NEJM

A 𝐧𝐞𝐨𝐚𝐧𝐭𝐢𝐠𝐞𝐧 is a novel peptide that is derived from a somatic variant in a tumor cell and can be recognized as “nonself” by T cells. Neoantigens are tumor-specific and have not been encountered during thymic T-cell development and are therefore not subject to central tolerance. To learn more about this NEJM Illustrated Glossary term, read the Clinical Implications of Basic Research article “Understanding How Aspirin Prevents Metastasis” by Ruth E. Langley, MB, BS, PhD, and John Burn, MD, from University College London and @uniofnewcastle: nej.md/4pTzyaw Explore more terms: nej.md/glossary

Original Article: Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation (CLOSURE-AF trial) nejm.org/doi/full/10.10… Editorial: Left Atrial Appendage Closure — Another Overused Method in Cardiology? nejm.org/doi/full/10.10… #Cardiology

In an international, randomized trial involving patients with acute venous thromboembolism, the risk of clinically relevant bleeding was significantly lower with apixaban than with rivaroxaban during the 3-month treatment period. Full COBRRA trial results and Research Summary: nejm.org/doi/full/10.10…

To control EBOV outbreaks, defining potential sanctuary sites where the virus may persist and lead to transmission is important. In this report, persistence of EBOV RNA in breast milk was identified and characterized. Read the full report: nejm.org/doi/full/10.10…

In a new blog post, @PaulSaxMD shares 20 facts about a surprisingly common group of infections: nontuberculous mycobacteria, or NTM. See the list: voices.nejm.org/doi/full/10.10…

A new interactive feature describes a 52-year-old man who presented to his primary care clinic with a 3-week history of fevers, drenching night sweats, fatigue, myalgias, and dyspnea on exertion. Test your diagnostic and therapeutic skills: nejm.org/doi/full/10.10…

The treatment goal for patients with polymyalgia rheumatica is the absence of clinical symptoms and systemic inflammation. Glucocorticoids are the first-line therapy. Abatement of symptoms and inflammatory signs is usually rapid (seen in figure). Learn more in a new review: nejm.org/doi/full/10.10…

The authors of a new Perspective write that the CMS Innovation Center is approaching the next negotiation cycle for the CGT Access Model. Several considerations will guide the selection of future candidate diseases and potential new model designs. Perspective by A. Sutton (@AbeSutton) et al.: nejm.org/doi/full/10.10…

A 74-year-old man was admitted to the hospital with a 3-week history of intermittent fevers, muscle aches, and vomiting. Thin blood smears showed spirochetes. Read the full case details in the Images in Clinical Medicine article “Soft Tick Relapsing Fever,” from @ucdavis: nejm.org/doi/full/10.10…

The authors of a new Perspective write that some foreign pharmaceutical plants that export generic drugs to the United States have glaring quality problems that can lead to drug shortages. There is a better way to assure the safety of generic drugs. Read the Perspective by Kevin Schulman, MD, and Arthur L. Kellermann, MD, MPH: nejm.org/doi/full/10.10…

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: nejm.org/doi/full/10.10… Editorial: Left Atrial Appendage Closure — Another Overused Method in Cardiology? nejm.org/doi/full/10.10…

Original Article: Romiplostim versus Placebo for Chemotherapy-Induced Thrombocytopenia (phase 3 RECITE trial) nejm.org/doi/full/10.10… Editorial: Thrombopoietin-Receptor Agonists in Chemotherapy-Induced Thrombocytopenia nejm.org/doi/full/10.10… #Oncology #Gastroenterology

In a Perspective, Melissa Arguello Belli, MD, argues that U.S. clinicians, health systems, and policymakers should recognize immigration enforcement as a social determinant of health currently implicated in a public health crisis and act accordingly. Read the full Perspective: nejm.org/doi/full/10.10…

Some of these rabies exposure stories from infectious diseases expert Paul Sax, MD, are pretty wild. Watch the full video for a rundown of the animal species most likely to have rabies ― any guesses?? clinician.nejm.org/dr-paul-sax-ra…

Case Record of the Massachusetts General Hospital (@MassGeneralNews): A 57-year-old woman was evaluated at this hospital because of 2 days of chest pain, dyspnea, lightheadedness, and syncopal episodes. Six weeks before this evaluation, the patient was admitted to this hospital because of a temperature of 41.1°C, dyspnea and hypoxemia, tachycardia, altered mental status, and opioid injection. The results of blood and urine cultures and imaging of the chest, abdomen, pelvis, head, and neck were unrevealing. Transthoracic echocardiography revealed thickening of the mitral-valve leaflets and the noncoronary aortic-valve leaflet and no pericardial effusion. The patient received treatment for hypoxemic respiratory failure with mechanical ventilation, a brief course of empirical broad-spectrum antibiotic therapy, diuretic therapy, and albuterol and ipratropium bromide nebulizers. In addition, methadone therapy was started to alleviate the symptoms of opioid withdrawal. Her mental status and respiratory status improved, and she was discharged on hospital day 10 in stable condition. Read the full case details in “A 57-Year-Old Woman with Chest Pain, Dyspnea, and Syncope,” a Case Record of the Massachusetts General Hospital, by P.T. O’Gara et al., from @MassGenBrigham, @harvardmed, and Massachusetts General Hospital: nejm.org/doi/full/10.10…

In the latest episode of AI Grand Rounds, Dr. Kyunghyun Cho (@kchonyc) discusses his wide-ranging career spanning fundamental AI research, co-founding Prescient Design (acquired by @genentech), and driving applications of AI in health care. Full episode: nejm.ai/ep40

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. What is the most likely diagnosis in this case? 🗳️ Cast your vote before March 25: nejm.org/do/10.1056/NEJ…

Original Article: Prehospital Whole Blood in Traumatic Hemorrhage — a Randomized Controlled Trial (phase 3 SWiFT trial) nejm.org/doi/full/10.10… #ISICEM | @ISICEM

Original Article: High-Flow or Standard Oxygen in Acute Hypoxemic Respiratory Failure (SOHO trial) nejm.org/doi/full/10.10… Editorial: Rethinking High-Flow Oxygen in Acute Hypoxemic Respiratory Failure nejm.org/doi/full/10.10… #ISICEM | @ISICEM

Original Article: DB-OTO Gene Therapy for Inherited Deafness (CHORD study) nejm.org/doi/full/10.10… Science behind the Study: Gene Therapy to Treat Profound Hearing Loss nejm.org/doi/full/10.10… #Genetics #Otolaryngology

Artificial Intelligence in the Clinic: Don’t Pay for the Tool, Pay for the Care nej.md/3ZEpqYr