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The master regulator behind the development of antibody-producing cells has been identified in a new study. The findings provide new insight into the inner workings of the immune system and may help understand how tissues develop and how certain cancers arise.

When cells multiply and migrate, they can be compressed and their nucleus may break open. This phenomenon causes DNA damage. Scientists have now shown that this facilitates the spread of cancer cells in breast tumors.

A new study found that adults who reported experiencing sexual abuse by the age of 16 had a 2.6 times higher risk of dying in middle age -- that is, between 45 and 58 -- than those who did not report sexual abuse.

Can specific dietary guidelines help people living with bipolar disorders better manage their health? Clinical trial results showed that a diet designed to alter levels of specific fatty acids consumed by participants may help patients have less variability in their mood.

Engineers designed a relatively low-cost, energy-efficient approach to treating water contaminated with heavy metals such as lead.

A recent increase in the literature regarding the evidence base for clozapine has made it increasingly difficult for clinicians to judge "best evidence" for clozapine use. As such, we aimed at elucidating the state-of-the-art for clozapine with regard to efficacy, effectiveness, tolerability, and management of clozapine and clozapine-related adverse events in neuropsychiatric disorders. We conducted a systematic PRISMA-conforming quantitative meta-review of available meta-analytic evidence...

A wave of new treatments and treatment combinations are becoming available for solid tumours. Trials performed to obtain registration establish a positive benefit-risk but unavoidably leave many questions unanswered on place-in-therapy and the relative efficacy of different treatment sequences. Such limitations create problems in terms of strength of treatment guidelines and reimbursement (in countries where a public payer exists). Data on new drugs arriving during the last 10 years for the...

INTRODUCTION: Chronic conditions impact indigenous peoples of Australia at a much higher rate than non-indigenous Australians. Attendance at the Medicare Benefits Scheme (MBS) supported indigenous health checks are crucial to improve prevention and management of chronic health conditions. However, in conjunction with lifestyle and environmental factors, attendance rates at primary healthcare services for screening and treatment have fallen in Australia during the COVID-19 pandemic. This study...

Epidemiologically, metabolic disorders have garnered much attention, perhaps due to the predominance of obesity. The early postnatal life represents a critical period for programming multifactorial metabolic disorders of adult life. Though, altricial rodents are prime subjects for investigating neonatal programming, there is still no sufficiently generalised literature on their usage and methodology. This review focuses on establishing five approach-based models of neonatal rodents adopted for...

CONCLUSIONS: Of the eligible CPGs, the CAM sections were of lower quality compared to the overall recommendations across all domains of the AGREE II instrument. CPGs that scored well could serve as a framework for discussion between patients and healthcare professionals regarding use of CAM therapies in the context of headache and migraine.

This Appendix presents data from the 2020-2021 Liaison Committee on Medical Education (LCME) annual questionnaire, which provides information on the number of students, student demographics, and curriculum content at US medical schools.

This Appendix presents 2020 National GME Census data detailing the numbers and types of ACGME-accredited training programs and the residents and fellows in them.

In the US Preventive Services Task Force report titled “Counseling and Behavioral Interventions for Healthy Weight and Weight Gain in Pregnancy: Evidence Report and Systematic Review for the US Preventive Services Task Force,” published in the May 25, 2021, issue of JAMA, group sizes appeared incorrectly in a figure. In the “Obese” section of Figure 3, in the row reporting data for the study by Daly et al, the number of participants in the treatment group should have been 34, rather than 33, and the number in the control group should have been 42, rather than 36. This article was corrected online.

Bicuspid aortic valve (BAV) disease is a congenital condition that affects an estimated 1% of the world’s population. While initial valve function is relatively normal and has little early clinical consequence, progressive valve fibrosis and calcification eventually results in severe aortic stenosis, requiring aortic valve replacement in nearly all patients with BAV in later life.

In this issue of JAMA, Lee et al provide the results of a carefully structured, comprehensive effort to define the elements to be included in reports of studies using mediation analyses. Mediation analysis refers to a group of statistical methods for assessing the relative contributions of multiple pathways by which a treatment or risk factor may affect clinical outcomes. Mediators are quantifiable characteristics in the causal pathway through which an intervention (such as a treatment) exerts its effect. For example, if a behavioral intervention leads to reduced caloric intake, and patients lose weight as a result, then caloric intake would be a likely mediator of the effect of the behavioral intervention on weight loss. A mediation analysis evaluates the relationships between the treatment and potential mediators and, separately, between the mediators and outcomes, and quantitatively partitions the overall treatment effect among the different causal pathways. One of the causal pathways may be direct without any identified mediator.

Many patients experience neurocognitive deficits, PTSD, and generalized weakness and disability following an intensive care unit (ICU) stay. JAMA Medical News Senior Writer Rita Rubin talks with E. Wesley Ely, MD, MPH, a professor of medicine at Vanderbilt University School of Medicine, about ICU aftereffects, post-acute COVID-19 syndrome, and how the coronavirus pandemic, particularly hospitals’ restrictions on visitors, impeded progress made since the 1990s in caring for the critically ill.

Related Content:

How COVID-19 Made It Even Tougher to Know ICU Patients as Individuals

More than half of the 80 000 emergency personnel, volunteers, and recovery and cleanup workers known to have responded to the September 11, 2001, terrorist attacks at the World Trade Center, the Pentagon, and the crash site near Shanksville, Pennsylvania, have at least 1 certified physical or mental health condition related to their exposures. First responder Terrence Jordan, a retired lieutenant with the Fire Department of the City of New York, shares his story.

Related Content:

• Twenty Years After 9/11, Responders Are Still Healing
• 9/11 Responders’ Health 20 Years Later, Part 1

More than half of the 80 000 emergency personnel, volunteers, and recovery and cleanup workers known to have responded to the September 11, 2001, terrorist attacks at the World Trade Center, the Pentagon, and the crash site near Shanksville, Pennsylvania, have at least 1 certified physical or mental health condition related to their exposures. Pulmonologist David Prezant, MD, chief medical officer for the Fire Department of the City of New York and a professor of medicine at Albert Einstein College of Medicine in the Bronx, shares his 9/11 story and updates us on how the responders are doing 20 years after the events.

Related Content:

• Twenty Years After 9/11, Responders Are Still Healing
• 9/11 Responders’ Health 20 Years Later, Part 2

FDA’s Approval of New Alzheimer Drug Raises Many Questions; Überantibodies From Recovered COVID-19 Patients Could Spur New Therapeutics and Vaccines; Detecting Kids’ Broken Hearts—Cardiac Screening Advised During Well-Child Visits

Related Content:

• Recently Approved Alzheimer Drug Raises Questions That Might Never Be Answered
• Überantibodies From Recovered COVID-19 Patients Could Spur New Therapeutics and Vaccines
• Detecting Kids’ Broken Hearts—Cardiac Screening Advised During Well-Child Visits

The Search for a Single Vaccine Against Coronaviruses Yet to Come; Semaglutide’s Success Could Usher in a “New Dawn” for Obesity Treatment; Confronting High HIV Rates Among Transgender Women With Empowerment and Gender Affirmation.

Related Content:

• The Search for a Single Vaccine Against Coronaviruses Yet to Come
• Semaglutide’s Success Could Usher in a “New Dawn” for Obesity Treatment
• Confronting High HIV Rates Among Transgender Women With Empowerment and Gender Affirmation

Recognizing a potentially difficult intubation can help clinicians prepare for complications by getting assistance from colleagues with airway training and by ensuring advanced airway management equipment is available. Michael E. Detsky, MD, MSHP, assistant professor of medicine at the University of Toronto and the Mount Sinai Health System, discusses findings from a Rational Clinical Examination systematic review identifying physical findings and risk factors that can help predict difficult endotracheal intubation.

Related Content:

• Will This Patient Be Difficult to Intubate? The Rational Clinical Examination Systematic Review
• Will This Patient Be Difficult to Intubate? (video)

Critically ill patients often require IV fluids for resuscitation but questions remain about the optimal type of IV fluid and best rate of IV fluid bolus infusion. JAMA Associate Editor Kristin Walter, MD, MS, discusses a recent clinical trial that examined the effect of 2 different crystalloid solutions and 2 IV fluid bolus infusion rates on ICU patient mortality with Alexandre B. Cavalcanti, MD, PhD, director of the Research Institute HCor in San Paulo, Brazil, and Craig M. Coopersmith, MD, professor of surgery and director of the Critical Care Center at Emory University School of Medicine in Atlanta, Georgia.

Related Content:

• Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial
• Does Crystalloid Composition or Rate of Fluid Administration Make a Difference When Resuscitating Patients in the ICU?
• Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial
• Effect of Intravenous Fluid Treatment With a Balanced vs Normal Saline Solution at a High vs Low Infusion Rate on Mortality in Critically Ill Patients

Interview with Chien-Wen Tseng, MD, USPSTF member and coauthor of Screening for Prediabetes and Type 2 Diabetes: US Preventive Services Task Force Recommendation Statement.

Related Content:

• Screening for Gestational Diabetes
• Screening for Prediabetes and Type 2 Diabetes
• Updated USPSTF Screening Recommendations for Diabetes

Interview with Chien-Wen Tseng, MD, USPSTF member and coauthor of Screening for Gestational Diabetes

Related Content:

• USPSTF Review: Screening for Gestational Diabetes
• USPSTF Recommendation: Screening for Prediabetes and Type 2 Diabetes

Cost-effectiveness analysis defines trade-offs between costs, harms, and benefits of alternative treatments and combines them into a single metric, the incremental cost-effectiveness ratio (ICER), that can inform decisions about which interventions to recommend when limited resources are available. Gillian Sanders-Schmidler, PhD, professor of population health sciences and medicine at Duke University, explains the method in terms clinicians can understand.

Related Articles:

• Overview of Cost-effectiveness Analysis
• Choosing a Time Horizon in Cost and Cost-effectiveness Analyses

In the JAMA Insights article titled “Novel Lipid-Lowering Therapies to Reduce Cardiovascular Risk,” published July 20, 2021, the dosing of inclisiran required clarification. The fourth sentence of the “Inclisiran” section that stated that inclisiran was dosed as “1 to 3 injections administered over a 3-month period, followed by dosing once every 6 months” should be replaced with “Clinical trials reveal durable 30% to 60% reductions in LDL-C.10 Inclisiran is dosed by injection at day 1 and day 90, followed by dosing once every 6 months.” This article was corrected online.

This Viewpoint offers potential changes to improve the process of US Food and Drug Administration accelerated approval.

This Viewpoint discusses protein folding and the use of computers to solve the protein folding problem along with the limitations of protein structure prediction and the practical benefits that may be yielded from the breakthrough discovery.

This Viewpoint discusses SB8, the recent law passed in Texas that essentially prohibits abortion after 6 weeks of gestational age, and the effect this will have on persons seeking pregnancy termination as well as the future of constitutional protection of abortion services.

This Medical News feature examines the growing use of over-the-counter rapid antigen tests for SARS-CoV-2 infection.

Here's what we chose for you from NEJM Group today: New England Journal of Medicine: Perspective: As difficult as 2020 was, it also brought some...

Dear Readers, This marks our final issue of Physician's First Watch. Over the past couple of weeks, hundreds of you have written to us to...

Blood pressure (BP)–lowering treatment is associated with lower risk for cardiovascular (CV) events across a wide range of BP levels and in patients with...

Higher body-mass index is associated with increased risk for severe COVID-19–related outcomes, even at a BMI considered a healthy weight, according to...

The FDA has embarked on a process to ban menthol cigarettes and all flavored cigars. In a statement released Thursday, the acting FDA commissioner, Dr...

Many patients with chronic pancreatitis transition among continuous pain, intermittent pain, and no pain.

In an emergency department study, thiazide users had a high prevalence of not only hyponatremia and hypokalemia, but also syncope and falls.

A low-dose combination pill was more effective than full-dose irbesartan alone as initial treatment.

In an observational study, new users of angiotensin-receptor blockers had similar cardiovascular outcomes and fewer side effects.

In a meta-analysis, thyroid dysfunction was not associated with cognitive decline or dementia.

In an emergency department study, thiazide users had a high prevalence of not only hyponatremia and hypokalemia, but also syncope and falls.

A low-dose combination pill was more effective than full-dose irbesartan alone as initial treatment.

The side effects seem more related to taking a pill than to what's in the pill.

Across more than 300 medical centers, use of stress testing was highly variable and not associated with better outcomes.

An admittedly inconclusive study points to some benefit of OACs in these patients.

Despite its widespread use, the proprietary electronic health record system missed sepsis 67% of the time.

Fewer than 1% of patients developed intracranial hemorrhage at 6 hours after initially negative head computed tomography.

Direct transfer to the angiography suite without stopping for computed tomography improved functional outcomes in a single-center randomized trial, although many patients already had conventional CT done at a primary stroke center before transfer.

Mortality was high, regardless of which inotrope was administered.

Infusion centers had better outcomes than emergency departments for managing uncomplicated crises.

An internist at Massachusetts General Hospital, Dr. Joseph Betancourt also runs their program on equity and community health. In this, the final entry in our four-interview exploration of race and clinical equity, Betancourt talks about the need for medical institutions to pay attention to what’s happening in their patients’ communities. To that end, MGH has a […]

The post Podcast 278: Where equity and community health intersect — a conversation with Joseph Betancourt first appeared on Clinical Conversations.

Dr. Sheares talks about her experience with inequities. She believes that clinicians should aspire to be students of their patients as well as of the pathophysiology of the diseases their patients present with. Listen in. Running time: 20 minutes

The post Podcast 277: Race and clinical equity — know your patients — a conversation with Karen Dorsey Sheares first appeared on Clinical Conversations.

In this, our second conversation on race and clinical equity, Dr. Karol Watson of UCLA offers her observations on what she’s observed as a cardiologist trying to deal with treatment plans for patients who’ve lost their health insurance or have had to go to a plan that doesn’t cover what’s needed. She reminds us that tagging […]

The post Podcast 276: Pay attention to the structural barriers that contribute to clinical inequity — Karol Watson first appeared on Clinical Conversations.

We’ve conducted a set of four interviews with physicians on the topic of race and clinical equity. The conversations center not so much on their published research, but on the roles that these physicians take in their organizations and, in addition, the stories they tell about their own experiences. Our first is with Dr. Kimberly Manning, who’s […]

The post Podcast 275: Race and Clinical Equity — a Conversation with Dr. Kimberly Manning first appeared on Clinical Conversations.

Apologies for the long silence. We have been off doing other things — one of which has been figuring out how to cover conferences. Last month, after much preparation, we covered the American Society of Hematology (ASH) annual conference; our second foray consists of brief coverage of the American Society of Clinical Oncology (ASCO) gastrointestinal […]

The post Podcast 274: Preliminary Thoughts on the 2021 ASCO Gastrointestinal Cancer Conference first appeared on Clinical Conversations.

Several categories of medications were used more by lonely people.

Composite physical performance measures and walking speed were both affected.

Brief cessation advice plus free nicotine-replacement products helped some men quit smoking.

During preventative-care visits, 56% of adolescents without prior mental health issues screened positive for depression.

Cognitive-behavioral therapy during antidepressant taper was as effective as continuing antidepressants.

A retrospective study and expert guidance suggest that many inpatients can be managed with sliding scale insulin alone.

Prevalence of both type 1 and type 2 diabetes in children and teens increased from 2001 to 2017.

The U.S. Preventive Services Task Force recommends screening asymptomatic overweight adults starting at age 35.

For type 2 diabetes, weekly insulin icodec seems to be comparable to daily insulin glargine.

During 15 years of follow-up, people who cycled had ≈25% lower mortality risk.