CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Endocrinology: [Formula: see text] Geriatrics: [Formula: see text] Rheumatology: [Formula: see text].
CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text].
CLINICAL IMPACT RATINGS:Emergency Med: [Formula: see text] GIM/FP/GP: [Formula: see text] Infectious Disease: [Formula: see text] Critical Care: [Formula: see text].
CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Gastroenterology: [Formula: see text] Public Health: [Formula: see text].
CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Endocrinology: [Formula: see text].
CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text] Endocrinology: [Formula: see text] Nephrology: [Formula: see text].
CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Nephrology: [Formula: see text] Hematology: [Formula: see text].
BACKGROUND:Maternal folic acid prevents neural tube defects, but associations of parental folate and vitamin B12 with birth defects remain unclear. OBJECTIVE:To quantify associations of parental vitamin B12 and red blood cell (RBC) folate with offspring birth defects. DESIGN:Prospective cohort study. SETTING:Shanghai Preconception Cohort, China. PARTICIPANTS:3032 couples (73 birth defect cases) with biomarkers sampled within 4 months before conception, and 17 765 women (327 birth defect cases) sampled at 4 months' gestation or earlier. MEASUREMENTS:Standardized predicted prevalences of birth defects ascertained among live births, stillbirths, and abortions due to fetal abnormalities were estimated using weighted logistic regression. RESULTS:Higher preconception parental levels of vitamin B12 were associated with lower predicted prevalences of birth defects in dose-response analyses. For preconception maternal vitamin B12 from the lowest (<148 pmol/L) to highest (≥590 pmol/L) categories, predicted prevalence decreased from 49.6 to 16.2 cases per 1000 pregnancies; paternal vitamin B12 showed a similar but attenuated pattern (55.5 to 24.0 cases per 1000 pregnancies). Preconception parental RBC folate showed imprecise patterns of lower predicted prevalence. For postconception maternal RBC folate, predicted prevalence was lower at levels of 906 to 1131 nmol/L than at levels below 453 nmol/L (16.5 vs. 25.7 cases per 1000 pregnancies), with little further reduction at higher levels. For postconception maternal vitamin B12, predicted prevalence changed little across lower categories but was lower at higher levels (11.8 vs. 20.4 cases per 1000 pregnancies at ≥590 vs. 148 to 294 pmol/L, respectively). LIMITATION:Residual confounding. CONCLUSION:Periconception parental vitamin B12 and postconception maternal RBC folate were associated with lower predicted prevalences of birth defects. PRIMARY FUNDING SOURCE:National Key Research and Development Program of China, National Natural Science Foundation of China, and Chinese Academy of Medical Sciences.
CLINICAL IMPACT RATINGS:Emergency Med: [Formula: see text] GIM/FP/GP: [Formula: see text] Neurology: [Formula: see text].
Artificial intelligence (AI) in health care is being rapidly adopted in perhaps one of the most rapid implementations of technology in medicine to date. Better thought of as augmented intelligence, as a tool that provides assistance to physicians and patients, many guidelines for its use have been issued, but consensus has not yet been achieved on issues such as privacy, disclosure, and fairness. Patients and physicians need ethical guidance at the point of care. Three guideposts described in this American College of Physicians position paper and rooted in the patient-physician relationship-principles of medical ethics, clinical integrity, and physician-independent practical reasoning-can inform the ethical use of AI: relationality, self-governance, and competence. This paper examines the implications of AI for patients, physicians, and health care and provides guidance for its ethical use.
CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Rheumatology: [Formula: see text].
BACKGROUND:Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for weight management. PURPOSE:To update our prior systematic review evaluating the efficacy and safety of GLP-1 RAs and co-agonists among adults with overweight or obesity without diabetes. DATA SOURCES:MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from 5 October 2024 through 25 March 2026. STUDY SELECTION:Randomized controlled trials ([RCTs] treatment duration ≥16 weeks). DATA EXTRACTION:Two reviewers independently extracted data. DATA SYNTHESIS:Thirty-eight RCTs (n = 25 816) were included, adding 14 new trials (n = 11 000) to the prior review. Among commercially available therapies, placebo-subtracted weight loss reached up to -5.8% (95% CI, -8.0% to -3.6%) for liraglutide, -14.8% (CI, -16.2% to -13.4%) for subcutaneous semaglutide, -14.3% (CI, -17.2% to -11.4%) for oral semaglutide, -12.4% (CI, -15.1% to -9.7%) for orforglipron, and -19.0% (CI, -21.6% to -16.4%) for tirzepatide. Numerically greater placebo-subtracted reductions were seen with emerging multiagonists, including -23.9% (CI, -29.3% to -18.5%) with amycretin and -22.1% (CI, -24.9% to -19.3%) with retatrutide. Gastrointestinal adverse events (AEs) remained common (GLP-1 RA vs. placebo: 76.0% vs. 40.1%). Discontinuation due to AEs was generally low (10.7% vs. 3.4%) but numerically higher with some oral agents. Serious AEs (6.5% vs. 5.2%) and deaths (0.1% vs. 0.0%) were rare, with no new safety signals identified. Head-to-head data showed greater weight loss with semaglutide and JNJ-64565111 than liraglutide and greater weight loss with tirzepatide and cagrilintide-semaglutide (CagriSema; Novo Nordisk) than semaglutide. LIMITATIONS:Heterogeneity precluded quantitative synthesis. Safety outcomes were inconsistently reported. CONCLUSION:Glucagon-like peptide-1 receptor agonists demonstrate substantial weight loss in adults without diabetes, with an expanding range of therapeutic options, including oral and multiagonist therapies. PRIMARY FUNDING SOURCE:None. (PROSPERO: CRD42024505558).
CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Neurology: [Formula: see text].
