Nature Medicine

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ISSN / EISSN : 1078-8956 / 1546-170X
Published by: Springer Nature (10.1038)
Total articles ≅ 13,594
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Evan Xu, Yan Xie,
Published: 22 September 2022
Journal: Nature Medicine
Abstract:
The neurologic manifestations of acute COVID-19 are well characterized, but a comprehensive evaluation of postacute neurologic sequelae at 1 year has not been undertaken. Here we use the national healthcare databases of the US Department of Veterans Affairs to build a cohort of 154,068 individuals with COVID-19, 5,638,795 contemporary controls and 5,859,621 historical controls; we use inverse probability weighting to balance the cohorts, and estimate risks and burdens of incident neurologic disorders at 12 months following acute SARS-CoV-2 infection. Our results show that in the postacute phase of COVID-19, there was increased risk of an array of incident neurologic sequelae including ischemic and hemorrhagic stroke, cognition and memory disorders, peripheral nervous system disorders, episodic disorders (for example, migraine and seizures), extrapyramidal and movement disorders, mental health disorders, musculoskeletal disorders, sensory disorders, Guillain–Barré syndrome, and encephalitis or encephalopathy. We estimated that the hazard ratio of any neurologic sequela was 1.42 (95% confidence intervals 1.38, 1.47) and burden 70.69 (95% confidence intervals 63.54, 78.01) per 1,000 persons at 12 months. The risks and burdens were elevated even in people who did not require hospitalization during acute COVID-19. Limitations include a cohort comprising mostly White males. Taken together, our results provide evidence of increased risk of long-term neurologic disorders in people who had COVID-19.
, Steven Le Gouill, Roberta Di Blasi, Pierre Sesques, Guillaume Manson, Guillaume Cartron, , Louise Roulin, François Xavier Gros, Marie Thérèse Rubio, et al.
Published: 22 September 2022
Journal: Nature Medicine
Abstract:
Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) have both demonstrated impressive clinical activity in relapsed/refractory (R/R) diffuse large B cell lymphoma (DLBCL). In this study, we analyzed the outcome of 809 patients with R/R DLBCL after two or more previous lines of treatment who had a commercial chimeric antigen receptor (CAR) T cells order for axi-cel or tisa-cel and were registered in the retrospective French DESCAR-T registry study (NCT04328298). After 1:1 propensity score matching (n = 418), the best overall response rate/complete response rate (ORR/CRR) was 80%/60% versus 66%/42% for patients treated with axi-cel compared to tisa-cel, respectively (P < 0.001 for both ORR and CRR comparisons). After a median follow-up of 11.7 months, the 1-year progression-free survival was 46.6% for axi-cel and 33.2% for tisa-cel (hazard ratio (HR) = 0.61; 95% confidence interval (CI), 0.46–0.79; P = 0.0003). Overall survival (OS) was also significantly improved after axi-cel infusion compared to after tisa-cel infusion (1-year OS 63.5% versus 48.8%; HR = 0.63; 95% CI, 0.45–0.88; P = 0.0072). Similar findings were observed using the inverse probability of treatment weighting statistical approach. Grade 1–2 cytokine release syndrome was significantly more frequent with axi-cel than with tisa-cel, but no significant difference was observed for grade ≥3. Regarding immune effector cell-associated neurotoxicity syndrome (ICANS), both grade 1–2 and grade ≥3 ICANS were significantly more frequent with axi-cel than with tisa-cel. In conclusion, our matched comparison study supports a higher efficacy and also a higher toxicity of axi-cel compared to tisa-cel in the third or more treatment line for R/R DLBCL.
Thore Buergel, Jakob Steinfeldt, Greg Ruyoga, Maik Pietzner, Daniele Bizzarri, Dina Vojinovic, Julius Upmeier zu Belzen, Lukas Loock, Paul Kittner, Lara Christmann, et al.
Published: 22 September 2022
Journal: Nature Medicine
Abstract:
Risk stratification is critical for the early identification of high-risk individuals and disease prevention. Here we explored the potential of nuclear magnetic resonance (NMR) spectroscopy-derived metabolomic profiles to inform on multidisease risk beyond conventional clinical predictors for the onset of 24 common conditions, including metabolic, vascular, respiratory, musculoskeletal and neurological diseases and cancers. Specifically, we trained a neural network to learn disease-specific metabolomic states from 168 circulating metabolic markers measured in 117,981 participants with ~1.4 million person-years of follow-up from the UK Biobank and validated the model in four independent cohorts. We found metabolomic states to be associated with incident event rates in all the investigated conditions, except breast cancer. For 10-year outcome prediction for 15 endpoints, with and without established metabolic contribution, a combination of age and sex and the metabolomic state equaled or outperformed established predictors. Moreover, metabolomic state added predictive information over comprehensive clinical variables for eight common diseases, including type 2 diabetes, dementia and heart failure. Decision curve analyses showed that predictive improvements translated into clinical utility for a wide range of potential decision thresholds. Taken together, our study demonstrates both the potential and limitations of NMR-derived metabolomic profiles as a multidisease assay to inform on the risk of many common diseases simultaneously.
, , Barbara Wendelberger, Hilary W. Heuer, , Yann Cobigo, Amy Wolf, Sheng-Yang Matt Goh, Leonard Petrucelli, , et al.
Published: 22 September 2022
Journal: Nature Medicine
The publisher has not yet granted permission to display this abstract.
Rebecca C. Simpson, Erin R. Shanahan, Marcel Batten, Irene L. M. Reijers, , Ines P. Silva, Judith M. Versluis, Rosilene Ribeiro, Alexandra S. Angelatos, Jian Tan, et al.
Published: 22 September 2022
Journal: Nature Medicine
The publisher has not yet granted permission to display this abstract.
Addendum
Joana Isidro, Vítor Borges, Miguel Pinto, , João Dourado Santos, , Verónica Mixão, Rita Ferreira, Daniela Santos, Silvia Duarte, et al.
Published: 21 September 2022
Journal: Nature Medicine
Published: 21 September 2022
Journal: Nature Medicine
Nature Medicine, Volume 28, pp 1725-1725; https://doi.org/10.1038/s41591-022-02020-w

The publisher has not yet granted permission to display this abstract.
, Nicholas E. Banovich, , Cansu Cimen-Bozkus, Josephine R. Giles, Zinaida Good, Daniel Goodman, Vanessa D. Jonsson, , , et al.
Published: 20 September 2022
Journal: Nature Medicine
Nature Medicine, Volume 28, pp 1761-1764; https://doi.org/10.1038/s41591-022-01986-x

The publisher has not yet granted permission to display this abstract.
, Valtteri Wirta, Lucia Cavelier, Eva Berglund, Mikaela Friedman, Michael Akhras, Johan Botling, , Lars Engstrand, Gisela Helenius, et al.
Published: 19 September 2022
Journal: Nature Medicine
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