Weight Gain Was Associated With Worsening Glycemia and Cardiovascular and Kidney Outcomes in Patients With Type 2 Diabetes Independent of Diabetes Medication in the GRADE Randomized Controlled Trial

OBJECTIVE: Weight gain with glucose-lowering medications may interfere with effective type 2 diabetes (T2D) management. We evaluated weight change and the effect of weight gain on outcomes over 5 years on four diabetes medications. RESEARCH DESIGN AND METHODS: The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) randomized trial compared the addition of insulin glargine, glimepiride, liraglutide, or sitagliptin to metformin in participants with T2D. We report weight change and hazard ratio (HR) per kilogram of weight change for HbA1c \u3e7.5%; cardiovascular disease (CVD), kidney disease, and neuropathy outcomes; and diabetes treatment satisfaction. RESULTS: Participants (n = 4,980) were 57 ± 10 years, 44% non-White, with HbA1c 7.5% ± 0.5%, and BMI 34.3 ± 6.8 kg/m2. Mean (95% CI) weight change (kg) during the first year was -3.5 (-3.8,-3.2) with liraglutide,-1.07 (-1.4,-0.78) with sitagliptin, 0.45 (0.16, 0.74) with glargine, and 0.89 (0.60, 1.2) with glimepiride (P \u3c 0.0001). Thereafter, weight decreased in all groups. Weight gain within the first 6 months was associated with increased risk of HbA1c \u3e7.5%, with modest differences by treatment, and with subsequent CVD (HR 1.03 [95% CI 1.005, 1.06]). Weight gain at 1 year was associated with increased risk of HbA1c \u3e7.5% (HR 1.05 [1.04, 1.07]) and kidney disease (HR 1.03 [1.01, 1.06]). Baseline weight, but not weight gain, was associated with new-onset neuropathy. Weight gain was associated with lower diabetes treatment satisfaction. CONCLUSIONS: Liraglutide and sitagliptin were associated with initial weight loss and glargine and glimepiride with slight weight gain, followed by weight loss in metformin-treated T2D. Weight gain was associated with worsening glycemia and increased risk of cardiovascular and kidney outcomes largely independent of treatment

Association of Physiologic Parameters with Neurologic Outcome After Arteriovenous Malformation Rupture in Children

Evidence to guide the critical care management of children with ruptured brain arteriovenous malformations is lacking. We aimed to determine whether there are associations between physiologic parameters and outcome in children with ruptured brain arteriovenous malformations. We performed a single-center retrospective review of patients ≤18 years of age with a ruptured brain arteriovenous malformation from 2011 to 2023. Categorization of outcome was based on the Pediatric Stroke Outcome Measure. Descriptive statistics were used. Most patients with an arteriovenous malformation rupture had a poor outcome at discharge (31/49, 63%) and in follow-up at 3-12 months (21/37, 57%). Patients who were normothermic and normoglycemic for the first 7 days after arteriovenous malformation rupture were less likely to have a poor outcome at discharge than those who had a temperature ≥38 °C (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.04-0.52; P = .01) or a blood glucose ≥200 mg/dL (OR 0.11, 95% CI 0.01-0.92; P = .04). A lower minimum hemoglobin concentration (10.00 g/dL [standard deviation (SD) 1.67] vs 12.46 g/dL [SD 6.29], t(47) 2.07, P = .04) and a higher average partial pressure of carbon dioxide (Paco) (40.98 mm Hg [SD 4.30] vs 35.58 mm Hg [SD 7.72], t(47) -2.09, P = .046) were also associated with a poor discharge outcome. A higher average maximum temperature was associated with a poor outcome in follow-up (37.46° C [SD 0.49] vs 37.09 °C [SD 0.59], t(47) -2.09; P = .04). Temperature, blood glucose, hemoglobin concentration, and Paco are potentially modifiable parameters that could be targeted by quality improvement interventions to improve outcomes in this population

HIV Clinic Visit Attendance Among People With HIV Aged 50+ Years: Exploring the Role of Increasing Age, Comorbidity Burden, and the COVID-19 Pandemic

OBJECTIVE: To evaluate the impact of advancing age, comorbidity burden, and the COVID-19 pandemic on HIV clinic visit attendance. STUDY SETTING AND DESIGN: We implemented a repeated cross-sectional study using an ongoing longitudinal cohort of people with HIV (PWH) receiving care in Washington, DC. DATA SOURCES AND ANALYTIC SAMPLE: Our primary exposures of interest were older age categories (60-69 and 70+ compared with 50-59 years), Veterans Aging Cohort Study (VACS) Index (surrogate for comorbidity burden), calendar year (with the three time points of 2018, 2020, and 2022 representing pre-, peri- and post-COVID). Our outcome was the number of HIV clinic visits (including telehealth) in 2018, 2020, and 2022. Associations were assessed using zero-inflated negative binomial modeling. PRINCIPAL FINDINGS: 4041 (72.7% men, 59.3% ages 50-59; 78.8% Black) DC Cohort participants aged 50+ years were included. In 2018, mean VACS indices for participants aged 50-59, 60-69, and 70+ years were 27.5 (standard deviation [SD] 15.8), 36.9 (SD 17.8), and 50.7 (SD 15.5) respectively. Increase in VACS Index was associated with increase in HIV clinic visits (Rate ratio: 1.03, 95% CI 1.01, 1.05). A VACS Index-calendar year interaction term was significant, indicating the relationship between VACS Index and visits was attenuated in the post-COVID time period. All age groups experienced a decrease in visits from 2018 to 2022. HIV RNA suppression remained stable. CONCLUSIONS: These findings underscore the pandemic\u27s impact on accessing healthcare among the most vulnerable, that is, the oldest participants with the most comorbidities. Developing differential care models for PWH to target services to their local context, clinical status, and preferences may point to a broader public health approach to mitigate post-pandemic changes in HIV care utilization

Data-Driven Estimated Glomerular Filtration Rate Strata Predict 90-Day Major Complications Following Total Knee Arthroplasty in Patients With Chronic Kidney Disease

INTRODUCTION: Lower estimated glomerular filtration rate (eGFR) in patients who have chronic kidney disease (CKD) is associated with increased risk of complications following total knee arthroplasty (TKA). However, there is a lack of literature that identifies eGFR levels those are associated with notable differences in risk of these complications. The purpose of this study was to create eGFR strata for CKD patients that are associated with varying risks of 90-day major complications following TKA. METHODS: Nondialysis patients who have CKD and known eGFR levels one month before primary TKA were identified using a national database. Stratum-specific likelihood ratio (SSLR) analysis was used to construct data-driven eGFR strata associated with varying risks of 90-day major complications. The incidence rates were recorded for each stratum. Each stratum was propensity score matched to the highest eGFR stratum. The risk ratio with a corresponding 95% confidence interval for 90-day major complications was recorded for each stratum. RESULTS: A total of 24,895 patients with CKD who underwent TKA were included in this study. SSLR identified four data-driven eGFR strata: 15-31, 32-44, 45-54, and 55+. The unmatched 90-day major complication incidence increased sequentially as the eGFR strata decreased: 55+ (10.72%), 45-54 (13.87%), 32-44 (17.30%), and 15-31 (25.16%). When compared with the matched highest eGFR strata (55+), the risk of sustaining a 90-day major complication increased sequentially as the eGFR strata decreased (RR: 1.27, 1.56, 2.06, P \u3c 0.001). The risk of death within 90 days was higher in the 15-31 stratum (RR: 3.08, P \u3c 0.001) when compared with the matched 55+ stratum. CONCLUSION: Using SSLR analysis, four data-driven strata were identified with varying risks of 90-day major complications following TKA. These eGFR thresholds were created specifically for TKA and can therefore be appropriately used to risk-stratify CKD patients in the preoperative setting when discussing TKA

Digital Resurrection and Posthumous Identity: Toward a Cross-Cultural Neurorights Framework

Digital resurrection technologies use artificial intelligence to recreate the voices, images, and personalities of deceased individuals, raising ethical concerns about memory, identity, and respect for the dignity of the deceased. This paper examines key neuroethical challenges, including mental privacy, cognitive liberty, and the authenticity of AI-generated representations. Rather than framing East-West differences as opposing cultural values, the paper identifies shared ethical concerns expressed through diverse practices. It proposes a cross-cultural governance framework based on universal principles: protecting mental privacy, ensuring faithful representations of identity, and preventing exploitation. Practical mechanisms include digital neural wills, tiered regulation based on technology capabilities, and structured family decision-making. By integrating evidence from neuroscience, law, and cultural studies, this framework aims to ensure that digital resurrection technologies support ethical remembrance rather than commodifying identity. Without proactive governance, these technologies risk distorting how societies remember and honor the deceased

Fool\u27s gold

Already rocked by decades of political interference, corporate influence, mismanagement, and partisan efforts to undermine its authority, the expert bureaucracy, the lifeblood of the US administrative state, is now gasping for air. On 23 May, President Trump issued an executive order (EO)-Restoring Gold Standard Science-promising to fix these issues. Instead, the EO is poised to make them far worse: It officially empowers political appointees to override conclusions and interpretations of government scientists, threaten their professional autonomy, and undermine the scientific capacity of research and regulatory agencies

Risk and management of cardiac disease in kidney and liver transplant recipients

Organ transplantation is the treatment of choice for individuals with kidney failure requiring kidney replacement therapy, as well as for those with end-stage liver disease. Despite the significant reduction in long-term morbidity and mortality with transplantation, kidney and liver allograft recipients remain at high risk for cardiovascular disease (CVD) and premature death from cardiovascular causes. This heightened risk is represented across all phenotypes of CVD, including coronary heart disease, heart failure, arrhythmias, valvulopathies and pulmonary hypertension. Pre-existing vascular risk factors for CVD, coupled with superimposed cardiovascular-kidney-metabolic derangements after transplantation, driven at least in part by post-transplant weight gain, immunosuppressive therapies and de novo risk factors such as dyslipidaemia and diabetes, coalesce to increase total CVD risk. In this review, we summarise pathophysiological considerations for both the short- and long-term increase in CVD risk following kidney/liver transplantation. We review the different phenotypes of CVD, with unique considerations for post-transplant care in this patient population. Finally, we highlight the need for awareness about long-term CVD risk and a multidisciplinary approach to managing organ-specific CVD risk in kidney and liver transplant patients

A Bug\u27s Life: Deleted Scene

Photograph A brief moment where one of nature’s many spectacles unfolds — a tiny Spotted Cucumber Beetle, sitting on the fiery petals of a Blanket Flower, as if a curious little traveler pausing mid-adventure to admire the glow of its bloom. Captured in my parents\u27 garden, this photograph celebrates the vibrant and delicate blends of life that often go unnoticed.https://hsrc.himmelfarb.gwu.edu/artshow_gallery_2025/1030/thumbnail.jp

Isoflavones and changes in body weight and severe hot flashes in postmenopausal women: A secondary analysis of a randomized clinical trial

OBJECTIVE: Severe hot flashes have been associated with an increased risk of cardiovascular disease and diabetes. This secondary analysis assessed associations between isoflavone intake, body weight, and severe hot flashes in postmenopausal women. METHODS: Participants (n = 84) were randomly assigned to a low-fat vegan diet supplemented with soybeans (n = 42) or a control group who made no changes to their diet (n = 42) for 12 weeks. Three-day diet records were analyzed using the Nutrition Data System for Research software. A repeated measures analysis of variance, Spearman correlations, and a linear regression model were used for statistical analyses. RESULTS: Daidzein intake increased in the vegan group (effect size: +34.4 mg/day [95 % CI +28.1 to +40.8], p \u3c 0.001). Similarly, genistein and glycitein increased in the vegan group (effect sizes: +34.8 mg/day [95 % CI +27.7 to +42.0], p \u3c 0.001; and +4.2 mg/day [95 % CI +3.2 to +5.2], p \u3c 0.001, respectively). Mean body weight decreased by 3.6 kg in the vegan group and by 0.2 kg in the control group (effect size: -3.4 kg [95 % CI -4.5 to -2.3], p \u3c 0.001). Severe hot flashes were reduced by 92 % (from 1.3/day to 0.1/day) in the vegan group (p \u3c 0.001) and did not change significantly in the control group (between-group p = 0.02). The increased consumption of each of the three isoflavones was associated with weight loss (r = -0.67, p \u3c 0.001 for daidzein; r = -0.67, p \u3c 0.001 for genistein; and r = -0.66, p \u3c 0.001 for glycitein), but not with the reduction in severe hot flashes. There was no significant association between weight loss and a reduction in severe hot flashes (r = +0.20, p = 0.12). Controlling for energy intake and changes in body mass index, the main independent predictor of a reduction in severe hot flashes was the increased intake of daidzein (p = 0.04). Controlling for fiber and fat intake did not change the results. CONCLUSIONS: These findings suggest that the mechanisms by which a low-fat vegan diet supplemented with soybeans reduces the frequency of severe hot flashes include the increased consumption of daidzein, among other potential factors. Confirmatory trials are needed. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04587154, registered on Oct 14, 2020