Impf_Info – Following Feed 478 Posts (gefiltert)

Correspondence: Digital Twin–Guided Ablation for Ventricular Tachycardia https://www.nejm.org/doi/full/10.1056/NEJMc2517822 #Cardiology

Among patients with atrial fibrillation at high risk for stroke and bleeding, left atrial appendage closure was not noninferior to medical therapy in reducing the risk of stroke, embolism, major bleeding, or death at 3 years. Full CLOSURE-AF trial results and Research Summary: https://www.nejm.org/doi/full/10.1056/NEJMoa2513310 #Cardiology #AFib

A new review by Clifford J. Rosen, MD, and Julie R. Ingelfinger, MD, describes a new generation of treatment with GLP-1 receptor agonists for persons with obesity with or without diabetes or prediabetes. Learn more: https://www.nejm.org/doi/full/10.1056/NEJMra2500106

Original Article: CRISPR-Cas12a Gene Editing of HBG1 and HBG2 Promoters to Treat Sickle Cell Disease (RUBY study) https://www.nejm.org/doi/full/10.1056/NEJMoa2415550 Editorial: More Options for Gene Editing in Hemoglobinopathies https://www.nejm.org/doi/full/10.1056/NEJMe2602194 Further reading: 📄 Original Article: Base Editing of HBG1 and HBG2 Promoters for Sickle Cell Disease (BEACON study) https://www.nejm.org/doi/full/10.1056/NEJMoa2504835 📄 Original Article: CRISPR-Cas12a Gene Editing of HBG1 and HBG2 Promoters to Treat β-Thalassemia (EdiThal study) https://www.nejm.org/doi/full/10.1056/NEJMoa2501277

Should we hold GLP-1–based medications before upper endoscopy? @NEJMClinician Editor-in-Chief Raja-Elie Abdulnour, MD (@BageLeMage), explains a trial that evaluated the clinical impact of continuing vs holding GLP-1–based medications prior to upper endoscopy. Read the key results and comment from Sara Turbow, MD, MPH: https://jwat.ch/4sKvoUq Visit http://clinician.nejm.org to see What Matters Most This Week, including: 🗣️ Does Your Patient Have Laryngopharyngeal Symptoms, or Laryngopharyngeal Reflux Disease? 🫁 Comparing Dual Bronchodilators for COPD 💊 Progestin-Only Contraception and Venous Thromboembolism Risk 🫀 Does Ciprofloxacin Really Prolong QT Intervals?

Perspective by Martin G. Lee, MD: The Age Illusion — Limitations of Chronologic Age in Medicine https://www.nejm.org/doi/full/10.1056/NEJMp2516973 #MedicalEthics #MedicalPractice

Low back pain has the highest global prevalence of all musculoskeletal conditions. A new Video in Clinical Medicine demonstrates how to perform a physical examination of the lumbar spine. Watch the full video and read the accompanying article: https://www.nejm.org/doi/full/10.1056/NEJMvcm2402306

In patients hospitalized with West Nile virus (WNV) disease, does treatment with WNV-neutralizing plasma reduce unfavorable outcomes? This small RCT showed no difference in the rate of 30-day death or functional decline compared to placebo. Learn more: https://eviden.cc/4bmcgWC

In cisplatin-ineligible patients with muscle-invasive bladder cancer, enfortumab vedotin–pembrolizumab plus surgery led to better event-free survival (74.7%, vs. 39.4%) and overall survival (79.7%, vs. 63.1%) than surgery alone at 2 years. Full phase 3 KEYNOTE-905 trial results and Research Summary: https://www.nejm.org/doi/full/10.1056/NEJMoa2511674

Images in Clinical Medicine: Hepatic Arterial Buffer Response https://www.nejm.org/doi/full/10.1056/NEJMicm2516362 #Gastroenterology #Radiology

Original Article: Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation (CLOSURE-AF trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2513310 Editorial: Left Atrial Appendage Closure — Another Overused Method in Cardiology? https://www.nejm.org/doi/full/10.1056/NEJMe2518067 #Cardiology #AFib

The Corporatization of U.S. Health Care by Lawrence P. Casalino, MD, PhD: Physicians, Corporatization, and the Unmeasured Quality of Care https://www.nejm.org/doi/full/10.1056/NEJMp2415488 #HealthPolicy #MedicalEthics

GLP-1 receptor agonists are increasingly used to treat type 2 diabetes and obesity, and trials have shown reductions in cardiovascular risk and slowing of kidney failure. Adverse events are mostly gastrointestinal. Read the full review: https://www.nejm.org/doi/full/10.1056/NEJMra2500106

After total knee arthroplasty for knee osteoarthritis, preserving normal infrapatellar fat pad or resecting abnormal tissue did not improve 12-month Knee Injury and Osteoarthritis Outcome Score outcomes. 📊 Full trial results: https://eviden.cc/4sVDN73

In a recent @NEJM Perspective article, the authors detail their concerns about medical credit cards and discuss how clinicians can guide patients. Read the key points: https://jwat.ch/4m1xyN0

Original Article: Perioperative Enfortumab Vedotin and Pembrolizumab in Bladder Cancer (phase 3 KEYNOTE-905 trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2511674 Editorial: Enfortumab Vedotin plus Pembrolizumab as Perioperative Therapy https://www.nejm.org/doi/full/10.1056/NEJMe2515777 #Oncology

An 83-year-old woman with type 2 diabetes mellitus presented with a 6-month history of painful rash. Physical examination findings are shown. The glycated hemoglobin level was 9.1% (reference value, <5.8), which had increased from a level of 6.6% measured 4 months earlier. What is the most likely diagnosis? Submit your answer or see how others responded: https://www.nejm.org/image-challenge?ci=20260402

SMART-DECISION: Patients who have had an MI and do not have left ventricular systolic dysfunction or heart failure often receive beta-blockers over the long term, but data supporting this practice are lacking. Research findings are summarized in a new Quick Take video. https://www.nejm.org/do/10.1056/NEJMdo008451/full/

Geographic atrophy due to age-related macular degeneration (AMD) is the leading cause of irreversible blindness and affects more than 5 million persons worldwide. No therapies to restore vision in such persons currently exist. NEJM Editorial Fellow Katerina Lin, MD, explains a clinical trial in which the photovoltaic retina implant microarray (PRIMA) system restored central vision and led to a significant improvement in visual acuity. Read the full PRIMAvera trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2501396 #Ophthalmology

𝗧𝗵𝗲 𝗘𝗳𝗳𝗲𝗰𝘁 𝗼𝗳 𝗚𝗟𝗣-𝟭 𝗥𝗲𝗰𝗲𝗽𝘁𝗼𝗿 𝗔𝗴𝗼𝗻𝗶𝘀𝘁𝘀 𝗼𝗻 𝗚𝗹𝘆𝗰𝗮𝘁𝗲𝗱 𝗛𝗲𝗺𝗼𝗴𝗹𝗼𝗯𝗶𝗻 𝗟𝗲𝘃𝗲𝗹𝘀 Randomized, placebo-controlled trials of the glucagon-like peptide-1 (GLP-1) receptor agonists have provided strong evidence to support their use — in fact, they have presaged a mini-revolution in how type 2 diabetes is managed. 👉 https://www.nejm.org/doi/full/10.1056/NEJMra2500106 Tirzepatide was the first dual GLP-1 and glucose-dependent insulinotropic peptide receptor agonist approved for the treatment of type 2 diabetes on the basis of the SURPASS-1 (Tirzepatide [LY3298176] in Participants with Type 2 Diabetes Not Controlled with Diet and Exercise Alone) trial, a randomized, placebo-controlled trial of tirzepatide (administered in weekly doses of 5 mg, 10 mg, or 15 mg) paired with metformin for treatment of type 2 diabetes (seen in figure). Tirzepatide reduced glycated hemoglobin levels by as much as 2 percentage points and was superior to placebo at all dose levels. At 40 weeks, nearly 90% of participants had glycated hemoglobin levels of less than 7.0%, a change that was associated with profound weight loss. Read the Review Article “GLP-1 Receptor Agonists” by Clifford J. Rosen, MD, and Julie R. Ingelfinger, MD, from @TuftsMedSchool and the Maine Medical Center Institute for Research: https://www.nejm.org/doi/full/10.1056/NEJMra2500106

Among patients with carpal tunnel syndrome randomized to a rigid wrist splint versus placebo bandage, 12-week change in symptom scores was not significantly different and proportion undergoing surgery within 1 year was similar between the two groups. https://eviden.cc/4rFztrz

In a new Perspective essay, @MichaelRUlrich, JD, MPH, argues that 𝘊𝘩𝘪𝘭𝘦𝘴 𝘷. 𝘚𝘢𝘭𝘢𝘻𝘢𝘳, a challenge to Colorado’s ban on conversion therapy, could seriously affect LGBTQ+ health, mental health professionals, and the legal relevance of standards of care. [Note: On March 30, the Court held that Colorado’s law was a content-based viewpoint restriction of speech that requires lower courts to apply the most stringent form of judicial review.] Read the full Perspective: https://www.nejm.org/doi/full/10.1056/NEJMp2516723

A 68-year-old woman with rosacea presented with a 6-week history of dark patches on the skin of her arms and legs. Two weeks before the onset of the skin changes, she had started taking minocycline daily. Read the full case details in the Images in Clinical Medicine article “Minocycline-Induced Hyperpigmentation,” from UF Health Jacksonville (@UFHealthJax) and the Southeast Georgia Health System: https://www.nejm.org/doi/full/10.1056/NEJMicm2513782

Lawrence P. Casalino, MD, PhD, discusses qualities of corporate organizations that could affect physicians’ intrinsic motivation and the quality of the care they provide. Listen to the full interview with NEJM Executive Managing Editor Stephen Morrissey (@srm128): https://www.nejm.org/do/10.1056/NEJMdo008483/full/

Perspective by J.W. Jacobs et al.: Legislating Medicine — Directed Donation and the Politics of Patient Choice https://www.nejm.org/doi/full/10.1056/NEJMp2602587 #HealthPolicy #MedicalEthics

CLOSURE-AF trial: In patients with atrial fibrillation, catheter-based left atrial appendage closure has been suggested as an alternative to medication for stroke prevention. Research findings comparing these approaches are summarized in a new Quick Take video. https://www.nejm.org/do/10.1056/NEJMdo008427/full/ #AFib

An 83-year-old woman with type 2 diabetes mellitus presented with a 6-month history of painful rash. Physical examination findings are shown. The glycated hemoglobin level was 9.1% (reference value, <5.8), which had increased from a level of 6.6% measured 4 months earlier. What is the most likely diagnosis? https://www.nejm.org/image-challenge?ci=20260402

In a new blog post, @PaulSaxMD writes about one-month treatment for latent tuberculosis, and asks, “Why aren’t we using it?” Read the reasons why physicians should use it: https://voices.nejm.org/doi/full/10.1056/VOICESpost2600007

Chronologic age plays an outsized role in various aspects of medicine, writes Martin G. Lee, MD, in a new Perspective. Yet people of the same age can differ dramatically when it comes to aging-related risk factors. Learn more: https://www.nejm.org/doi/full/10.1056/NEJMp2516973

Could advanced practice practitioners (APPs) replace primary care physicians? Christine Sinsky, MD, an internist and expert in primary care practice design, addresses this question in the latest episode of the Not Otherwise Specified podcast hosted by NEJM National Correspondent Lisa Rosenbaum, MD. Do you see use of APPs as raising or lowering the bar in your experience? Share your thoughts in the comments. Listen to the full episode: https://not-otherwise-specified-podcast.nejm.org/e/dream-team/ Listen to past episodes and subscribe to the podcast: https://not-otherwise-specified-podcast.nejm.org/

In a simulation involving 15 healthy trainees, slowing respiration to 10 seconds per breath produced pulsus measurements exceeding 20 mm Hg, enabling improved teaching simulation and understanding of underlying physiology. Learn more: https://www.nejm.org/doi/full/10.1056/NEJMc2518685

Original Article: Base Editing of HBG1 and HBG2 Promoters for Sickle Cell Disease (BEACON study) https://www.nejm.org/doi/full/10.1056/NEJMoa2504835 Editorial: More Options for Gene Editing in Hemoglobinopathies https://www.nejm.org/doi/full/10.1056/NEJMe2602194 Further reading: 📄 Original Article: CRISPR-Cas12a Gene Editing of HBG1 and HBG2 Promoters to Treat Sickle Cell Disease (RUBY study) https://www.nejm.org/doi/full/10.1056/NEJMoa2415550 📄 Original Article: CRISPR-Cas12a Gene Editing of HBG1 and HBG2 Promoters to Treat β-Thalassemia (EdiThal study) https://www.nejm.org/doi/full/10.1056/NEJMoa2501277 #Hematology #Genetics

Phase 3 KEYNOTE-905/EV-303 trial: Patients with muscle-invasive bladder cancer who are ineligible for cisplatin often proceed directly to surgery. Research evaluating perioperative enfortumab vedotin plus pembrolizumab is summarized in a new Quick Take video. https://www.nejm.org/do/10.1056/NEJMdo008425/full/

In a 10-patient feasibility study, heart digital twins were used to guide VT ablation. Afterward, VT was noninducible in all patients; at a mean follow-up of 13 months, 8 patients were free of recurrence, without drug therapy. Full study results: https://www.nejm.org/doi/full/10.1056/NEJMc2517822

In a new Perspective, Lawrence P. Casalino, MD, PhD, argues that society depends on clinicians to provide high-quality services in the vast areas of medical care in which quality isn’t measured. But corporate entities may not support this type of professionalism. Read the full Perspective, the latest in the Corporatization of U.S. Health Care series: https://www.nejm.org/doi/full/10.1056/NEJMp2415488

New in the April 2, 2026, issue of NEJM: Enfortumab Vedotin and Pembrolizumab in Bladder Cancer (phase 3 KEYNOTE-905/EV-303 trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2511674 Left Atrial Appendage Closure in Atrial Fibrillation (CLOSURE-AF trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2513310 Editing the HBG1 and HBG2 Promoters for Sickle Cell Disease (RUBY study) https://www.nejm.org/doi/full/10.1056/NEJMoa2415550 Editing HBG1 and HBG2 Promoters for β-Thalassemia (EdiThal study) https://www.nejm.org/doi/full/10.1056/NEJMoa2501277 Discontinuation of Beta-Blocker Therapy after MI (SMART-DECISION trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2601005 Subscribe to NEJM for the latest medical research: https://store.nejm.org/nejm/subscribe/choice

In a 12-year-old boy with severe idiopathic acute necrotizing pancreatitis, CT showed a right portal vein thrombus and a wedge-shaped area of hyperperfusion corresponding to the liver region supplied by the thrombosed vein. Read the full case details in the Images in Clinical Medicine article “Hepatic Arterial Buffer Response” from the University of Washington (@UW) and Seattle Children's Hospital (@seattlechildren): https://www.nejm.org/doi/full/10.1056/NEJMicm2516362

GLP-1 receptor agonists are increasingly used to treat type 2 diabetes and obesity, and trials have shown reductions in cardiovascular risk and slowing of kidney failure. Adverse events are mostly gastrointestinal. Read the Review Article “GLP-1 Receptor Agonists” by Clifford J. Rosen, MD, and Julie R. Ingelfinger, MD, from @tuftsmedschool and the Maine Medical Center Institute for Research: https://www.nejm.org/doi/full/10.1056/NEJMra2500106

In the EdiThal study, a Cas12a–guide RNA complex was used to target the promoters of HBG1 and HBG2 in autologous stem cells to treat transfusion-dependent β-thalassemia. Full study results: https://www.nejm.org/doi/full/10.1056/NEJMoa2501277 Editorial: More Options for Gene Editing in Hemoglobinopathies https://www.nejm.org/doi/full/10.1056/NEJMe2602194 Further reading: 📄 Original Article: Base Editing of HBG1 and HBG2 Promoters for Sickle Cell Disease (BEACON study) https://www.nejm.org/doi/full/10.1056/NEJMoa2504835 📄 Original Article: CRISPR-Cas12a Gene Editing of HBG1 and HBG2 Promoters to Treat Sickle Cell Disease (RUBY study) https://www.nejm.org/doi/full/10.1056/NEJMoa2415550

In the RUBY study, a Cas12a–guide RNA complex was used to target the promoters of HBG1 and HBG2 in autologous stem cells to treat sickle cell disease. Full study results: https://www.nejm.org/doi/full/10.1056/NEJMoa2415550 Editorial: More Options for Gene Editing in Hemoglobinopathies https://www.nejm.org/doi/full/10.1056/NEJMe2602194 Further reading: 📄 Original Article: Base Editing of HBG1 and HBG2 Promoters for Sickle Cell Disease (BEACON study) https://www.nejm.org/doi/full/10.1056/NEJMoa2504835 📄 Original Article: CRISPR-Cas12a Gene Editing of HBG1 and HBG2 Promoters to Treat β-Thalassemia (EdiThal study) https://www.nejm.org/doi/full/10.1056/NEJMoa2501277