The American journal of medicine
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Recent applications of artificial intelligence-derived methods of computational design have permitted de novo creation of proteins that do not exist in nature but have potent effects on human cells and organ systems. These rapid procedures also allow in 1 step protein modifications that optimize function, potency, stability, resistance to biodegradation, cellular and tissue distribution and biological half-time. Such proteins generated to date include cytokines, antibodies, inhibitors of cell death proteins and antagonists of extracellular receptors for growth factors and viruses. Newly designed proteins have broad medical diagnostic and therapeutic potentials, as well as the capacity to alter many normal activities of human cells.
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Thirty percent of Americans report insomnia. After eliminating obvious causes, the best therapy for insomnia is cognitive behavioral therapy, but this is not widely available. ⋯ Recently, a new class of safe, nonaddicting, mechanism-based hypocretin blockers have been developed. Herein we review the information not only for insomnia but also for narcolepsy.
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Primary clinicians foster long-term relationships with patients and play key roles in the treatment journey for patients with cancer. Primary clinicians are important members of the multidisciplinary team and are central in coordinating and providing supportive care. The use of immune checkpoint inhibitors in adjuvant/neoadjuvant treatments and metastatic disease requires an awareness of their long-term survival benefits and immune-related adverse events (irAEs). ⋯ Delayed irAEs underscore the importance of continued clinical vigilance following treatment, as primary clinicians are patients' most enduring point of contact. Primary clinicians have a critical role in supporting the care of patients with cancer and ensuring appropriate irAE recognition, monitoring, and intervention. Long-term continuity of care is critical for the immuno-oncology patient journey.
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Meta Analysis
Fever of Unknown Origin (FUO) Criteria Influences Diagnostic Outcomes: A Systematic Review and Meta-Analysis.
Criteria classifying fever of unknown origin (FUO) patients remains subject to discrepancies. A minimal standardized set of investigative tests serves as the foundation for the qualitative criteria, whereas quantitative incorporates the length of evaluation (7 or 3 days). A systematic review of studies would help physicians anticipate the frequency of illness types that could influence management. ⋯ Use of either qualitative or quantitative FUO criteria was associated with a statistically significant risk of over- or under-estimating infectious diseases and undiagnosed illnesses when using an ICD-10 adjusted FUO five-category system. Clinicians should anticipate differences depending on which criteria are used. While further research is warranted, qualitative criteria provide the best framework for study comparisons.
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Review
Inclusion of Dental Services in Medicare to Improve Oral and General Health for Older Americans.
Poor oral health negatively impacts overall health, quality of life, and well-being. Increasing evidence suggests that provision of basic dental care for elderly Americans would improve outcomes for a variety of systemic diseases and reduce the overall cost of healthcare. ⋯ This article outlines evidence, rationale, and approaches required for inclusion of dental benefits for more Americans through the Medicare program. Improving access to dental services through Medicare to help prevent and manage common chronic diseases is an important step toward integration of dental care with general healthcare to improve the overall health, quality of life, and well-being for many older Americans.