New England Journal of Medicine最新文献

{"title":"Global Effect of Cardiovascular Risk Factors on Lifetime Estimates.","authors":"Kenneth H Cooper","doi":"10.1056/NEJMc2511206","DOIUrl":"https://doi.org/10.1056/NEJMc2511206","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"393 12","pages":"1245"},"PeriodicalIF":78.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139465","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":"Digitoxin in Patients with Heart Failure and Reduced Ejection Fraction.","authors":"Udo Bavendiek, Anika Großhennig, Johannes Schwab, Dominik Berliner, Andreas Rieth, Lars S Maier, Thomas Gaspar, Nele Henrike Thomas, Xiaofei Liu, Sven Schallhorn, Eleonora Angelini, Samira Soltani, Fabian Rathje, Mircea-Andrei Sandu, Welf Geller, Rainer Hambrecht, Marija Zdravkovic, Sebastian Philipp, Dragana Kosevic, Georg Nickenig, Daniel Scheiber, Sebastian Winkler, Peter Moritz Becher, Philipp Lurz, Martin Hülsmann, Sören Wiesner, Christoph Schröder, Barbara Neuhaus, Anika Seltmann, Heiko von der Leyen, Christian Veltmann, Stefan Störk, Michael Böhm, Armin Koch, Johann Bauersachs","doi":"10.1056/NEJMoa2415471","DOIUrl":"10.1056/NEJMoa2415471","url":null,"abstract":"<p><strong>Background: </strong>The therapeutic efficacy of the cardiac glycoside digitoxin in patients with heart failure and reduced ejection fraction is not established.</p><p><strong>Methods: </strong>In this international, double-blind, placebo-controlled trial, we randomly assigned patients with chronic heart failure who had a left ventricular ejection fraction of 40% or less and a New York Heart Association (NYHA) functional class of III or IV or a left ventricular ejection fraction of 30% or less and an NYHA functional class of II in a 1:1 ratio to receive digitoxin (at a starting dose of 0.07 mg once daily) or matching placebo in addition to guideline-directed medical therapy. The primary outcome was a composite of death from any cause or hospital admission for worsening heart failure, whichever occurred first.</p><p><strong>Results: </strong>Among 1240 patients who underwent randomization, 1212 fulfilled the criteria for inclusion in the modified intention-to-treat population: 613 patients in the digitoxin group and 599 in the placebo group. Over a median follow-up of 36 months, a primary-outcome event occurred in 242 patients (39.5%) in the digitoxin group and 264 (44.1%) in the placebo group (hazard ratio for death or first hospital admission for worsening heart failure, 0.82; 95% confidence interval [CI], 0.69 to 0.98; P = 0.03). Death from any cause occurred in 167 patients (27.2%) in the digitoxin group and 177 (29.5%) in the placebo group (hazard ratio, 0.86; 95% CI, 0.69 to 1.07). A first hospital admission for worsening heart failure occurred in 172 patients (28.1%) in the digitoxin group and 182 (30.4%) in the placebo group (hazard ratio, 0.85; 95% CI, 0.69 to 1.05). At least one serious adverse event occurred in 29 patients (4.7%) in the digitoxin group and 17 (2.8%) in the placebo group.</p><p><strong>Conclusions: </strong>Treatment with digitoxin led to a lower combined risk of death from any cause or hospital admission for worsening heart failure than placebo among patients with heart failure and reduced ejection fraction who received guideline-directed medical therapy. (Funded by the German Federal Ministry of Research, Technology, and Space and others; DIGIT-HF EudraCT number, 2013-005326-38.).</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":"1155-1165"},"PeriodicalIF":78.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979260","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":"Cerebral Embolic Protection during TAVI.","authors":"Gaurav Sharma","doi":"10.1056/NEJMc2510558","DOIUrl":"https://doi.org/10.1056/NEJMc2510558","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"393 12","pages":"1243-1244"},"PeriodicalIF":78.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139478","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":"Nonoperative Management of Mismatch Repair-Deficient Tumors. Reply.","authors":"Wassim Abida, Luis A Diaz, Andrea Cercek","doi":"10.1056/NEJMc2510154","DOIUrl":"https://doi.org/10.1056/NEJMc2510154","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"393 12","pages":"1242-1243"},"PeriodicalIF":78.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139575","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":"Transformative Research in Cystic Fibrosis.","authors":"Eric J Sorscher","doi":"10.1056/NEJMcibr2510197","DOIUrl":"10.1056/NEJMcibr2510197","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":"1231-1234"},"PeriodicalIF":78.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042467","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":"Risk and Benefit.","authors":"Eric J Rubin","doi":"10.1056/NEJMe2513817","DOIUrl":"https://doi.org/10.1056/NEJMe2513817","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":78.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139432","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":"Proliferation of Prior Authorization in Traditional Medicare - None the WISeR?","authors":"Michael Liu,Kushal T Kadakia,Rishi K Wadhera","doi":"10.1056/nejmp2510451","DOIUrl":"https://doi.org/10.1056/nejmp2510451","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"2 1","pages":""},"PeriodicalIF":158.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134145","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":"Permethrin-Treated Baby Wraps for the Prevention of Malaria.","authors":"Ross M Boyce,Bonnie E Shook-Sa,Ronnie Ndizeye,Emmanuel Baguma,Dana Giandomenico,Caitlin A Cassidy,Solomon Eshun,Mark J Siedner,Sarah G Staedke,Moses Ntaro,Jonathan J Juliano,Raquel Reyes,Edgar M Mulogo","doi":"10.1056/nejmoa2501628","DOIUrl":"https://doi.org/10.1056/nejmoa2501628","url":null,"abstract":"BACKGROUNDMalaria remains a major cause of childhood death in sub-Saharan Africa. We leveraged the traditional practice of mothers carrying children on their backs in cloth wraps to assess whether treating the wraps with an insect repellent might provide a layer of protection against malaria.METHODSIn a double-blind, randomized, placebo-controlled trial conducted in Uganda, we enrolled adult women with a child who was 6 to 18 months of age. The mother-child pairs were randomly assigned in a 1:1 ratio to use permethrin-treated wraps (intervention group) or sham-treated wraps (control group). The wraps underwent retreatment every 4 weeks. All the participants received a new, pyrethroid-only long-lasting insecticide-treated bed net. The participants visited the trial clinics every 2 weeks for 24 weeks and made unscheduled visits in the case of febrile illness in the children. The primary outcome was clinical malaria in the children, as defined by fever and a positive malaria rapid diagnostic test.RESULTSFrom June 2022 through April 2024, a total of 419 mother-child pairs were screened, and 400 underwent randomization; 200 pairs were assigned to the intervention group and 200 to the control group. Clinic attendance was high (5194 of 5200 planned visits [99.9%] were attended), and no participants were lost to follow-up. The incidence rate of clinical malaria was 0.73 cases per 100 person-weeks (95% confidence interval [CI], 0.51 to 1.02) in the intervention group and 2.14 cases per 100 person-weeks (95% CI, 1.73 to 2.62) in the control group (incidence rate ratio, 0.34; 95% CI, 0.23 to 0.51; P<0.001). Rash was reported more often in the intervention group than in the control group (8.5% vs. 6.0% of participants).CONCLUSIONSAmong mother-child pairs who had access to bed nets, maternal use of permethrin-treated baby wraps significantly reduced the incidence of clinical malaria in the children. (Funded by the Doris Duke Foundation and others; ClinicalTrials.gov number, NCT05391230.).","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"10 1","pages":""},"PeriodicalIF":158.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134146","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":"Structural and Scientific Racism, Science, and Health - Evidence versus Ideology.","authors":"Nancy Krieger,Mary T Bassett","doi":"10.1056/nejmp2508916","DOIUrl":"https://doi.org/10.1056/nejmp2508916","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"22 1","pages":""},"PeriodicalIF":158.5,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103345","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 Health to Wealth - Reframing Global Aid through the Gates Foundation's Final Chapter.","authors":"Steven Phillips","doi":"10.1056/nejmp2508188","DOIUrl":"https://doi.org/10.1056/nejmp2508188","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"60 1","pages":""},"PeriodicalIF":158.5,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103508","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}