NEJM evidence最新文献

{"title":"Gram-Positive Bacteria and Their Metabolites as Mediators of Asthma Protection.","authors":"Jehan Alladina","doi":"10.1056/EVIDe2600190","DOIUrl":"https://doi.org/10.1056/EVIDe2600190","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 8","pages":"EVIDe2600190"},"PeriodicalIF":11.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610835","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":"Logistic Regression.","authors":"Julie R Barzilay, Chana A Sacks, Daniel Müller, Stacy Cheavens, Adam Straus, Sharon-Lise Normand, C Corey Hardin","doi":"10.1056/EVIDstat2600146","DOIUrl":"https://doi.org/10.1056/EVIDstat2600146","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 8","pages":"EVIDstat2600146"},"PeriodicalIF":11.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610866","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":"Implementing Evidence-Based Care for Alcohol Use Disorder.","authors":"Scott E Hadland, Brittany B Dennis, Evan Wood","doi":"10.1056/EVIDra2500065","DOIUrl":"https://doi.org/10.1056/EVIDra2500065","url":null,"abstract":"<p><p>AbstractAlcohol use is a major contributor to morbidity and mortality, but most individuals with problematic alcohol use do not receive evidence-based care or accurate information about drinking. Recommendations on safe levels of alcohol consumption are rapidly evolving, with recent research finding health and social harms at levels well below traditional lower-risk drinking guidelines. Screening tools to identify alcohol use are widely available but infrequently used. Alcohol withdrawal management protocols have not kept pace with recent evidence highlighting the safety and benefits of benzodiazepine-sparing approaches. Similarly, despite clear evidence on the efficacy of psychosocial treatments and evidence-based pharmacotherapies (e.g., naltrexone) to treat alcohol use disorders, most individuals do not receive such treatment. Research also shows a lack of benefit and potential harm of routine use of antidepressants and other psychotropic medications commonly prescribed to individuals with alcohol use disorders. There is a critical opportunity for clinicians across specialties and healthcare systems to better identify and address alcohol use.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 8","pages":"EVIDra2500065"},"PeriodicalIF":11.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610907","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":"All-<i>Trans</i> Retinoic Acid plus Eltrombopag for Refractory/Relapsed Immune Thrombocytopenia.","authors":"Haixia Fu, Zhuoyu An, Menglin Li, Yi Liu, Hui Liu, Ru Feng, Zhao Wang, Gaochao Zhang, Jingwen Wang, Lei Yang, Qiusha Huang, Peng Zhao, Mengtong Zang, Chencong Wang, Yun He, Xiaolu Zhu, Huixin Liu, Yu Wang, Lanping Xu, Yuan Kong, Yingjun Chang, Xiangyu Zhao, Yang Wang, Guoshuang Feng, Xiaojun Huang, Xiaohui Zhang","doi":"10.1056/EVIDoa2500333","DOIUrl":"10.1056/EVIDoa2500333","url":null,"abstract":"<p><strong>Background: </strong>Eltrombopag is an effective second-line therapy for immune thrombocytopenia (ITP), but its long-term efficacy is limited. All-<i>trans</i> retinoic acid (ATRA) has immunomodulatory effects targeting ITP pathophysiology. We investigated whether combining ATRA with eltrombopag improves long-term outcomes for glucocorticoid-resistant or relapsed ITP.</p><p><strong>Methods: </strong>We conducted a multicenter, randomized, open-label trial in adults with glucocorticoid-resistant or relapsed ITP (platelets <30×10⁹/l). Patients were randomly assigned 1:1 to ATRA (12 weeks) plus eltrombopag or eltrombopag monotherapy. The primary outcome was an 18-month sustained response (platelet count ≥30×10⁹/l without clinically significant bleeding or rescue therapy).</p><p><strong>Results: </strong>Ninety-six patients were randomly assigned, 48 per group. At 18 months, 60% (29/48) in the ATRA-plus-eltrombopag group achieved a sustained response, versus 35% (17/48) in the monotherapy group (odds ratio: 2.78; 95% confidence interval [CI]: 1.22-6.37; P=0.014). The combination was associated with a higher complete response rate (79% vs. 58%; 95% CI for difference, 2 to 39 percentage points) and longer median response duration (75 vs. 37 weeks; hazard ratio for relapse, 0.45; 95% CI, 0.23-0.86). Adverse events were comparable between groups, with no grade 3-4 events or treatment-related deaths. However, clinically significant bleeding of World Health Organization grades 2 or 3 was 21% in the combination group at baseline compared with 10% in the monotherapy group.</p><p><strong>Conclusions: </strong>In patients with glucocorticoid-resistant or relapsed ITP, a 12-week ATRA course with eltrombopag significantly enhanced the 18-month sustained response rate compared to eltrombopag alone. (Funded by Capital Health Research and Development of Special Fund and others; ClinicalTrials.gov number, NCT05438875.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 8","pages":"EVIDoa2500333"},"PeriodicalIF":11.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610870","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":"Gram-Positive Bacteria and the Inverse Association between Farm Exposure and Childhood Asthma.","authors":"Giulia Pagani, Georg Loss, Sonali Pechlivanis, Martin Depner, Constanze Müller, Jinlong Ru, Christine Strunz-Lehner, Greg Humphrey, Gail Ackermann, Amnon Amir, Alexey Melnik, Neha Garg, Rob Knight, Pieter C Dorrestein, Philippe Schmitt-Kopplin, Li Deng, Michael Schloter, Amandine Divaret-Chauveau, Caroline Roduit, Anne M Karvonen, Jon Genuneit, Erika von Mutius, Markus J Ege","doi":"10.1056/EVIDoa2500271","DOIUrl":"10.1056/EVIDoa2500271","url":null,"abstract":"<p><strong>Background: </strong>The inverse association of farm exposure with asthma and atopic conditions has been attributed to the diversity of environmental bacteria and fungi, but the specific taxa and the underlying mechanisms remain elusive.</p><p><strong>Methods: </strong>We performed sequencing of the bacterial 16S ribosomal ribonucleic acid (16S rRNA) gene in mattress dust samples from 1018 schoolchildren from two German populations of the cross-sectional GABRIELA (Multidisciplinary Study to Identify the Genetic and Environmental Causes of Asthma in the European Community [GABRIEL] Advanced Study) survey. Bacterial metabolic pathways and enzymes were assessed bioinformatically, and metabolites were measured by using mass spectrometry. Statistical methods included network, interaction, and mediation analyses.</p><p><strong>Results: </strong>Within the highly diverse microbial exposure in a farm environment, the study identified nine gram-positive environmental bacterial genera, whose composite score explained two thirds of the inverse association of farm exposure and asthma in a mediation analysis. The effect was independent of gram-negative farm-associated bacteria. A PICRUSt2 (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States) analysis revealed nine pathways, whose enzymes were encoded by the identified genera and whose metabolites were detected in cowshed dust by using mass spectrometry. The metabolites included ligands of the human aryl hydrocarbon receptor (kynurenine and xanthine) and the peroxisome proliferator-activated receptor-γ (α-linoleic and stearidonic acid). Single nucleotide polymorphisms of the corresponding human receptor genes interacted with the composite score of the bacterial genera for asthma. Fungi and bacteriophages co-occurred with the beneficial bacteria but did not carry the protective effect. All results were replicated in independent populations.</p><p><strong>Conclusions: </strong>In this analysis, the inverse association of childhood asthma and farm exposure was largely mediated by exposure to gram-positive bacterial genera. Gene-environment interactions of a compound score of these bacteria with human receptors recognizing bacterial metabolites suggest novel approaches to asthma prevention.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 8","pages":"EVIDoa2500271"},"PeriodicalIF":11.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610817","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":"Public Health Response to Clade Ib Mpox with Multiple Exposures in Congregate Living Settings - New Hampshire, February 2025.","authors":"Benjamin P Chan, Alexandra Tuttle, Katrina E Hansen, Krystle Mallory, Hannah W Bowen, Melissa D Mullen, Faisal S Minhaj, Shama Cash-Goldwasser, Rachel Schubert Kusch, Rebecca Lovell, Megan S Heddy, Fengxiang Gao, Stephanie Locke, Colleen Smith, Satish K Pillai, Elizabeth A Talbot","doi":"10.1056/EVIDpha2600127","DOIUrl":"10.1056/EVIDpha2600127","url":null,"abstract":"<p><p>AbstractData on clade Ib mpox virus transmission risk and response effectiveness in congregate settings in the United States are limited. This report describes the public health response to a travel-associated case of mpox (formerly known as monkeypox) in New Hampshire with exposures in congregate living, health care, and household settings.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDpha2600127"},"PeriodicalIF":11.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341215","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 \"Minimally Invasive versus Open Pancreatoduodenectomy for Resectable Neoplasms\".","authors":"","doi":"10.1056/EVIDex2500356","DOIUrl":"https://doi.org/10.1056/EVIDex2500356","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 8","pages":"EVIDex2500356"},"PeriodicalIF":11.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610824","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":"U.S. Drug Overdose Deaths that Occurred in Isolation, 2022-2024.","authors":"Zerleen S Quader, Lauren J Tanz, R Matthew Gladden, Kya Grooms, Alice Asher","doi":"10.1056/EVIDpha2600113","DOIUrl":"10.1056/EVIDpha2600113","url":null,"abstract":"<p><p>AbstractTimeliness of drug overdose response efforts may be improved when bystanders are present to provide life-saving care. From January 2022 through December 2024, a total of 191,577 unintentional or undetermined intent overdose deaths occurred in 46 U.S. states and Washington, DC. Of these, 75.5% occurred in isolation (i.e., with no evidence of a bystander present or with a bystander spatially separated from the decedent), and 55.0% occurred in isolation in a house or apartment setting. Emerging technological approaches, in addition to improvements in overdose education and distribution of opioid overdose reversal medications, may help address the challenge of preventing death among individuals who use drugs in isolation, particularly in the home.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDpha2600113"},"PeriodicalIF":11.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563924","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":"Treatment of Recurrent <i>C. difficile</i> Infection - Making the Best Use of What We Have.","authors":"Thomas J Louie","doi":"10.1056/EVIDe2600198","DOIUrl":"https://doi.org/10.1056/EVIDe2600198","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 8","pages":"EVIDe2600198"},"PeriodicalIF":11.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610961","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 Interval Likelihood Ratios for Clinical Decision-Making.","authors":"Maksym Goryachok, Jintong Liu, Tyler Benjamin, Brett G Fischer, Andrew R Lai, Kathryn L Levy, Adane F Wogu, Arthur T Evans, Amiran Baduashvili","doi":"10.1056/EVIDoa2500249","DOIUrl":"10.1056/EVIDoa2500249","url":null,"abstract":"<p><strong>Background: </strong>Dichotomized reporting of diagnostic test results may oversimplify test characteristics. Interval likelihood ratios (ILRs), test characteristics across a range of values, offer a nuanced alternative, but their impact on decision-making is uncertain. We assessed whether ILRs improve clinical decisions compared to two traditional formats: single-threshold and binary test characteristics.</p><p><strong>Methods: </strong>We conducted a multicenter randomized trial of internal medicine residents, attending physicians, and advanced practice providers. Participants were presented with two fictional vignettes (cases involving pulmonary embolism diagnosis and heart failure treatment), each with a clearly correct response centered on a key diagnostic test result. The vignettes were identical except for participants' random assignment to one of three test characteristic presentations: (1) single threshold, (2) binary test characteristics, or (3) ILRs. We compared the correct management decision rates between the ILR and threshold groups and between the ILR and binary groups. Secondary objectives included comparing threshold and binary groups and subgroup analyses by case vignette.</p><p><strong>Results: </strong>The trial enrolled 611 participants. The correct decision rate was 93.4% in the ILR group compared with 82.2% in the threshold group (difference of 11.2 percentage points; 95% confidence interval [CI], 6.9-15.6, P<0.001) and compared with 75.1% in the binary group (difference of 18.3 percentage points; 95% CI, 13.5-23.1, P<0.001). In the pulmonary embolism case, the correct response rate was 91.9% in the ILR group, 70.9% in the threshold group, and 64.7% in the binary group. In the heart failure case, the correct response rate was 94.9% in the ILR group, 93.4% in the threshold group, and 85.6% in the binary group.</p><p><strong>Conclusions: </strong>Presenting diagnostic test information using ILRs improved vignette-based clinical decisions. The magnitude of improvement appeared to vary by case vignette.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 7","pages":"EVIDoa2500249"},"PeriodicalIF":11.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304119","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}