Road Traffic Noise and Risk of Parkinson Disease
https://jamanetwork.com/journals/jamaneurology/fullarticle/2851756
This cohort study evaluates the association between long-term exposure to road traffic noise and risk of Parkinson disease.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2851756
This cohort study evaluates the association between long-term exposure to road traffic noise and risk of Parkinson disease.
Exercise and Aortic Stenosis
https://jamanetwork.com/journals/jamacardiology/fullarticle/2851755
The management of severe aortic stenosis (AS) is undergoing a fundamental transformation. For decades, intervention was generally deferred until symptom onset or overt left ventricular systolic dysfunction. This strategy reflected a rational clinical balance: procedural risk was substantial, symptom development signaled clinical decompensation, and watchful waiting appeared prudent. Today, that paradigm is increasingly challenged.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2851755
The management of severe aortic stenosis (AS) is undergoing a fundamental transformation. For decades, intervention was generally deferred until symptom onset or overt left ventricular systolic dysfunction. This strategy reflected a rational clinical balance: procedural risk was substantial, symptom development signaled clinical decompensation, and watchful waiting appeared prudent. Today, that paradigm is increasingly challenged.
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First Effective Nanobody in Myasthenia Gravis Therapy
https://jamanetwork.com/journals/jamaneurology/fullarticle/2851973
In generalized myasthenia gravis (gMG), a continuously increasing spectrum of immunomodulatory agents with different mechanisms of action have been studied, including T- and B-cell directed drugs and drugs acting on downstream antibody-metabolism, such as neonatal Fc receptor (FcRn) and complement inhibitors. Because of the particular pathogenic properties of anti–acetylcholine receptor antibody (AChR-Ab) of the IgG1 and IgG3 type, blocking of complement factor 5 (C5) has been established as a rapidly effective therapeutic principle in generalized AChR-Ab–positive MG during the last decade. Inhibition of complement factor 5 (C5) activation (and thereby cleavage of C5 into C5a and C5b) prevents from membrane attack complex mediated structural damage of the postsynaptic muscle end plate contributing to impaired neuromuscular transmission in AChR-Ab–positive gMG. Apart from already approved C5 inhibitors like eculizumab, ravulizumab, and zilucoplan, further agents directed against C5 but also against other complement factors have been developed. Gefurulimab (formerly ALXN1720), a bispecific nanobody, specifically targets C5 and also human serum albumin (HSA) by a C-terminal C5-binding heavy domain of heavy chain (VHH) connected to an N-terminal albumin-binding VHH via a flexible linker. Binding to HSA extends half-life time of gefurulimab by FcRn-mediated recycling.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2851973
In generalized myasthenia gravis (gMG), a continuously increasing spectrum of immunomodulatory agents with different mechanisms of action have been studied, including T- and B-cell directed drugs and drugs acting on downstream antibody-metabolism, such as neonatal Fc receptor (FcRn) and complement inhibitors. Because of the particular pathogenic properties of anti–acetylcholine receptor antibody (AChR-Ab) of the IgG1 and IgG3 type, blocking of complement factor 5 (C5) has been established as a rapidly effective therapeutic principle in generalized AChR-Ab–positive MG during the last decade. Inhibition of complement factor 5 (C5) activation (and thereby cleavage of C5 into C5a and C5b) prevents from membrane attack complex mediated structural damage of the postsynaptic muscle end plate contributing to impaired neuromuscular transmission in AChR-Ab–positive gMG. Apart from already approved C5 inhibitors like eculizumab, ravulizumab, and zilucoplan, further agents directed against C5 but also against other complement factors have been developed. Gefurulimab (formerly ALXN1720), a bispecific nanobody, specifically targets C5 and also human serum albumin (HSA) by a C-terminal C5-binding heavy domain of heavy chain (VHH) connected to an N-terminal albumin-binding VHH via a flexible linker. Binding to HSA extends half-life time of gefurulimab by FcRn-mediated recycling.
Gefurulimab and Generalized Myasthenia Gravis
https://jamanetwork.com/journals/jamaneurology/fullarticle/2851972
This randomized clinical trial compares the novel dual-binding nanobody gefurulimab vs placebo for treating anti–acetylcholine receptor antibody–positive generalized myasthenia gravis.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2851972
This randomized clinical trial compares the novel dual-binding nanobody gefurulimab vs placebo for treating anti–acetylcholine receptor antibody–positive generalized myasthenia gravis.
Moving Beyond Legal Phobia to Medicolegal Advocacy in Neurology
https://jamanetwork.com/journals/jamaneurology/fullarticle/2851971
This Viewpoint discusses neurologists writing letters on patients’ behalf for legal proceedings.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2851971
This Viewpoint discusses neurologists writing letters on patients’ behalf for legal proceedings.
Lessons From a Community-Designed Meal Program for Heart Failure
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2852238
The ambitious new trial by Eberly et al reports positive changes in health care utilization and clinical outcomes among patients with heart failure (HF) in Navajo Nation receiving a medically tailored meal program. Three months after starting an 8-week treatment that provided 2 meals per day prepared with Indigenous foods, the proportion of patients with any all-cause hospitalization or emergency department visit was significantly lower among those in the treatment arm compared with controls (40.6% vs 57.0%), with a 71% reduction in HF-specific hospitalizations. Beneficial changes in secondary outcomes included improvements in Kansas City Cardiomyopathy Questionnaire scores, food security, dietary intake, financial strain, weight, and blood pressure.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2852238
The ambitious new trial by Eberly et al reports positive changes in health care utilization and clinical outcomes among patients with heart failure (HF) in Navajo Nation receiving a medically tailored meal program. Three months after starting an 8-week treatment that provided 2 meals per day prepared with Indigenous foods, the proportion of patients with any all-cause hospitalization or emergency department visit was significantly lower among those in the treatment arm compared with controls (40.6% vs 57.0%), with a 71% reduction in HF-specific hospitalizations. Beneficial changes in secondary outcomes included improvements in Kansas City Cardiomyopathy Questionnaire scores, food security, dietary intake, financial strain, weight, and blood pressure.
Progressive Dyspnea After Mitral Valve Replacement
https://jamanetwork.com/journals/jamacardiology/fullarticle/2851855
A 58-year-old woman with a history of mechanical mitral valve replacement presented with progressive exertional dyspnea that had worsened markedly over the preceding 2 weeks. What would you do next?
https://jamanetwork.com/journals/jamacardiology/fullarticle/2851855
A 58-year-old woman with a history of mechanical mitral valve replacement presented with progressive exertional dyspnea that had worsened markedly over the preceding 2 weeks. What would you do next?
Woman in Her 40s With Complex Cardiopulmonary Vascular Anomalies and Hemoptysis
https://jamanetwork.com/journals/jamacardiology/fullarticle/2851854
This case report discusses scimitar syndrome in a woman in her 40s who presented with 8 days of recurrent hemoptysis.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2851854
This case report discusses scimitar syndrome in a woman in her 40s who presented with 8 days of recurrent hemoptysis.
Continuous Glucose Monitoring for Persons With and Without Diabetes
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2851942
This JAMA Internal Medicine Patient Page describes use of continuous glucose monitors, as well as their benefits and drawbacks.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2851942
This JAMA Internal Medicine Patient Page describes use of continuous glucose monitors, as well as their benefits and drawbacks.
Continuous Glucose Monitoring in Type 2 Diabetes and Beyond
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2851941
This review examines the evidence for continuous glucose monitoring use beyond type 1 diabetes or pregnancy, explores its usefulness as a behavior change aid, and critically assesses its expanding role in the care of people with dysglycemia.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2851941
This review examines the evidence for continuous glucose monitoring use beyond type 1 diabetes or pregnancy, explores its usefulness as a behavior change aid, and critically assesses its expanding role in the care of people with dysglycemia.
Artificial Intelligence in Correctional Health Care
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2851940
This Viewpoint explores how artificial intelligence may mitigate or exacerbate inequities in correctional health systems and outlines policy and implementation considerations necessary to ensure health equity for incarcerated populations.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2851940
This Viewpoint explores how artificial intelligence may mitigate or exacerbate inequities in correctional health systems and outlines policy and implementation considerations necessary to ensure health equity for incarcerated populations.
Cataplexy in Narcolepsy Type 1
https://jamanetwork.com/journals/jamaneurology/fullarticle/2852246
This case report describes a 60-year-old woman presenting with sudden loss of muscle tone with preserved consciousness and severe daytime sleepiness.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2852246
This case report describes a 60-year-old woman presenting with sudden loss of muscle tone with preserved consciousness and severe daytime sleepiness.
Multiple Sclerosis Onset Preceding Epstein-Barr Virus Infection
https://jamanetwork.com/journals/jamaneurology/fullarticle/2852245
This cohort study examines data for a large population-based cohort to identify and characterize any cases of primary Epstein-Barr virus infection that occurred after the onset of multiple sclerosis.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2852245
This cohort study examines data for a large population-based cohort to identify and characterize any cases of primary Epstein-Barr virus infection that occurred after the onset of multiple sclerosis.
Serum GFAP Dynamics, Disease Progression, and Therapy Response in MS
https://jamanetwork.com/journals/jamaneurology/fullarticle/2852244
This cohort study evaluates the association between serum glial fibrillary acidic protein levels and future progression of multiple sclerosis.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2852244
This cohort study evaluates the association between serum glial fibrillary acidic protein levels and future progression of multiple sclerosis.
Automated Speech Analysis in Primary Progressive Aphasia
https://jamanetwork.com/journals/jamaneurology/fullarticle/2852243
This cross-sectional study investigates if automated analysis of connected speech can distinguish primary progressive aphasia variants and reflect neuroanatomical and neuropathologic substrates.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2852243
This cross-sectional study investigates if automated analysis of connected speech can distinguish primary progressive aphasia variants and reflect neuroanatomical and neuropathologic substrates.
Food Insecurity Is Not a Nutritional Phenotype in Heart Failure
https://jamanetwork.com/journals/jamacardiology/fullarticle/2852487
To the Editor Pandey et al should be congratulated for completing a pragmatic randomized clinical trial of food as medicine in the highest-risk period after heart failure (HF) hospitalization. However, we believe that FOOD-HF is most important not as a negative trial, but as a cautionary example of phenotype-end point mismatch.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2852487
To the Editor Pandey et al should be congratulated for completing a pragmatic randomized clinical trial of food as medicine in the highest-risk period after heart failure (HF) hospitalization. However, we believe that FOOD-HF is most important not as a negative trial, but as a cautionary example of phenotype-end point mismatch.
Food Insecurity Is Not a Nutritional Phenotype in Heart Failure
https://jamanetwork.com/journals/jamacardiology/fullarticle/2852486
To the Editor Pandey and colleagues report that 90-day postdischarge food supplementation was feasible and well accepted in patients recently hospitalized for heart failure (HF), but did not reduce HF readmission or emergency department visits compared with usual care. Two interpretive issues limit generalizability.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2852486
To the Editor Pandey and colleagues report that 90-day postdischarge food supplementation was feasible and well accepted in patients recently hospitalized for heart failure (HF), but did not reduce HF readmission or emergency department visits compared with usual care. Two interpretive issues limit generalizability.
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Food Insecurity Is Not a Nutritional Phenotype in Heart Failure—Reply
https://jamanetwork.com/journals/jamacardiology/fullarticle/2852485
In Reply We thank Wang and Liu and Zavaleta-Monestel and Chaverri-Fernandez for their thoughtful comments on the FOOD-HF trial. Their letters converge on 3 themes: nutritional phenotyping, potential for bias in open-label patient-reported outcome assessment, and the bundling of food delivery with dietitian co-intervention. We address each in turn.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2852485
In Reply We thank Wang and Liu and Zavaleta-Monestel and Chaverri-Fernandez for their thoughtful comments on the FOOD-HF trial. Their letters converge on 3 themes: nutritional phenotyping, potential for bias in open-label patient-reported outcome assessment, and the bundling of food delivery with dietitian co-intervention. We address each in turn.
Left Ventricular Dimension and Mortality in Patients With Heart Failure
https://jamanetwork.com/journals/jamacardiology/fullarticle/2852484
This cohort study investigates the association between left ventricular dimension and mortality in patients with heart failure.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2852484
This cohort study investigates the association between left ventricular dimension and mortality in patients with heart failure.
Trials Terminated Early
https://jamanetwork.com/journals/jama/fullarticle/2852512
What does it mean to stop a clinical trial early? In the early days of the modern randomized trial, it meant the research had not gone according to plan. Trialists were expected to adhere to the sample sizes they originally proposed based on early assumptions about underlying event rates, loss to follow-up, and variability in outcomes. When a trial was stopped prematurely, it indicated that foundational assumptions had proven incorrect, critical safety or protocol issues had emerged, or logistical challenges had grown insurmountable. Early trial termination carried an implicit presumption of failure: that the trial had been inadequately planned, poorly executed, or simply overtaken by circumstances beyond investigators’ control.
https://jamanetwork.com/journals/jama/fullarticle/2852512
What does it mean to stop a clinical trial early? In the early days of the modern randomized trial, it meant the research had not gone according to plan. Trialists were expected to adhere to the sample sizes they originally proposed based on early assumptions about underlying event rates, loss to follow-up, and variability in outcomes. When a trial was stopped prematurely, it indicated that foundational assumptions had proven incorrect, critical safety or protocol issues had emerged, or logistical challenges had grown insurmountable. Early trial termination carried an implicit presumption of failure: that the trial had been inadequately planned, poorly executed, or simply overtaken by circumstances beyond investigators’ control.