New England Journal of Medicine最新文献

{"title":"IVUS-Guided PCI in Left Main Coronary Disease.","authors":"Bernard Wong, Sarah Fairley","doi":"10.1056/NEJMc2609433","DOIUrl":"https://doi.org/10.1056/NEJMc2609433","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"395 16","pages":"1663"},"PeriodicalIF":84.5,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240618","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":"Response-Tailored or Standard-Duration Antibiotic Treatment for Infective Endocarditis.","authors":"Henning Bundgaard, Mia Pries-Heje, Julie Hjulmand, Rasmus Hasselbalch, Peter Godsk Jørgensen, Søren Fanø, Nana Køber, Christian Tuxen, Nareen Kader, Ekim Seven, Lars Ege Rasmussen, Malene Wienberg, Niels Eske Bruun, Marlene Tofterup, Magnus Rasmussen, Lindsey R Baden, Ann Woolley, Theis Lange, Jannik Helweg-Larsen, Jonas Agerlund Povlsen, Emil Fosbøl, Claus Moser, Kasper Iversen","doi":"10.1056/NEJMoa2607887","DOIUrl":"10.1056/NEJMoa2607887","url":null,"abstract":"<p><strong>Background: </strong>In patients with infective endocarditis on the left side of the heart, the current recommendation of up to 6 weeks of antibiotic therapy is based largely on expert consensus opinion. Whether a clinical response-tailored antibiotic management strategy can shorten treatment duration without compromising safety is unclear.</p><p><strong>Methods: </strong>In this international, open-label, randomized trial, we assigned adults in stable condition with infective endocarditis caused by <i>Staphylococcus aureus</i>, <i>Enterococcus faecalis</i>, or streptococcus species to receive either response-tailored or standard-duration antibiotic therapy. Before randomization, all the patients received at least the prespecified 2 to 4 weeks of therapy and met criteria for clinical stabilization. After randomization, patients in the tailored-therapy group discontinued antibiotics and those in the standard-therapy group continued standard treatment (total duration, 4 to 6 weeks). The primary efficacy end point was days alive without antibiotic treatment for infective endocarditis or bacteremia within 6 months after randomization (tested for superiority). The primary safety end point was a composite of death from any cause, unplanned cardiac surgery, or symptomatic embolic events within 6 months after randomization (tested for noninferiority; margin, 7.5 percentage points). Relapse of bacteremia or infective endocarditis was a key secondary end point.</p><p><strong>Results: </strong>A total of 508 patients underwent randomization, with 255 assigned to response-tailored therapy and 253 to standard-duration therapy. The median time alive without antibiotic treatment was 183 days (interquartile range, 181 to 183) with tailored therapy and 169 days (interquartile range, 166 to 171) with standard therapy (Hodges-Lehmann estimated difference, 13 days; 95% confidence interval [CI], 12 to 13; P<0.001 for superiority). A primary safety end-point event occurred in 21 patients (8.2%) with tailored therapy and in 27 patients (10.7%) with standard therapy (absolute between-group difference, -2.4 percentage points; 95% CI, -7.7 to 2.7; P<0.001 for noninferiority), indicating noninferiority. Relapse occurred in 13 patients (5.1%) with tailored therapy and in 4 patients (1.6%) with standard therapy (P = 0.04).</p><p><strong>Conclusions: </strong>Among patients with infective endocarditis on the left side of the heart, the use of a response-tailored antibiotic strategy resulted in a longer time alive without antibiotic therapy than standard-duration therapy and met the criterion for noninferiority with respect to safety but was associated with a higher incidence of relapse of bacteremia or infective endocarditis. (Funded by Sygeforsikringen \"danmark\" and others; POET II ClinicalTrials.gov number, NCT03851575.).</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":"1600-1609"},"PeriodicalIF":84.5,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842087","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":"<i>Helicobacter pylori</i> Infection - Advances, Challenges, and the Road Ahead.","authors":"Hong Li, Francis Megraud, Barry J Marshall","doi":"10.1056/NEJMra2414530","DOIUrl":"10.1056/NEJMra2414530","url":null,"abstract":"<p><p>The discovery of <i>Helicobacter pylori</i> has revolutionized the prevention and treatment of gastritis, peptic ulcers, and, most important, gastric cancer. In the past 40 years, enormous progress has been achieved in the clinical and basic research on <i>H. pylori</i> infection. However, challenges in preventing and treating <i>H. pylori</i> infection exist owing to the lack of an <i>H. pylori</i> vaccine and the ever-increasing resistance to antibiotics worldwide. This review summarizes the history of and key milestones in <i>H. pylori</i> research, provides an update on the understanding of the pathogenesis and global burden of <i>H. pylori</i> infection and the screening strategy for the primary prevention of gastric cancer, and focuses on the emerging trends in the management of <i>H. pylori</i> infection.</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"395 16","pages":"1621-1633"},"PeriodicalIF":84.5,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240439","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":"Retatrutide Once Weekly for Treatment of Obstructive Sleep Apnea.","authors":"Ronald R Grunstein, Virend K Somers, Ali Azarbarzin, Atul Malhotra, Scott A Sands, Brendan P Lucey, Sheryl E Allen, Kathryn Giblin, Beverly L Falcon, So Young Park, Jitong Lou, Kathryn Krueger","doi":"10.1056/NEJMoa2611477","DOIUrl":"https://doi.org/10.1056/NEJMoa2611477","url":null,"abstract":"<p><strong>Background: </strong>Retatrutide, an investigational triple agonist of glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and glucagon receptors, may be useful for treating obstructive sleep apnea (OSA).</p><p><strong>Methods: </strong>In two phase 3, double-blind, randomized, placebo-controlled trials nested within larger basket trials of once-weekly subcutaneous retatrutide, we assigned adults with moderate-to-severe OSA and a body-mass index (the weight in kilograms divided by the square of the height in meters) of at least 27, without (TRIUMPH-1-OSA) or with (TRIUMPH-2-OSA) type 2 diabetes, to receive retatrutide (4, 9, or 12 mg) or placebo. The primary end point was the change in the apnea-hypopnea index (AHI, the average number of apneas and hypopneas per hour of sleep) at 80 weeks with 9 mg and 12 mg of retatrutide. For OSA-related end points, a hybrid-treatment estimand was applied, with a hypothetical strategy used for participants who had intercurrent events suggesting treatment failure and a treatment-policy strategy used elsewhere. We also report intention-to-treat (ITT) results.</p><p><strong>Results: </strong>A total of 243 participants underwent randomization in TRIUMPH-1-OSA and 448 in TRIUMPH-2-OSA. The baseline mean AHI was 58.6 and 55.9 events per hour, respectively, and the mean body weight was 119.6 and 115.9 kg. At 80 weeks, the mean changes in the AHI (hybrid-treatment estimand) with retatrutide in TRIUMPH-1-OSA were -22.9 (4 mg), -34.3 (9 mg), and -31.7 (12 mg) events per hour, versus -9.9 with placebo (difference vs. placebo, -13.0 [95% confidence interval {CI}, -23.0 to -3.0], -24.4 [95% CI, -34.1 to -14.7], and -21.9 [95% CI, -32.2 to -11.5], respectively). The changes with retatrutide in TRIUMPH-2-OSA were -19.2 (4 mg), -24.7 (9 mg), and -25.4 (12 mg) events per hour, versus -10.3 with placebo (difference vs. placebo, -8.9 [95% CI, -15.9 to -2.0], -14.4 [95% CI, -21.6 to -7.2], and -15.1 [95% CI, -22.5 to -7.7]). For the ITT estimand, the corresponding differences from placebo were -13.2 (95% CI, -22.6 to -3.9), -24.7 (95% CI, -34.1 to -15.3), and -22.5 (95% CI, -31.9 to -13.1) in TRIUMPH-1-OSA and -8.8 (95% CI, -15.8 to -1.7), -13.9 (95% CI, -21.3 to -6.6), and -15.0 (95% CI, -22.5 to -7.4) in TRIUMPH-2-OSA. The mean percent change in body weight with retatrutide (key secondary end point) was -12.5 to -22.2% in TRIUMPH-1-OSA and -12.1 to -18.5% in TRIUMPH-2-OSA, versus -4.8% and -5.6% with placebo (treatment-regimen estimand). The most common adverse events were gastrointestinal.</p><p><strong>Conclusions: </strong>In adults with OSA and obesity or overweight with or without type 2 diabetes, retatrutide resulted in significantly greater decreases in the AHI than placebo. (Funded by Eli Lilly; TRIUMPH-1 and -2 ClinicalTrials.gov numbers, NCT05929066 and NCT05929079.).</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":84.5,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240475","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":"Community Engagement Requirements in Medicaid — Law as a Determinant of Health","authors":"Nicole Huberfeld,Paul R. Shafer","doi":"10.1056/nejmp2608810","DOIUrl":"https://doi.org/10.1056/nejmp2608810","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"27 1","pages":""},"PeriodicalIF":158.5,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208675","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":"Why Shared-Savings ACOs Have Failed to Deliver for Primary Care","authors":"Lisa S. Rotenstein,Nicholas Stine,Bruce Landon","doi":"10.1056/nejmp2605590","DOIUrl":"https://doi.org/10.1056/nejmp2605590","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"168 1","pages":""},"PeriodicalIF":158.5,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208676","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":"What I See before Anyone Speaks","authors":"Robert B. Shpiner","doi":"10.1056/nejmp2604584","DOIUrl":"https://doi.org/10.1056/nejmp2604584","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"10 1","pages":""},"PeriodicalIF":158.5,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208677","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":"Integration-Associated Paraspinal Neoplasm after AAV Gene Therapy.","authors":"Josh N Vo, Yi-Mi Wu, Amer Heider, Xuhong Cao, Rui Wang, Tiffany Pham, Guo Ci Teo, Suresh N Magge, Hemant Parmar, Rajen Mody, Dan R Robinson, Arul M Chinnaiyan","doi":"10.1056/NEJMc2607927","DOIUrl":"10.1056/NEJMc2607927","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"395 15","pages":"1555-1558"},"PeriodicalIF":84.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186249","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":"Extended DAPT for Multivessel Coronary Artery Disease.","authors":"Domenico S Castiello, Ernest Spitzer","doi":"10.1056/NEJMc2610855","DOIUrl":"https://doi.org/10.1056/NEJMc2610855","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"395 15","pages":"1559"},"PeriodicalIF":84.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186232","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":"Setmelanotide for the Treatment of Acquired Hypothalamic Obesity.","authors":"Jiafeng Zhang, Xinhui Zhan, Tuo Li","doi":"10.1056/NEJMc2610994","DOIUrl":"https://doi.org/10.1056/NEJMc2610994","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"395 15","pages":"1562-1563"},"PeriodicalIF":84.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186269","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}