NEJM Group

Approximately 50% of patients who receive standard treatment for muscle-invasive bladder cancer have a recurrence within 3 years.?? ? A phase 2 trial suggested that adding perioperative durvalumab to standard treatment may be safe and efficacious. Additional data are needed.? ? In the NIAGARA trial, researchers assessed the efficacy and safety of adding perioperative durvalumab immunotherapy to standard treatment in patients with muscle-invasive bladder cancer.? ? Adults with muscle-invasive bladder cancer were randomly assigned to receive neoadjuvant durvalumab plus gemcitabine–cisplatin followed by radical cystectomy and adjuvant durvalumab or to receive neoadjuvant gemcitabine–cisplatin followed by radical cystectomy alone.?? ? Event-free survival was one of two primary end points; the second was pathological complete response. Overall survival was the key secondary end point.? ? In cisplatin-eligible patients with muscle-invasive bladder cancer, perioperative durvalumab in combination with neoadjuvant gemcitabine–cisplatin and radical cystectomy improved survival outcomes as compared with neoadjuvant gemcitabine–cisplatin and radical cystectomy alone.? ? Read the full NIAGARA trial results and Plain Language Summary: https://nej.md/4gmAqk3? ? #ClinicalTrials #MedicalResearch?

An ?????????????????? ?????????????????????????????? is a short (typically 12 to 30 nucleotides) single strand of chemically modified nucleotides that target messenger RNA (mRNA) to prevent translation into protein. Antisense oligonucleotides can bind directly to mRNA, leading to mRNA degradation; can inhibit generation of mature mRNA by blocking splicing of precursor forms of mRNA; or can block ribosome recruitment to inhibit protein translation. Antisense oligonucleotides can also be designed to target other RNAs, such as microRNAs and long noncoding RNAs.? ? 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?

?????????????? ?????????? was first identified in 2009, in an isolate from the ear canal of a patient in Japan (“auris” is the Latin word for “ear”) and has rapidly emerged as a serious global public health threat. The species, which has spread across more than 45 countries in six continents, is subdivided into five clades (I through V) with distinct geographic distributions. ??. ?????????? is of particular concern because of its ability to adhere to human skin and inanimate objects and to persist, frequently causing difficult-to-control outbreaks in health care facilities. The misidentification of ??. ?????????? as another candida species, an incomplete understanding of its environmental reservoirs, the high morbidity and mortality associated with invasive infections, and the resistance of ??. ?????????? to several classes of antifungal agents represent additional challenges to providing effective patient care. The serious risks posed by ??. ?????????? led the Centers for Disease Control and Prevention to classify it as an urgent threat in the 2019 Antibiotic Resistance Threats report. Similarly, the World Health Organization recently placed ??. ?????????? in the “critical” group of human fungal pathogens, indicating an urgent need to prioritize research on improving diagnosis, treatment, and outcomes in patients affected by this opportunistic fungus.? ? Read the Review Article “?????????????? ?????????? Infections,” which includes an interactive map, by Michail Lionakis, MD, ScD, and Anuradha Chowdhary, MD, PhD, from The National Institutes of Health and the University of Delhi: https://nej.md/3CMj8gT?

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?

?????????? (???? ??????????) ?????????????????????? ?????? (??????????)?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?