JAMA Network Open最新文献

{"title":"The Role of Hospital Management in Addressing Health-Related Social Needs.","authors":"David E Velasquez, Jose F Figueroa","doi":"10.1001/jamanetworkopen.2025.16356","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.16356","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2516356"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paternal Preconception Metformin Use and Offspring Risk of Congenital Malformations.","authors":"Krista F Huybrechts, Loreen Straub, Ran S Rotem, Brian T Bateman, Sonia Hernández-Díaz","doi":"10.1001/jamanetworkopen.2025.15002","DOIUrl":"10.1001/jamanetworkopen.2025.15002","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2515002"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune Checkpoint Inhibitors for Patients With Preexisting Autoimmune Neurologic Disorders.","authors":"Kylie Fletcher, Marc Machaalani, Razane El Hajj Chehade, Amin H Nassar, Rashad Nawfal, Michael Manos, Alexander M Menzies, Frank Aboubakar-Nana, Jessica C Hassel, David J Pinato, Alexandra Johnson, Anna C Olsson-Brown, Matteo S Carlino, Andrea Malgeri, Alessio Cortellini, Aditi Singh, Kaushal Parikh, So Yeon Kim, Abdul Rafeh Naqash, Georgina V Long, Pavan Challa, Toni K Choueiri, Elad Sharon, Shailee Shah, Douglas B Johnson","doi":"10.1001/jamanetworkopen.2025.13727","DOIUrl":"10.1001/jamanetworkopen.2025.13727","url":null,"abstract":"<p><strong>Importance: </strong>Immune checkpoint inhibitors (ICIs) are efficacious in many cancer types but can produce immune-related adverse events (irAEs). As such, patients with preexisting autoimmune disorders are often excluded from clinical trials, although subsequent studies have shown that many of these patients have acceptable ICI tolerance. The safety and efficacy of ICIs among patients with preexisting neurologic autoimmune disorders (NAIDs) is not well characterized.</p><p><strong>Objective: </strong>To evaluate the safety and clinical outcomes associated with ICI therapy among patients with NAIDs.</p><p><strong>Design, setting, and participants: </strong>This multicenter retrospective cohort study included patients with cancer who were treated with ICIs between October 2013 and May 2023 and had preexisting multiple sclerosis (MS), myasthenia gravis (MG), Guillain-Barré syndrome (GBS), and other NAIDs as well as a control cohort of patients with Parkinson disease (PD).</p><p><strong>Exposure: </strong>ICI therapy.</p><p><strong>Main outcomes and measures: </strong>Demographic and clinical characteristics (neurologic disability, active or recent immunosuppression), ICI outcomes (response, progression-free survival [PFS], and overall survival [OS]), and safety outcomes (NAID exacerbation, irAEs) were collected.</p><p><strong>Results: </strong>A total of 135 patients were included; the median (range) age was 72 (40-88) years, 84 (62%) were men, and 51 (38%) were women. A total of 45 patients had MS; 18, MG; 10, GBS; 5, another NAID; and 57, PD. Exacerbations occurred most frequently in MG (12 of 18 patients [67%]), often resulting in hospitalization (6 [50%]) or death (2 [17%]), with much lower rates in the MS cohort (8 of 45 patients [18%]). Ten patients with a history of GBS tolerated ICI without exacerbations, although 1 developed a fatal case of Lambert Eaton myasthenic syndrome following ICI treatment. No differences in response rate, PFS, or OS were observed between NAID groups.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of ICI use in NAIDs, patients with MG had frequent and more severe exacerbations, while those with MS had few exacerbations. No obvious differences in survival between groups were observed. ICI may be an option for many patients with appropriate oncologic indications and preexisting NAIDs.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2513727"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multinational Attitudes Toward AI in Health Care and Diagnostics Among Hospital Patients.","authors":"Felix Busch, Lena Hoffmann, Lina Xu, Long Jiang Zhang, Bin Hu, Ignacio García-Juárez, Liz N Toapanta-Yanchapaxi, Natalia Gorelik, Valérie Gorelik, Gaston A Rodriguez-Granillo, Carlos Ferrarotti, Nguyen N Cuong, Chau A P Thi, Murat Tuncel, Gürsan Kaya, Sergio M Solis-Barquero, Maria C Mendez Avila, Nevena G Ivanova, Felipe C Kitamura, Karina Y I Hayama, Monserrat L Puntunet Bates, Pedro Iturralde Torres, Esteban Ortiz-Prado, Juan S Izquierdo-Condoy, Gilbert M Schwarz, Jochen G Hofstaetter, Michihiro Hide, Konagi Takeda, Barbara Peric, Gašper Pilko, Hans O Thulesius, Thomas Lindow, Israel K Kolawole, Samuel Adegboyega Olatoke, Andrzej Grzybowski, Alexandru Corlateanu, Oana-Simina Iaconi, Ting Li, Izabela Domitrz, Katarzyna Kepczynska, Matúš Mihalcin, Lenka Fašaneková, Tomasz Zatonski, Katarzyna Fulek, András Molnár, Stefani Maihoub, Zenewton A da Silva Gama, Luca Saba, Petros Sountoulides, Marcus R Makowski, Hugo J W L Aerts, Lisa C Adams, Keno K Bressem, Álvaro Aceña Navarro, Catarina Águas, Martina Aineseder, Muaed Alomar, Rashid Al Sliman, Gautam Anand, Salita Angkurawaranon, Shuhei Aoki, Samuel Arkoh, Gizem Ashraf, Yesi Astri, Sameer Bakhshi, Nuru Y Bayramov, Antonis Billis, Almir G V Bitencourt, Anetta Bolejko, Antonio J Bollas Becerra, Joe Bwambale, Andreia Capela, Riccardo Cau, Kelly R Chacon-Acevedo, Tafadzwa L Chaunzwa, Rubens Chojniak, Warren Clements, Renato Cuocolo, Victor Dahlblom, Kelienny de Meneses Sousa, Jorge Esteban Villarrubia, Vijay B Desai, Ajaya K Dhakal, Virginia Dignum, Rubens G Feijo Andrade, Giovanna Ferraioli, Shuvadeep Ganguly, Harshit Garg, Cvetanka Gjerakaroska Savevska, Marija Gjerakaroska Radovikj, Anastasia Gkartzoni, Luis Gorospe, Ian Griffin, Martin Hadamitzky, Martin Hakorimana Ndahiro, Alessa Hering, Bruno Hochhegger, Mehriban R Huseynova, Fujimaro Ishida, Nisha Jha, Lili Jiang, Rawen Kader, Helen Kavnoudias, Clément Klein, George Kolostoumpis, Abraham Koshy, Nicholas A Kruger, Alexander Löser, Marko Lucijanic, Despoina Mantziari, Gaelle Margue, Sonyia McFadden, Masahiro Miyake, Wipawee Morakote, Issa Ngabonziza, Thao T Nguyen, Stefan M Niehues, Marc Nortje, Subish Palaian, Natalia V Pentara, Rui P Pereira de Almeida, Gianluigi Poma, Mitayani Purwoko, Nikolaos Pyrgidis, Vasileios Rafailidis, Clare Rainey, João C Ribeiro, Nicolás Rozo Agudelo, Keina Sado, Julia M Saidman, Pedro J Saturno-Hernandez, Vidyani Suryadevara, Gerald B Schulz, Ena Soric, Javier Soto-Pérez-Olivares, Arnaldo Stanzione, Julian Peter Struck, Hiroyuki Takaoka, Satoru Tanioka, Tran T M Huyen, Daniel Truhn, Elon H C van Dijk, Peter van Wijngaarden, Yuan-Cheng Wang, Matthias Weidlich, Shuhang Zhang","doi":"10.1001/jamanetworkopen.2025.14452","DOIUrl":"10.1001/jamanetworkopen.2025.14452","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;The successful implementation of artificial intelligence (AI) in health care depends on its acceptance by key stakeholders, particularly patients, who are the primary beneficiaries of AI-driven outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To survey hospital patients to investigate their trust, concerns, and preferences toward the use of AI in health care and diagnostics and to assess the sociodemographic factors associated with patient attitudes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study developed and implemented an anonymous quantitative survey between February 1 and November 1, 2023, using a nonprobability sample at 74 hospitals in 43 countries. Participants included hospital patients 18 years of age or older who agreed with voluntary participation in the survey presented in 1 of 26 languages.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Information sheets and paper surveys handed out by hospital staff and posted in conspicuous hospital locations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was participant responses to a 26-item instrument containing a general data section (8 items) and 3 dimensions (trust in AI, AI and diagnosis, preferences and concerns toward AI) with 6 items each. Subgroup analyses used cumulative link mixed and binary mixed-effects models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 13 806 patients participated, including 8951 (64.8%) in the Global North and 4855 (35.2%) in the Global South. Their median (IQR) age was 48 (34-62) years, and 6973 (50.5%) were male. The survey results indicated a predominantly favorable general view of AI in health care, with 57.6% of respondents (7775 of 13 502) expressing a positive attitude. However, attitudes exhibited notable variation based on demographic characteristics, health status, and technological literacy. Female respondents (3511 of 6318 [55.6%]) exhibited fewer positive attitudes toward AI use in medicine than male respondents (4057 of 6864 [59.1%]), and participants with poorer health status exhibited fewer positive attitudes toward AI use in medicine (eg, 58 of 199 [29.2%] with rather negative views) than patients with very good health (eg, 134 of 2538 [5.3%] with rather negative views). Conversely, higher levels of AI knowledge and frequent use of technology devices were associated with more positive attitudes. Notably, fewer than half of the participants expressed positive attitudes regarding all items pertaining to trust in AI. The lowest level of trust was observed for the accuracy of AI in providing information regarding treatment responses (5637 of 13 480 respondents [41.8%] trusted AI). Patients preferred explainable AI (8816 of 12 563 [70.2%]) and physician-led decision-making (9222 of 12 652 [72.9%]), even if it meant slightly compromised accuracy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cross-sectional study of patient attitudes toward AI use in health care acr","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514452"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraosseous vs Intravenous Access for Epinephrine in Pediatric Out-of-Hospital Cardiac Arrest.","authors":"Masashi Okubo, Sho Komukai, Junichi Izawa, SunHee Chung, Cameron Dezfulian, Francis X Guyette, Joshua R Lupton, Christian Martin-Gill, Sylvia Owusu-Ansah, Sriram Ramgopal, Clifton W Callaway","doi":"10.1001/jamanetworkopen.2025.17291","DOIUrl":"10.1001/jamanetworkopen.2025.17291","url":null,"abstract":"<p><strong>Importance: </strong>While epinephrine is commonly administered in children with out-of-hospital cardiac arrest (OHCA) via an intraosseous (IO) or intravenous (IV) route, the optimal route of epinephrine delivery is unclear.</p><p><strong>Objective: </strong>To evaluate the association between the route of epinephrine administration (IO or IV) and patient outcomes after pediatric OHCA.</p><p><strong>Design, setting, and participants: </strong>Retrospective cohort study of pediatric patients (aged <18 years) with nontraumatic OHCA treated by emergency medical services who received prehospital epinephrine either via an IO or IV route. Patients were included in the Resuscitation Outcomes Consortium Epidemiologic Registry, a prospective OHCA registry at 10 sites in the US and Canada from April 2011 to June 2015. Data analysis was performed from May 2024 to April 2025.</p><p><strong>Exposure: </strong>Epinephrine administration route: IO or IV route.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was survival to hospital discharge. The secondary outcome was return of spontaneous circulation (ROSC) before hospital arrival. Propensity scores were calculated and inverse probability of treatment weighting (IPTW) was performed with stabilized weights to control imbalances in measured patient demographics, cardiac arrest characteristics, and bystander and prehospital interventions.</p><p><strong>Results: </strong>Of 739 eligible patients (median [IQR] age, 1 [0-11] years), 449 (60.8%) were male. Epinephrine was administered via an IO route for 535 (72.4%) and via an IV route for 204 (27.6%) patients. In the IPTW pseudopopulation (740 weighted cases), there was no significant difference in survival to hospital discharge (IO epinephrine: 28 of 528 patients [5.3%] vs IV epinephrine: 12 of 212 patients [5.7%]; risk ratio [RR], 0.92; 95% CI, 0.41-2.07) or prehospital ROSC (IO epinephrine: 76 of 528 patients [14.4%] vs IV epinephrine: 46 of 212 patients [21.7%]; RR, 0.66; 95% CI, 0.42-1.03) between the IO and IV epinephrine groups.</p><p><strong>Conclusions and relevance: </strong>In this retrospective cohort study of pediatric patients with OHCA in the US and Canada, the route of epinephrine administration was not associated with survival to hospital discharge or prehospital ROSC. This may support the practice of administering epinephrine via IO or IV route.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2517291"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12199053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurodevelopment Among Infants With Late-Onset Fetal Growth Restriction.","authors":"Liqun Sun, Fu-Tsuen Lee, Natasha Milligan, Mengyuan Zhu, Joshua F P van Amerom, Brahmdeep S Saini, Jessie Mei Lim, Christopher K Macgowan, Edmond Kelly, John C Kingdom, Mike Seed","doi":"10.1001/jamanetworkopen.2025.17360","DOIUrl":"10.1001/jamanetworkopen.2025.17360","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Fetal growth restriction (FGR) is associated with adverse neurodevelopmental outcomes. However, the delineation of neurodevelopmental sequela in late-onset FGR has been hampered by challenges in diagnosing late-onset FGR and the confounding influence of prematurity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To characterize neurodevelopmental outcomes in full-term infants exposed to late-onset FGR and to examine the association of FGR with fetal hemodynamics, perinatal brain development, and somatic growth.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this single-center cohort study, pregnant persons with fetuses small for gestational age were enrolled between April 1, 2010, and August 31, 2016, and followed up until the infant was 36 months of age. Follow-up was completed November 2019. Data analysis was performed from June to August 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Late-onset FGR diagnosed based on a composite scoring system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcomes were neurodevelopmental outcomes at 4, 8, and 12 months of age assessed by the Alberta Infant Motor Scale (AIMS) and at 18 and 36 months of age assessed by the Bayley Scales of Infant and Toddler Development, Third Edition. Secondary outcomes included fetal hemodynamics and perinatal brain development assessed by magnetic resonance imaging findings and serial somatic growth.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 97 singleton pregnancies (mean [SD] maternal age, 33.5 [3.8] years; 50 [52%] male neonates), 41 neonates (42%) were exposed to late-onset FGR. At 12-month follow-up, motor development was significantly delayed among full-term infants exposed to late-onset FGR compared with neonates appropriate for gestational age (AIMS mean difference, -4.5; 95% CI, -8.6 to -0.3). At all other time points, neurodevelopmental outcomes were similar between the groups. In models adjusted for covariates, gestational age at birth was associated with 18-month cognitive outcomes (coefficient, 4.13 [95% CI, 0.54-7.72]), while the diagnosis of late-onset FGR was not. Preterm infants exposed to FGR exhibited higher fetal combined ventricular output, higher ratio of cerebral to pulmonary blood flow, and lower oxygen saturation compared with full-term infants exposed to FGR and infants with no FGR exposure. In general, neonatal brain maturation and somatic growth by 12 months of age were similar between full-term infants exposed to FGR and those with no exposure. However, head circumference was smaller from birth until the 36-month follow-up in infants exposed to FGR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this cohort study, full-term infants exposed to late-onset FGR exhibited normal neurodevelopmental outcomes by 18 and 36 months of age, and longer gestation was associated with improved outcomes. These findings suggest that early delivery is unlikely to offer neurodevelopmental benefit, and any adverse impact on neurodevelopm","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2517360"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12199057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medullary Thyroid Cancer Risk and Mortality in Carriers of Incidentally Identified MEN2A RET Variants.","authors":"Courtney E West, Uyenlinh L Mirshahi, Katherine S Ruth, Luke N Sharp, Ankit M Arni, Clare Turnbull, Caroline F Wright, Bijay Vaidya, Martina M Owens, David J Carey, Kashyap A Patel","doi":"10.1001/jamanetworkopen.2025.17937","DOIUrl":"10.1001/jamanetworkopen.2025.17937","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;RET germline pathogenic variants cause multiple endocrine neoplasia type 2 (MEN2), which is associated with medullary thyroid cancer. With increasing incidental identification of these variants in asymptomatic individuals outside family screening, these individuals' risk of medullary thyroid cancer and all-cause mortality without intervention remain unknown in this context.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the risk of medullary thyroid cancer and all-cause mortality in clinically unselected individuals with incidentally identified RET variants and assess whether the risk of medullary thyroid cancer differs from those with clinically ascertained RET variants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This prospective cohort study of 383 914 unrelated individuals from the clinically unselected UK population (UK Biobank, recruited in 2006-2010, with follow-up to June 2023) and 122 640 unrelated individuals from a US health system (Geisinger MyCode cohort, recruited 2004-2020, with follow-up to October 2023) compared medullary thyroid cancer risk in these cohorts with 1078 individuals who were clinically ascertained with suspicion of MEN2 from a UK routine practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;RET germline pathogenic variants causing MEN2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Frequency and the spectrum of pathogenic RET variants, risk of clinically present medullary thyroid cancer, and all-cause mortality without thyroidectomy were assessed using proportions with exact binomial 95% CIs and survival analysis adjusted for age at recruitment and sex.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the UK Biobank, 169 unrelated individuals (mean [SD] age at recruitment, 57.0 [8.1] years; 94 male [55.6%]) had a pathogenic RET variant (prevalence, 0.04% [95% CI, 0.04%-0.05%]). In the US health system-based cohort, 77 unrelated individuals (mean [SD] age at recruitment, 56.2 [17.8] years; 45 female [58.4%]) had a pathogenic RET variant (prevalence, 0.06% [95% CI, 0.05%-0.78%]). The variants were predominantly from the moderate-risk category per American Thyroid Association guidelines (168 individuals [99.4%] and 75 individuals [94.8%], respectively). The Kaplan-Meier estimated medullary thyroid cancer risk by age 75 years in variant carriers in the UK population was 2.2% (95% CI, 0.7%-6.9) and 19.3% (95% CI, 6.4%-30.2%) in US health system cohort. These risks were significantly lower compared with the clinically ascertained cohort with the matched variants (95.7% [95% CI, 82.1%-99.7%]). In the UK Biobank, most variant carriers (166 [98.2%]) did not undergo thyroidectomy, and their all-cause mortality by age 75 years was similar to noncarriers (6.1% [95% CI, 2.7%-13.8%] vs 5.7% [95% CI, 5.6%-5.8%]), with consistent findings in the US health system cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study, moderate-risk RET variants were most common in incidental cases. T","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2517937"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-Glucose Cotransporter 2 Inhibitors and Serious Liver Events in Patients With Cirrhosis.","authors":"Mohamad-Noor Abu-Hammour, Rashid Abdel-Razeq, Aravinthan Vignarajah, Raneem Khedraki, Omar T Sims, Nishanthi Vigneswaramoorthy, Dian J Chiang","doi":"10.1001/jamanetworkopen.2025.18470","DOIUrl":"10.1001/jamanetworkopen.2025.18470","url":null,"abstract":"<p><strong>Importance: </strong>Cirrhosis is a significant global health burden, with serious liver-related complications leading to high morbidity and mortality. Effective therapeutic options to mitigate these complications remain limited. Sodium-glucose cotransporter 2 (SGLT-2) inhibitors, primarily used in diabetes and heart failure management, may offer additional liver-related benefits.</p><p><strong>Objective: </strong>To evaluate the association between SGLT-2 inhibitor use and the risk of serious liver events in patients with cirrhosis receiving furosemide and spironolactone.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from over 120 health care organizations within the TriNetX platform. Adult patients with cirrhosis who were receiving furosemide and spironolactone from January 2013 to July 2021 were included. Patients who were receiving SGLT-2 inhibitors plus furosemide and spironolactone were matched with a control group of patients who were receiving furosemide and spironolactone alone according to age, demographics, and comorbidities using 1:1 propensity matching. Each patient was followed up for 3 years; follow-up ended on July 11, 2024.</p><p><strong>Exposure: </strong>Use of SGLT-2 inhibitors.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was a composite of serious liver events defined as incidence of ascites, variceal development, hyponatremia, or all-cause mortality. Secondary outcomes included incidence of variceal bleeding, paracentesis, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, hepatocellular carcinoma, hypoglycemia, and all-cause hospitalizations. Continuous variables were compared using an independent-samples t test; categorical variables were compared using the Pearson χ2 test.</p><p><strong>Results: </strong>Among 10 660 propensity-matched patients (mean [SD] age, 63.8 [10.7] years; 57.8% male), those receiving SGLT-2 inhibitors had a lower incidence of serious liver events compared with control patients (hazard ratio [HR], 0.68 [95% CI, 0.66-0.71]; P < .001). Secondary outcomes included hepatorenal syndrome (HR, 0.47 [95% CI, 0.40-0.56]), spontaneous bacterial peritonitis (HR, 0.55 [95% CI, 0.46-0.65]), paracentesis (HR, 0.54 [95% CI, 0.50-0.60]), variceal bleeding (HR, 0.79 [95% CI, 0.73-0.84]), hypoglycemia (HR, 0.75 [95% CI, 0.62-0.91]), and all-cause hospitalizations (HR, 0.67 [95% CI, 0.63-0.71]), all of which were associated with a reduced risk among those in the SGLT-2 inhibitors group.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of adults with cirrhosis who were receiving diuretic therapy, the findings suggest that SGLT-2 inhibitor use was associated with a lower incidence of serious liver events. These findings further suggest a potential role for SGLT-2 inhibitors in cirrhosis management.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2518470"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silver Diamine Fluoride vs Atraumatic Restoration for Managing Dental Caries in Schools: A Cluster Randomized Clinical Trial.","authors":"Ryan Richard Ruff, Aditi Ashish Gawande, Qianhui Xu, Tamarinda Barry Godín","doi":"10.1001/jamanetworkopen.2025.13826","DOIUrl":"10.1001/jamanetworkopen.2025.13826","url":null,"abstract":"<p><strong>Importance: </strong>Dental caries is a pervasive and inequitable chronic disease stemming from a lack of access to preventive and therapeutic care. Minimally invasive interventions may be provided in schools to treat caries in children.</p><p><strong>Objective: </strong>To compare the effectiveness of silver diamine fluoride (SDF) with atraumatic restorative treatment (ART) in the control of dental caries among US schoolchildren.</p><p><strong>Design, setting, and participants: </strong>The CariedAway study was a cluster randomized clinical trial conducted from February 1, 2019, to June 1, 2023, in 48 primary schools in New York City. Participants were followed up for up to 4 years. Schools with a student population of at least 50% Black and/or Hispanic or Latino students and 80% receiving free or reduced-cost lunch were eligible. Within enrolled schools, any child with parental informed consent was eligible. Treatment was provided biannually. Analysis was restricted to children aged 5 to 13 years who completed at least 1 follow-up observation and had at least 1 tooth surface with dental caries.</p><p><strong>Interventions: </strong>Participants were randomized at the school level to receive SDF or ART.</p><p><strong>Main outcomes and measures: </strong>Any surface lesion with an International Caries Detection and Assessment System score of 5 or 6 was recorded as caries. The primary outcome was the number of carious surfaces that had a recurrence of caries. Analysis was performed on an intent-to-treat basis.</p><p><strong>Results: </strong>Of the 17 741 children eligible, 7418 were randomized (mean [SD] age at baseline, 7.6 [1.9] years; 4006 girls [54.0%]), and 1668 were analyzed (mean [SD] age at baseline, 6.8 [1.5] years; 881 girls [52.8%]; 861 in the SDF group and 807 in the ART group). The total surface-level failure in the SDF group was 38.3% (2167 of 5651 carious surfaces) compared with 45.5% (2116 of 4647) in the ART group. There were 2167 surface failures observed among SDF participants over 1372 person-years compared with 2116 ART surface failures over 1291 person-years (incidence rate ratio, 0.96 [95% CI, 0.91-1.02]). At the person level, 45.5% of SDF recipients (392 of 861) experienced at least 1 surface failure compared with 53.3% of ART recipients (430 of 807; odds ratio, 0.51 [95% CI, 0.39-0.66]). There were no significant differences in the risk of recurrent surface failure between treatments (hazard ratio, 0.92 [95% CI, 0.82-1.04]).</p><p><strong>Conclusions and relevance: </strong>In this study of treatments for caries, similar failures in surface control were observed among children receiving SDF or ART. These results support the use of secondary preventive therapies for caries in schools.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03442309.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2513826"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunotherapy for Resectable Non-Small Cell Lung Cancer-Not If, But When.","authors":"Lauren Reed-Guy, Melina E Marmarelis","doi":"10.1001/jamanetworkopen.2025.17962","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.17962","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2517962"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}