New England Journal of Medicine最新文献

{"title":"Erysipelas.","authors":"Nathan I Wood, Andre N Sofair","doi":"10.1056/NEJMicm2404869","DOIUrl":"https://doi.org/10.1056/NEJMicm2404869","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 17","pages":"1632"},"PeriodicalIF":96.2,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548978","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":"Inavolisib-Based Therapy in <i>PIK3CA</i>-Mutated Advanced Breast Cancer.","authors":"Nicholas C Turner, Seock-Ah Im, Cristina Saura, Dejan Juric, Sibylle Loibl, Kevin Kalinsky, Peter Schmid, Sherene Loi, Patrapim Sunpaweravong, Antonino Musolino, Huiping Li, Qingyuan Zhang, Zbigniew Nowecki, Roland Leung, Eirini Thanopoulou, Noopur Shankar, Guiyuan Lei, Thomas J Stout, Katherine E Hutchinson, Jennifer L Schutzman, Chunyan Song, Komal L Jhaveri","doi":"10.1056/NEJMoa2404625","DOIUrl":"https://doi.org/10.1056/NEJMoa2404625","url":null,"abstract":"<p><strong>Background: </strong>Inavolisib is a highly potent and selective inhibitor of the alpha isoform of the p110 catalytic subunit of the phosphatidylinositol 3-kinase complex (encoded by <i>PIK3CA</i>) that also promotes the degradation of mutated p110α. Inavolisib plus palbociclib-fulvestrant has shown synergistic activity in preclinical models and promising antitumor activity in early-phase trials.</p><p><strong>Methods: </strong>In a phase 3, double-blind, randomized trial, we compared first-line inavolisib (at an oral dose of 9 mg once daily) plus palbociclib-fulvestrant (inavolisib group) with placebo plus palbociclib-fulvestrant (placebo group) in patients with <i>PIK3CA</i>-mutated, hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative locally advanced or metastatic breast cancer who had had relapse during or within 12 months after the completion of adjuvant endocrine therapy. The primary end point was progression-free survival as assessed by the investigator.</p><p><strong>Results: </strong>A total of 161 patients were assigned to the inavolisib group and 164 to the placebo group; the median follow-up was 21.3 months and 21.5 months, respectively. The median progression-free survival was 15.0 months (95% confidence interval [CI], 11.3 to 20.5) in the inavolisib group and 7.3 months (95% CI, 5.6 to 9.3) in the placebo group (hazard ratio for disease progression or death, 0.43; 95% CI, 0.32 to 0.59; P<0.001). An objective response occurred in 58.4% of the patients in the inavolisib group and in 25.0% of those in the placebo group. The incidence of grade 3 or 4 neutropenia was 80.2% in the inavolisib group and 78.4% in the placebo group; grade 3 or 4 hyperglycemia, 5.6% and 0%, respectively; grade 3 or 4 stomatitis or mucosal inflammation, 5.6% and 0%; and grade 3 or 4 diarrhea, 3.7% and 0%. No grade 3 or 4 rash was observed. Discontinuation of any trial agent because of adverse events occurred in 6.8% of the patients in the inavolisib group and in 0.6% of those in the placebo group.</p><p><strong>Conclusions: </strong>In patients with <i>PIK3CA</i>-mutated, hormone receptor-positive, HER2-negative locally advanced or metastatic breast cancer, inavolisib plus palbociclib-fulvestrant led to significantly longer progression-free survival than placebo plus palbociclib-fulvestrant, with a greater incidence of toxic effects. The percentage of patients who discontinued any trial agent because of adverse events was low. (Funded by F. Hoffmann-La Roche; INAVO120 ClinicalTrials.gov number, NCT04191499.).</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 17","pages":"1584-1596"},"PeriodicalIF":96.2,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548983","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":"Lead Poisoning.","authors":"Bruce Lanphear, Ana Navas-Acien, David C Bellinger","doi":"10.1056/NEJMra2402527","DOIUrl":"https://doi.org/10.1056/NEJMra2402527","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 17","pages":"1621-1631"},"PeriodicalIF":96.2,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548984","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 Way to a Patient's Heart - Vascular Access in Cardiac Arrest.","authors":"Niklas Nielsen","doi":"10.1056/NEJMe2412901","DOIUrl":"https://doi.org/10.1056/NEJMe2412901","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":96.2,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548971","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":"Postacute Sequelae of SARS-CoV-2 Infection in Several Eras. Reply.","authors":"Yan Xie, Ziyad Al-Aly","doi":"10.1056/NEJMc2411213","DOIUrl":"10.1056/NEJMc2411213","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 17","pages":"1659-1660"},"PeriodicalIF":96.2,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548990","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":"Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis.","authors":"Thomas Frydendal, Robin Christensen, Inger Mechlenburg, Lone R Mikkelsen, Claus Varnum, Anders E Graversen, Per Kjærsgaard-Andersen, Peter H Revald, Christian Hofbauer, Manuel J Bieder, Haidar Qassim, Mohammad S Munir, Stig S Jakobsen, Sabrina M Nielsen, Kim G Ingwersen, Søren Overgaard","doi":"10.1056/NEJMoa2400141","DOIUrl":"https://doi.org/10.1056/NEJMoa2400141","url":null,"abstract":"<p><strong>Background: </strong>Total hip replacement is routinely recommended for severe hip osteoarthritis, but data from randomized trials are lacking regarding comparison of the effectiveness of this procedure with that of nonsurgical treatment such as resistance training.</p><p><strong>Methods: </strong>We conducted a multicenter, randomized, controlled trial to compare total hip replacement with resistance training in patients 50 years of age or older who had severe hip osteoarthritis and an indication for surgery. The primary outcome was the change in patient-reported hip pain and function from baseline to 6 months after the initiation of treatment, assessed with the use of the Oxford Hip Score (range, 0 to 48, with higher scores indicating less pain and better function). Safety was also assessed.</p><p><strong>Results: </strong>A total of 109 patients (mean age, 67.6 years) were randomly assigned to total hip replacement (53 patients) or resistance training (56 patients). In an intention-to-treat analysis, the mean increase (indicating improvement) in the Oxford Hip Score was 15.9 points in patients assigned to total hip replacement and 4.5 points in patients assigned to resistance training (difference, 11.4 points; 95% confidence interval, 8.9 to 14.0; P<0.001). At 6 months, 5 patients (9%) who had been assigned to total hip replacement had not undergone surgery, and 12 patients (21%) who had been assigned to resistance training had undergone total hip replacement. The incidence of serious adverse events at 6 months was similar in the two groups; the majority of such events were known complications of total hip replacement.</p><p><strong>Conclusions: </strong>In patients 50 years of age or older who had severe hip osteoarthritis and an indication for surgery, total hip replacement resulted in a clinically important, superior reduction in hip pain and improved hip function, as reported by patients, at 6 months as compared with resistance training. (Funded by the Danish Rheumatism Association and others; PROHIP ClinicalTrials.gov number, NCT04070027.).</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 17","pages":"1610-1620"},"PeriodicalIF":96.2,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548992","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":"Case 22-2024: A Woman with Postpartum Fever, Abdominal Pain, and Skin Ulcers.","authors":"Konstantinos Parperis","doi":"10.1056/NEJMc2410558","DOIUrl":"10.1056/NEJMc2410558","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 17","pages":"1663"},"PeriodicalIF":96.2,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548975","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":"Improving the Outcome of Bad-Acting Hormone Receptor-Positive Breast Cancer.","authors":"William J Gradishar","doi":"10.1056/NEJMe2411229","DOIUrl":"https://doi.org/10.1056/NEJMe2411229","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 17","pages":"1644-1647"},"PeriodicalIF":96.2,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548982","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":"More on Type 2 Diabetes in Patients with G6PD Deficiency. Reply.","authors":"Ariel Israel, Shlomo Vinker, Eugene Merzon","doi":"10.1056/NEJMc2411261","DOIUrl":"10.1056/NEJMc2411261","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 17","pages":"1664"},"PeriodicalIF":96.2,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548986","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":"Toward a Biomedical Research Enterprise That Better Serves the United States.","authors":"E Albert Reece, Victor J Dzau","doi":"10.1056/NEJMsb2412007","DOIUrl":"10.1056/NEJMsb2412007","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":"1651-1655"},"PeriodicalIF":96.2,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332516","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}