Humans

Summary Daratumumab, a human IgG1κ monoclonal antibody targeting CD38, is used to treat multiple myeloma. We describe successful treatment with daratumumab in a case of treatment-refractory pure red-cell aplasia after ABO-mismatched allogeneic stem-cell transplantation. The patient was a 72-year-old man with the myelodysplastic syndrome who received a transplant from an HLA-matched, unrelated donor with a
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To the Editor: Despite the astonishing advances in hepatitis C virus (HCV) treatment, HCV remains a major source of chronic liver disease.1,2 Abul-Husn et al.3 recently reported an association between a loss-of-function variant (rs72613567:TA) in HSD17B13 and reduced risk of alcoholic and nonalcoholic nonviral chronic liver diseases. We conducted a test for association between the
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To the Editor Figure 1. Figure 1. Trends in Hospitalizations, Cost of Each Hospitalization, and Death among Adult Patients with Sickle Cell Anemia, 2000 through 2014. Niihara et al. (July 19 issue)1 show the clinical benefits of oral therapy with pharmaceutical-grade l-glutamine (USAN, glutamine; Endari, Emmaus Medical). We analyzed the growing financial burden of sickle
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A 39-year-old man presented to the emergency department with a 4-week history of increasing abdominal pain and constipation. Physical examination of the abdomen and the results on abdominal imaging, including ultrasonography and computed tomography, were normal. Laboratory investigations revealed a hemoglobin level of 12.5 g per deciliter (normal range, 14.0 to 17.5). Findings on upper
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Hypertension is the most common preventable cause of cardiovascular disease (CVD) worldwide. It is commonly referred as a “silent killer” because it gradually damages the heart, blood vessels, and other organs without any apparent symptoms. Elevated blood pressure (BP) is a major risk factor for myocardial infarction, heart failure (HF), stroke, chronic kidney disease, peripheral
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Primary care practices are increasingly participating in pay-for-performance programs linked to quality measures, such as hypertension control. Practices report on these metrics for benchmarking and eligibility for financial incentives as part of accountable care organizations, delivery system reform incentive payment programs, and other initiatives. In this Viewpoint, we recommend that quality measure stewards allow health
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In Reply We welcome the opportunity to elaborate on the concept of management reasoning as discussed in our Viewpoint.1 We did not mean to imply that diagnostic reasoning and management reasoning are sequential. On the contrary, we agree that in practice, these typically occur in parallel and often influence one another.2 Indeed, naturalistic studies of
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If your blood pressure is suspected to be high, it is important to know your blood pressure measurement pattern outside the doctor’s office. If you are taking medication to control your blood pressure, regular blood pressure monitoring could help your doctor decide how to adjust your medication, if necessary. There are 2 different ways to
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The FDA has approved a humanized monoclonal antibody to prevent chronic migraine headaches in adults. Teva Pharmaceuticals Marketed as Ajovy, fremanezumab-vfrm binds to calcitonin gene-related peptide ligand and blocks it from binding to its receptor. The drug is administered by injection, either monthly or quarterly. Its ability to prevent migraine headaches was evaluated in 2
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Clinical practice guidelines are an important established resource in medicine and public health. Clinical practice guidelines are particularly well suited to conditions such as high blood pressure (BP) that are common, result in a substantial disease burden and utilization of health care resources, incur individual and societal cost, demonstrate large variation in practice patterns, and
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In Reply Drs Agustini and Berk raise 3 primary concerns regarding our analysis demonstrating an association between the use of prescription medications with depression as a potential adverse effect and concurrent depression. Their first concern is that we did not account for the association between depression and other health conditions besides hypertension—particularly conditions related to
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This issue of JAMA, from illustrated cover to in-depth content, is dedicated to hypertension, a worldwide problem of enormous consequence. High blood pressure affects more than 1 billion people worldwide, and that number is increasing. Untreated or uncontrolled, hypertension is the single largest contributor to cardiovascular disease, causing stroke, heart failure, coronary artery disease, and
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Explaining consciousness is one of the hardest problems in science and philosophy. Recent neuroscientific discoveries suggest that a solution could be within reach – but grasping it will mean rethinking some familiar ideas. Consciousness, I argue in a new paper, may be caused by the way the brain generates loops of energetic feedback, similar to
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Neanderthals are often depicted as barrel-chested, hunched-over cavemen, but a close inspection of their fossils is telling a different story. For the first time, an international team of researchers has reconstructed the ribcage and upper spine of a Neanderthal man who died roughly 60,000 years ago. The findings suggest that contrary to popular images, these
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Analysis for Relapse-Specific Mutations To determine whether AML relapse after transplantation was associated with recurrent mutations, we performed enhanced exome sequencing on samples from 15 patients who had a relapse after transplantation, including 6 patients who presented with isolated extramedullary disease. The transplants had been from HLA-matched related donors, HLA-matched unrelated donors, or HLA-mismatched unrelated
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To the Editor We thank Kao et al. (June 21 issue)1 for their discussion but question the diagnosis of atypical hemolytic–uremic syndrome, a disorder we similarly considered in a 3-year-old girl who presented with anemia (hemoglobin level, 78 g per deciliter), thrombocytopenia (platelet count, 22,000 per cubic millimeter), and azotemia (creatinine level, 1.9 mg per
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Abstract Background The Hu5F9-G4 (hereafter, 5F9) antibody is a macrophage immune checkpoint inhibitor blocking CD47 that induces tumor-cell phagocytosis. 5F9 synergizes with rituximab to eliminate B-cell non-Hodgkin’s lymphoma cells by enhancing macrophage-mediated antibody-dependent cellular phagocytosis. This combination was evaluated clinically. Methods We conducted a phase 1b study involving patients with relapsed or refractory non-Hodgkin’s lymphoma.
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Abstract Background A point-prevalence survey that was conducted in the United States in 2011 showed that 4% of hospitalized patients had a health care–associated infection. We repeated the survey in 2015 to assess changes in the prevalence of health care–associated infections during a period of national attention to the prevention of such infections. Methods At
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To the Editor: Several classic cardiac genetic disorders have been identified from specific electrocardiographic (ECG) patterns.1-3 Here, we describe five unrelated families, from three different countries, with features that appear to represent a previously unrecognized autosomal dominant syndrome. These families were identified at three tertiary referral centers for patients with known or suspected inherited cardiac
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Trial Design and Oversight We conducted this prospective, randomized, open-label, blinded end-point,14 controlled trial at 50 sites in the United Kingdom. The trial protocol15 (available with the full text of this article at NEJM.org) was approved by the relevant health authorities and institutional review boards, and all the patients provided written informed consent. An independent
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Trial Design and Oversight We performed screening and randomization between January 4, 2016, and October 22, 2017, in 33 ICUs in Denmark, Finland, the Netherlands, Norway, Switzerland, and the United Kingdom after obtaining institutional approval at each site. We obtained written informed consent from the patients or their legal surrogates in accordance with national regulations.
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Critical illness can disrupt local and systemic mechanisms that protect against upper gastrointestinal bleeding, a condition that may be associated with increased mortality,1 particularly among patients receiving extracorporeal life support.2 On the basis of randomized trials performed over a period of 40 years,3 most guidelines recommend preventive therapy with either histamine H2–receptor antagonists or proton-pump
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To the Editor The results of the Suppression of Ovarian Function Trial (SOFT) and the Tamoxifen and Exemestane Trial (TEXT) reported by Francis et al. (July 12 issue)1 prompt one to consider their global relevance. The annual global case burden of hormone-receptor–positive breast cancer in premenopausal women is approximately 350,000 to 420,000 cases in low-
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To the Editor The Trial Assigning Individualized Options for Treatment (TAILORx) conducted by Sparano et al. (July 12 issue)1 showed that endocrine therapy alone was noninferior to chemoendocrine therapy in women with hormone-receptor–positive, human epidermal growth factor receptor 2–negative, axillary node–negative breast cancer who had a midrange 21-gene recurrence score. Recurrence scores based on the
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To the Editor: Long-duration spaceflight has detrimental effects in several physiological systems. Several studies have shown an upward shift of the cerebral hemispheres, a decrease in frontotemporal volume, and an increase in ventricle size after spaceflight.1-3 However, information is limited about the effects of microgravity on brain volume, particularly regarding changes that are evident more
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To the Editor The POINT (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke) trial conducted by Johnston et al. (July 19 issue)1 showed that the combination of clopidogrel and aspirin was superior to aspirin alone and led to a lower risk of major ischemic events in the first 90 days among patients with minor
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To the Editor Figure 1. Figure 1. Estimates of Mortality Related to Hurricane Maria. Panel A depicts mortality forecast on the basis of the average of a state-space and autoregressive integrated moving average (ARIMA) model. Model fit was calculated on the basis of mortality data before September 2017 with the use of cross-validation on a
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