The latest medical research on General Medicine / Internal Medicine

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about general medicine / internal medicine gathered by our medical AI research bot.

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Mapping and role of T cell response in SARS-CoV-2-infected mice.

J Exp Med

Virus-specific T cells play essential roles in protection against multiple virus infections, including SARS-CoV and MERS-CoV. While SARS-CoV-2-spec...

Association of the Intensity of Diagnostic Evaluation With Outcomes in Incidentally Detected Lung Nodules.

JAMA Internal Medicine

Whether guideline-concordant lung nodule evaluations lead to better outcomes remains unknown.

To examine the association between the intensity of lung nodule diagnostic evaluations and outcomes, safety, and health expenditures.

This comparative effectiveness research study analyzed health plan enrollees at Kaiser Permanente Washington in Seattle, Washington, and Marshfield Clinic in Marshfield, Wisconsin, with an incidental lung nodule detected between January 1, 2005, and December 31, 2015. Included patients were 35 years or older, had no high suspicion of infection, had no history of malignant neoplasm, and had no evidence of advanced lung cancer on nodule detection. Data analysis was conducted from January 7 to August 19, 2020.

With the 2005 Fleischner Society guidelines (selected for their applicability to the time frame under investigation) as the comparator, 2 other intensities of lung nodule evaluation were defined. Guideline-concordant evaluation followed the guidelines. Less intensive evaluation was the absence of recommended testing, longer-than-recommended surveillance intervals, or less invasive testing than recommended. More intensive evaluation consisted of testing when the guidelines recommended no further testing, shorter-than-recommended surveillance intervals, or more invasive testing than recommended.

The main outcome was the proportion of patients with lung cancer who had stage III or IV disease, radiation exposure, procedure-related adverse events, and health expenditures 2 years after nodule detection.

Among the 5057 individuals included in this comparative effectiveness research study, 1925 (38%) received guideline-concordant, 1863 (37%) less intensive, and 1269 (25%) more intensive diagnostic evaluations. The entire cohort comprised 2786 female patients (55%), and the mean (SD) age was 67 (13) years. Adjusted analyses showed that compared with guideline-concordant evaluations, less intensive evaluations were associated with fewer procedure-related adverse events (risk difference [RD], -5.9%; 95% CI, -7.2% to -4.6%), lower mean radiation exposure (-9.5 milliSieverts [mSv]; 95% CI, -10.3 mSv to -8.7 mSv), and lower mean health expenditures (-$10 916; 95% CI, -$16 112 to -$5719); no difference in stage III or IV disease was found among patients diagnosed with lung cancer (RD, 4.6%; 95% CI, -22% to +31%). More intensive evaluations were associated with more procedure-related adverse events (RD, +8.1%; 95% CI, +5.6% to +11%), higher mean radiation exposure (+6.8 mSv; 95% CI, +5.8 mSv to +7.8 mSv), and higher mean health expenditures ($20 132; 95% CI, +$14 398 to +$25 868); no difference in stage III or IV disease was observed (RD, -0.5%; 95% CI, -28% to +27%).

This study found inconclusive evidence of an association between less intensive diagnostic evaluations and more advanced stage at lung cancer diagnosis compared with guideline-concordant care; higher intensities of diagnostic evaluations were associated with greater procedural complications, radiation exposure, and expenditures. These findings underscore the need for more evidence on better ways to evaluate lung nodules and to avoid unnecessarily intensive diagnostic evaluations of lung nodules.

Measuring Peripheral Chemoreflex Hypersensitivity in Heart Failure.

Frontiers in Physiology

Heart failure with reduced ejection fraction (HFrEF) induces chronic sympathetic activation. This disturbance is a consequence of both compensatory...

Inhaled Treprostinil in Pulmonary Hypertension Due to Interstitial Lung Disease.

N Engl J

No therapies are currently approved for the treatment of pulmonary hypertension in patients with interstitial lung disease. The safety and efficacy of inhaled treprostinil for patients with this condition are unclear.

We enrolled patients with interstitial lung disease and pulmonary hypertension (documented by right heart catheterization) in a multicenter, randomized, double-blind, placebo-controlled, 16-week trial. Patients were assigned in a 1:1 ratio to receive inhaled treprostinil, administered by means of an ultrasonic, pulsed-delivery nebulizer in up to 12 breaths (total, 72 μg) four times daily, or placebo. The primary efficacy end point was the difference between the two groups in the change in peak 6-minute walk distance from baseline to week 16. Secondary end points included the change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) level at week 16 and the time to clinical worsening.

A total of 326 patients underwent randomization, with 163 assigned to inhaled treprostinil and 163 to placebo. Baseline characteristics were similar in the two groups. At week 16, the least-squares mean difference between the treprostinil group and the placebo group in the change from baseline in the 6-minute walk distance was 31.12 m (95% confidence interval [CI], 16.85 to 45.39; P<0.001). There was a reduction of 15% in NT-proBNP levels from baseline with inhaled treprostinil as compared with an increase of 46% with placebo (treatment ratio, 0.58; 95% CI, 0.47 to 0.72; P<0.001). Clinical worsening occurred in 37 patients (22.7%) in the treprostinil group as compared with 54 patients (33.1%) in the placebo group (hazard ratio, 0.61; 95% CI, 0.40 to 0.92; P = 0.04 by the log-rank test). The most frequently reported adverse events were cough, headache, dyspnea, dizziness, nausea, fatigue, and diarrhea.

In patients with pulmonary hypertension due to interstitial lung disease, inhaled treprostinil improved exercise capacity from baseline, assessed with the use of a 6-minute walk test, as compared with placebo. (Funded by United Therapeutics; INCREASE ClinicalTrials.gov number, NCT02630316.).

Effectiveness of a Nurse-Led Multidisciplinary Intervention vs Usual Care on Advance Care Planning for Vulnerable Older Adults in an Accountable Care Organization: A Randomized Clinical Trial.

JAMA Internal Medicine

Advance care planning (ACP), especially among vulnerable older adults, remains underused in primary care. Additionally, many ACP initiatives fail to integrate directly into the electronic health record (EHR), resulting in infrequent and disorganized documentation.

To determine whether a nurse navigator-led ACP pathway combined with a health care professional-facing EHR interface improves the occurrence of ACP discussions and their documentation within the EHR.

This was a randomized effectiveness trial using the Zelen design, in which patients are randomized prior to informed consent, with only those randomized to the intervention subsequently approached to provide informed consent. Randomization began November 1, 2018, and follow-up concluded November 1, 2019. The study population included patients 65 years or older with multimorbidity combined with either cognitive or physical impairments, and/or frailty, assessed from 8 primary care practices in North Carolina.

Participants were randomized to either a nurse navigator-led ACP pathway (n = 379) or usual care (n = 380).

The primary outcome was documentation of a new ACP discussion within the EHR. Secondary outcomes included the usage of ACP billing codes, designation of a surrogate decision maker, and ACP legal form documentation. Exploratory outcomes included incident health care use.

Among 759 randomized patients (mean age 77.7 years, 455 women [59.9%]), the nurse navigator-led ACP pathway resulted in a higher rate of ACP documentation (42.2% vs 3.7%, P < .001) as compared with usual care. The ACP billing codes were used more frequently for patients randomized to the nurse navigator-led ACP pathway (25.3% vs 1.3%, P < .001). Patients randomized to the nurse navigator-led ACP pathway more frequently designated a surrogate decision maker (64% vs 35%, P < .001) and completed ACP legal forms (24.3% vs 10.0%, P < .001). During follow-up, the incidence of emergency department visits and inpatient hospitalizations was similar between the randomized groups (hazard ratio, 1.17; 95% CI, 0.92-1.50).

A nurse navigator-led ACP pathway integrated with a health care professional-facing EHR interface increased the frequency of ACP discussions and their documentation. Additional research will be required to evaluate whether increased EHR documentation leads to improvements in goal-concordant care.

ClinicalTrials.gov Identifier: NCT03609658.

The Cxxc1 subunit of the Trithorax complex directs epigenetic licensing of CD4+ T cell differentiation.

J Exp Med

Different dynamics of gene expression are observed during cell differentiation. In T cells, genes that are turned on early or turned off and stay o...

A robust platform for expansion and genome editing of primary human natural killer cells.

J Exp Med

Genome editing is a powerful technique for delineating complex signaling circuitry and enhancing the functionality of immune cells for immunotherap...

Stem cell origins of JMML.

J Exp Med

In this issue of JEM, Louka et al. (https://doi.org/10.1084/jem.20180853) report that leukemia stem cells lie within the phenotypic hematopoietic s...

On the Use of the Repeated-Sprint Training in Hypoxia in Tennis.

Frontiers in Physiology

To examine physiological and technical responses to repeated-sprint training in normobaric hypoxia at ∼3,000 m (RSH, n = 11) or in normoxia (RSN, n = 11) compared to a control group (CON, n = 8) in well-trained tennis players. Participants were 28.8 ± 5.9 years old without any previous experience of training in hypoxia.

In addition to maintaining their usual training (CON), both RSH and RSN groups completed five tennis specific repeated-shuttle sprint sessions (4 × 5 × ∼8 s maximal sprints with ∼22 s passive recovery and ∼5 min rest between sets) over 12 days. Before (Pre), the week after (Post-1) and 3 weeks after Post-1 (Post-2), physical/technical performance during Test to Exhaustion Specific to Tennis (TEST), repeated-sprint ability (RSA) (8 × ∼20 m shuttle runs-departing every 20 s) and heart rate variability (HRV) were assessed.

From Pre to Post-1 and Post-2, RSH improved TEST time to exhaustion (+18.2 and +17.3%; both P < 0.001), while the "onset of blood lactate accumulation" at 4 mmol L-1 occurred at later stages (+24.4 and +19.8%, both P < 0.01). At the same time points, ball accuracy at 100% V̇O2max increased in RSH only (+38.2%, P = 0.003 and +40.9%, P = 0.007). Markers of TEST performance did not change for both RSN and CON. Compared to Pre, RSA total time increased significantly at Post-1 and Post-2 (-1.9 and -2.5%, P < 0.05) in RSH only and this was accompanied by larger absolute Δ total hemoglobin (+82.5 and +137%, both P < 0.001). HRV did not change either supine or standing positions.

Five repeated sprint training sessions in hypoxia using tennis specific shuttle runs improve physiological and technical responses to TEST, RSA, and accompanying muscle perfusion responses in well-trained tennis players.

The Role(s) of Eicosanoids and Exosomes in Human Parturition.

Frontiers in Physiology

The roles that eicosanoids play during pregnancy and parturition are crucial to a successful outcome. A better understanding of the regulation of e...

The Performance of Olfactory Receptor Neurons: The Rate of Concentration Change Indicates Functional Specializations in the Cockroach Peripheral Olfactory System.

Frontiers in Physiology

Slow and continuous changes in odor concentration were used as a possible easy method for measuring the effect of the instantaneous concentration a...

Cellular and Molecular Mechanisms of Spinal Cord Vascularization.

Frontiers in Physiology

During embryonic central nervous system (CNS) development, the neural and the vascular systems communicate with each other in order to give rise to...