Nature Medicine最新文献

{"title":"Diagnosing ALS: a surprisingly arduous hike lasting 150 years.","authors":"","doi":"10.1038/s41591-025-03989-w","DOIUrl":"https://doi.org/10.1038/s41591-025-03989-w","url":null,"abstract":"","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":" ","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125357","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":"Heat-related mortality in Europe during 2024 and health emergency forecasting to reduce preventable deaths.","authors":"Tomáš Janoš, Marcos Quijal-Zamorano, Natalia Shartova, Elisa Gallo, Raúl Fernando Méndez Turrubiates, Nadia Denisse Beltrán Barrón, Fabien Peyrusse, Joan Ballester","doi":"10.1038/s41591-025-03954-7","DOIUrl":"https://doi.org/10.1038/s41591-025-03954-7","url":null,"abstract":"<p><p>Successive record-breaking summer temperatures, both globally and in Europe, raise the urgent question of how to better protect vulnerable populations. Here we quantified the heat-related mortality burden during the summers of 2022-2024, and assessed the forecast skill of a new generation of continental-wide, impact-based early warning systems during health emergencies. We fitted epidemiological models with the newly created, format-homogeneous daily mortality database of the EARLY-ADAPT project, covering 654 contiguous regions across 32 European countries, which represents the entire urban and rural population of 539 million people. We estimated 62,775 (95% confidence interval = 36,765-84,379) heat-related deaths in 2024, largely exceeding the burden in 2023 (50,798; 29,442-68,610), but somewhat smaller than that of 2022 (67,873; 38,465-92,455). We demonstrated that health emergencies can be forecast with high confidence at least 1 week in advance, even for highly vulnerable regions and population subgroups. These findings have implications for public health agencies and end users, given that the adoption of the system would enable reliable heat-health emergency alerts within the time window that is relevant for stakeholders to take effective actions to reduce preventable deaths.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":" ","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125336","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":"Clinical implementation of an AI-based prediction model for decision support for patients undergoing colorectal cancer surgery.","authors":"Andreas Weinberger Rosen, Ilze Ose, Mikail Gögenur, Lars Peter Kloster Andersen, Rasmus Dahlin Bojesen, Rasmus Peuliche Vogelsang, Martin Høyer Rose, Philip Wallentin Steenfos, Lasse Bremholm Hansen, Helle Skadborg Spuur, Ines Raben, Søren Thorgaard Skou, Ellen Astrid Holm, Karina Mortensen, Trine Kjær, Jens Ravn Eriksen, Ismail Gögenur","doi":"10.1038/s41591-025-03942-x","DOIUrl":"https://doi.org/10.1038/s41591-025-03942-x","url":null,"abstract":"<p><p>Adverse outcomes after elective cancer surgery are a main contributor to decreased survival, poorer oncological outcomes and increased healthcare costs. Identifying high-risk patients and selecting interventions according to individual risk profiles in the perioperative period in cancer surgery is a challenge. Using real-world data on 18,403 patients with colorectal cancer from Danish national registries and consecutive patients from a single center, we developed, validated and implemented an artificial-intelligence-based risk prediction model in clinical practice as a decision support tool for personalized perioperative treatment. Personalized treatment pathways were designed according to the predicted risk of 1-year mortality with the intensity of interventions increasing with the predicted risk. The developed model had an area under the receiver operating characteristic curve of 0.79 in the validation set. Results from the nonrandomized before/after cohort study showed an incidence proportion of the comprehensive complication index >20 of 19.1% in the personalized treatment group versus 28.0% in the standard-of-care group, adjusted odds ratio of 0.63 (95% confidence interval, 0.42-0.92; P = 0.02). The incidence of any medical complication was 23.7% in the personalized treatment group and 37.3% in the standard-of-care group; odds ratio of 0.53 (95% confidence interval, 0.36-0.76; P < 0.001). According to the short-term health economic modeling, personalized perioperative treatment was cost effective. The study demonstrates a fully scalable registry-based approach for using readily available data in an artificial-intelligence-based decision support pipeline in clinical practice. Our results indicate that this specific approach can be a cost-effective strategy to improve key surgical clinical outcomes.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":" ","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086529","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 arts for disease prevention and health promotion: a systematic review.","authors":"Jill Sonke, Michael Koon Boon Tan, Jennifer Baxley Lee, Virginia Pesata, Seher Akram, Tasha Golden, Jane Morgan-Daniel, Sanmi Oduntan, Sharifa Abdulla, Daisy Fancourt, Michael Pratt, J Jaime Miranda, Courtney Pyche, Kremlin Wickramasinghe, Nils Fietje, Nisha Sajnani","doi":"10.1038/s41591-025-03962-7","DOIUrl":"https://doi.org/10.1038/s41591-025-03962-7","url":null,"abstract":"<p><p>Differences in risk factor exposure and access to prevention resources have led to unequal health outcomes for noncommunicable diseases (NCDs) globally. Recent studies elucidate the health benefits of arts participation, but no systematic reviews have focused on NCD prevention and health promotion. Here we share results of a mixed-methods systematic review that included 95 studies of arts programs, practices and activities, addressing NCD risk factors across 27 countries. We found that most reported outcomes were related to physical inactivity, unhealthy diets, mental health, and systemic, structural and social drivers of health. Our findings suggest that the arts may support NCDs prevention and health promotion by generating cultural relevance, providing opportunities for increased physical activity and social connectedness and by helping to identify and address systemic, structural and social forces contributing to health disparities and inequities.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":" ","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086563","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":"An implantable system to restore hemodynamic stability after spinal cord injury","authors":"Aaron A. Phillips,&nbsp;Aasta P. Gandhi,&nbsp;Nicolas Hankov,&nbsp;Sergio D. Hernandez-Charpak,&nbsp;Julien Rimok,&nbsp;Anthony V. Incognito,&nbsp;Anouk E. J. Nijland,&nbsp;Marina D’Ercole,&nbsp;Anne Watrin,&nbsp;Maxime Berney,&nbsp;Aikaterini Damianaki,&nbsp;Grégory Dumont,&nbsp;Nicolò Macellari,&nbsp;Laura De Herde,&nbsp;Nadine Intering,&nbsp;Donovan Smith,&nbsp;Ryan Miller,&nbsp;Meagan N. Smith,&nbsp;Jordan Lee,&nbsp;Edeny Baaklini,&nbsp;Jean-Baptiste Ledoux,&nbsp;Javier G. Ordonnez,&nbsp;Taylor Newton,&nbsp;Ettore Flavio Meliadò,&nbsp;Léa Duguet,&nbsp;Charlotte Jacquet,&nbsp;Léa Bole-Feysot,&nbsp;Markus Rieger,&nbsp;Kristen Gelenitis,&nbsp;Yoann Dumeny,&nbsp;Miroslav Caban,&nbsp;Damien Ganty,&nbsp;Edoardo Paoles,&nbsp;Thomas Baumgartner,&nbsp;Clinical Study Team,&nbsp;Onward Team,&nbsp;Cathal Harte,&nbsp;Charles David Sasportes,&nbsp;Paul Romo,&nbsp;Tristan Vouga,&nbsp;Jemina Fasola,&nbsp;Jimmy Ravier,&nbsp;Matthieu Gautier,&nbsp;Frédéric Merlos,&nbsp;Rik Buschman,&nbsp;Tomislav Milekovic,&nbsp;Andreas Rowald,&nbsp;Stefano Mandija,&nbsp;Cornelis A. T. van den Berg,&nbsp;Niels Kuster,&nbsp;Esra Neufeld,&nbsp;Etienne Pralong,&nbsp;Lorenz Hirt,&nbsp;Stefano Carda,&nbsp;Fabio Becce,&nbsp;Etienne Aleton,&nbsp;Kyle Rogan,&nbsp;Patrick Schoettker,&nbsp;Grégoire Wuerzner,&nbsp;Nelleke Langerak,&nbsp;Noël L. W. Keijsers,&nbsp;Brian K. Kwon,&nbsp;James D. Guest,&nbsp;Erika Ross,&nbsp;John Murphy,&nbsp;Erkan Kurt,&nbsp;Steve Casha,&nbsp;Fady Girgis,&nbsp;Ilse van Nes,&nbsp;Kelly A. Larkin-Kaiser,&nbsp;Robin Demesmaeker,&nbsp;Léonie Asboth,&nbsp;Jordan W. Squair,&nbsp;Jocelyne Bloch,&nbsp;Grégoire Courtine","doi":"10.1038/s41591-025-03614-w","DOIUrl":"10.1038/s41591-025-03614-w","url":null,"abstract":"A spinal cord injury (SCI) causes immediate and sustained hemodynamic instability that threatens neurological recovery and impacts quality of life. Here we establish the clinical burden of chronic hypotensive complications due to SCI in 1,479 participants and expose the ineffective treatment of these complications with conservative measures. To address this clinical burden, we developed a purpose-built implantable system based on biomimetic epidural electrical stimulation (EES) of the spinal cord that immediately triggered robust pressor responses. The system durably reduced the severity of hypotensive complications in people with SCI, removed the necessity for conservative treatments, improved quality of life and enabled superior engagement in activities of daily living. Central to the development of this therapy was the head-to-head demonstration in the same participants that EES must target the last three thoracic segments, and not the lumbosacral segments, to achieve the safe and effective regulation of blood pressure in people with SCI. These findings in 14 participants establish the path to designing a pivotal device trial that will evaluate the safety and efficacy of EES to treat the underappreciated, treatment-resistant hypotensive complications due to SCI. A purpose-built implantable system based on biomimetic epidural electrical stimulation of the spinal cord reduces the severity of hypotensive complications in people with spinal cord injury and improves quality of life.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"31 9","pages":"2946-2957"},"PeriodicalIF":50.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving AI coaching with Gemini using real-world Fitbit data.","authors":"","doi":"10.1038/s41591-025-03988-x","DOIUrl":"https://doi.org/10.1038/s41591-025-03988-x","url":null,"abstract":"","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":" ","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081222","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":"Time for the exposome to shape policy","authors":"","doi":"10.1038/s41591-025-03990-3","DOIUrl":"10.1038/s41591-025-03990-3","url":null,"abstract":"For exposome research to make a difference, it must be diversified and translate into policies that protect health.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"31 9","pages":"2823-2823"},"PeriodicalIF":50.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41591-025-03990-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oligodendrocyte-targeted adeno-associated virus gene therapy for Canavan disease in children: a phase 1/2 trial","authors":"Paola Leone, Robert M. Lober, Jeremy Francis, Olga Flamini, Kim M. Cecil, David Shera, Christopher G. Janson","doi":"10.1038/s41591-025-03919-w","DOIUrl":"https://doi.org/10.1038/s41591-025-03919-w","url":null,"abstract":"<p>This open-label phase 1/2 clinical study uses a novel recombinant vector, rAAV-Olig001, with selective tropism for oligodendrocytes, to deliver gene therapy for Canavan disease (CD), a rare leukodystrophy characterized by defective aspartoacylase and elevated <i>N</i>-acetyl-aspartic acid (NAA) concentrations. A total of 8 participants received intracranial doses of 3.7 × 10¹³ vector genomes (vg) of rAAV-Olig001-ASPA (MYR-101), with an interim analysis at 12 months. The primary objective was to assess the safety of intracranial dosing of MYR-101 in children with typical CD. Efficacy measures included Mullen Scales of Early Learning (MSEL), Gross Motor Function Measure (GMFM) and analysis of NAA, myelination, white matter and extracellular water content in the brain. The participants were White; 5 (62.5%) were male. Of the participants, 7 (87.5%) experienced ≥1 serious adverse event, none of which were considered MYR-101 related. All participants experienced ≥1 adverse event. All adverse events and serious adverse events resolved fully. Treatment reduced NAA concentrations in cerebrospinal fluid (<i>P</i> = 0.0008), increased myelination (<i>P</i> = 0.0137) and improved MSEL developmental outcomes (<i>P</i> = 0.0171). Thus, interim results suggest that gene therapy with MYR-101 is well tolerated and shows early effects in CD. While these findings are preliminary, reductions in NAA concentrations indicate <i>ASPA</i> expression and increases in myelination and imply successful targeting of oligodendrocytes. These results may support the development of similar gene therapy strategies for other demyelinating and metabolic brain disorders. ClinicalTrials.gov registration: NCT04833907.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"30 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068163","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":"Macrovascular and microvascular outcomes of metabolic surgery versus GLP-1 receptor agonists in patients with diabetes and obesity","authors":"Hamlet Gasoyan, Mohammad Hesam Alavi, Alexander Zajichek, Nicholas J. Casacchia, Abdullah Al Jabri, James Bena, Xiaoxi Feng, Rickesha Wilson, Ricard Corcelles, W. Scott Butsch, Rishi P. Singh, Nikhil Das, Hejin Jeong, Amgad Mentias, W. H. Wilson Tang, Bartolome Burguera, Raul J. Rosenthal, Steven E. Nissen, Michael B. Rothberg, Ali Aminian","doi":"10.1038/s41591-025-03893-3","DOIUrl":"https://doi.org/10.1038/s41591-025-03893-3","url":null,"abstract":"<p>Both metabolic surgery and glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) improve cardiometabolic outcomes, but their long-term outcomes have not been directly compared. Here, we compared macrovascular and microvascular outcomes in 1,657 patients (65.7% female) with type 2 diabetes and obesity who underwent metabolic surgery with 2,275 similar patients (53.5% female) who received treatment with GLP-1 RAs. Using a doubly robust estimation method to balance baseline characteristics between groups, we examined the time to all-cause mortality, incident major adverse cardiovascular events (MACE), nephropathy and retinopathy over a median follow-up of 5.9 years. The 10-year cumulative incidence of all-cause mortality was 9.0% (95% confidence interval (CI) 6.8–10.8%) in the metabolic surgery group and 12.4% (95% CI 9.9–15.2%) in the GLP-1 RA group (adjusted hazard ratio (HR) 0.68 (95% CI 0.48–0.96), <i>P</i> = 0.028). Compared with the GLP-1 RA group, metabolic surgery was also associated with a lower risk of MACE (adjusted HR 0.65; 95% CI 0.51–0.82; <i>P</i> &lt; 0.001), nephropathy (adjusted HR 0.53; 95% CI 0.43–0.67; <i>P</i> &lt; 0.001) and retinopathy (adjusted HR 0.46; 95% CI 0.29–0.75; <i>P</i> = 0.002). These findings indicate that even with the availability of GLP-1 RAs, metabolic surgery remains superior to medical treatment. Future studies should compare the cardiometabolic outcomes of metabolic surgery with newer GLP-1 RAs that are more effective for weight reduction.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"16 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067704","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 STARD-AI reporting guideline for diagnostic accuracy studies using artificial intelligence","authors":"Viknesh Sounderajah, Ahmad Guni, Xiaoxuan Liu, Gary S. Collins, Alan Karthikesalingam, Sheraz R. Markar, Robert M. Golub, Alastair K. Denniston, Shravya Shetty, David Moher, Patrick M. Bossuyt, Ara Darzi, Hutan Ashrafian","doi":"10.1038/s41591-025-03953-8","DOIUrl":"https://doi.org/10.1038/s41591-025-03953-8","url":null,"abstract":"<p>The Standards for Reporting Diagnostic Accuracy (STARD) 2015 statement facilitates transparent and complete reporting of diagnostic test accuracy studies. However, there are unique considerations associated with artificial intelligence (AI)-centered diagnostic test studies. The STARD-AI statement, which was developed through a multistage, multistakeholder process, provides a minimum set of criteria that allows for comprehensive reporting of AI-centered diagnostic test accuracy studies. The process involved a literature review, a scoping survey of international experts, and a patient and public involvement and engagement initiative, culminating in a modified Delphi consensus process involving over 240 international stakeholders and a consensus meeting. The checklist was subsequently finalized by the Steering Committee and includes 18 new or modified items in addition to the STARD 2015 checklist items. Authors are encouraged to provide descriptions of dataset practices, the AI index test and how it was evaluated, as well as considerations of algorithmic bias and fairness. The STARD-AI statement supports comprehensive and transparent reporting in all AI-centered diagnostic accuracy studies, and it can help key stakeholders to evaluate the biases, applicability and generalizability of study findings.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"78 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059605","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}