New England Journal of Medicine最新文献

{"title":"Randomized Trial of Very Early Medication Abortion.","authors":"Karin Brandell, Tagrid Jar-Allah, John Reynolds-Wright, Helena Kopp Kallner, Helena Hognert, Frida Gyllenberg, Janina Kaislasuo, Anand Tamang, Heera Tuladhar, Clare Boerma, Karen Schimanski, Gillian Gibson, Mette Løkeland, Pia Teleman, Marie Bixo, Mette Mandrup Kjaer, Ervin Kallfa, Johan Bring, Oskari Heikinheimo, Sharon Cameron, Kristina Gemzell-Danielsson","doi":"10.1056/NEJMoa2401646","DOIUrl":"https://doi.org/10.1056/NEJMoa2401646","url":null,"abstract":"<p><strong>Background: </strong>Medication abortion, with a combination of mifepristone and misoprostol, is highly effective and safe. However, there is insufficient evidence on efficacy and safety at very early gestations before a pregnancy can be visualized with ultrasonography.</p><p><strong>Methods: </strong>We conducted a multicenter, noninferiority, randomized, controlled trial involving women requesting medication abortion at up to 42 days of gestation with an unconfirmed intrauterine pregnancy on ultrasound examination (visualized as an empty cavity or a sac-like structure without a yolk sac or embryonic pole). Participants were randomly assigned to either immediate start of abortion (early-start group) or standard-care treatment delayed until intrauterine pregnancy was confirmed (standard group). The primary outcome was complete abortion. The noninferiority margin was set at 3.0 percentage points for the absolute between-group difference.</p><p><strong>Results: </strong>In total, 1504 women were included at 26 sites in nine countries and were randomly assigned to the early-start group (754 participants) or the standard group (750 participants). In an intention-to-treat analysis, a complete abortion occurred in 676 of 710 participants (95.2%) in the early-start group and in 656 of 688 (95.3%) in the standard group; the absolute between-group difference was -0.1 percentage points (95% confidence interval, -2.4 to 2.1). Ectopic pregnancies occurred in 10 of 741 participants (1.3%) in the early-start group and in 6 of 724 (0.8%) in the standard group, with one rupture before diagnosis (early-start group). Serious adverse events occurred in 12 of 737 participants (1.6%) in the early-start group and in 5 of 718 (0.7%) in the standard group (P = 0.10); the majority were uncomplicated hospitalizations for treatment of ectopic pregnancy or incomplete abortion.</p><p><strong>Conclusions: </strong>Medication abortion before confirmed intrauterine pregnancy was noninferior to standard, delayed treatment with respect to complete abortion. (Funded by the Swedish Research Council and others; VEMA EudraCT number, 2018-003675-35; ClinicalTrials.gov number, NCT03989869.).</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 18","pages":"1685-1695"},"PeriodicalIF":96.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592286","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":"Long Covid Defined.","authors":"E Wesley Ely, Lisa M Brown, Harvey V Fineberg","doi":"10.1056/NEJMsb2408466","DOIUrl":"10.1056/NEJMsb2408466","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":"1746-1753"},"PeriodicalIF":96.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861653","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":"Frailty in Older Adults.","authors":"Nir Y Krakauer, Jesse C Krakauer","doi":"10.1056/NEJMc2411327","DOIUrl":"10.1056/NEJMc2411327","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 18","pages":"1758"},"PeriodicalIF":96.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592281","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":"Two Sides to the Story.","authors":"Cody E Cotner, Richard M Stone, Amy C Sherman, Katherine H Walker, Joseph Loscalzo","doi":"10.1056/NEJMcps2400493","DOIUrl":"https://doi.org/10.1056/NEJMcps2400493","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 18","pages":"1735-1741"},"PeriodicalIF":96.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592303","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":"From Evidence to Policy - Finding Authoritative Sources of Information on Health.","authors":"Eric J Rubin, Victor J Dzau","doi":"10.1056/NEJMe2409293","DOIUrl":"10.1056/NEJMe2409293","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":"1744-1745"},"PeriodicalIF":96.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861652","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":"Frailty in Older Adults. Reply.","authors":"Dae Hyun Kim, Kenneth Rockwood","doi":"10.1056/NEJMc2411327","DOIUrl":"10.1056/NEJMc2411327","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 18","pages":"1759-1760"},"PeriodicalIF":96.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592283","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":"Semaglutide for Chronic Kidney Disease in Type 2 Diabetes.","authors":"Rogerio da Hora Passos, Roberto Camargo Narciso, Arnaldo Alves da Silva","doi":"10.1056/NEJMc2410532","DOIUrl":"10.1056/NEJMc2410532","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 18","pages":"1757"},"PeriodicalIF":96.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592289","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":"Uterine Fibroids.","authors":"Elizabeth A Stewart, Shannon K Laughlin-Tommaso","doi":"10.1056/NEJMcp2309623","DOIUrl":"https://doi.org/10.1056/NEJMcp2309623","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 18","pages":"1721-1733"},"PeriodicalIF":96.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592305","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 U.S. Latino HIV Crisis - Ending an Era of Invisibility.","authors":"Vincent Guilamo-Ramos, Marco Thimm-Kaiser, Adam Benzekri","doi":"10.1056/NEJMp2406595","DOIUrl":"10.1056/NEJMp2406595","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":"1665-1668"},"PeriodicalIF":96.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395347","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":"Neoadjuvant Nivolumab and Ipilimumab in Resectable Stage III Melanoma.","authors":"Christian U Blank, Minke W Lucas, Richard A Scolyer, Bart A van de Wiel, Alexander M Menzies, Marta Lopez-Yurda, Lotte L Hoeijmakers, Robyn P M Saw, Judith M Lijnsvelt, Nigel G Maher, Saskia M Pulleman, Maria Gonzalez, Alejandro Torres Acosta, Winan J van Houdt, Serigne N Lo, Anke M J Kuijpers, Andrew Spillane, W Martin C Klop, Thomas E Pennington, Charlotte L Zuur, Kerwin F Shannon, Beatrijs A Seinstra, Robert V Rawson, John B A G Haanen, Sydney Ch'ng, Kishan A T Naipal, Jonathan Stretch, Johannes V van Thienen, Michael A Rtshiladze, Sofie Wilgenhof, Rony Kapoor, Aafke Meerveld-Eggink, Lindsay G Grijpink-Ongering, Alexander C J van Akkooi, Irene L M Reijers, David E Gyorki, Dirk J Grünhagen, Frank M Speetjens, Sonja B Vliek, Joanna Placzke, Lavinia Spain, Robert C Stassen, Mona Amini-Adle, Céleste Lebbé, Mark B Faries, Caroline Robert, Paolo A Ascierto, Rozemarijn van Rijn, Franchette W P J van den Berkmortel, Djura Piersma, Andre van der Westhuizen, Gerard Vreugdenhil, Maureen J B Aarts, Marion A M Stevense-den Boer, Victoria Atkinson, Muhammad Khattak, Miles C Andrews, Alfons J M van den Eertwegh, Marye J Boers-Sonderen, Geke A P Hospers, Matteo S Carlino, Jan-Willem B de Groot, Ellen Kapiteijn, Karijn P M Suijkerbuijk, Piotr Rutkowski, Shahneen Sandhu, Astrid A M van der Veldt, Georgina V Long","doi":"10.1056/NEJMoa2402604","DOIUrl":"10.1056/NEJMoa2402604","url":null,"abstract":"<p><strong>Background: </strong>In phase 1-2 trials in patients with resectable, macroscopic stage III melanoma, neoadjuvant immunotherapy was more efficacious than adjuvant immunotherapy.</p><p><strong>Methods: </strong>In this phase 3 trial, we randomly assigned patients with resectable, macroscopic stage III melanoma to two cycles of neoadjuvant ipilimumab plus nivolumab followed by surgery or surgery followed by 12 cycles of adjuvant nivolumab. Only patients in the neoadjuvant group with a partial response or nonresponse received adjuvant treatment. The primary end point was event-free survival.</p><p><strong>Results: </strong>A total of 423 patients underwent randomization. At a median follow-up of 9.9 months, the estimated 12-month event-free survival was 83.7% (99.9% confidence interval [CI], 73.8 to 94.8) in the neoadjuvant group and 57.2% (99.9% CI, 45.1 to 72.7) in the adjuvant group. The difference in restricted mean survival time was 8.00 months (99.9% CI, 4.94 to 11.05; P<0.001; hazard ratio for progression, recurrence, or death, 0.32; 99.9% CI, 0.15 to 0.66). In the neoadjuvant group, 59.0% of patients had a major pathological response, 8.0% had a partial response, 26.4% had a nonresponse (>50% residual viable tumor), and 2.4% had progression; in 4.2%, surgery had not yet been performed or was omitted. The estimated 12-month recurrence-free survival was 95.1% in patients in the neoadjuvant group who had a major pathological response, 76.1% among those with a partial response, and 57.0% among those with a nonresponse. Adverse events of grade 3 or higher that were related to systemic treatment occurred in 29.7% of patients in the neoadjuvant group and in 14.7% in the adjuvant group.</p><p><strong>Conclusions: </strong>Among patients with resectable, macroscopic stage III melanoma, neoadjuvant ipilimumab plus nivolumab followed by surgery and response-driven adjuvant therapy resulted in longer event-free survival than surgery followed by adjuvant nivolumab. (Funded by Bristol Myers Squibb and others; NADINA ClinicalTrials.gov number, NCT04949113.).</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":"1696-1708"},"PeriodicalIF":96.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201441","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}