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What I Do Not Tell the Medical Student N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-16 Erica Andrist
What do we tell medical students who are wowed by senior physicians’ power and control over patients’ conditions and outcomes when we know this power and control are largely illusory?
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Rhino-orbital-cerebral Mucormycosis N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-16 Cristian-Mihail Niculae, Laura Craciun
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Intraventricular CARv3-TEAM-E T Cells in Recurrent Glioblastoma N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-13 Bryan D. Choi, Elizabeth R. Gerstner, Matthew J. Frigault, Mark B. Leick, Christopher W. Mount, Leonora Balaj, Sarah Nikiforow, Bob S. Carter, William T. Curry, Kathleen Gallagher, Marcela V. Maus
In this first-in-human, investigator-initiated, open-label study, three participants with recurrent glioblastoma were treated with CARv3-TEAM-E T cells, which are chimeric antigen receptor (CAR) T cells engineered to target the epidermal growth factor receptor (EGFR) variant III tumor-specific antigen, as well as the wild-type EGFR protein, through secretion of a T-cell–engaging antibody molecule (TEAM)
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The Journal’s Historical “Indian Problem” N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-14
To the Editor: The Perspective article by Jones et al. (Jan. 4 issue)1 discusses outside perceptions of Indigenous peoples. These communities have maintained their cultures and medicinal practices despite centuries of undue adversity. How can medicine respond? By understanding determinants of Indigenous health, our health systems can tailor care protocols and patient resources, given that the integration
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Wearable Technology in Clinical Practice for Depressive Disorder N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-14
To the Editor: Fedor et al. (Dec. 28 issue)1 review a topic of growing interest: the potential of wearable devices to gather objective measures to aid in the treatment of depression. However, in psychiatry, we posit that subjectivity plays a primary role in treatment2; the evaluation of depression is more complex than a simple sum of symptoms.3,4 Furthermore, medication that is commonly used to treat
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Lumasiran, Isolated Kidney Transplantation, and Continued Vigilance N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-14 Justine Bacchetta, Stéphanie Clavé, Peggy Perrin, Sandrine Lemoine, Anne-Laure Sellier-Leclerc, Lisa J. Deesker
Although lumasiran targets glycolate oxidase and decreases hepatic oxalate synthesis, systemic oxalate release continues after single-organ kidney transplantation, requiring close follow-up with rigorous hyperhydration.
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Improving Noninvasive Colorectal Cancer Screening N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-14 John M. Carethers
Noninvasive colorectal cancer screening commenced historically with the use of guaiac-based tests that require the addition of hydrogen peroxide to oxidize the presence of substances such as blood in stool. Large, randomized, controlled trials of these tests in a screened population showed the detection of earlier-stage cancers that could be curable, a reduction in mortality from colorectal cancer
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Case 8-2024: A 55-Year-Old Man with Cardiac Arrest, Cardiogenic Shock, and Hypoxemia N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-14 Robert O. Roswell, Man Piu Wong, Ada C. Stefanescu Schmidt, Milena Petranovic, Emily K. Zern, Daniel Burkhoff, Thoralf M. Sundt, Patrick T. O’Gara, Cynthia K. Harris
A 55-year-old man had an out-of-hospital cardiac arrest. An evaluation showed 2-mm ST-segment elevations in the inferior leads on electrocardiography, cardiogenic shock, and a new systolic murmur. A diagnosis was made.
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Cavernous Malformations of the Central Nervous System N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-14 Edward R. Smith
Cerebral cavernous malformations occur in 0.5% of the population; 85% are sporadic, and 15% are familial or radiation-induced. Several genetic variants, including variants in CCM, drive their development.
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RSV Prefusion F Protein–Based Maternal Vaccine — Preterm Birth and Other Outcomes N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-14 Ilse Dieussaert, Joon Hyung Kim, Sabine Luik, Claudia Seidl, Wenji Pu, Jens-Ulrich Stegmann, Geeta K. Swamy, Peggy Webster, Philip R. Dormitzer
Background Vaccination against respiratory syncytial virus (RSV) during pregnancy may protect infants from RSV disease. Efficacy and safety data on a candidate RSV prefusion F protein–based maternal vaccine (RSVPreF3-Mat) are needed. Methods We conducted a phase 3 trial involving pregnant women 18 to 49 years of age to assess the efficacy and safety of RSVPreF3-Mat. The women were randomly assigned
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Oral Iptacopan Monotherapy in Paroxysmal Nocturnal Hemoglobinuria N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-14 Régis Peffault de Latour, Alexander Röth, Austin G. Kulasekararaj, Bing Han, Phillip Scheinberg, Jaroslaw P. Maciejewski, Yasutaka Ueda, Carlos M. de Castro, Eros Di Bona, Rong Fu, Li Zhang, Morag Griffin, Saskia M.C. Langemeijer, Jens Panse, Hubert Schrezenmeier, Wilma Barcellini, Vitor A.Q. Mauad, Philippe Schafhausen, Suzanne Tavitian, Eloise Beggiato, Lee Ping Chew, Anna Gaya, Wei-Han Huang, Jun
Background Persistent hemolytic anemia and a lack of oral treatments are challenges for patients with paroxysmal nocturnal hemoglobinuria who have received anti-C5 therapy or have not received complement inhibitors. Iptacopan, a first-in-class oral factor B inhibitor, has been shown to improve hemoglobin levels in these patients. Methods Download a PDF of the Research Summary. In two phase 3 trials
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Next-Generation Multitarget Stool DNA Test for Colorectal Cancer Screening N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-14 Thomas F. Imperiale, Kyle Porter, Julia Zella, Zubin D. Gagrat, Marilyn C. Olson, Sandi Statz, Jorge Garces, Philip T. Lavin, Humberto Aguilar, Don Brinberg, Charles Berkelhammer, John B. Kisiel, Paul J. Limburg
Background A next-generation multitarget stool DNA test, including assessments of DNA molecular markers and hemoglobin level, was developed to improve the performance of colorectal cancer screening, primarily with regard to specificity. Methods In a prospective study, we evaluated a next-generation multitarget stool DNA test in asymptomatic adults 40 years of age or older who were undergoing screening
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A Cell-free DNA Blood-Based Test for Colorectal Cancer Screening N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-14 Daniel C. Chung, Darrell M. Gray, Harminder Singh, Rachel B. Issaka, Victoria M. Raymond, Craig Eagle, Sylvia Hu, Darya I. Chudova, AmirAli Talasaz, Joel K. Greenson, Frank A. Sinicrope, Samir Gupta, William M. Grady
Background Colorectal cancer is the third most diagnosed cancer in adults in the United States. Early detection could prevent more than 90% of colorectal cancer–related deaths, yet more than one third of the screening-eligible population is not up to date with screening despite multiple available tests. A blood-based test has the potential to improve screening adherence, detect colorectal cancer earlier
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Vertical Integration and the Transformation of American Medicine N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-09 Dhruv Khullar, Lawrence P. Casalino, Amelia M. Bond
Hospital acquisition of physician practices has become a dominant trend in American medicine. The FTC and the DOJ recently issued guidelines that could strengthen their approach to vertical integration in health care.
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Shift in the Night N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-09 Margo A. Peyton
When a resident wakes in the night to find her fiancé having a seizure, her two roles become blurred. How do we travel safely between the bedsides in our homes and the bedsides in the hospital?
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Green Dialysis Effluent and Plasma N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-09 Bao-ping Xu, Xiao-tao Wang
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Back to the Future in Alabama N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-06 R. Alta Charo
An Alabama Supreme Court decision about frozen embryos may trigger a wave of activism that sends much of the country back to the 1980s, as abortion politics again force women to endure substandard care.
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Actionable Genotypes and Life Span in Iceland N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-07
To the Editor: Jensson et al. (Nov. 9 issue)1 report the results of a population-based genotyping study involving 57,933 Icelanders, focusing on the analysis of pathogenic variants in 73 genes for which effective medical interventions are available (i.e., actionable genotypes). The most notable finding was the considerably shorter survival among persons who were heterozygous for pathogenic variants
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Increasing Exposure of Young Children to Illicit Fentanyl in the United States N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-07 Courtney Temple, Robert G. Hendrickson
Reported exposures to illicit fentanyl in children younger than 6 years of age in the United States have increased by a factor of 100 during the past decade.
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Plastics, Fossil Carbon, and the Heart N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-07 Philip J. Landrigan
Plastics have enabled extraordinary advances in virtually every area of medicine and have made our lives immeasurably more convenient. Multiple lines of evidence now indicate, however, that plastics are neither as safe nor as inexpensive as they seem. The benefits of plastics come at great and increasingly visible costs to human health and the environment. Plastics are manufactured chemical materials
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Enfortumab Vedotin and Pembrolizumab — A New Perspective on Urothelial Cancer N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-07 Günter Niegisch
For several decades, platinum-based chemotherapy has been the standard first-line option for patients with advanced inoperable or metastatic (or both) urothelial carcinoma. This paradigm, in which platinum-based chemotherapy was considered to be the only effective first-line chemotherapy, was implemented in the 1980s1 and remained unchanged even after immune checkpoint inhibitors were introduced in
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Health Effects of Fossil Fuel–Derived Endocrine Disruptors N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-07 Tracey J. Woodruff
Many fossil fuel–derived chemicals found in air, water, food, and manufactured products affect hormonal function. Exposure is associated with health risks, including cancers, cardiovascular disease, and infertility.
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Microplastics and Nanoplastics in Atheromas and Cardiovascular Events N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-07 Raffaele Marfella, Francesco Prattichizzo, Celestino Sardu, Gianluca Fulgenzi, Laura Graciotti, Tatiana Spadoni, Nunzia D’Onofrio, Lucia Scisciola, Rosalba La Grotta, Chiara Frigé, Valeria Pellegrini, Maurizio Municinò, Mario Siniscalchi, Fabio Spinetti, Gennaro Vigliotti, Carmine Vecchione, Albino Carrizzo, Giulio Accarino, Antonio Squillante, Giuseppe Spaziano, Davida Mirra, Renata Esposito, Simona
Background Microplastics and nanoplastics (MNPs) are emerging as a potential risk factor for cardiovascular disease in preclinical studies. Direct evidence that this risk extends to humans is lacking. Methods We conducted a prospective, multicenter, observational study involving patients who were undergoing carotid endarterectomy for asymptomatic carotid artery disease. The excised carotid plaque specimens
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Enfortumab Vedotin and Pembrolizumab in Untreated Advanced Urothelial Cancer N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-07 Thomas Powles, Begoña P. Valderrama, Shilpa Gupta, Jens Bedke, Eiji Kikuchi, Jean Hoffman-Censits, Gopa Iyer, Christof Vulsteke, Se Hoon Park, Sang Joon Shin, Daniel Castellano, Giuseppe Fornarini, Jian-Ri Li, Mahmut Gümüş, Nataliya Mar, Yohann Loriot, Aude Fléchon, Ignacio Duran, Alexandra Drakaki, Sujata Narayanan, Xuesong Yu, Seema Gorla, Blanca Homet Moreno, Michiel S. van der Heijden
Background No treatment has surpassed platinum-based chemotherapy in improving overall survival in patients with previously untreated locally advanced or metastatic urothelial carcinoma. Methods Download a PDF of the Research Summary. We conducted a phase 3, global, open-label, randomized trial to compare the efficacy and safety of enfortumab vedotin and pembrolizumab with the efficacy and safety of
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Alzheimer’s Disease — Anti-Amyloid Medications, Early Detection, and Screening N. Engl. J. Med. (IF 158.5) Pub Date : 2024-03-07 Nathaniel A. Chin, Debra Dinsmore, Tony Gonzales, Betsy Groves, DeLois Johnson, Julia Napolitano, Allan Ropper, Stephen Salloway, Lori Weiss
In this Double Take video from the New England Journal of Medicine, Drs. Nathanial Chin and Stephen Salloway review the pathophysiology of Alzheimer’s disease and discuss how anti-amyloid medications can help in early stages of the disease. The video notes disparities in diagnosis and treatment of Alzheimer’s disease and provides guidance on screening and diagnosis and on which patients should be referred
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The End of B/Yamagata Influenza Transmission — Transitioning from Quadrivalent Vaccines N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-28 Arnold S. Monto, Maria Zambon, Jerry P. Weir
Since the Yamagata lineage of type B influenza has not circulated since early 2020, experts agree that countries using a quadrivalent influenza vaccine should return to a trivalent one.
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Gantenerumab in Early Alzheimer’s Disease N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-29
To the Editor: In the phase 3 GRADUATE trials of gantenerumab for early Alzheimer’s disease reported by Bateman et al. (Nov. 16 issue),1 participants receiving gantenerumab had a greater decrease in the amyloid level on positron-emission tomography (PET) than those receiving placebo over a period of 116 weeks. However, gantenerumab had no effect on the level of tau on PET in specific regions. The authors
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When Less Is More — The Importance of Patient Selection N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-29 Pedro T. Ramirez
The field of gynecologic oncology is rapidly evolving with the increasing availability of new therapeutics, including targeted therapies. In parallel, the field of surgery is shifting from the use of radical procedures to more-conservative approaches with fewer risks of complications. For patients with early-stage cervical cancer, the current recommendation according to National Comprehensive Cancer
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Long Covid and Impaired Cognition — More Evidence and More Work to Do N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-29 Ziyad Al-Aly, Clifford J. Rosen
During the early stages of the Covid-19 pandemic, reports emerged that persons who had been infected with SARS-CoV-2 were having lingering health problems. Such long-term issues were collectively referred to as “long Covid” and were reported to affect nearly every organ system.1 The cardinal features of long Covid include fatigue, dysautonomia (or postural orthostatic tachycardia syndrome), postexertional
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Case 7-2024: A 67-Year-Old Woman with Alternating Sixth Cranial Nerve Palsy N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-29 Janeth M. Yinh, Jeremy N. Ford, April M. Jorge, Reza Zonozi
A 67-year-old woman was evaluated because of headache and retro-orbital pain. MRI of the head showed edema and enhancement of the optic-nerve sheath, sparing the nerve. A diagnosis was made.
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Crazy-Paving Pattern in Pulmonary Sarcoidosis N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-29 Shiyao Wang, Huaping Dai
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Cardiac Rehabilitation — Challenges, Advances, and the Road Ahead N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-29 Randal J. Thomas
Cardiac rehabilitation provides evidence-based, secondary prevention after a cardiovascular event. This review addresses the benefits of cardiac rehabilitation programs and current barriers to participation.
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Simple versus Radical Hysterectomy in Women with Low-Risk Cervical Cancer N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-29 Marie Plante, Janice S. Kwon, Sarah Ferguson, Vanessa Samouëlian, Gwenael Ferron, Amandine Maulard, Cor de Kroon, Willemien Van Driel, John Tidy, Karin Williamson, Sven Mahner, Stefan Kommoss, Frederic Goffin, Karl Tamussino, Brynhildur Eyjólfsdóttir, Jae-Weon Kim, Noreen Gleeson, Lori Brotto, Dongsheng Tu, Lois E. Shepherd
Background Retrospective data suggest that the incidence of parametrial infiltration is low in patients with early-stage low-risk cervical cancer, which raises questions regarding the need for radical hysterectomy in these patients. However, data from large, randomized trials comparing outcomes of radical and simple hysterectomy are lacking. Methods Download a PDF of the Research Summary. We conducted
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Cognition and Memory after Covid-19 in a Large Community Sample N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-29 Adam Hampshire, Adriana Azor, Christina Atchison, William Trender, Peter J. Hellyer, Valentina Giunchiglia, Masud Husain, Graham S. Cooke, Emily Cooper, Adam Lound, Christl A. Donnelly, Marc Chadeau-Hyam, Helen Ward, Paul Elliott
Cognitive symptoms after coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are well-recognized. Whether objectively measurable cognitive deficits exist and how long they persist are unclear.
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Omalizumab for the Treatment of Multiple Food Allergies N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-25 Robert A. Wood, Alkis Togias, Scott H. Sicherer, Wayne G. Shreffler, Edwin H. Kim, Stacie M. Jones, Donald Y.M. Leung, Brian P. Vickery, J. Andrew Bird, Jonathan M. Spergel, Ahmar Iqbal, Julie Olsson, Monica Ligueros-Saylan, Alkaz Uddin, Agustin Calatroni, Charmaine Marquis Huckabee, Nicole H. Rogers, Nancy Yovetich, Jennifer Dantzer, Kim Mudd, Julie Wang, Marion Groetch, David Pyle, Corinne A. Keet
Background Food allergies are common and are associated with substantial morbidity; the only approved treatment is oral immunotherapy for peanut allergy. Methods In this trial, we assessed whether omalizumab, a monoclonal anti-IgE antibody, would be effective and safe as monotherapy in patients with multiple food allergies. Persons 1 to 55 years of age who were allergic to peanuts and at least two
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A Salon-Based Intervention to Improve PrEP Uptake among Black Women N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-24 Schenita D. Randolph, Ragan Johnson
In partnership with local communities, the Duke University School of Nursing piloted a salon-based intervention to reduce barriers to the uptake of HIV preexposure prophylaxis among Black cisgender women in the U.S. South.
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Medically Tailored Meals to Address the Health Consequences of Food Insecurity N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-24 Seth A. Berkowitz, Jean Terranova
Collaborators from Massachusetts General Hospital, Community Servings, and the University of North Carolina provide medically tailored meals for people with chronic illness and food insecurity.
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Transforming Diversity of a Family Medicine Residency Program N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-24 José E. Rodríguez, Kirsten Stoesser
The University of Utah’s Family Medicine Residency program analyzed and continuously revised the rubric used to select candidates for interviews and introduced structural changes to support residents.
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Benralizumab versus Mepolizumab for Eosinophilic Granulomatosis with Polyangiitis N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-23 Michael E. Wechsler, Parameswaran Nair, Benjamin Terrier, Bastian Walz, Arnaud Bourdin, David R.W. Jayne, David J. Jackson, Florence Roufosse, Lena Börjesson Sjö, Ying Fan, Maria Jison, Christopher McCrae, Sofia Necander, Anat Shavit, Claire Walton, Peter A. Merkel
Background Eosinophilic granulomatosis with polyangiitis (EGPA) is a vasculitis characterized by eosinophilic inflammation. Benralizumab, a monoclonal antibody against the interleukin-5α receptor expressed on eosinophils, may be an option for treating EGPA. Methods We conducted a multicenter, double-blind, phase 3, randomized, active-controlled noninferiority trial to evaluate the efficacy and safety
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PPAR Agonists in Primary Biliary Cholangitis N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-21 Bernd Schnabl
This editorial describes the science behind clinical trials testing elafibranor and seladelpar in the treatment of primary biliary cholangitis.
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Advancing Second-Line Treatment for Primary Biliary Cholangitis N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-21 David N. Assis
Primary biliary cholangitis is a chronic cholestatic, autoimmune disease characterized by the destruction of small, intrahepatic biliary epithelial cells.1 If left untreated, primary biliary cholangitis can result in liver failure and death. Patients with primary biliary cholangitis also have debilitating symptoms, notably pruritus and fatigue. Effective treatment is essential to prevent disease progression
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More on Pre–Covid-19, SARS-CoV-2–Negative MIS-C N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-22
Benezech et al. (Nov. 30 issue)1 describe cases of six children in the pre–Covid-19 era who presented with an acute inflammatory syndrome and increased T-cell receptor (TCR) expression of Vβ21.3. The authors cite a hypothesis that a SARS-CoV-2 peptide acts as a superantigen in multisystemic inflammatory syndrome in children (MIS-C).2
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Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-22
To the Editor: Ehrmann et al. (Nov. 30 issue)1 found, in the Inhaled Amikacin vs. Placebo to Prevent Ventilator Associated Pneumonia (AMIKINHAL) trial, that among adults who had undergone mechanical ventilation for at least 3 days, a subsequent 3-day course of inhaled amikacin reduced the incidence of ventilator-associated pneumonia. The use of a low suspicion threshold for reporting possible cases
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Semaglutide and Cardiovascular Outcomes N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-22
To the Editor: In the SELECT trial, Lincoff and colleagues (Dec. 14 issue)1 found that weekly subcutaneous semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, was superior to placebo in the reduction of cardiovascular events at 3 years in patients who had preexisting cardiovascular disease and overweight or obesity but who did not have diabetes. In contrast to previous semaglutide trials
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Persistent False Positive Covid-19 Rapid Antigen Tests N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-22 Carly Herbert, David D. McManus, Apurv Soni
Rapid antigen tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are effective tools for the diagnosis of acute infection, particularly when used serially.1 The percentage of rapid antigen tests with false positive results is reported to be less than 1%.2 However, we have observed persons who repeatedly test positive with rapid antigen tests despite concurrent negative molecular
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Alzheimer’s Disease Biomarkers — Timing Is Everything N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-22 Richard Mayeux
Alzheimer’s disease typically evolves over a period of several years before an affected person seeks medical attention for a diagnosis. The pathologic features of the brain in patients with Alzheimer’s disease include extracellular amyloid plaques, intraneuronal neurofibrillary tangles, and the loss of neurons and synapses. For decades, researchers speculated about which of these manifestations appears
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CAR T Cells — A New Horizon for Autoimmunity? N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-22 John D. Isaacs
The management of autoimmune diseases has improved substantially since the turn of the century, owing largely to the emergence of targeted biologic therapies. Nonetheless, treatment is still considered to be disease-suppressive and lifelong in most cases. In this issue of the Journal, Müller et al. describe a series of 15 patients with systemic autoimmunity treated with a single infusion of CD19-targeted
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Case 6-2024: A 21-Year-Old Man with Fatigue and Night Sweats N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-22 Jonathan C.T. Carlson, Madeleine M. Sertic, Maria Y. Chen
A 21-year-old man was admitted because of pancytopenia, an elevated lactate dehydrogenase level, and a low haptoglobin level. Abdominal ultrasonography revealed splenomegaly. A diagnosis was made.
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Wearable Digital Health Technology for Epilepsy N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-22 Elizabeth Donner, Orrin Devinsky, Daniel Friedman
One third of people with epilepsy have seizures despite medical treatment. The authors examine wearable digital health devices that can detect seizures and how these devices can affect epilepsy care.
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Rusfertide, a Hepcidin Mimetic, for Control of Erythrocytosis in Polycythemia Vera N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-22 Marina Kremyanskaya, Andrew T. Kuykendall, Naveen Pemmaraju, Ellen K. Ritchie, Jason Gotlib, Aaron Gerds, Jeanne Palmer, Kristen Pettit, Uttam K. Nath, Abdulraheem Yacoub, Arturo Molina, Samuel R. Saks, Nishit B. Modi, Frank H. Valone, Sarita Khanna, Suneel Gupta, Srdan Verstovsek, Yelena Z. Ginzburg, Ronald Hoffman
Background Polycythemia vera is a chronic myeloproliferative neoplasm characterized by erythrocytosis. Rusfertide, an injectable peptide mimetic of the master iron regulatory hormone hepcidin, restricts the availability of iron for erythropoiesis. The safety and efficacy of rusfertide in patients with phlebotomy-dependent polycythemia vera are unknown. Methods Download a PDF of the Research Summary
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Biomarker Changes during 20 Years Preceding Alzheimer’s Disease N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-22 Jianping Jia, Yuye Ning, Meilin Chen, Shuheng Wang, Hao Yang, Fangyu Li, Jiayi Ding, Yan Li, Bote Zhao, Jihui Lyu, Shanshan Yang, Xin Yan, Yue Wang, Wei Qin, Qi Wang, Ying Li, Jintao Zhang, Furu Liang, Zhengluan Liao, Shan Wang
Background Biomarker changes that occur in the period between normal cognition and the diagnosis of sporadic Alzheimer’s disease have not been extensively investigated in longitudinal studies. Methods Download a PDF of the Research Summary. We conducted a multicenter, nested case–control study of Alzheimer’s disease biomarkers in cognitively normal participants who were enrolled in the China Cognition
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CD19 CAR T-Cell Therapy in Autoimmune Disease — A Case Series with Follow-up N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-22 Fabian Müller, Jule Taubmann, Laura Bucci, Artur Wilhelm, Christina Bergmann, Simon Völkl, Michael Aigner, Tobias Rothe, Ioanna Minopoulou, Carlo Tur, Johannes Knitza, Soraya Kharboutli, Sascha Kretschmann, Ingrid Vasova, Silvia Spoerl, Hannah Reimann, Luis Munoz, Roman G. Gerlach, Simon Schäfer, Ricardo Grieshaber-Bouyer, Anne-Sophie Korganow, Dominique Farge-Bancel, Dimitrios Mougiakakos, Aline Bozec
Background Treatment for autoimmune diseases such as systemic lupus erythematosus (SLE), idiopathic inflammatory myositis, and systemic sclerosis often involves long-term immune suppression. Resetting aberrant autoimmunity in these diseases through deep depletion of B cells is a potential strategy for achieving sustained drug-free remission. Methods We evaluated 15 patients with severe SLE (8 patients)
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Childhood Obesity Prevention — Focusing on Population-Level Interventions and Equity N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-17 Steven L. Gortmaker, Sara N. Bleich, David R. Williams
Although new weight-loss drugs are important, scholars and policymakers shouldn’t lose sight of population-level strategies that can prevent excess weight gain and obesity among children in the first place.
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What Is a Mentor? N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-17 Suzanne Koven
Having benefited from excellent mentors over the course of her career, a physician concludes that a true mentor is someone who has more imagination about you than you have about yourself.
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Direct-to-Consumer Platforms for New Antiobesity Medications — Concerns and Potential Opportunities N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-17 Ilya Golovaty, Scott Hagan
Direct-to-consumer models offer a pathway for patients to obtain access to GLP-1 receptor agonists outside the confines of traditional clinics, often by means of telemedicine. But they may pose risks.
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Renal Malakoplakia N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-17 Serena Bagnasco, Samir C. Gautam
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Postmenopausal Osteoporosis N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-15
To the Editor: With regard to the Clinical Practice article on postmenopausal osteoporosis by Walker and Shane (Nov. 23 issue),1 we believe that one additional topic merits emphasis — the systemic underuse of evidence-based antiosteoporosis medications after fragility fracture. This divergence between guideline recommendations and real-world practice is termed the “osteoporosis care gap.” Less than
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HIV-1 Remission after Allogeneic Hematopoietic-Cell Transplantation N. Engl. J. Med. (IF 158.5) Pub Date : 2024-02-15 Jana K. Dickter, Ahmed Aribi, Angelo A. Cardoso, Sara Gianella, Ketevan Gendzekhadze, Shirley Li, Ye Feng, Antoine Chaillon, Gregory M. Laird, Diana L. Browning, Justine A. Ross, Deepa D. Nanayakkara, Alfredo Puing, Rodica Stan, Lily L. Lai, Sue Chang, Trilokesh D. Kadambi, Sandra Thomas, Monzr M. Al Malki, Ryo Nakamura, Joseph Alvarnas, Randy A. Taplitz, Sanjeet S. Dadwal, Stephen J. Forman, John
A patient with a 33-year history of HIV-1 infection who underwent stem-cell transplantation for the treatment of acute myelogenous leukemia remained HIV-1 free nearly 5 years later.