NEJM evidence最新文献

{"title":"Interpreting Evidence with Bayesian Meta-Analysis.","authors":"Sharon-Lise T Normand","doi":"10.1056/EVIDe2600097","DOIUrl":"10.1056/EVIDe2600097","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDe2600097"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clonal Selection and Evolution after Treatment of Severe Aplastic Anemia.","authors":"Fernanda Gutierrez-Rodrigues, Emma M Groarke, Rui Miao, Ruba Shalhoub, Lemlem Alemu, Hiroki Mizumaki, Olga Rios, Joshua Glass, Jibran Durrani, Luiz Fernando Bazzo Catto, Luca Arcuri, Sachiko Kajigaya, Shouguo Gao, Subrata Paul, Justin Lack, Masanori Yoshida, Diego Quinones Raffo, Jennifer Lotter, Colin O Wu, Cynthia E Dunbar, Marcin Wlodarski, Neal S Young, Bhavisha A Patel","doi":"10.1056/EVIDoa2500171","DOIUrl":"https://doi.org/10.1056/EVIDoa2500171","url":null,"abstract":"<p><strong>Background: </strong>Clonal hematopoiesis (CH) is a feature of severe aplastic anemia (SAA), but its clinical significance is debated.</p><p><strong>Methods: </strong>We integrated longitudinal clinical and CH data from patients with SAA treated with immunosuppression plus eltrombopag (IST-EPAG) in a phase 2 trial to characterize clonal dynamics during recovery and progression to myeloid cancer or paroxysmal nocturnal hemoglobinuria (PNH); CH was defined as the presence of somatic mutations at a variant allele frequency of 0.1% or greater.</p><p><strong>Results: </strong>In total, 204 SAA patients treated with IST-EPAG were evaluated from disease onset to median follow-up of 5.5 years. CH was observed in 128 of 204 (63%) patients before treatment and in 131 of 180 (73%) after therapy who were evaluated at the 6-month timepoint and were not off-study. Patients mostly had CH in <i>PIGA</i> (N=53, 26%), DNMT3A (N=42, 21%), BCOR (N=35, 17%), and <i>ASXL1</i> (N=25, 12%). There appeared to be two distinct patterns of malignant clonal evolution. Early evolutions, within 1 year from treatment, were primarily chromosome 7 aberrations and occurred in 11 (5%) patients. In another eight (4%) patients, late evolutions, 4-5 years after therapy, were initiated by early selection of <i>ASXL1-</i>mutated or <i>U2AF1</i>-mutated clones. Evolution to PNH, observed in 10 of 204 patients (5%), was associated with expansion of <i>PIGA</i> clones usually present before treatment.</p><p><strong>Conclusions: </strong>Among patients with SAA treated with IST-EPAG, early and late patterns of clonal evolution to myeloid cancer were observed: Chromosome 7 abnormalities occurred within 1 year, whereas later events (4-5 years) involved stepwise mutation acquisition in preexisting <i>ASXL1-</i> or <i>U2AF1-</i>mutated clones.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 5","pages":"EVIDoa2500171"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of a Single Measles Infection Using Untargeted Ultra-Deep Metagenomic Sequencing of Wastewater in Cook County, Illinois.","authors":"Rachel S Poretsky, Vineet K Dhiman, Dylan L Hendricks, Chi-Yu Lin, Dolores Sanchez Gonzalez, Stephanie Greenwald, Sarah M Owens, Charles H Williams, Matthew T Leslie, Kelley Bemis, Mabel Frias, Jeff T Kaufman, David H O'Connor, Marc C Johnson","doi":"10.1056/EVIDpha2600079","DOIUrl":"https://doi.org/10.1056/EVIDpha2600079","url":null,"abstract":"<p><p>AbstractMeasles is a contagious, vaccine-preventable viral disease that can be shed into wastewater by infected individuals. In September 2025, as part of an ongoing, nontargeted, ultra-deep metagenomic sequencing effort of wastewater in Cook County, Illinois, we detected measles reads from a facility serving more than 1 million people. Out of more than 900 million reads sequenced from wastewater collected on September 14, 2025, 43 matched measles virus genotype B3. Subsequent genomic analysis linked these reads to a confirmed measles infection that was present in the community on that day, demonstrating that untargeted metagenomics appeared to detect a single measles infection in a large municipal wastewater stream.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDpha2600079"},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Exchange about \"Oral Diuretic Intensification as a Worsening Heart Failure Event in the Primary Outcome of Clinical Trials\".","authors":"","doi":"10.1056/EVIDe2500363","DOIUrl":"https://doi.org/10.1056/EVIDe2500363","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 4","pages":"EVIDe2500363"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequencing of Pleural Fluid and Plasma for Tuberculous Pleuritis.","authors":"W K Jacky Lam, Ken K P Chan, Guangya Wang, Christopher K C Lai, Guannan Kang, Christopher Chan, Angela C Y Leung, Natalie H L Wong, Crystal S N Tso, K M Chow, Saravanan Ramakrishnan, K T Wong, Charlotte H Y Lau, Joyce K C Ng, Rachel L P Lo, W H Yip, Jenny C L Ngai, K W To, Irene O L Tse, S H Cheng, Huimin Shang, K W Chan, Angel Lai, Charles M L Chan, Vicky C T Lee, Yasine Malki, L Y Lois Choy, Mary-Jane L Ma, Qing Zhou, Stephanie C Y Yu, Peiyong Jiang, Fanny W S Ko, K C Allen Chan, David S C Hui, Y C Gary Lee, Y M Dennis Lo","doi":"10.1056/EVIDoa2500237","DOIUrl":"https://doi.org/10.1056/EVIDoa2500237","url":null,"abstract":"<p><strong>Background: </strong>The laboratory diagnosis of tuberculous pleuritis (TBP) is hindered by the paucibacillary nature of <i>Mycobacterium tuberculosis</i> in the pleural space, resulting in low sensitivity of microbiological culture and polymerase chain reaction-based analyses on pleural fluid. The use of metagenomic next-generation sequencing for diagnosing TBP may be limited by the background noise of DNA from nontuberculous mycobacteria.</p><p><strong>Methods: </strong>We performed targeted sequencing to analyze <i>M. tuberculosis</i> DNA in paired pleural fluid and plasma from prospectively enrolled consecutive patients with new-onset pleural effusion. We used a bioinformatics alignment algorithm to the <i>M. tuberculosis</i> genome that was masked for regions with high sequence similarity to nontuberculous mycobacteria. Our primary outcome was a comparison of diagnostic sensitivity between <i>M. tuberculosis</i> sequencing as described above and culture using McNemar's test.</p><p><strong>Results: </strong>Among the included 329 patients with pleural effusion, 34 patients with TBP were identified. Targeted sequencing detected <i>M. tuberculosis</i> DNA fragments in the pleural fluid of all TBP cases (median, 267.6 reads per 10 million [RP10M]; interquartile range [IQR], 30.8-2644.3) but absent in 288 out of 295 (97.6%) non-TBP samples (median, 0 RP10M; IQR, 0-0). Targeted sequencing of pleural fluid achieved a sensitivity of 97.1% for TBP detection at a cutoff of 2 RP10M, in contrast to 47.1% by <i>M. tuberculosis</i> culture (P<0.001, McNemar's test). Sequencing yielded an area-under-the-curve value of 0.9996 (95% confidence interval, 0.9988-1.0000) for differentiating TBP and non-TBP. Plasma analysis by targeted sequencing with the same alignment algorithm reported an area-under-the-curve value of 0.9475 (95% confidence interval, 0.8929-1.0000).</p><p><strong>Conclusions: </strong>Targeted sequencing of pleural fluid with selectively masked <i>M. tuberculosis</i> genomic alignment accurately diagnosed TBP and outperformed conventional diagnostic tests. (Supported by InnoHK and the Hong Kong Tuberculosis, Chest and Heart Diseases Association; ClinicalTrials.gov number, NCT05397730.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 4","pages":"EVIDoa2500237"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tobacco Product Use among U.S. Adults, 2023-2024.","authors":"Israel Agaku","doi":"10.1056/EVIDpha2500339","DOIUrl":"10.1056/EVIDpha2500339","url":null,"abstract":"<p><p>AbstractAnalysis of 2023-2024 National Health Interview Survey data suggest that prevalence of cigarette smoking among U.S. adults declined from 10.8% of the population in 2023 to 9.9% in 2024. Use of other tobacco products, including cigars and e-cigarettes, remained unchanged, and 18.8% of adults (47.7 million) used at least one tobacco product.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDpha2500339"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wrist Splinting versus a Placebo Soft Bandage for Carpal Tunnel Syndrome.","authors":"Isam Atroshi, Jesper Nordenskjöld, Kamelia Möllestam","doi":"10.1056/EVIDoa2500261","DOIUrl":"https://doi.org/10.1056/EVIDoa2500261","url":null,"abstract":"<p><strong>Background: </strong>Wrist splinting is a common treatment for carpal tunnel syndrome (CTS), but there is little evidence supporting its efficacy.</p><p><strong>Methods: </strong>In this parallel-group clinical trial, patients with primary idiopathic CTS with symptoms for at least 1 month and no previous treatment were randomly assigned to wear either a rigid wrist splint or placebo soft bandage (allowed full wrist motion) for 6 weeks. If symptoms persisted after 6 weeks, treatment was continued for 4 more weeks. If symptoms persisted after 12 weeks, surgery was considered. Co-primary outcomes were change in the six-item CTS symptoms score (range 1-5, higher score indicates worse symptoms, minimal clinically important difference, 0.9) from baseline to 12 weeks and proportion of patients undergoing surgery at 1 year. Adverse events were assessed at 6 weeks and 1 year.</p><p><strong>Results: </strong>Seventy patients were randomly assigned to the rigid splint group and 72 patients to the placebo bandage group. The mean CTS symptoms scores were as follows: rigid splint: baseline, 2.81 and 12 weeks, 2.45 (unadjusted mean difference, -0.36 [95% confidence interval (CI), -0.51 to -0.21]) and placebo bandage: baseline, 2.80 and 12 weeks, 2.52 (unadjusted mean difference, -0.28 [95% CI, -0.45 to -0.11]). The adjusted mean difference in the 12-week change in scores between the two groups was 0.08 (95% CI, -0.15 to 0.31; P=0.478). At 1 year, 40 (57.1%) patients in the rigid splint group and 37 (51.4%) patients in the placebo bandage group had surgery (adjusted relative risk, 1.10 [95% CI, 0.81-1.48]). Minor local adverse events were reported by 12 patients in each group. There were no serious adverse events.</p><p><strong>Conclusions: </strong>Among patients with CTS randomly assigned to treatment with a rigid wrist splint versus placebo soft bandage, the change of symptom scores after 12 weeks was not significantly different and the proportion undergoing surgery within 1 year was similar between the two groups. (Funded by a Southern Healthcare Region Research and Development Grant, Swedish Governmental Funding for Clinical Research [ALF], and Lions Foundation Skåne; ISRCTN number, ISRCTN81836603.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 4","pages":"EVIDoa2500261"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unlocking the Diagnostic Challenge of Tuberculous Pleural Effusions.","authors":"Hesham Atef AbdelHalim, Heba Helmy AboElNaga","doi":"10.1056/EVIDe2500329","DOIUrl":"https://doi.org/10.1056/EVIDe2500329","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 4","pages":"EVIDe2500329"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infrapatellar Fat Pad Preservation versus Resection in Total Knee Arthroplasty.","authors":"Weiyu Han, Peihua Cao, Han Cen, Bing Li, Min Chen, Yusheng Li, Chengliang Yang, Ming Lu, Huantian Zhang, Yan Ke, Zhaohua Zhu, Xuelian Liu, Peichun Gao, Xiaoni Zhou, Yanqi Liu, Zhiyan Dou, Yu Liu, Mengdi Zhang, Jianhao Lin, Zhengang Zha, Zongsheng Yin, Jing Tian, Lijun Lin, Xifu Shang, David J Hunter, Jun Liu, Guanghua Lei, Changhai Ding","doi":"10.1056/EVIDoa2500135","DOIUrl":"https://doi.org/10.1056/EVIDoa2500135","url":null,"abstract":"<p><strong>Background: </strong>Preservation of normal-quality infrapatellar fat pads (IPFP) during total knee arthroplasty (TKA) has been proposed, and IPFP of abnormal quality are recommended for resection.</p><p><strong>Methods: </strong>In this trial, patients with knee osteoarthritis (OA) undergoing TKA were stratified by IPFP status on magnetic resonance imaging (Group 1 with normal IPFP [signal intensity score ≤1; ranging from 0 to 3]; Group 2 with abnormal IPFP [signal intensity score ≥2]) and randomly assigned in a 1:1 ratio to IPFP preservation or IPFP resection. The primary outcome was 12-month change in the mean of five Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales (KOOS₅), which range from 0 (worst) to 100 (best).</p><p><strong>Results: </strong>In Group 1, 179 participants were randomly allocated to IPFP preservation (n=90) and IPFP resection (n=89), and 198 participants were randomly assigned to IPFP preservation (n=101) and IPFP resection (n=97) in Group 2. The increases in KOOS₅ score were 38.1 and 36.1 in Group 1 and were 39.2 and 37.5 in Group 2 in IPFP preservation and IPFP resection groups, respectively, resulting in between-group differences of 1.9 (95% confidence interval [CI], -1.7 to 5.6) in Group 1 and 1.6 (95% CI, -1.3 to 4.6) in Group 2. Adverse events were predominantly nonserious musculoskeletal or skin-related events (three vs. two in Group 1 and eight vs. two in Group 2).</p><p><strong>Conclusions: </strong>Resection of abnormal IPFP and preservation of normal IPFP did not improve postoperative outcomes 12 months after TKA. (Funded by National Key Research & Development Program of China, Clinical Research Startup Program of Southern Medical University, and National Natural Science Foundation of China; ClinicalTrials.gov number, NCT03763448.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 4","pages":"EVIDoa2500135"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policy Implications of Placebo Bandage for Carpal Tunnel Syndrome.","authors":"Karen C Smith, Jeffrey N Katz","doi":"10.1056/EVIDe2600038","DOIUrl":"https://doi.org/10.1056/EVIDe2600038","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 4","pages":"EVIDe2600038"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}