Nature Medicine最新文献

{"title":"The effect of geopolitical flux on antimicrobial resistance","authors":"Scott J. C. Pallett, Alex Tasker, Danny Chambers, Michael Corley, Matthew K. O’Shea, Sally Davies, Luke S. P. Moore","doi":"10.1038/s41591-025-03758-9","DOIUrl":"https://doi.org/10.1038/s41591-025-03758-9","url":null,"abstract":"<p>Changing international relationships and increasing geopolitical tensions can present very real hazards to health and healthcare, particularly in relation to communicable diseases¹. Conflicts in Ukraine, Gaza and Syria have resulted in mass population displacements, and disruptions to sanitation, hygiene, health infrastructures and key public health initiatives challenge efforts to curb the spread of infectious and vaccine-preventable diseases (https://www.iom.int/crisis-ukraine; https://www.iom.int/crisis-syrian-arab-republic).</p><p>Political stability and health are closely interlinked, underlining how investments in global health can have profound impacts on humanitarian issues. Put simply, global disease surveillance and prevention are parts of a complex geopolitical tapestry, and we ignore these multiple threads at our peril. The spread of antimicrobial resistance (AMR) is a sobering illustration of such complexity and one of the greatest global health threats of our time². In Ukraine, we have seen how AMR continues to extend hospital stays and morbidity while presenting a serious threat to health services across Europe³. International collaboration in health surveillance, therapeutic development and intelligence-sharing therefore is fundamental to limiting the spread of drug-resistant infections⁴.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"178 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Alzheimer’s disease, dimers do the damage","authors":"","doi":"10.1038/s41591-025-03770-z","DOIUrl":"https://doi.org/10.1038/s41591-025-03770-z","url":null,"abstract":"<p>In our 2008 paper (Shankar, G. M. et al. <i>Nat. Med.</i> <b>14</b>, 837–842; 2008), we moved beyond cellular and animal models to isolate pathogenic forms of amyloid-β directly from human brains and apply them to reproduce key features of AD: synaptic dysfunction, loss of dendritic spines, and impaired memory per se. We identified stable dimers of amyloid-β in Alzheimer’s cerebral cortex and their dose-dependent impairment of synaptic plasticity. Separating dimers from other amyloid-β assemblies in AD brain extracts enabled us to attribute synaptic deficits directly to these smallest building blocks of oligomers and fibrils.</p><p>Perhaps most relevant to the human condition, we found that microinjection of dimer-rich isolates from the brains of deceased patients into the cerebral ventricles of healthy adult rats decreased the animals’ ability to remember a learned behavior (a passive avoidance task). The timing of this amyloid-β-induced failure of recall mirrored the known temporal pattern of transcriptional regulation of synapse remodeling that accompanies such learning.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"12 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144296171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inclusion of medical students in the next generation of clinician scientist training programs","authors":"Deniz Buyukkaplan, Yaren Canpolat, Andrea Cuschieri, Devin Inan, Deniz Koc, Benedikt Pelzer","doi":"10.1038/s41591-025-03760-1","DOIUrl":"https://doi.org/10.1038/s41591-025-03760-1","url":null,"abstract":"<p>We appreciate the insights provided by Melk et al. in their Comment¹ in <i>Nature Medicine</i>. The authors effectively highlight the importance of structured programs in preparing clinician scientists to bridge the gap between clinical practice and research. However, we would like to emphasize the critical role of medical students in this ecosystem and the need for greater accessibility and support at the undergraduate level.</p><p>We agree with Melk et al. that career counseling, mentoring and protected research time are fundamental elements of successful clinician scientist programs. However, these opportunities are largely inaccessible to medical students, who are at the very beginning of their professional journeys. Therefore, we suggest extending these structured programs to the undergraduate level, providing early exposure to research and the necessary support systems to cultivate future clinician scientists.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"78 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for shortening tuberculosis therapy","authors":"Véronique A. Dartois, Valerie Mizrahi, Radojka M. Savic, Jared A. Silverman, David Hermann, Clifton E. Barry","doi":"10.1038/s41591-025-03742-3","DOIUrl":"https://doi.org/10.1038/s41591-025-03742-3","url":null,"abstract":"<p>In the absence of effective patient-stratification approaches, tuberculosis (TB) treatment relies on overtreating most patients to ensure high cure rates. Shortening treatment duration without compromising efficacy is therefore high on the agenda of the global TB community. While new and better drugs are certainly needed, we argue that innovative but rational treatment strategies, using both new and existing therapies, will help achieve this goal. There is growing recognition that patient stratification, based on host and pathogen factors, is key to delivering the right drug regimen for the right duration. In this Perspective, we review the current knowledge on the heterogeneity of TB disease and propose approaches to optimize treatment duration in distinct patient groups, taking into consideration the realities of TB control globally. We emphasize key insights that improve the understanding of bacterial vulnerabilities in patients with easy-to-treat and hard-to-treat TB, helping to reduce diagnostic uncertainties. We explore how the TB research community can integrate disease biology, pathology and symptoms, to rethink therapeutic strategies and reduce TB treatment duration.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"19 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How AI can deliver the Human Exposome Project","authors":"Thomas Hartung","doi":"10.1038/s41591-025-03749-w","DOIUrl":"https://doi.org/10.1038/s41591-025-03749-w","url":null,"abstract":"An ambitious Human Exposome Project aims to reveal how our environment shapes our health.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"19 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The power of patient engagement at Peace and Love Hospitals in Ghana","authors":"Lawrencia Bawuah Dsane, Beatrice W. Addai","doi":"10.1038/s41591-025-03756-x","DOIUrl":"https://doi.org/10.1038/s41591-025-03756-x","url":null,"abstract":"<p>In today’s evolving healthcare landscape, patient engagement has emerged as a cornerstone of delivering high-quality care. By incorporating patient voices throughout the care life cycle, including survivorship, healthcare systems are fostering a more holistic and inclusive approach to treatment and recovery. Modern patient engagement strategies prioritize the active involvement of patients at every stage of their healthcare journeys. From initial diagnosis to survivorship, understanding and integrating patient perspectives helps personalize care plans, ensuring that treatment aligns with the unique needs and preferences of individuals.</p><p>For instance, including patients in shared decision-making has been shown to improve treatment adherence and patient satisfaction. Studies suggest that when patients feel heard, they are more likely to participate actively in their own care, leading to better health outcomes¹. Additionally, research highlights shared decision-making as a strategy to overcome common barriers in patient care, ensuring more equitable and effective treatment².</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"11 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Education of healthcare professionals to improve guideline adherence in atrial fibrillation: the STEEER-AF cluster-randomized clinical trial","authors":"Dipak Kotecha, Karina V. Bunting, Samir Mehta, Philipp Sommer, Maciej Sterliński, Kim Rajappan, Lluís Mont, Eduard Guasch, Serge Boveda, Giuseppe Boriani, Yongzhong Sun, Colinda van Deutekom, Chris P. Gale, Tom J. R. De Potter, Isabelle C. van Gelder","doi":"10.1038/s41591-025-03751-2","DOIUrl":"https://doi.org/10.1038/s41591-025-03751-2","url":null,"abstract":"<p>Guideline-adherent care is associated with better patient outcomes, but whether this can be achieved by professional education is unclear. Here we conducted a cluster-randomized controlled trial across 70 centers in six countries to understand if a program for the education of healthcare professionals could improve patient-level adherence to clinical practice guidelines on atrial fibrillation (AF). Each center recruited patients with AF seen in routine practice (total <i>N</i> = 1,732), after which the centers were randomized, accounting for baseline guideline adherence to class I and III recommendations from the European Society of Cardiology on stroke prevention and rhythm control. Healthcare professionals in the intervention centers received a 16-week structured educational program with an average of 9 h of online engagement, whereas those at control centers received no additional education beyond standard practice. For the co-primary stroke prevention outcome, guideline adherence was 63.4% and 58.6% at baseline and 67.5% and 60.9% at 6–9-months follow-up for the intervention and control groups, respectively (adjusted risk ratio 1.10; 95% confidence interval (CI) 0.97 to 1.24; <i>P</i> = 0.13). For the co-primary rhythm control outcome, guideline adherence was 21.4% and 20.4% at baseline and 33.9% and 22.9% at follow-up for the intervention and control groups, respectively (adjusted risk ratio 1.51; 95% CI 1.04 to 2.18; <i>P</i> = 0.03). The secondary outcome of patient-reported integrated AF management showed a 5.1% improvement in the intervention group compared with the control group (95% CI 1.4% to 8.9%; <i>P</i> = 0.01). Thus, while the education of healthcare professionals improved substantial gaps in implementation for rhythm control, it had no significant effect on stroke prevention. ClinicalTrials.gov registration: NCT04396418.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"47 5 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tackling overweight and obesity in the youth with the PAS GRAS project","authors":"Afshan N. Malik, Anabela Marisa Azul, Eugénia Carvalho, John G. Jones, Paulo Matafome, Paulo J. Oliveira","doi":"10.1038/s41591-025-03721-8","DOIUrl":"https://doi.org/10.1038/s41591-025-03721-8","url":null,"abstract":"<p>It is a startling reality that today, over 245 million children aged 5–14, 249 million adolescents and young adults aged 15–24, and 2.1 billion adults are overweight or obese, with substantial increases for all age groups predicted for 2050^1,2. The younger cohorts in particular are consigned to a lifetime of obesity-related comorbidities, whose treatment will consume an increasingly larger fraction of healthcare resources, with estimated costs reaching US$4.32 trillion by 2035³.</p><p>Youth obesity is particularly concerning because of the unique vulnerabilities of this age group and requires early intervention and decades of management⁵. Indicators of early onset metabolic complications, such as redox and energy imbalances, DNA methylation and transcriptional alterations, are already present in pre-pubertal children with obesity, resulting in greater adulthood metabolic risks. Many, if not most, of the determinants of lifetime obesity and metabolic sequelae are established during early stages of life. Investment in early childhood, from preconception to adolescence, can yield a 10:1 benefit:cost ratio in health and socioeconomic outcomes during later life⁵.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"19 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Publisher Correction: Integrating liver endpoints in clinical trials of cardiovascular and kidney disease","authors":"Faiez Zannad, Arun J. Sanyal, Javed Butler, Veronica Miller, Stephen A. Harrison","doi":"10.1038/s41591-025-03818-0","DOIUrl":"https://doi.org/10.1038/s41591-025-03818-0","url":null,"abstract":"<p>Correction to: <i>Nature Medicine</i> https://doi.org/10.1038/s41591-024-03223-z, published online 3 September 2024.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"41 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Battle of the mosquitoes","authors":"","doi":"10.1038/s41591-025-03753-0","DOIUrl":"https://doi.org/10.1038/s41591-025-03753-0","url":null,"abstract":"Malaria has found a new ally in the concrete jungle — but scientists are fighting back with mosquitoes of their own.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"256 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144260552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}