Discoveries & Impact (August 2021)

Discoveries & Impact highlights selected scientific discoveries per section within the Department of Internal Medicine.

Cardiovascular Medicine

This study, published in Circulation: Cardiovascular Quality and Outcomes, provides new insights about postoperative pain experiences for people undergoing cardiac surgery and highlights the variations between different sites. The authors examine the determinants of different experiences and possible interventions to relieve pain.

Mori M, Brooks C, Dhruva SS, Lu Y, Spatz ES, Dey P, Zhang Y, Chaudhry SI, Geirsson A, Allore HG, Krumholz HM. Trajectories of pain after cardiac surgery: implications for measurement, reporting and individualized treatment. Circ Cardiovascular Qual Results. 2021 July 26: OUTCOME 120007781. doi: 10.1161/CIRCOUTCOMES.120.007781. E-publication before printing. PMID: 34304586.

Digestive Diseases

Yale researchers evaluated whether SGLT2i can reduce the incidence of ascites and death over a 36-month period in patients with cirrhosis and diabetes mellitus. Among 846 patients at Veterans Affairs hospitals in the United States, they found no significant difference in the risk of ascites, but they did find that SGLT2i users had a reduced risk of death. Compared to dipeptidyl peptidase-4 inhibitors, SGLT2i may improve survival in patients with cirrhosis who require additional pharmacotherapy for diabetes mellitus in addition to metformin, but additional studies are needed. Read the report in Diabetes, Obesity and Metabolism.

Saffo S, Kaplan DE, Mahmud N, Serper M, John BV, Ross JS, Taddei T. Impact of SGLT2 inhibitors compared to DPP4 inhibitors on ascites and death in veterans with cirrhosis on metformin. Diabetes Obesity Metab. 2021 Jul 6 doi: 10.1111/dom.14488. E-publication before printing. PMID: 34227216.

Endocrinology and Metabolism and Pulmonary, Critical Care and Sleep Medicine

Although there is a well-documented bidirectional association between obesity and mood- and stress-related psychiatric disorders, molecular mechanisms altered in obesity have not been fully explained. Yale researchers examined relationships between obesity and synaptic density using the radioligand [11C]UCB-J, which binds to synaptic glycoprotein SV2A, and positron emission tomography in obese subjects with or without stress-related psychiatric disorders. Read more in Nature.

Asch RH, Holmes SE, Jastreboff AM, Potenza MN, Baldassarri SR, Carson RE, Pietrzak RH, Esterlis I. Lower synaptic density is associated with psychiatric and cognitive changes in obesity. Neuropsychopharmacology. 2021 Jul 22. doi: 10.1038/s41386-021-01111-5. E-publication before printing. PMID: 34294874.

General Internal Medicine

Entrust decision-making in core EPAs: Results of a multi-institutional study published in Academic Medicine in July reports that medical schools are able to longitudinally collect and assess student data to make decisions about graduating readiness students for indirect supervision of important clinical activities during the residency. The data also points to work that remains to be done, in particular with regard to workplace assessments and the availability of other data.

Brown DR, Moeller JJ, Grbic D, Biskobing DM, Crowe R, Cutrer WB, Green ML, Obeso VT, Wagner DP, Warren JB, Yingling SL, Andriole DA; Core Reliable Professional Activities for Participating in a Residency Pilot. Allocation decision-making in the core EPAs: results of a multi-institutional study. Acad Med. 2021 July 13. doi: 10.1097/ACM.0000000000004242. E-publication before printing. PMID: 34261864.

Geriatrics

In this new study from Yale School of Medicine and Yale School of Public Health, researchers looked at nationally representative data on 5,571 community-dwelling older adults from the National Health and Aging Trends Study (NHATS) and found that an average of nearly 9 major surgeries were performed. performed per year for every 100 persons 65 years of age. In the 5 years of data analyzed, more than 1 in 7 Medicare beneficiaries underwent at least 1 major surgery; 40% of major operations were unplanned. These results have critical implications for healthcare in the US Read more…

Becher RD, Wyk BV, Leo-Summers L, Desai MM, Gill TM. The incidence and cumulative risk of major surgery in the elderly in the United States. Ann Surg. 2021 July 14. doi: 10.1097/SLA.0000000000005077. E-publication before printing. PMID: 34261884.

hematology

In the new publication, “Peri-transfusion Quality of Life Assessment for Patients with Myelodysplastic Syndromes,” researchers conducted a prospective pilot study in 62 adults with myelodysplastic syndromes who received red blood cell transfusions for anemia. They concluded that while peri-transfusion QOL assessment was possible, red cell transfusion may not improve quality of life for many patients. Learn more…

Abel GA, Klepin HD, Magnavita ES, Jaung T, Lu W, Shallis RM, Hantel A, Bahl NE, Dellinger-Johnson R, Winer ES, Zeidan AM. Peri-transfusion quality of life assessment for patients with myelodysplastic syndromes. Transfusion. 2021 July 12. doi: 10.1111/trf.16584. E-publication before printing. PMID: 34251040.

Infectious Diseases

In “Early but not late recovering plasma is associated with better survival in moderate to severe COVID-19,” scientists at Yale School of Medicine conducted a cohort study of 151 patients hospitalized with moderate to severe COVID-19 and who got COVID-19. 19 convalescent plasma (CCP) to determine whether when the CCP was administered made a difference in patient outcomes. They found that the timing of CCP administration does matter, with those who received treatment within six days of admission had a lower mortality and fewer days on the ventilator. Learn more…

Briggs N, Gormally MV, Li F, Browning SL, Treggiari MM, Morrison A, Laurent-Rolle M, Deng Y, Hendrickson JE, Tormey CA, Desruisseaux MS. Early but not late recovering plasma is associated with better survival in moderate to severe COVID-19. PLUS One. 2021 July 28;16(7):e0254453. doi: 10.1371/journal.pone.0254453. PMID: 343202004; PMCID: PMC8318280.

Medical Oncology

In the United States, the incidence of hepatocellular carcinoma (HVC) is increasing, with more than 1/3 of cases related to viral hepatitis B infection. This study retrospectively looked at 581 patients with HVC and their neutrophil-to-lymphocyte ratio (NLR) to see if an individual’s NLR could be used as a biomarker to predict survival. They concluded that lower NLR was associated with better overall survival. Learn more…

Sellers CM, Uhlig J, Ludwig JM, Pollak JS, Taddei TH, Stein SM, Lim JK, Kim HS. The effect of chronic viral hepatitis on the prognostic value of inflammatory biomarkers in hepatocellular carcinoma. Cancer Med. 2021 July 28. doi: 10.1002/cam4.3573. E-publication before printing. PMID: 34318618.

nephrology

In this new report from the Yale School of Medicine, the team looked at a patient with action myoclonus-renal failure syndrome (AMRF), a rare autosomal recessive progressive myoclonic epilepsy associated with progressive myoclonic epilepsy and kidney disease to see if taking miglustat would help. can improve. neurological symptoms. The work suggests that these symptoms can be improved by targeting glycosphingolipid metabolism with miglustat. Learn more…

Quraishi IH, Szekely AM, Shirali AC, Mistry PK, Hirsch LJ. Miglustat therapy for SCARB2-associated action Myoclonus renal failure syndrome. Neurol Genet. 2021 July 28;7(5):e614. doi: 10.1212/NXG.0000000000000614. PMID: 34337151; PMCID: PMC8320328.

Pulmonary, Critical Care and Sleep Medicine

A mitochondrial molecule, nucleotide-binding domain and leucine-rich repeat-containing protein X1 (NLRX1), represents the only NLR family member targeting this cellular location, implying that NLRX1 likely establishes a fundamental link between mitochondrial functions and cellular functions. physiology. A recent study by Yale researchers provides evidence for NLRX1 as a critical regulator of cellular aging and in vivo lung aging.

Shin HJ, Kim SH, Park HJ, Shin MS, Kang I, Kang MJ. Nucleotide-binding domain and leucine-rich repeat-containing protein X1 deficiency induces decrease in nicotinamide adenine dinucleotide, mechanistic target of rapamycin activation and cellular senescence and accelerates aging lung-like changes. Aging cell. 2021 July;20(7):e13410. doi: 10.1111/acel.13410. Epub 2021 June 4. PMID: 34087956; PMCID: PMC8282248.

Rheumatology, Allergy & Immunology

A study by Yale researchers, published in The Journal of Rheumatology in July, presents research findings from positron emission tomography-computed tomography (PET/CT) myocardial perfusion imaging. Patients with systemic sclerosis showed decreased myocardial flow reserve, which may indicate coronary microvascular dysfunction compared to two control groups (healthy individuals and patient group matched for age, gender, and comorbidities). Decreased Myocardial Current Reserve on 82Rubidium Positron Emission Computed Tomography in Patients with Systemic Sclerosis

Feher A, Boutagy NE, Oikonomou EK, Thorn S, Liu YH, Miller EJ, Sinusas AJ, Hinchcliff M. Decreased myocardial current reserve on 82Rubidium Positron emission computed tomography in patients with systemic sclerosis. J Rheumatol. 2021 July 15: jrheum.210040. doi: 10.3899/jrheum.210040. E-publication before printing. PMID: 34266986.

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