NEJM Group

𝗙𝗲𝘁𝗮𝗹 𝗵𝗲𝗺𝗼𝗹𝘆𝘀𝗶𝘀 is the rupture of red cells, which causes release of cellular debris and proteins, such as hemoglobin, into surrounding fluids. Fetal hemolysis can lead to fetal anemia and, as a result of heme degradation, the production of bilirubin, which is eliminated by the placenta. Hemolysis during pregnancy can lead to anemia in the fetus and hyperbilirubinemia and anemia in the newborn. To learn more about this NEJM Illustrated Glossary term, read the editorial “Inhibiting IgG in Hemolytic Disease of the Fetus” by Emeline Maisonneuve, MD, Alice Panchaud, PhD, and David Baud, MD, PhD: https://nej.md/3YS7Scb    Explore more terms: https://nej.md/glossary  

One third of Black and Latinx residents in Chicago are food insecure, write the authors of a new Perspective.     Food insecurity was exacerbated by closure of supermarkets during the Covid-19 pandemic, which led to especially low availability of fresh produce on the city’s racially minoritized West Side.    VeggieRx is a produce prescription program anchored by the Farm on Ogden, a 20,000-square-foot urban agriculture facility.    VeggieRx prescriptions are provided by health center clinicians to patients with diet-related diseases such as obesity and diabetes, many of whom are also experiencing food insecurity. To redeem prescriptions, patients are given an appointment at the Farm on Ogden, a 20,000-square-foot urban agriculture facility that is located on the West Side of Chicago, one block from Lawndale Christian Health Center’s main campus, and is accessible by several public bus and train routes. The farm is operated by the Chicago Botanic Garden’s urban agriculture program, Windy City Harvest, and houses a 7300-square-foot indoor greenhouse, a 50,000-gallon aquaponics system, a year-round indoor farmer’s market, commercial and teaching kitchens for nutrition education and local culinary entrepreneurs, an aggregation space for urban farmers, job training for justice-involved residents, and certificate programs in farming, food safety, cooking, and nutrition (shown in photo).    Learn more about this program in the Perspective “An Urban Farm–Anchored Produce Prescription Program — Food as Medicine and Economic Justice” by K.M. Fruin et al., from UCLA, the University of Chicago, the Chicago Botanic Garden, and the Lawndale Christian Health Center: https://nej.md/3WQXIpt 

Acute kidney injury (AKI) is a serious and common complication of cardiac surgery, for which reduced kidney perfusion is a key contributing factor.    Intravenous amino acids increase kidney perfusion and recruit renal functional reserve. However, the efficacy of amino acids in reducing the occurrence of AKI after cardiac surgery is uncertain.    In the PROTECTION trial, researchers evaluated the efficacy and safety of intravenous amino acid therapy in reducing the risk of AKI in adult patients undergoing elective cardiac surgery with cardiopulmonary bypass.    A total of 3511 adults scheduled to undergo cardiac surgery requiring cardiopulmonary bypass were randomly assigned to receive either a balanced mixture of amino acids, at a dose of 2 g per kilogram of ideal body weight per day, or placebo, from the time of admission to the operating room for up to 3 days.     The primary outcome was AKI within 1 week after surgery, with AKI defined according to the Kidney Disease: Improving Global Outcomes creatinine criteria for stage 1 or greater AKI.    Among adult patients undergoing cardiac surgery, infusion of amino acids reduced the occurrence of AKI.    Read the full PROTECTION trial results and Plain Language Summary: https://nej.md/45zYDyF    #ClinicalTrials #MedicalResearch

𝗩𝗼𝗻 𝗪𝗶𝗹𝗹𝗲𝗯𝗿𝗮𝗻𝗱 𝗙𝗮𝗰𝘁𝗼𝗿 is a multidomain adhesive glycoprotein produced in megakaryocytes and endothelial cells that protects factor VIII from degradation and is crucial for primary hemostasis and thus plug (or clot) formation. It forms multimers that circulate in the blood. After endothelial damage, von Willebrand factor binds to the subendothelial extracellular matrix and unfolds to expose platelet-binding sites, capturing platelets and thus contributing to the formation of a platelet plug. It promotes changes in platelet shape and granule release, which contribute to coagulation and hemostasis. Genetic variants in the von Willebrand factor gene result in changes in von Willebrand factor, causing a common bleeding disorder known as von Willebrand disease. To learn more about this NEJM Illustrated Glossary term, read the editorial “Bioengineered Factor VIII — More Innovation for Hemophilia A” by Pratima Chowdary, MD, from the Royal Free London NHS Foundation Trust: https://nej.md/3Y6RTWY    Explore more terms: https://nej.md/glossary  

Free Virtual Event from NEJM AI: AI in Health Care — Putting Patients First    Patients are using #ArtificialIntelligence for a variety of reasons – from second opinions to self-diagnoses, finding appointments, and more. Today, health care organizations have the opportunity to optimize that AI use, not only to minimize risk for patients, but also to enhance engagement and the overall patient experience.    Join us for a free virtual event to hear experts in the field of AI discuss:    🛠️ The ground truth on the tools patients are using independently  🩺 How clinicians can guide patients on optimal AI use despite current constraints and uncertainties  🤖 What meaningful patient engagement can look like with AI   📝 Strategies to leverage patient input to prioritize research and technology development    📅 October 9, 2024  ⏰ 12:00–2:15 PM  🔗 https://nej.md/3AQXCqh    #AIinMedicine #HealthCare 

Because there is no universal definition of normal sexual function, what constitutes sexual difficulty is determined by a person’s subjective definition of unsatisfactory sexual well-being. The condition is usually described as unsatisfactory interest, arousal, orgasm, or other aspects of sexuality (e.g., sexual self-image), and the symptoms often coexist. The term “sexual dysfunction” is used when at least one of the symptoms is of substantial concern to the affected person.     Sexual dysfunction in women impairs quality of life and is determined by multiple factors. Treatment includes lifestyle modification, counseling and psychosexual therapies, and pharmacotherapy.    Learn more in the Clinical Practice article “Sexual Dysfunction in Women” by Susan R. Davis, MB, BS, PhD, from Monash University and Alfred Health: https://nej.md/3yPp3jN 

A storytelling initiative launched by health care, academic, and community organizations produces narrative interventions to help heal and empower the people most deeply affected by gun violence in Boston.     Ruth Rollins, president and founder of We Are Better Together, Warren Daniel Hairston Project (WAB2G), holds a photo of her son Danny, who was murdered in Boston in 2007. Driven by her personal experiences and her expertise as a domestic violence advocate, Ruth founded WAB2G in 2017 to empower women and girls affected on both sides of gun violence in the peacemaking process. Full Perspective in comments.    Read the Perspective “Transforming Narratives of Gun Violence” by P.T. Masiakos et al., from Massachusetts General Hospital, the Louis D. Brown Peace Institute, and Emerson College: https://nej.md/3SSBRgd 

Chronic kidney disease (CKD) is a public health challenge that affects more than 800 million people worldwide. CKD can be caused by a variety of disease processes. Many causes are difficult to identify with the use of traditional clinical diagnostics, and precise causes often remain unknown. Globally, most cases of CKD have been attributed to diabetes mellitus or hypertension. However, genetic causes of CKD are increasingly recognized. The Kidney Disease: Improving Global Outcomes (KDIGO) organization recently highlighted the importance of genetics in the classification and management of CKD and advised clinicians to consider genetic testing in order to improve diagnostic accuracy and facilitate personalized medical management in nephrology.    Asaf Vivante, M.D., Ph.D., discusses the diagnosis and management of CKD of genetic origin in adults, focusing on single-gene variants that cause or confer a substantial risk of progressive CKD.    Read the Review Article “Genetics of Chronic Kidney Disease” by Asaf Vivante, M.D., Ph.D., from Sheba Medical Center and Tel Aviv University: https://nej.md/3SMFpAv 

Approximately 20 to 30% of patients with non–small-cell lung cancer (NSCLC) present with locally advanced stage III disease at the time of diagnosis. Of these patients, 60 to 90% are considered to have unresectable disease.    Osimertinib is a recommended treatment for advanced NSCLC with an epidermal growth factor receptor (𝘌𝘎𝘍𝘙) mutation and as adjuvant treatment for resected 𝘌𝘎𝘍𝘙-mutated NSCLC. EGFR tyrosine kinase inhibitors have shown preliminary efficacy in unresectable stage III 𝘌𝘎𝘍𝘙-mutated NSCLC.    In the LAURA trial, researchers examined the efficacy and safety of adjuvant osimertinib in patients with unresectable, stage III NSCLC that had an 𝘌𝘎𝘍𝘙 mutation.     216 adults with stage III, unresectable, 𝘌𝘎𝘍𝘙-mutated NSCLC who had not had disease progression during or after chemoradiotherapy were randomly assigned in a 2:1 ratio to receive oral osimertinib or placebo until disease progression or a serious toxic effect had occurred or until the patient wished to stop treatment. The primary end point was progression-free survival.    Treatment with osimertinib resulted in significantly longer progression-free survival than placebo in patients with unresectable stage III 𝘌𝘎𝘍𝘙-mutated NSCLC.    Read the full LAURA trial results and Plain Language Summary: https://nej.md/451OXwi    #ClinicalTrials #MedicalResearch 

𝗘𝗻𝗱𝗼𝗰𝘆𝘁𝗼𝘀𝗶𝘀 is a process by which cells actively internalize extracellular substances by invagination of the cellular membrane and subsequent formation of vesicles. Types of endocytosis are phagocytosis (e.g., microorganisms), pinocytosis (e.g., fluid), and receptor-mediated endocytosis (e.g., binding of extracellular molecules to specific receptors). To learn more about this NEJM Illustrated Glossary term, read the editorial “Inhibiting IgG in Hemolytic Disease of the Fetus” by Emeline Maisonneuve, M.D., Alice Panchaud, Ph.D., and David Baud, M.D., Ph.D.: https://nej.md/3YS7Scb    Explore more terms: https://nej.md/glossary