NEJM evidence最新文献

{"title":"Margin Call - On the Selection of the Noninferiority Margin in Noninferiority Clinical Trials.","authors":"Juned Siddique, Shirlene D Wang","doi":"10.1056/EVIDe2500068","DOIUrl":"https://doi.org/10.1056/EVIDe2500068","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 5","pages":"EVIDe2500068"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060151","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":"A 7-Year-Old Boy with Prolonged Fever.","authors":"Zoe King, Brenda I Anosike, Rachel Offenbacher, Kaitlin Strumph","doi":"10.1056/EVIDmr2400330","DOIUrl":"https://doi.org/10.1056/EVIDmr2400330","url":null,"abstract":"<p><p>AbstractMorning Report is a time-honored tradition in which physicians-in-training present cases to their colleagues and clinical experts to collaboratively explore a patient's presentation. The Morning Report section continues this tradition by presenting a patient's chief concern and clinical course, inviting readers to develop a differential diagnosis and uncover the final diagnosis alongside the authors. This report details the story of a previously healthy 7-year-old boy who presented with 10 days of fever after travel to Bangladesh. Through targeted history, physical examination, and diagnostic testing, an illness script is developed. As the case progresses, the differential diagnosis is refined until a final diagnosis is established.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 5","pages":"EVIDmr2400330"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058728","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":"Foselutoclax (UBX1325) for Diabetic Macular Edema - A Potential Novel Therapy?","authors":"Emily Y Chew","doi":"10.1056/EVIDe2500004","DOIUrl":"https://doi.org/10.1056/EVIDe2500004","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 5","pages":"EVIDe2500004"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999870","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":"Larsucosterol for the Treatment of Alcohol-Associated Hepatitis.","authors":"","doi":"10.1056/EVIDcx2500084","DOIUrl":"10.1056/EVIDcx2500084","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDcx2500084"},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805058","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":"Cervical Radiculopathy and the Role of Surgery - \"First, Do No Harm\".","authors":"Jerome Paquet","doi":"10.1056/EVIDe2500008","DOIUrl":"https://doi.org/10.1056/EVIDe2500008","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 4","pages":"EVIDe2500008"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702271","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":"Associations between Class I, II, or III Obesity and Health Outcomes.","authors":"Zhiqi Yao, Beverly G Tchang, Michael Albert, Roger S Blumenthal, Khurram Nasir, Michael J Blaha","doi":"10.1056/EVIDoa2400229","DOIUrl":"10.1056/EVIDoa2400229","url":null,"abstract":"<p><strong>Background: </strong>The burden of obesity-related health conditions remains incompletely explored. Previous studies have been underpowered to study severe obesity, focused on a limited set of health outcomes, and lacked diversity in study populations.</p><p><strong>Methods: </strong>We studied 270,657 participants from the All of Us research program with linked electronic health records and body mass index (the weight in kilograms divided by the square of the height in meters) greater than or equal to 18.5. We investigated the prevalence and incidence of 16 a priori-identified outcomes covering cardiovascular-kidney-metabolic syndrome and others: hypertension, type 2 diabetes mellitus, hyperlipidemia/dyslipidemia, heart failure, atrial fibrillation, atherosclerotic cardiovascular disease, chronic kidney disease, pulmonary embolism, deep vein thrombosis, gout, metabolic dysfunction-associated steatotic liver disease, biliary calculus, obstructive sleep apnea, asthma, gastroesophageal reflux disease, and osteoarthritis. Adjusted hazard ratios were calculated for each BMI category and compared with normal weight. The population-attributable fraction was calculated for different obesity classifications.</p><p><strong>Results: </strong>The included population was 62.0% women and 22.0% Black. Class I, II, and III obesity was observed in 21.2%, 11.3%, and 9.8% of participants, respectively. Obesity was strongly associated with all incident outcomes, with graded associations across higher classes of obesity. Class III obesity was most strongly associated with obstructive sleep apnea, type 2 diabetes mellitus, and metabolic dysfunction-associated steatotic liver disease (hazard ratio [95% confidence interval {CI}], 10.94 [9.97 to 12.00], 7.74 [7.03 to 8.53], and 6.72 [6.01 to 7.50], respectively), with weaker associations for asthma, osteoarthritis, and atherosclerotic cardiovascular disease (hazard ratio [95% CI], 2.14 [1.95 to 2.35], 2.06 [1.94 to 2.19], and 1.96 [1.70 to 2.25], respectively). Associations were consistent across sex and race. The obesity-related population-attributed fraction ranged from 14.0% (osteoarthritis) to 51.5% (obstructive sleep apnea) in this population.</p><p><strong>Conclusions: </strong>Obesity, particularly severe obesity, was strongly associated with the incidence of 16 common health outcomes.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 4","pages":"EVIDoa2400229"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702287","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":"Forty Percent and Rising - Why Every Specialist Must Care about Obesity.","authors":"Christopher N Schmickl, Janna Raphelson, Atul Malhotra","doi":"10.1056/EVIDe2500054","DOIUrl":"10.1056/EVIDe2500054","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 4","pages":"EVIDe2500054"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Interim Analyses Work.","authors":"Christos Kotanidis, Sarah Gorey, Daniel Müller, Kim Knoper, Adam Straus, Alison Burke, Sharon-Lise Normand, C Corey Hardin, Chana A Sacks","doi":"10.1056/EVIDstat2500047","DOIUrl":"https://doi.org/10.1056/EVIDstat2500047","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 4","pages":"EVIDstat2500047"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702295","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":"Preventing Surgical Site Infections with Air Purification - Lessons from the EPOS Trial.","authors":"James Masters, Andrew Hotchen","doi":"10.1056/EVIDe2500006","DOIUrl":"https://doi.org/10.1056/EVIDe2500006","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 4","pages":"EVIDe2500006"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702359","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":"A Randomized Trial of an App-Based Therapeutic for Lower Urinary Tract Symptoms.","authors":"Christian Gratzke, Sandra Schönburg, Sven Eger, Katharina Raude, Markus Grabbert, Sophie Astheimer, Jan Halbich, Dirko Hercher, Waseem Mousa, Ralph Raschke, Bastian Keck, Oleg Krivov, Erik Krieger, Kurt Miller, Laura Wiemer","doi":"10.1056/EVIDoa2400290","DOIUrl":"10.1056/EVIDoa2400290","url":null,"abstract":"<p><strong>Background: </strong>Male lower urinary tract symptoms (LUTS) increase with age and negatively impact quality of life. Conservative treatment with physiotherapeutic approaches and changes in lifestyle are often neglected. App-based therapeutics may have some benefits for patients with LUTS.</p><p><strong>Methods: </strong>In this prospective, two-center, single-blinded trial, men with LUTS were randomly assigned 1:1 to either an intervention group with access to an app-based therapeutic in addition to their usual medical care or a control group receiving only their usual medical care. The primary end point was symptom improvement (change from baseline to week 12) as measured by the International Prostate Symptom Score (IPSS; range 0 to 35, with higher scores indicating more severe symptoms; minimal clinically important difference of 3). Secondary end points included symptom improvement, as measured by the Overactive Bladder Questionnaire - Short Form part 1 (OAB-q-SF symptom bother, six items; range 6 to 36, transformed to a scale from 0 to 100, with higher scores indicating more severe symptoms), and health-related quality of life (HRQOL), as measured with the OAB-q-SF part 2 (13 items; range 13 to 78, transformed to a scale from 0 to 100 with higher scores indicating better HRQOL).</p><p><strong>Results: </strong>A total of 237 patients were randomly assigned, with seven participants subsequently dropping out. The mean age (± standard deviation [SD]) was 58.4 (12.3) years; 46.4% had benign prostatic enlargement alone, 22.4% had benign prostatic enlargement combined with overactive bladder, and 31.2% had overactive bladder alone. Compared with the control group, the intervention group showed significantly greater improvement in the primary end point (least- squares mean [LSM], -7.0 points; 95% confidence interval [CI], -8.1 to -5.9; P<0.001) and the secondary end points OAB-q-SF part 1 (symptom bother, LSM -18.; 95% CI, -22.2 to -15.0; P<0.001) and part 2 (health-related quality of life, LSM +17.2; 95% CI, 14.2 to 20.2; P<0.001). A total of 12 patients (10.7%) had at least one adverse event in the intervention group compared with five patients (4.0%) in the control group. There were five patients (4.5%) with serious adverse events (SAEs) in the intervention group and one patient (0.8%) with SAEs in the control group.</p><p><strong>Conclusions: </strong>This randomized trial demonstrated significant symptom improvement measured by the IPSS for patients with LUTS using app-based therapeutics compared with usual care. Additional symptom scores and quality of life also significantly improved in patients with LUTS with the use of app-based therapeutics. (Funded by Kranus Health GmbH; German Clinical Trials Registry number, DRKS00030935.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 4","pages":"EVIDoa2400290"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702281","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}