NEJM Group

What is the impact of microplastics on human health? How can we use observational data to support the argument that microplastics may lead to poor health outcomes?? ? The latest episode of the Beyond Journal Club podcast, a collaboration between Core IM and NEJM Group, takes a deep dive into the APAChE study on microplastics and cardiovascular disease (published in NEJM in 2024).?? ? This podcast series puts #ClinicalTrials into context, telling the story of how we arrived at the current standard of care, appreciating the clinical question of the trial at hand, and interpreting what the findings may mean for these patients.? ? ?? Listen here: https://nej.md/4igpJQy? ? Learn more about the APAChE study:? ?? Read the full results published in NEJM: https://nej.md/3IrM6T8? ?? Read the editorial by Philip J. Landrigan, MD: https://nej.md/48CvGSs? ?? Watch the interview with Dr. Landrigan: https://nej.md/41SCs6f? ? Shreya P. Trivedi Gregory Katz Harleen Marwah, MD MS #Cardiology?

Primary infertility is defined as a history of no previous conception, and secondary infertility is an inability to conceive after any previously documented pregnancy.?? ? As defined by the American Society for Reproductive Medicine (ASRM), any need for reproductive technology in order to conceive is meant to be inclusive of same-sex couples, single parents by choice, persons who want to freeze oocytes, and transgender persons.? ? Assisted conception accounts for 5% of U.S. births. Although in vitro fertilization (IVF) was invented to circumvent blockage of the fallopian tubes, the expected live birth rate with IVF per round of treatment exceeds that of a couple with normal fertility in any given cycle and surpasses all other treatments to obtain a live birth.?? ? This degree of efficacy has led to the use of IVF for the treatment of infertility due to almost any cause. However, fertility treatment is expensive in the United States, and insurance coverage is inconsistent, factors that lead to inequitable access.?? ? Only 21 states mandate partial or complete insurance coverage. Regardless of access, Black, Hispanic, and Asian persons have lower live birth rates than White persons with most treatments, particularly IVF.? ? Learn more in a new Clinical Practice article, “Infertility Evaluation and Treatment,” by Nanette Santoro, MD, and Alex Polotsky, MD, from University of Colorado Anschutz Medical Campus and Shady Grove Fertility: https://nej.md/3DxEf7E #OBGYN #ClinicalMedicine??

?????????????????? is the delivery of cytoplasmic cargo for lysosomal degradation. (Autophagy originates from Greek and means “self-eating.”) Autophagy plays a role in cellular physiology — for example, in removal of cellular products, damaged organelles, and pathogens. To learn more about this NEJM Illustrated Glossary term, read the editorial “Genetic Medicine for Danon Disease” by Elizabeth McNally, MD, PhD, and Melissa J. Spencer, PhD, from Northwestern University - The Feinberg School of Medicine and the David Geffen School of Medicine at UCLA: https://nej.md/4irkBsB?? ? Explore more terms: https://nej.md/glossary?? ? #Genetics #Cardiology??? ?

Obesity is a chronic, relapsing, and progressive disease that necessitates appropriate management strategies endorsed by multiple guidelines. ? No medications are currently approved for the treatment of nonmonogenic, nonsyndromic obesity in children younger than 12 years of age. Although the use of liraglutide has been shown to induce weight loss in adults and adolescents with obesity, its safety and efficacy have not been established in children. ? The SCALE Kids trial, summarized here by NEJM Editorial Fellow Harleen Marwah, MD MS, assessed the efficacy and safety of liraglutide, as compared with placebo, as an adjunct treatment to lifestyle interventions, for the treatment of obesity in children 6 to 12 years of age. ? Full trial results: https://nej.md/3MBP1uc #ClinicalTrials #Endocrinology

Does tirzepatide in participants with obesity and prediabetes show substantial and sustained weight reduction and decreased risk of progression to diabetes, as compared with placebo?? ? In an earlier analysis of the SURMOUNT-1 trial, tirzepatide (a dual glucose-dependent insulinotropic polypeptide [GIP] and glucagon-like peptide-1 [GLP-1] receptor agonist) was shown to provide substantial and sustained reductions in body weight in adults with obesity over a 72-week period.?? ? Jastreboff et al. report the 3-year safety outcomes with tirzepatide and its efficacy in reducing weight and delaying progression to type 2 diabetes in persons with both obesity and prediabetes.? ? Adults with obesity and prediabetes were assigned to receive tirzepatide at a dose of 5 mg, 10 mg, or 15 mg or placebo, administered subcutaneously once weekly for 176 weeks, followed by a 17-week period without treatment.?? ? The three key secondary end points were the percent change in body weight from baseline to week 176 and the onset of type 2 diabetes during the 176-week and 193-week periods.? ? In adults with obesity and prediabetes, weekly tirzepatide therapy for 3 years resulted in sustained weight reductions and a lower risk of progression to type 2 diabetes than with placebo.? ? Read the full SURMOUNT-1 trial results and Research Summary: https://nej.md/48VdDZp? ? #Endocrinology #ClinicalTrials?

The latest Double Take video describes a man with recurrent severe diffuse abdominal pain without obvious associated symptoms. Based on a Clinical Problem-Solving article published in NEJM, the video explores the broad differential diagnosis of recurring abdominal pain and the evolution of the diagnosis as new clinical findings are presented. Watch it here: https://nej.md/3Dlpkx7? ? ?? Further reading:? A Swell Diagnosis (Allam et al., in the January 4, 2024, issue of NEJM) ?? https://nej.md/3NPTnPt?

The authors of a new editorial describe the foundations of a study of gene therapy to treat children and young adults with Danon disease. ?? https://nej.md/4irkBsB? ? Danon disease is an X-linked disorder arising from loss-of-function variants in LAMP2, which encodes lysosomal-associated membrane protein 2 (LAMP2).?? ? Lysosomes are acidic, enzyme-packed intracellular organelles that digest the cell’s own contents to maintain cellular homeostasis in a process called autophagy. Such digestion occurs on fusion of lysosome and autophagosome, a membrane-bound vacuole containing the cellular content destined for degradation.? ? Deficiency of LAMP2 produces a lysosomal storage disorder in which autophagosomes accumulate in different cell types and tissues. This process is especially problematic in skeletal myofibers and cardiomyocytes.?? ? Hypertrophic cardiomyopathy develops in the second to third decade in men and can warrant heart transplantation (see figure). Skeletal-muscle weakness and cognitive impairment can also accompany Danon disease.?? ? Because LAMP2 is on the X chromosome, male carriers of LAMP2 variants are disproportionately affected by Danon disease. Female carriers can be affected but usually less severely, and they usually receive a diagnosis later in life.? ? Because LAMP2 is reduced or absent in Danon disease, Greenberg et al. tested a gene-therapy approach to restore LAMP2 in persons with the disease.?? ? They used an adeno-associated virus (AAV) serotype 9 (AAV9) vector to deliver the gene to tissues of interest and a genetic element (a promoter) to force the expression of LAMP2 by different cell types, including the cardiomyocyte. (LAMP2 has three known isoforms; the authors used complementary DNA [cDNA] encoding the LAMP2B isoform, which is expressed by cardiomyocytes.)?? ? The study participants, who were 11 to 21 years of age, each received a single dose of the construct by intravenous infusion. All were treated with methylprednisolone and combinations of rituximab and sirolimus or tacrolimus to reduce immune responses to the construct and vector-encoded LAMP2.? ? Learn more in the editorial “Genetic Medicine for Danon Disease” by Elizabeth McNally, MD, PhD, and Melissa J. Spencer, PhD, from Northwestern University - The Feinberg School of Medicine and the David Geffen School of Medicine at UCLA: https://nej.md/4irkBsB? ? ?????????????? ?????????????? Original Article by B. Greenberg et al.: Phase 1 Study of AAV9.LAMP2B Gene Therapy in Danon Disease https://nej.md/40IBJVh? ? #Genetics #Cardiology??

There are approximately 20 essential micronutrients, and deficiency in one or more has distinct effects on the metabolome, proteome, and genome.? ? Since basic information about micronutrients is available in textbooks, reports on the ways in which requirements were established, reviews, and websites, the main purpose of a new Nutrition in Medicine article is to provide an overview of current issues in micronutrient assessment, interventions, and research that are of interest to health care practitioners.?? ? In the United States, the prevalence of most micronutrient deficiencies is low. National surveys — namely, the National Health and Nutrition Examination Survey (NHANES), which assesses biochemical markers of nutritional status, as well as its interview component, What We Eat in America, which measures nutrient intakes — provide some data on micronutrient status in the general population.?? ? However, these measures are made cross-sectionally, so it is difficult both to infer causality between micronutrient deficiencies and chronic diseases and to assess the health benefits of interventions such as supplementation.?? ? In recent decades, there has been a concerted international effort to study micronutrient deficiencies and interventions in low- and middle-income countries and population groups in which the prevalence and severity of most deficiencies are highest. One third of the world’s population has one or more micronutrient deficiencies.? ? Continue reading “Micronutrients — Assessment, Requirements, Deficiencies, and Interventions” by Lindsay H. Allen, PhD, from the US Department of Agriculture (USDA) Agricultural Research Service (ARS) and University of California, Davis: https://nej.md/4ith0um? ? #PublicHealth?

Because symptoms of cardiopulmonary disease often occur with exertion, cardiopulmonary exercise testing (CPET) has a unique role in the assessment of patient symptoms, disease severity, prognosis, and response to therapy.?? ? In addition to the evaluation of cardiovascular and pulmonary physiology, CPET provides an assessment of the interaction of the cardiovascular and pulmonary systems with the musculoskeletal, nervous, and hematological systems.? ? In a Review Article published in NEJM Evidence, Tiffany L. Brazile, MD, Benjamin D. Levine, MD, and Keri Shafer, MD, review key CPET variables, protocols, and clinical indications.??? https://eviden.cc/4aC6uOt #Cardiology #Pulmonology?

Does the addition of blinatumomab after induction chemotherapy in children with standard-risk disease of average or higher risk of relapse significantly improve disease-free survival?? ?? In the AALL1731 phase 3 trial, children between 1 and 10 years of age with newly diagnosed standard-risk B-cell ALL who were considered to have an average or higher risk of relapse after induction therapy were randomly assigned to receive chemotherapy alone or chemotherapy plus two nonsequential cycles of intravenous blinatumomab. The primary end point was disease-free survival.? ?? Among children with standard-risk B-cell ALL and an average or higher risk of relapse, the addition of blinatumomab to chemotherapy resulted in significant improvement in disease-free survival over chemotherapy alone.? ?? Read the full AALL1731 trial results and Research Summary at NEJM.org: https://nej.md/49CVkc1? ?? #Hematology #ClinicalTrials?