Impf_Info – Following Feed 478 Posts (gefiltert)

Original Article: Mavacamten in Adolescents with Obstructive Hypertrophic Cardiomyopathy (phase 3 SCOUT-HCM trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2601103 #ACC26 | @ACCinTouch

Presented at #ACC26: Among patients with unprotected left main coronary artery disease, intravascular ultrasonography–guided PCI did not result in a lower risk of ischemic events or death than angiography-guided PCI. Full OPTIMAL trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2600440 Editorial: Seeing the Left Main Coronary Artery Clearly — Is IVUS Always Necessary? https://www.nejm.org/doi/full/10.1056/NEJMe2602959 @ACCinTouch

Presented at #ACC26: In the IVUS-CHIP trial involving patients undergoing complex high-risk PCI, the risk of target-vessel failure (a composite outcome) was not lower with intravascular ultrasound guidance than with angiography guidance. Full trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2601521 Editorial: IVUS — A Zigzag Path to Success https://www.nejm.org/doi/full/10.1056/NEJMe2603397 @ACCinTouch

Presented at #ACC26: Among patients with infrainguinal artery disease who were undergoing angioplasty, the risk of major adverse limb events at 1 year was lower with sirolimus-coated balloons than with uncoated balloons, and mortality was similar. Full phase 3 SirPAD trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2600360 Editorial: Sirolimus-Eluting Technology for the Treatment of Peripheral Artery Disease https://www.nejm.org/doi/full/10.1056/NEJMe2602625 @ACCinTouch

Original Article: Angiography-Based Physiology to Guide Coronary Revascularization (FAST III trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2601841 Editorial: Redefining Physiology in the Cardiac Catheterization Laboratory https://www.nejm.org/doi/full/10.1056/NEJMe2603714 #ACC26 | @ACCinTouch

Original Article: Angiography-Derived Fractional Flow Reserve to Guide PCI (ALL-RISE trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2600949 Editorial: Toward Broader Adoption of Coronary Physiological Assessment https://www.nejm.org/doi/full/10.1056/NEJMe2603396 #ACC26 | @ACCinTouch

Presented at #ACC26: Among patients with a preserved ejection fraction at least 1 year after myocardial infarction, stopping beta-blockers was noninferior to continuing therapy with respect to major clinical outcomes. Full SMART-DECISION trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2601005 @ACCinTouch

Original Article: Left Ventricular Unloading in High-Risk Percutaneous Coronary Intervention (CHIP-BCIS3 trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2515704 Editorial: Price of Protection — Microaxial Flow Pump in High-Risk PCI https://www.nejm.org/doi/full/10.1056/NEJMe2602727 #ACC26 | @ACCinTouch

Original Article: Iptacopan in IgA Nephropathy — Final 24-Month Data (phase 3 APPLAUSE-IgAN trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2600743 #ISNWCN | @ISNWCN

Original Article: Intensive LDL Cholesterol Targeting in Atherosclerotic Cardiovascular Disease (Ez-PAVE trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2600283 Editorial: Paving the Road toward Targeted Lipid Lowering https://www.nejm.org/doi/full/10.1056/NEJMe2601725 #ACC26 | @ACCinTouch

Original Article: A Phase 3 Trial of Brepocitinib in Dermatomyositis (VALOR trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2503531 #AAD2026 | @AADmember

A 68-year-old woman with rosacea presented to clinic with a 6-week history of asymptomatic dark patches on her arms and legs. Two weeks before the onset of the skin changes, she had started treatment for the rosacea. Physical examination is shown. What is the most likely causative agent? Submit your answer or see how others responded: https://www.nejm.org/image-challenge?ci=20260326

Original Article: Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis at 10 Years (RECOVERY trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2511920 #Surgery #Cardiology

Medical evidence comes in the form of population statistics, but patients behave like people, each one unique. Physicians walk the line, studying bell curves but hoping each intervention has an NNT of 1. Read the Perspective essay by W. Michael Brode, MD: https://www.nejm.org/doi/full/10.1056/NEJMp2511419

Presented at #ACC26: In the phase 3 SCOUT-HCM trial, among adolescents with obstructive hypertrophic cardiomyopathy, the cardiac myosin inhibitor mavacamten led to a significantly greater reduction in left ventricular outflow tract obstruction than placebo. Full trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2601103 @ACCinTouch

Original Article: Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism (HI-PEITHO trial) https://nej.md/4uMu4lv Editorial: Advanced Therapy for Intermediate-Risk Pulmonary Embolism https://nej.md/4sBg7Fo #ACC26 | @ACCinTouch

Original Article: Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation (CHAMPION-AF) https://www.nejm.org/doi/full/10.1056/NEJMoa2517213 Editorial: Left Atrial Appendage Closure — Should Recommendations Be Expanded? https://www.nejm.org/doi/full/10.1056/NEJMe2603846 #ACC26 | @ACCinTouch

Presented at #ACC26: Among patients with intermediate coronary lesions, angiography-guided revascularization was noninferior to pressure-wire–based guidance with respect to death, myocardial infarction, or revascularization. FAST III trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2601841 Editorial: Redefining Physiology in the Cardiac Catheterization Laboratory https://www.nejm.org/doi/full/10.1056/NEJMe2603714 @ACCinTouch

Presented at #ACC26: In the ALL-RISE trial, FFRangio (fractional flow reserve derived from angiography) was noninferior to pressure-wire–guided assessment in reducing risk among patients with intermediate coronary stenosis. Full trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2600949 Editorial: Toward Broader Adoption of Coronary Physiological Assessment https://www.nejm.org/doi/full/10.1056/NEJMe2603396 @ACCinTouch

Presented at #ACC26: Among patients undergoing complex PCI, elective unloading with a microaxial flow pump did not reduce the risk of major adverse clinical outcomes as compared with standard care. Full CHIP-BCIS3 trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2515704 Editorial: Price of Protection — Microaxial Flow Pump in High-Risk PCI https://www.nejm.org/doi/full/10.1056/NEJMe2602727 @ACCinTouch

𝗠𝗶𝗻𝗶𝗽𝘂𝗯𝗲𝗿𝘁𝘆 𝗶𝗻 𝗜𝗻𝗳𝗮𝗻𝘁 𝗕𝗼𝘆𝘀 Infant boys have two separate hormonal surges during minipuberty — an earlier one involving Leydig cells and a later one involving Sertoli-cell markers. A longitudinal study involving 119 healthy boys showed that follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels peaked at 11 to 18 days after birth, testosterone and insulin-like 3 levels (Leydig-cell markers) peaked at 1 month of age, and inhibin B and antimüllerian hormone levels (Sertoli-cell markers) peaked at 4 to 5 months of age, with concomitant increases in testicular volume. This increase in testosterone levels may promote final testicular descent, as evidenced by a decrease in the prevalence of cryptorchidism from 9% at birth to 2% at 3 months of age. Testosterone and dihydrotestosterone levels correlate with penile length and growth, and inhibin B levels correlate with testicular volume during minipuberty. The first postnatal surge in gonadotropins is associated with a proliferation of Sertoli cells, key components in adult spermatogenesis, as well as with a subsequent increase in testicular volume. The undifferentiated Sertoli cells do not express androgen receptors at this time, so spermatogenesis is delayed until more androgen receptors are expressed with age (seen in figure). Finally, the LH:FSH ratio increases during minipuberty and is significantly higher in boys than in girls. Learn more in the Review Article “Clinical Implications of Minipuberty” by Anders Juul, MD, DMSc, PhD, from Copenhagen University Hospital–Rigshospitalet and the University of Copenhagen: https://www.nejm.org/doi/full/10.1056/NEJMra2305989

Presented at #ISNWCN: Alternative complement pathway overactivation contributes to IgA nephropathy. In a placebo-controlled trial, iptacopan, a complement factor B inhibitor, significantly slowed kidney-function decline in patients with IgA nephropathy. Full phase 3 APPLAUSE-IgAN trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2600743 @ISNWCN

Perspective by Amy W. Stimpfel, PhD, RN, and Maja Djukic, PhD, RN: Using Data to Inform Decision Making — Borrowing Limits for Graduate Nursing Students https://www.nejm.org/doi/full/10.1056/NEJMp2600236 #HealthPolicy #MedEd

Presented at #ACC26: Among patients with atherosclerotic cardiovascular disease, targeting an LDL cholesterol level below 55 mg per deciliter led to a lower 3-year risk of cardiovascular events than targeting a level below 70 mg per deciliter. Full Ez-PAVE trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2600283 Editorial: Paving the Road toward Targeted Lipid Lowering https://www.nejm.org/doi/full/10.1056/NEJMe2601725 @ACCinTouch

Infection with Japanese encephalitis virus, a mosquito-borne flavivirus, was identified in a patient who received a liver transplant from a donor who resided in California. Read the full report: https://www.nejm.org/doi/full/10.1056/NEJMc2514269

Presented at #AAD2026: In the VALOR trial of brepocitinib in adults with dermatomyositis, the 30-mg dose (but not the 15-mg dose) led to greater improvement on a composite myositis index at 52 weeks than placebo. Serious infections were more frequent with the 30-mg dose. Full trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2503531 @AADmember

The authors of a new Medicine and Society article argue that corporations that make and market health-harming products are a primary vector for the global increase in mortality related to noncommunicable diseases. Research using internal industry documents can help. Read the full article by the Consortium of the Center to End Corporate Harm, University of California, San Francisco (@UCSF_PRHE): https://www.nejm.org/doi/full/10.1056/NEJMms2507028

Preferred treatment of asymptomatic severe aortic stenosis is unclear. Guidelines recommend watchful waiting until symptoms occur, but a recent trial showed reduced mortality with early surgery. Research findings from the RECOVERY trial are summarized in a new Quick Take video. https://www.nejm.org/do/10.1056/NEJMdo008414/full/

In an evaluation in low- and middle-income countries involving 95 patients with chronic myeloid leukemia who had deep remission for more than 1 year, 79% remained in treatment-free remission after imatinib discontinuation. Learn more: https://www.nejm.org/doi/full/10.1056/NEJMc2518028

A woman with a history of necrotizing pancreatitis presented with abdominal pain and fevers. CT showed a fluid collection with gas and septations in the pancreatic region. A retroperitoneal necrosectomy was performed (shown in a video). Read the full case details in the Images in Clinical Medicine article “Walled-Off Pancreatic Necrosis”: https://www.nejm.org/doi/full/10.1056/NEJMicm2515752

Presented at #ACC26: In patients with pulmonary embolism, ultrasound-facilitated, catheter-directed fibrinolysis led to a lower risk of a composite of major adverse outcomes than anticoagulation alone. Full HI-PEITHO trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2516567 Editorial: Advanced Therapy for Intermediate-Risk Pulmonary Embolism https://www.nejm.org/doi/full/10.1056/NEJMe2603115 @ACCinTouch

Presented at #ACC26: In patients with atrial fibrillation, left atrial appendage closure was noninferior to NOACs in an analysis of death from cardiovascular causes, stroke, or systemic embolism and was superior for non–procedure-related bleeding. Full CHAMPION-AF trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2517213 Editorial: Left Atrial Appendage Closure — Should Recommendations Be Expanded? https://www.nejm.org/doi/full/10.1056/NEJMe2603846 @ACCinTouch

Douglas J. Opel, MD, MPH, discusses the importance of clinician–parent communication amid changes to the childhood vaccine schedule. Listen to the full interview with NEJM Executive Managing Editor Stephen Morrissey (@srm128): https://www.nejm.org/doi/full/10.1056/NEJMdo008469

Original Article: Atezolizumab plus FOLFOX for Stage III Mismatch Repair–Deficient Colon Cancer (phase 3 ATOMIC trial) https://www.nejm.org/media/doi/full/10.1056/NEJMoa2507874 Editorial: ATOMIC Energy — Biomarker-Bespoke Adjuvant Therapy for Colon Cancer https://www.nejm.org/doi/full/10.1056/NEJMe2517910 #Oncology #Gastroenterology

A 68-year-old woman with rosacea presented to clinic with a 6-week history of asymptomatic dark patches on her arms and legs. Two weeks before the onset of the skin changes, she had started treatment for the rosacea. Physical examination is shown. What is the most likely causative agent? https://www.nejm.org/image-challenge?ci=20260326

In nine patients with GM1 gangliosidosis, a fatal neurodegenerative disease, AAV9 β-galactosidase gene therapy was associated with short-lived adverse events, increased β-galactosidase levels, and delayed progression. Full study results: https://www.nejm.org/doi/full/10.1056/NEJMoa2510935

In a new Perspective, Genevieve P. Kanter, PhD (@ProfGenKanter), argues that even by the most radical interpretation, the U.S. Department of Health and Human Services’ proposals for reducing conflicts of interest on its advisory committees are unlikely to restore public trust. Learn more: https://www.nejm.org/doi/full/10.1056/NEJMp2514012

Case Record of the Massachusetts General Hospital (@MassGeneralNews): A 12-year-old girl was admitted to the hospital with altered mental status and abdominal distention. The blood glucose level was 30 mg per deciliter. Symptoms abated with glucose administration. 👉 https://www.nejm.org/doi/full/10.1056/NEJMcpc2517859 CT of the abdomen and pelvis, performed after the administration of intravenous contrast material, revealed a solid, enhancing intraperitoneal abdominopelvic mass that measured 28 cm by 21 cm, with cystic features but no calcifications or fat. The right ovary appeared normal; the left ovary was not well visualized. The liver, spleen, kidneys, adrenal glands, and pancreas appeared normal. Contrast-enhanced magnetic resonance imaging (MRI) of the abdomen and pelvis (seen in figure) was also performed, since it is superior to CT for soft-tissue characterization. MRI showed the solid, enhancing abdominopelvic mass with restricted diffusion, which was consistent with an aggressive hypercellular tumor. Normal ovaries were also noted. These characteristics appear to indicate the presence of a large extraovarian, intraperitoneal, solid abdominopelvic mass with aggressive features. On the basis of these findings, the differential diagnosis includes a mesenchymal tumor, carcinoma, metastatic sarcoma, lymphoma, and atypical teratoma. Read the full case details in “A 12-Year-Old Girl with Altered Mental Status and Hypoglycemia,” a Case Record of the Massachusetts General Hospital, by K. Lord et al., from Children’s Hospital of Philadelphia (@ChildrensPhila), the Perelman School of Medicine at the University of Pennsylvania, Massachusetts General Hospital (@MassGeneralNews), and @harvardmed: https://www.nejm.org/doi/full/10.1056/NEJMcpc2517859

A woman with Bell’s palsy presented with a 1-month history of involuntary facial movements. Her face was nearly symmetric at rest, but when she raised her eyebrows, one side of her mouth involuntarily lifted (shown in a video). Read the full case details in the Images in Clinical Medicine article “Facial Synkinesis,” from All India Institute of Medical Sciences, Delhi (@aiims_newdelhi): https://www.nejm.org/doi/full/10.1056/NEJMicm2506222

The authors of a new Perspective write that states have responded to increasing health care consolidation by enhancing their review of mergers and acquisitions. But some states have carved out certain academic medical centers from such oversight. Learn more: https://www.nejm.org/doi/full/10.1056/NEJMp2514565