NEJM

A new Clinical Practice article summarizes the pathogenesis, diagnosis, and management of Barrett’s esophagus, a reflux-related condition with increased adenocarcinoma risk, highlighting endoscopic diagnosis, surveillance, and early curative therapy. Read “Barrett’s Esophagus” by Rebecca C. Fitzgerald, MD (@RFitzgerald_lab), from the University of Cambridge (@cambridge_uni): nejm.org/doi/full/10.10… #Oncology

Among participants 4 to 66 years of age with acquired hypothalamic obesity, setmelanotide, a melanocortin-4 receptor agonist, led to significantly greater reductions in body-mass index and hunger than placebo at 52 weeks. Read the full TRANSCEND trial results: nej.md/3Rm9E3L

In a phase 3 trial involving patients with idiopathic pulmonary fibrosis, inhaled treprostinil was associated with a smaller decline in forced vital capacity and a lower risk of clinical worsening than placebo over 52 weeks. Read the full TETON-2 trial results: nej.md/3RqUHgP

The United States faces a projected shortage of millions of long-term–care workers by 2040. Yet in each area where progress could help address this gap, federal policy is moving in the wrong direction. Andrew R. Olenski, PhD, and David C. Grabowski, PhD, discuss this issue in a new Perspective: nej.md/44jMrCg

In a new Audio Interview, Dr. Mark Unruh discusses projected increases in the need for long-term services and supports in the United States amid declines in nursing-home capacity. Listen here: nej.md/4bxQb6V

Unlike parenteral nutrition and the receipt of nothing by mouth, which impair gut health by reducing epithelial-cell proliferation, increasing apoptosis, and disrupting mucosal integrity, enteral nutrition supports gut function by enhancing tight-junction protein expression, reducing enterocyte apoptosis, preserving villous and crypt architecture, maintaining Paneth-cell function, supporting gut-associated lymphoid tissue, and helping to sustain commensal microbiota. Learn more in “Nutrition Therapy in Critically Ill Adults,” a new review by Jayshil J. Patel, MD, and Stephen A. McClave, MD: nej.md/44m85Wt

Updated estimates of the prevalence of chronic kidney disease (CKD) in the United States indicate that the overall national burden of CKD has remained stable, but an increasing proportion is associated with diabetes. Learn more: nej.md/4wxMc2f

In a new Voices blog post, Kemi Doll, MD, writes that too often, health equity scientists must challenge the existing bias of what people think they already know. Hear more from Dr. Doll: nej.md/4w1dUF4

In voluntary euthanasia, which has growing international acceptance, clinicians fulfill competent patients’ voluntary requests to relieve their suffering by intentionally ending their lives. In Canada, voluntary euthanasia was legalized in 2016 after the Carter v. Canada Supreme Court decision and now accounts for roughly 4.7% of all deaths. (Canada’s eligibility criteria are listed in Box 1; key milestones leading to current legislation are listed in Table 2.) Legalization of voluntary euthanasia introduced a new form of controlled death to which organ-donation regulation had to adapt. Read more in “Contextualizing the Dead Donor Rule in an Era of Voluntary Euthanasia” by Carter Winberg, MD, Ian Ball, MD, and Robert D. Truog, MD: nej.md/4wy8bX5

The hypothalamus is a small brain region whose primary function is to maintain a stable internal environment, as first described by the French physiologist Claude Bernard and later by Walter Cannon, who coined the term “homeostasis.” In 1901, Austrian physician Alfred Fröhlich described a case report of a boy with rapid-onset severe obesity and hypogonadism due to a tumor near the pituitary gland. Subsequently, Anand and Brobeck found that disruption of the hypothalamus (rather than the pituitary) causes weight gain, establishing the critical importance of hypothalamic pathways in weight regulation. Within the hypothalamus, distinct clusters of neurons, or nuclei, form a complex network of circuits that receive input from, and project to, other brain regions. Hetherington and Ranson found that lesions of the ventromedial nucleus and arcuate nucleus cause hyperphagia and obesity in animals, whereas disruption of the lateral hypothalamus causes the opposite — hypophagia and leanness. These findings indicated that the precise location and extent of hypothalamic damage determine the effect on body weight (shown in illustration). Continue reading “Treating Acquired Hypothalamic Obesity,” a new Science behind the Study by I. Sadaf Farooqi, MB, ChB, PhD: nej.md/4wpXohA

Original Article: Ensartinib in Resected ALK-Positive Non–Small-Cell Lung Cancer (ELEVATE) nej.md/4wsDQZS #Oncology

In resected 𝘈𝘓𝘒-positive non–small-cell lung cancer, treatment with ensartinib, a second-generation ALK inhibitor, led to higher disease-free survival than placebo. Learn more about the ELEVATE trial in a short Quick Take video: nej.md/4f3LD9u

Original Article: Meningococcal B Vaccine to Prevent 𝘕𝘦𝘪𝘴𝘴𝘦𝘳𝘪𝘢 𝘨𝘰𝘯𝘰𝘳𝘳𝘩𝘰𝘦𝘢𝘦 Infection nej.md/4wv9Qwi #InfectiousDisease

A 21-year-old man had measles after allogeneic stem-cell transplantation complicated by graft-versus-host disease. After he had recovered from the acute infection, an encephalitis developed that was ultimately fatal. Read more: nej.md/4bvswE8

A rapid growth in the population of older Americans has long been anticipated. But projections didn’t anticipate that this transition would coincide with a sustained reduction in nursing-home services. Read more in “Colliding Forces — The Aging of the Baby Boom Generation and Contracting Nursing-Home Supply,” by Mark A. Unruh, PhD, Vincent Mor, PhD, and Hye-Young Jung, PhD: nej.md/4bxQb6V

Among patients with idiopathic pulmonary fibrosis, inhaled treprostinil led to a smaller decline in forced vital capacity than placebo over 52 weeks. Cough and drug discontinuation were more common with treprostinil. Read the full TETON-1 trial results: nej.md/4wspx7x

Original Article: Setmelanotide for the Treatment of Acquired Hypothalamic Obesity (TRANSCEND) nej.md/3Rm9E3L Science behind the Study: Treating Acquired Hypothalamic Obesity nej.md/4wpXohA #Pediatrics

Case Records of the MGH: A 68-year-old man was evaluated in an outpatient clinic because of fatigue and dyspnea. The patient had a history of COPD with progressive bronchitis symptoms that had resulted in frequent emergency department visits and hospital admissions, as well as the use of supplemental oxygen during exertion. Three years before the current presentation, bronchoscopic lung-volume reduction surgery was performed, with placement of four endobronchial valves. One year later, symptoms progressed. Read the full case presentation: nej.md/4wBMrJW

A new Interactive Medical Case describes a 73-year-old man with a history of heart failure who presented to the ED with a rash, weight gain, dyspnea, and new-onset visible hematuria. Test your diagnostic and therapeutic skills: nej.md/4bz8Jnk

TETON-1 trial: For patients with IPF, effective therapies are needed. Results from two phase 3 trials on the efficacy and safety of inhaled treprostinil are summarized in a short Quick Take video: nej.md/4fbaLLF

Among patients with resected 𝘈𝘓𝘒-positive non–small-cell lung cancer, 2-year disease-free survival was higher with the ALK inhibitor ensartinib than with placebo. Grade 3 adverse events were more frequent with ensartinib. Full results of the ELEVATE trial: nej.md/4wsDQZS