohen, Rinaldo Bellomo, John Myburgh, Naomi Hammond, Balasubramanian Venkatesh
Journal: JAMA Network Open (2025)

Importance Sepsis-associated acute kidney injury (SA-AKI) is a common and clinically important condition in patients who are critically ill. Dysregulated inflammation may contribute to it. Intravenous hydrocortisone may decrease the risk of SA-AKI progression. Objective To describe the associations of hydrocortisone use with the incidence and outcomes of requirement for kidney replacement therapy (KRT), as well as source of sepsis, mean arterial pressure (MAP), and MAP indexed to required vasopressor (norepinephrine equivalent [NEE]). Design, Setting, and Participants This cohort study was conducted as a post hoc analysis of the Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock (ADRENAL) randomized clinical trial (RCT), a multicenter placebo-controlled RCT of hydrocortisone in patients with septic shock in 69 intensive care units in Australia, the United Kingdom, New Zealand, Saudi Arabia, and Denmark that recruited between 2013 and 2017. Participants were patients enrolled in the ADRENAL study with septic shock who did not require KRT in the 24 hours prior to randomization and who did not have a prior longstanding dialysis requirement. Data were analyzed between July and September 2024. Exposures Receipt of hydrocortisone (vs placebo), MAP at enrollment, vasopressor dose (NEE) and MAP:NEE ratio, source of sepsis, causative organism, bacteremia, and the use of nephrotoxic antimicrobials, vasopressin, or specific inotropes. Main Outcomes and Measures Outcomes of interest were KRT requirement and liberation from KRT, measured as days alive and free of KRT. Results A cohort of 3161 patients (median [IQR] age, 65 [53-74] years, 1921 [61%] male) was identified, including 1589 patients randomized to receive hydrocortisone and 1572 patients who received the placebo. Allocation to treatment with hydrocortisone was associated with a significantly reduced incidence of KRT requirement compared with placebo (329 patients [21%] vs 372 patients [24%]; odds ratio [OR], 0.84 [95% CI, 0.70 to 0.99]; P = .04). When controlled for factors associated with KRT requirement, randomization to hydrocortisone remained significantly associated with a reduced odds of new KRT requirement (OR, 0.79 [95% CI, 0.66 to 0.95]; P = .01). Among patients who started KRT following randomization, hydrocortisone was not associated with reduced days alive and free of KRT (mean difference, 1.28 [95% CI, −4.31 to 6.87] days; P = .65). Conclusions and Relevance In this post hoc cohort study of patients with septic shock enrolled in a large RCT, intravenous hydrocortisone was associated with a reduced risk of new KRT requirement following randomization.
FDA Approval Summary: Afamitresgene Autoleucel for Adults With HLA-Restricted MAGE-A4 Positive Unresectable or Metastatic Synovial Sarcoma After Prior Chemotherapy
Authors: Katherine K. Barnett, Abigail R. Johnson, Asha Das, Ching-Hsien J. Lee, Cong Wang, Xiaofei Wang, Elin S. Cho, Paul G. Kluetz, Lola A. Fashoyin-Aje
Journal: Clinical Cancer Research (2025)

Abstract On August 1, 2024, the FDA granted accelerated approval to afamitresgene autoleucel, a melanoma-associated antigen-A4 (MAGE-A4)-directed genetically modified autologous T-cell immunotherapy, for the treatment of adults with unresectable or metastatic synovial sarcoma (SS) who have received prior chemotherapy, are HLA-A*02:01P, -A*02:02P, -A*02:03P, or -A*02:06P positive, and whose tumors express MAGE-A4 as determined by FDA-approved or cleared companion diagnostic devices. Approval was based on results from the phase 2, single-arm, open-label, multicenter Study ADP-0044-002. Patients received a single dose of afamitresgene autoleucel following lymphodepleting chemotherapy. Of the 44 efficacy evaluable patients, the overall response rate was 43.2% (95% CI: 28.4, 59.0), with complete response in two patients (4.5%). The median duration of response was 6.0 months (95% CI: 4.6, not reached [NR]) with a median follow-up of 21.9 months. Among the 44 patients, cytokine release syndrome occurred in 75% (Grade ≥3, 2%) warranting a Boxed Warning. Grade ≥3 infections occurred in 14% of patients and prolonged severe cytopenias also occurred. One patient developed Grade 1 immune effector cell-associated neurotoxicity and one patient developed Epstein-Barr virus-positive lymphoproliferative disease. Notably, during review of this application, FDA identified issues with data quality and study conduct that prompted an independent re-review of imaging assessments. The results of the re-review were the basis for FDA’s determination of substantial evidence of effectiveness. This represents the first FDA approval of a T-cell receptor gene therapy. It is also the first FDA approval specifically for SS, representing a new treatment modality for this rare population who lack effective therapies.
Organ Donation for Research Biobanking Among Historically Marginalized Racial and Ethnic Groups
Authors: Camilo Toro, Oseiwe B. Eromosele, David B. Flynn, Andrew A. Wilson, Darrell N. Kotton, Timothy M. Hughes, Jesse D. Moreira-Bouchard, Wendy S. Post, Alain G. Bertoni, Emelia J. Benjamin, Deepa M. Gopal, Jessica L. Fetterman
Journal: JAMA Network Open (2025)

Importance Research biobanks of human cells and tissues, particularly tissues accessible only after death, are crucial for advancing the understanding of human pathophysiological function. Research biobanks are bereft of tissues from individuals of diverse races and ethnicities, thus limiting the generalizability of biobank findings. Objective To evaluate the barriers and facilitators to participation in postmortem brain donation for research among individuals from historically marginalized races and ethnicities. Evidence Review The published literature in PubMed, Embase, Web of Science, and PsycINFO databases was searched from 1973 to January 1, 2024. Studies that were written in English that involved adult participants (aged ≥18 years) and explored attitudes, perceptions, and beliefs on solid organ donation were included. Studies in which organ donation was for transplant and not for research, studies examining pediatric organ donation, narratives or perspectives, and studies that did not examine attitudes or beliefs toward organ donation were excluded. Two authors independently coded and performed a thematic analysis of eligible studies. Findings Eighteen studies met the inclusion criteria, which involved 12 124 participants across multiple self-reported races and ethnicities (eg, Black or African American, Chinese, Hispanic or Latiné, and White). Most studies (16 [89%]) evaluated perceptions, attitudes, and beliefs among Black or African American and Hispanic or Latiné individuals toward postmortem brain donation. Five themes that informed the decision to donate were identified: information and misconceptions about the organ donation process (16 studies [89%]), mistrust of the research and medical communities (9 studies [50%]), family involvement (9 studies [50%]), religious and cultural beliefs (9 studies [50%]), and altruism (7 studies [39%]). Mistrust and religious and cultural beliefs were largely barriers to considering postmortem organ donation for research. Misconceptions were common, particularly regarding the donation process and purpose of biospecimens for research. Family involvement was both a barrier and a facilitator. Altruism, particularly understanding that organ donation would benefit the participants’ family, future generations, and community, was a facilitator. Conclusions and Relevance This systematic review suggests that sharing culturally sensitive information about the organ donation process, engagement of participants and family members in shared decision-making, and addressing barriers and facilitators to donor recruitment practices may increase participation in research biobanks of individuals from underrepresented racial and ethnic groups.