NEJM Group

A 44-year-old woman presented to the primary care clinic with a 2-year history of shortness of breath with minimal exertion, cough productive of clear sputum, generalized fatigue, and an unintentional weight loss of 9 kg. She reported no chest pain at rest or with exertion. She had been feeling fatigued most days and had decreased appetite.    Seven months before the current presentation, a rash that was characterized by small, painless, nonpruritic red-brown papules developed on her arms and hands and resolved spontaneously.    Learn more about the case and test your diagnostic and therapeutic skills in “Out of Breath,” a new Interactive Medical Case: https://nej.md/3UQ4s6V 

In the December issue: leadership for artificial intelligence, cybersecurity, pediatric firearms injuries, behavioral health treatment, public health and care delivery collaboration, diabetes care, and improving care after gynecologic oncology surgery. 📖 View the issue: https://nej.md/4fSCcsb 🎧 Read/listen to the editor letter, How Collaboration Leads to Health Care Transformation: https://nej.md/3ACpFKJ 📱 Insights Report: The Rising Risks of Cybersecurity Breaches: https://nej.md/4exclF3 with expert advisor Jigar Kadakia ⌚ In Depth: A Hybrid Care Model to Manage Diabetes Mellitus in the United Arab Emirates: https://nej.md/3UX1hKs 👩⚕️ Case Study: Together Care: Transforming Perioperative Care for Patients Undergoing Benign and Oncologic Gynecologic Surgery: https://nej.md/4fxVLGm 🤝 Article: Advancing the Quintuple Aim Through Public Health and Health Care Collaboration: Perspectives from Washington State: https://nej.md/48Tj2Ah 🧠 Article: Improving Treatment and Lowering Costs for Behavioral Health Patients Through a Value-Based Care Program: https://nej.md/3Z8x0ed 👩💻 Commentary: Health Care Leadership in the AI Era: A Seventh Test for the Decade Ahead: https://nej.md/4fNkSW9 with our Editor-in-Chief Thomas Lee, MD 🧒 Commentary: Moving Beyond Thoughts and Prayers: Creating a Firearm-Related Injury Task Force: https://nej.md/3YLfPhB

#AHA24 Round up: Seven articles were simultaneously published in NEJM and presented at this year’s American Heart Association Scientific Sessions in Chicago. All articles included a podcast with NEJM Group editors discussing the significance of the trial results.     Intensive Blood-Pressure Control in Patients with Type 2 Diabetes (BPROAD)   📄 Full article: https://nej.md/4eyDckd  🎧 Podcast: https://nej.md/4hOCjqn    Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity (SUMMIT)   📄 Full article: https://nej.md/4hRGaTY   🎧 Podcast: https://nej.md/4fiZd7P    CRISPR-Cas9 Gene Editing with Nexiguran Ziclumeran for ATTR Cardiomyopathy   📄 Full article: https://nej.md/48OTgx4    🎧 Podcast: https://nej.md/48XIzIE     Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia (VANISH2)   📄 Full article: https://nej.md/3Z5ECOD  🎧 Podcast: https://nej.md/3UU6iDD     Left Atrial Appendage Closure after Ablation for Atrial Fibrillation (OPTION)   📄 Full article: https://nej.md/3Oben2U   🎧 Podcast: https://nej.md/3ATUjz0    Routine Spironolactone in Acute Myocardial Infarction (CLEAR)   📄 Full article: https://nej.md/4ftkpIc    🎧 Podcast: https://nej.md/3UR8agz     Phase 1 Study of AAV9.LAMP2B Gene Therapy in Danon Disease   📄 Full article: https://nej.md/40IBJVh   🎧 Podcast: https://nej.md/3Z5qQvj 

Because older patients are underrepresented in clinical trials, there is a lack of guidelines on specific pharmacologic and invasive treatments for acute coronary syndromes in older patients.    In the SENIOR-RITA trial, researchers evaluated whether a strategy of medical therapy plus invasive treatment or a conservative strategy of medical therapy alone is more beneficial in older adults with non–ST-segment elevation myocardial infarction (NSTEMI).    Adults 75 years of age or older with NSTEMI were randomly assigned to an invasive strategy of coronary angiography (and if appropriate, revascularization) plus the best available medical therapy or a conservative strategy of the best available medical therapy.     The primary outcome was a composite of death from cardiovascular causes or nonfatal myocardial infarction.    Among older adults with NSTEMI, a strategy of medical therapy plus invasive treatment did not result in a significantly lower risk of death from cardiovascular causes or nonfatal myocardial infarction than medical therapy alone.    Read the full SENIOR-RITA trial results and Plain Language Summary: https://nej.md/4fZIG9z    #ClinicalTrials #MedicalResearch 

𝗦𝗺𝗮𝗹𝗹 (𝗼𝗿 𝘀𝗵𝗼𝗿𝘁) 𝗶𝗻𝘁𝗲𝗿𝗳𝗲𝗿𝗶𝗻𝗴 𝗥𝗡𝗔 (𝘀𝗶𝗥𝗡𝗔) is defined as a short, double-stranded regulatory RNA molecule (20 to 25 nucleotides) that interferes with the expression of a specific gene. It does so by binding to and targeting for degradation the messenger RNA (mRNA) of that gene. The siRNA is processed from a longer double-stranded RNA molecule by the enzyme Dicer. One strand of the siRNA (the guide RNA) creates a complex with other proteins to form the RNA-induced silencing complex (RISC). The other strand (the passenger RNA) is degraded during or after the formation of the RISC. The residual guide RNA, ensconced in RISC, snares mRNA with with complementary sequence, bringing it into close contact with the RISC, which then degrades the mRNA. Artificial siRNAs, synthesized and chemically modified ex vivo, are the basis of some approved drugs and drugs in development.       To learn more about this NEJM Illustrated Glossary term, read the editorial “Linking a Neurodevelopmental Disorder with a lncRNA Deletion” by Ling-Ling Chen, PhD: https://nej.md/4hkctuu        Explore more terms: https://nej.md/glossary    

Lung transplantation has evolved over 60 years from an experimental to an accepted standard treatment for life-threatening lung disease. Suitable recipients can expect improved survival and quality of life despite commonly observed problems such as primary graft dysfunction, chronic lung allograft dysfunction (CLAD), increased risk for opportunistic infections, cancer, and chronic immunosuppression-related health issues. Although lung transplantation is becoming more common worldwide, the number of procedures performed is not keeping pace with growing demand. A new review focuses on the current status of and recent developments in lung transplantation and on future opportunities in the effective delivery of this challenging but potentially life-transforming therapy.    Continue reading the Review Article “Lung Transplantation” by Jason Christie, MD, Dirk Van Raemdonck, MD, PhD, and Andrew J. Fisher, PhD, BM, BS, from the University of Pennsylvania Perelman School of Medicine and elsewhere: https://nej.md/4fnAlvP 

Free Live Webinar: Health Care Workforce Innovation: Solutions to the Staffing Crisis    The health care workforce is characterized as in crisis. Staffing shortages affect care delivery organizations around the world at all levels, and clinician burnout is a longstanding and intractable problem. How can care organizations approach workforce challenges?     Join NEJM Catalyst for a free virtual event with an expert panel of health care executives and clinical leaders discussing different approaches they have applied with success, including:    🏥️ Leadership and organizational culture changes  💻 Technology innovations that can reduce clinician workloads  🩺 New models of care to address burnout    📅 December 11, 2024, Noon–2 PM ET   🔗 https://nej.md/3C7jKxg 

Osteoarthritis of the knee is the most prevalent form of osteoarthritis and leads to chronic pain and impaired quality of life.    Obesity is a major risk factor for development of knee osteoarthritis and disease progression. Whether glucagon-like peptide-1 (GLP-1) receptor agonists can reduce pain due to knee osteoarthritis in persons with obesity is unclear.    In the STEP 9 trial, researchers evaluated whether the GLP-1 receptor agonist semaglutide is superior to placebo in reducing body weight and pain related to knee osteoarthritis in persons with obesity and knee osteoarthritis.    Adults with obesity and moderate-to-severe pain due to knee osteoarthritis were randomly assigned to receive weekly subcutaneous semaglutide (2.4 mg) or placebo, in addition to counseling on physical activity and a reduced-calorie diet.     The primary end points were the percentage change in body weight and the change in WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain score (scale, 0 to 100, with higher scores reflecting worse outcomes). Both end points were assessed from baseline to week 68.    In persons with obesity and knee osteoarthritis, once-weekly semaglutide significantly reduced body weight and knee osteoarthritis pain, as compared with placebo.    Read the full STEP 9 trial results and Plain Language Summary: https://nej.md/40oSLHB    #ClinicalTrials #MedicalResearch 

NEJM Editorial Fellow Harleen Marwah, MD MS, summarizes results of the PROHIP trial, which compared total hip replacement with resistance training in patients with severe hip #osteoarthritis and an indication for surgery. Read the Original Article "Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis" for the full trial results: https://nej.md/4e6FyGD

𝗧𝗿𝗮𝗻𝘀��𝗿𝗶𝗽𝘁𝗶𝗼𝗻 is the synthesis of an RNA molecule using a sequence of DNA as a template. The sequence of the RNA is therefore complementary to the strand of DNA from which it was transcribed. Transcription of chromosomal DNA, which takes place in the nucleus of eukaryotic cells, can generate functional RNAs (such as microRNAs and long noncoding RNAs) that are not translated into protein or can generate pre–messenger RNA (mRNA) that is processed into mRNA; the mRNA is transported to the cytoplasm where it is translated into protein.    To learn more about this NEJM Illustrated Glossary term, read the editorial “Linking a Neurodevelopmental Disorder with a lncRNA Deletion” by Ling-Ling Chen, PhD: https://nej.md/4hkctuu      Explore more terms from the NEJM Illustrated Glossary: https://nej.md/glossary