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Esophageal squamous cell carcinoma (ESCC) remains a significant global health challenge, being the sixth leading cause of cancer mortality with pronounced geographic variability. The incidence rates range from 125 per 100,000 in northern China to 1-1.5 per 100,000 in the United States, driven by environmental and lifestyle factors such as tobacco and alcohol use, dietary habits, and pollution.

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Article Synopsis
  • The study focuses on the need for an objective method to evaluate and compare different computer-aided detection (CADe) algorithms used in colorectal cancer screening, as their performance varies and no standard exists.
  • A modified Delphi approach was employed, where 25 experts generated and prioritized scoring criteria over eight months, ultimately identifying six key metrics, including sensitivity and adenoma detection rate.
  • The resulting criteria aim to guide the development and improvement of CADe software, with future research suggested to validate these metrics on benchmark video datasets.
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Objective: Racial and ethnic disparities in rheumatoid arthritis (RA) outcomes are well recognized. However, whether disparities in RA treatment selection and outcomes differ by urban versus rural residence, independent of race, have not been studied. Our objective was to evaluate whether biologic disease-modifying antirheumatic drug (bDMARD) initiation after methotrexate administration differs by rural versus urban residence among veterans with RA.

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  • The study examined heart failure patients with initially low ejection fractions who later showed improvement, identifying about 20% of these individuals achieving a significant increase in heart function after 9 months.* -
  • Patients with improved ejection fraction experienced lower rates of rehospitalization and mortality compared to those with persistently low function, with consistent results found in two separate patient registries.* -
  • Five key predictors for improvement were identified: female sex, absence of ischemic heart disease, higher initial ejection fraction, and smaller heart sizes, allowing the development of a predictive model to better assess who may improve.*
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Aim: To explore the effect of canagliflozin on kidney and cardiovascular events and safety outcomes in individuals with type 2 diabetes and chronic kidney disease across geographic regions and racial groups.

Materials And Methods: A stratified Cox proportional hazards model was used to assess efficacy and safety outcomes by geographic region and racial group. The primary composite outcome was a composite of end-stage kidney disease (ESKD), doubling of the serum creatinine (SCr) level, or death from kidney or cardiovascular causes.

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Extracellular histones: a unifying mechanism driving platelet-dependent extracellular vesicle release and thrombus formation in COVID-19.

J Thromb Haemost

September 2024

Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA; Iowa City VA Healthcare System, Iowa City, Iowa, USA. Electronic address:

Background: COVID-19 can cause profound inflammation and coagulopathy, and while many mechanisms have been proposed, there is no known common pathway leading to a prothrombotic state.

Objectives: From the beginning of the COVID-19 pandemic, elevated levels of extracellular histones have been found in plasma of patients infected with SARS-CoV-2. We hypothesized that platelet activation triggered by extracellular histones might represent a unifying mechanism leading to increased thrombin generation and thrombosis.

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Screening of Living Kidney Donors for Genetic Diseases: CON.

Kidney360

October 2024

Department of Internal Medicine and Iowa Institute of Human Genetics, University of Iowa Carver College of Medicine, Iowa City, Iowa and VA Medical Center, Iowa City, Iowa.

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Article Synopsis
  • Individuals with chronic hypoparathyroidism on traditional therapy have a higher risk of kidney problems, and new treatments like palopegteriparatide could help improve kidney function while reducing reliance on conventional treatments.
  • The PaTHway trial assessed the effects of palopegteriparatide on renal function over 52 weeks, showing promising results such as improved eGFR levels.
  • After a year of treatment, many participants achieved normal calcium levels and stopped needing traditional therapies, with significant improvements in kidney function, especially in those with lower baseline eGFR.
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Clinical Trial registry name and registration number: ClinicalTrials.gov Identifiers: NCT02065791 (CREDENCE), NCT03036150 (DAPA-CKD), NCT03594110 (EMPA-KIDNEY).

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Bispecific BCMA/CD24 CAR-T cells control multiple myeloma growth.

Nat Commun

January 2024

Myeloma Center, Winthrop P. Rockefeller Institute, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.

Anti-multiple myeloma B cell maturation antigen (BCMA)-specific chimeric antigen receptor (CAR) T-cell therapies represent a promising treatment strategy with high response rates in myeloma. However, durable cures following anti-BCMA CAR-T cell treatment of myeloma are rare. One potential reason is that a small subset of minimal residual myeloma cells seeds relapse.

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Association Between Sleep Quantity and Quality in Early Adulthood With Cognitive Function in Midlife.

Neurology

January 2024

From the Department of Psychiatry and Behavioral Sciences (Y.L., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; Departments of Neurology (K.K.) and Preventive Medicine (M.R.C.), Northwestern University Feinberg School of Medicine, Chicago, IL; and VA Medical Center (K.Y.), San Francisco, CA.

Background And Objective: Growing evidence supports an association between sleep quality and risk of dementia. However, little is known about whether objectively measured sleep duration and quality influence cognition in midlife, a period of importance for understanding the direction of the association between sleep and dementia. We examined the association between sleep duration and quality, measured when participants were in their mid-30s to late 40s, and midlife cognition assessed 11 years later among Black and White adults.

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Aims: Metformin is the broadly accepted the first-line medication for diabetes. Its use, however, is limited by gastrointestinal side effects present in approximately 25% of patients. This study aimed to better understand the interplay between metformin intolerance and gut microbiota among Black individuals with diabetes.

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Background: Sodium glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1 RA), and the nonsteroidal mineralocorticoid receptor antagonist (ns-MRA) finerenone all individually reduce cardiovascular, kidney, and mortality outcomes in patients with type 2 diabetes and albuminuria. However, the lifetime benefits of combination therapy with these medicines are not known.

Methods: We used data from 2 SGLT2i trials (CANVAS [Canagliflozin Cardiovascular Assessment] and CREDENCE [Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation]), 2 ns-MRA trials (FIDELIO-DKD [Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease] and FIGARO-DKD [Efficacy and Safety of Finerenone in Subjects With Type 2 Diabetes Mellitus and the Clinical Diagnosis of Diabetic Kidney Disease]), and 8 GLP-1 RA trials to estimate the relative effects of combination therapy versus conventional care (renin-angiotensin system blockade and traditional risk factor control) on cardiovascular, kidney, and mortality outcomes.

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The American population is getting heavier and automated vehicles will accommodate unconventional postures. While studies replicating mid-size and upright fore-aft seated occupants are numerous, experiments with post-mortem human subjects (PMHS) with obese and reclined occupants are sparse. The objective of this study was to compare the kinematics of the head-neck, torso and pelvis, and document injuries and injury patterns in frontal impacts.

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Introduction: Any type of boot or footwear is designed to attenuate and distribute loading to the bottom of the foot. Anthropomorphic test device (ATDs) are used to assess potential countermeasures against these loads. The specific aims of this study were to compare and quantify force attenuation characteristics as a function of input energy for Hybrid-III and Mil-Lx ATD human surrogates.

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Metabolic Syndrome (MetS), a global problem, predisposes to an increased risk for type 2 diabetes and premature cardiovascular disease. While MetS is associated with central obesity, there is scanty data on adipocyte hypertrophy, increased fat cell size (FCS), in MetS. The aim of this study was to investigate FCS status in adipose tissue (AT) biopsy of patients with nascent MetS without the confounding of diabetes, cardiovascular disease, smoking, or lipid therapy.

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Background Sodium glucose cotransporter-2 inhibitors reduce systolic blood pressure (SBP), but whether they affect SBP variability is unknown. There also remains uncertainty regarding the prognostic value of SBP variability for different clinical outcomes. Methods and Results Using individual participant data from the CANVAS (Canagliflozin Cardiovascular Assessment Study) Program and CREDENCE (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) trial, we assessed the effect of canagliflozin on SBP variability in people with type 2 diabetes across 4 study visits over 1.

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Aims: To assess whether the sodium-glucose cotransporter-2 (SGLT2) inhibitor canagliflozin affects risk of non-genital skin and soft tissue infections (SSTIs).

Materials And Methods: We performed a post hoc pooled individual participant analysis of the CANVAS Program and CREDENCE trials that randomized people with type 2 diabetes at high cardiovascular risk and/or with chronic kidney disease to either canagliflozin or placebo. Investigator-reported adverse events were assessed by two blinded authors following predetermined criteria for non-genital SSTIs.

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Lost in translation: Misguided application of a laudable and well-intentioned policy.

Am J Transplant

August 2023

Department of Surgery, Section of Transplantation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA.

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This study fills a gap in literature by providing contemporary real-world evidence on the prevalence of patients with gastroesophageal reflux disease (GERD), Barrett esophagus (BE), and Barrett esophagus-related neoplasia (BERN) and their upper endoscopy utilization patterns in the United States. A retrospective cohort study design was used: adults with GERD, nondysplastic Barrett esophagus (NDBE), and BERN (indefinite for dysplasia [IND], low-grade dysplasia [LGD], high-grade dysplasia [HGD], or esophageal adenocarcinoma [EAC]) were identified from the MarketScan databases (January 01, 2015-December 31, 2019). For each disease stage, prevalence of adults in commercial claims by calendar year, annual number of upper endoscopies per patient and time between upper endoscopies were reported.

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Kidney and Cardiovascular Effects of Canagliflozin According to Age and Sex: A Post Hoc Analysis of the CREDENCE Randomized Clinical Trial.

Am J Kidney Dis

July 2023

The George Institute for Global Health, University of New South Wales, New South Wales, Australia; Department of Nephrology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.

Article Synopsis
  • The CREDENCE study analyzed the effects of canagliflozin on adverse kidney and cardiovascular events in individuals with diabetic kidney disease, focusing on variations by age and sex.
  • The study included a diverse participant group and assessed outcomes such as kidney failure, serum creatinine doubling, and cardiovascular-related death across different age groups (<60, 60-69, ≥70) and sexes.
  • Results showed that canagliflozin significantly reduced the risk of adverse kidney events across all age groups and sexes without notable differences in safety outcomes or effectiveness based on these demographics.
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Gastroesophageal reflux disease (GERD) is a risk factor for Barrett's esophagus (BE) and BE-related neoplasia (BERN). This study aimed to evaluate healthcare resource utilization (HRU) and costs associated with GERD, BE, and BERN in the United States. Adult patients with GERD, nondysplastic BE (NDBE), and BERN (including indefinite for dysplasia [IND], low-grade dysplasia [LGD], high-grade dysplasia [HGD] or esophageal adenocarcinoma [EAC]), were identified from a large US administrative claims database, the IBM Truven Health MarketScan® databases (Q1/2015-Q4/2019).

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Purpose: Research about the prevalence of dementia among older adults in the incarceration system is currently lacking, and further investigation is warranted. Considering the high level of healthcare needs, unique behavioural issues and difficulty to rehabilitate within the system due to its punitive approach and lack of effective rehabilitation programs, further investigation is warranted to characterize and determine the number of incarcerated older adults with dementia. The purpose of this study is to estimate the prevalence of individuals with dementia in the prison system while also describing the incarceration, demographic and offence-related characteristics of this unique population.

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