NEJM evidence最新文献

{"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":"Wrist Splinting versus a Placebo Soft Bandage for Carpal Tunnel Syndrome.","authors":"Isam Atroshi, Jesper Nordenskjöld, Kamelia Möllestam","doi":"10.1056/EVIDoa2500261","DOIUrl":"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":11.6,"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":"A 9-Year-Old Girl with Persistent Fevers and Lethargy.","authors":"Aoun Zaib Khan, Farva Zaib Khan, Ahmed Sajid, Zainab Zaib Khan, Kaitlin J Murphy, Monty Mazer","doi":"10.1056/EVIDmr2400406","DOIUrl":"10.1056/EVIDmr2400406","url":null,"abstract":"<p><p>AbstractMorning Report is a time-honored tradition where physicians-in-training present cases to their colleagues and clinical experts to collaboratively examine an interesting patient presentation. The Morning Report section seeks to carry on this tradition by presenting a patient's chief concern and story, inviting the reader to develop a differential diagnosis and discover the diagnosis alongside the authors of the case. This report examines the case of a 9-year-old girl who presented to the emergency department with prolonged fevers and malaise. Using questions, physical examination, and testing, an illness script for the presentation emerges. As the clinical course progresses, the differential is refined until a diagnosis is made.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 4","pages":"EVIDmr2400406"},"PeriodicalIF":11.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505661","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}

{"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":"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":11.6,"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":"Multistate Infant Botulism Outbreak Associated with Powdered Infant Formula.","authors":"Connie H Chung, Jason R Barash, Jacquelin L Castonguay, Claire Penzel-McNamara, Katie Lee, Jennifer S Read, Kerry A Padgett, Nir Dover, Aaron J Judson, Liz Lamere, Ethel V Taylor, Jennifer R Cope, Amanda Conrad, Rochelle Medford, Myra Brooks, Laura Whitlock, Janet Dykes, Carolina Lúquez, Julia M Bracken, Steven M Grube, Jessica M Khouri","doi":"10.1056/EVIDpha2600020","DOIUrl":"10.1056/EVIDpha2600020","url":null,"abstract":"<p><p>AbstractThis report details the identification of an outbreak of infant botulism linked to powdered infant formula in the United States. In October 2025, the Infant Botulism Treatment and Prevention Program, California Department of Public Health (IBTPP-CDPH) noted common powdered infant formula exposure among three neonates with suspected infant botulism. Subsequent laboratory analyses at CDPH identified <i>Clostridium botulinum</i> type A from an open container of ByHeart powdered infant formula associated with one infant with infant botulism. As of December 10, 2025, 51 suspected or confirmed infant botulism cases with exposure to ByHeart powdered infant formula had been identified across 19 states. All ByHeart powdered infant formula has been recalled nationwide.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDpha2600020"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286474","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":"Antibodies Elicited by the 2025-2026 Influenza Vaccine.","authors":"Jiaojiao Liu, Shuk Hang Li, Naiqing Ye, Tachianna Griffiths, Elizabeth M Drapeau, Reilly K Atkinson, Ronald G Collman, Scott E Hensley","doi":"10.1056/EVIDpha2600007","DOIUrl":"10.1056/EVIDpha2600007","url":null,"abstract":"<p><p>AbstractA new H3N2 variant (named subclade K) possesses several key hemagglutinin substitutions and is circulating widely during the 2025-2026 influenza season. We sought to determine whether the 2025-2026 seasonal influenza vaccine elicits antibodies in humans that recognize this variant. We found that H3N2 subclade K viruses are antigenically advanced; however, the 2025-2026 seasonal influenza vaccine elicited antibodies in many individuals that efficiently recognized these viruses. Thus, the current seasonal influenza vaccine likely will be partially effective at preventing illness associated with H3N2 subclade K virus infections.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDpha2600007"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349917","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":"To Preserve or Not to Preserve the Infrapatellar Fat Pad in Knee Arthroplasty Surgery.","authors":"L Stefan Lohmander, Gunnar Flivik","doi":"10.1056/EVIDe2600019","DOIUrl":"https://doi.org/10.1056/EVIDe2600019","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 4","pages":"EVIDe2600019"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505796","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":"Use of Deferred Consent in Randomized Clinical Trials.","authors":"Jessie Van Leeve, Michael Colacci","doi":"10.1056/EVIDctw2400266","DOIUrl":"10.1056/EVIDctw2400266","url":null,"abstract":"<p><p>AbstractGood clinical practice standards mandate that informed consent be obtained before enrollment for all trials that present more than minimal risk to participants. Deferred consent, the process of enrolling patients in a clinical trial before consent is obtained, is sometimes employed in emergency care settings when patients are unable to consent at the time of trial enrollment, are critically ill, and a delay in enrollment would preclude them from potentially benefiting from the trial treatment. This article reviews the risks and benefits associated with the use of deferred consent in randomized controlled trials and the ethical acceptability of its use within specific clinical trial contexts.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 4","pages":"EVIDctw2400266"},"PeriodicalIF":11.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505820","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":"West Nile Virus-Neutralizing Plasma for West Nile Virus Disease.","authors":"Gili Regev-Yochay, Noam Barda, Yonatan Shusterman, Erez Magiel, Ithamar Ganmore, Nadav Baharav, Ana Belkin, Ili Margalit, Victoria Indenbaum, Yaniv Lustig, Yael Weiss-Ottolenghi, Gili Joseph, Enosh Tomer, Nicola Maggio, Michal Canetti, Hagith Yonath, Eyal Leshem, Itzchak Levy, Yovel Peretz, Sharon Amit, Liron Miller, Mudi Misgav, Natalie Landa, Eilat Shinar, Marina Brod, Anat Wieder-Finesod, Dror Harats, Dafna Yahav","doi":"10.1056/EVIDoa2500169","DOIUrl":"10.1056/EVIDoa2500169","url":null,"abstract":"<p><strong>Background: </strong>In 2024, Israel faced a major West Nile virus (WNV) disease outbreak. We aimed to evaluate the efficacy and safety of WNV-neutralizing plasma for hospitalized patients with WNV disease.</p><p><strong>Methods: </strong>We conducted a randomized, double-blind, placebo-controlled trial. Patients hospitalized with laboratory-confirmed symptomatic WNV disease, 60 years of age or older, or 18 to 59 years of age and immunocompromised, were eligible. Participants were randomly assigned (2:1) to donor-derived WNV-neutralizing plasma or placebo. The primary outcome was a composite of all-cause mortality and any functional deterioration at 30 days, defined as a decrease of more than 5 points from baseline on the Barthel Index (range 0-100; higher scores indicate greater independence) for activities of daily living (i.e., failure to return to pre-illness functional status). Key secondary outcomes included mortality, functional capacity (Barthel Index), and cognitive score (Modified Mini-Mental State Examination; range 0-30; higher scores indicate higher cognitive ability) at 30 and 90 days.</p><p><strong>Results: </strong>Of the 34 participants enrolled, 22 were randomly assigned to the intervention group and 12 to placebo. Median age was 74 (interquartile range, 64-82), 50% were women, and 91% had neuroinvasive disease at enrollment. At 30 days, 11/22 (50%) and 6/12 (50%) patients in the treatment and placebo group, respectively, died or had functional deterioration (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.51-1.79). Two patients (2/22) died in the intervention group, compared with 4 (4/12) in the placebo group (RR, 0.33, 95% CI, 0.09-1.15). The intervention was associated with higher functional capacity (Barthel Index 85 in the intervention group vs. 78 in the placebo group; RR, 1.15; 95% CI, 1.05-1.27), and higher cognitive scores (Mini-Mental score 25 vs. 22; RR, 1.24; 95% CI, 1.04-1.47) at 30 days. One (4.5%) allergic reaction was observed in the intervention group.</p><p><strong>Conclusions: </strong>In this small, randomized trial of predominantly severe neuroinvasive WNV, treatment with WNV-neutralizing plasma did not reduce the composite outcome of death or functional deterioration at 30 days compared to placebo. It was associated with improved cognitive and functional outcomes. Potential differences in mortality warrant further evaluation. (ClinicalTrials.gov number, NCT06590207.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 4","pages":"EVIDoa2500169"},"PeriodicalIF":11.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505765","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}