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The New England Journal of Medicine is the world’s leading medical journal and website.

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Joined March 2009
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𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 infection is an infectious disease, and treatment regimens should ideally be guided by antimicrobial-susceptibility testing whenever possible. 🔗 nej.md/4Bj3O58 Both phenotypic (culture-based) and molecular methods of antimicrobial-susceptibility testing are available (seen in figure). Culture-based testing remains the reference standard because it is the only method that can ascertain the susceptibility of isolates to all antibiotics commonly used for eradication. Molecular antimicrobial-susceptibility testing offers greater efficiency than culture-based testing by eliminating the need for 𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 culture. Molecular-based testing can be conducted with fresh or formalin-fixed gastric-tissue samples (used for histopathological examination) and successfully cultured isolates. More recently, gastric-fluid samples obtained from a swallowed gastric string have emerged as a cost-effective alternative culture-based testing method. Stool-based molecular antimicrobial-susceptibility testing is now available, which avoids invasive endoscopy. Commercial polymerase-chain-reaction–based kits are now available for identifying 𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 resistance to clarithromycin and levofloxacin by detecting specific mutations in the 𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 23S ribosomal RNA and gyrA genes, respectively. A meta-analysis reported high accuracy of these molecular methods for detecting antibiotic resistance in gastric-biopsy samples, with sensitivity and specificity of 96% and 96%, respectively, for clarithromycin resistance and 97% and 99% for quinolone resistance. Learn more in the Review Article “𝘏𝘦𝘭𝘪𝘤𝘰𝘣𝘢𝘤𝘵𝘦𝘳 𝘱𝘺𝘭𝘰𝘳𝘪 Infection — Advances, Challenges, and the Road Ahead” by Hong Li, MD, PhD, Francis Megraud, MD, and Barry J. Marshall, MD: nej.md/4Bj3O58
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An 81-year-old man with a remote history of rib and lung resection was noted on examination to have a soft protrusion from the chest wall that moved inward during inspiration and outward during expiration (shown in a video). Read the full case details in the Images in Clinical Medicine article “Lung Hernia with a Chest-Wall Bulge”: nej.md/4iGMi2l
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The authors of a new Perspective argue that AI is changing the fundamental nature of surveillance in ways that strain existing privacy law and put public health at risk. Medicine has a responsibility to confront these developments. Read the full Perspective: nej.md/4k39Als
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𝗥𝗲𝘃𝗶𝗲𝘄 𝗔𝗿𝘁𝗶𝗰𝗹𝗲: 𝗣𝗿𝗲𝘃𝗲𝗻𝘁𝗶𝗻𝗴 𝗠𝗮𝗹𝗮𝗿𝗶𝗮 𝗜𝗻𝗳𝗲𝗰𝘁𝗶𝗼𝗻𝘀 𝗮𝗻𝗱 𝗠𝗼𝘃𝗶𝗻𝗴 𝘁𝗼𝘄𝗮𝗿𝗱 𝗠𝗮𝗹𝗮𝗿𝗶𝗮 𝗘𝗹𝗶𝗺𝗶𝗻𝗮𝘁𝗶𝗼𝗻 Malaria continues to be a major health challenge worldwide, causing an estimated 282 million cases of illness and 610,000 deaths in 2024, predominantly among African children. Despite recent stagnation in the progress of malaria prevention, the landscape is undergoing rapid transformation. A new review examines current and emerging approaches to preventing malaria infection and supporting malaria elimination, including vector control, transmission-blocking interventions, chemoprevention, monoclonal antibodies, and vaccines. Next-generation insecticide-treated nets, expanded use of seasonal malaria chemoprevention, and the introduction of RTS,S/AS01 and R21/Matrix-M vaccines are already reshaping control strategies. Looking ahead, long-acting injectable chemoprevention, transmission-blocking medicines and vaccines, and improved surveillance-driven deployment may further accelerate progress. As funding becomes constrained and decision making shifts increasingly to countries where malaria is endemic, effective malaria prevention will depend on locally tailored, integrated combinations of interventions supported by strong surveillance, regulatory capacity, and national leadership. Read more about these approaches in the Review Article “Preventing Malaria Infections and Moving toward Malaria Elimination” by Andre Marie Tchouatieu, MD, Timothy N.C. Wells, ScD, and Jane Achan, MD: nej.md/4sQ0qLg
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A trial of venous thromboembolism (VTE) prophylaxis after hip or knee arthroplasty did not show that aspirin was noninferior to rivaroxaban or warfarin for symptomatic VTE or death. Warfarin and rivaroxaban were not noninferior to aspirin for safety. Full PEPPER trial results: nej.md/4iIxVL0 Editorial: Aspirin Therapy — Enough after Arthroplasty nej.md/3UoXzwn
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Original Article: Plozasiran for Severe Hypertriglyceridemia and Risk of Pancreatitis (phase 3 SHASTA-3 and SHASTA-4 trials) nej.md/4iv82y3 #Gastroenterology #Genetics
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James C. Grotta, MD, reviews issues related to intravenous thrombolysis for stroke, including the choice of agent, dose, and timing and the relation to endovascular thrombectomy. Read the full review: nej.md/4iuL5Lr
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Among participants with IgA nephropathy, povetacicept, a dual inhibitor of B-cell activating factor and a proliferation-inducing ligand, led to a significantly greater reduction in proteinuria than placebo. Full phase 3 RAINIER AIS-D08 trial results and Research Summary: nej.md/3VWcGh6
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Perspective essay by Daniel A. Brenner, MD: When Patients Need an Enemy nej.md/4ixwJKb #MedicalEthics #MedicalPractice
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Images in Clinical Medicine: Disseminated Bartonellosis nej.md/4jRXf3t #InfectiousDisease #Radiology
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Clinical Decisions: Use of an Artificial Intelligence Scribe for Clinical Notes nej.md/47WS6QA #AIinMedicine
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Correspondence: Durability of Gene Therapy in Patients with Crigler–Najjar Syndrome nej.md/4jXF7oN #Gastroenterology #Genetics
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Should patients pay $1,000 for a full-body MRI scan? New @NEJMClinician Editor-in-Chief @PaulSaxMD, weighs the benefits and harms. See what else matters this week at clinician.nejm.org, including: ❤️ Anticoagulation for Patients with Atrial Fibrillation and One Risk Factor 🩺 Improving Management of Resistant Hypertension ☕ Coffee Consumption and the Liver 🥛 Unpasteurized Milk: Still a Raw Deal
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Perspective by Kenneth D. Mandl, MD, MPH, J. Michael McGinnis, MD, MPP, and Monica M. Bertagnolli, MD: The Learning Health System, Made Computable nej.md/4AeK3dW #HealthPolicy #MedEd
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In an extended analysis of the HORIZON Lp(a) trial, pelacarsen was not associated with a reduction in adverse cardiovascular events when evaluated by treatment exposure, baseline lipid levels, or achieved lipoprotein(a) level. Full results: eviden.cc/4eQEutM #AHA26
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A new review discusses the underlying targets for intravenous thrombolysis (IVT) as compared with endovascular thrombectomy, treatment with tenecteplase over alteplase, broadening of existing guidelines, and approaches that could increase the success of IVT. Full review: nej.md/4iuL5Lr
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In patients with severe hypertriglyceridemia, plozasiran, a small interfering RNA that targets APOC3 messenger RNA, reduced triglyceride levels and risk of acute pancreatitis. Full results of the phase 3 SHASTA-3 and SHASTA-4 trials and Research Summary: nej.md/4iv82y3
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Perspective by Irene Papanicolas, PhD, and Jose F. Figueroa, MD, MPH: Private Health Insurance and Profit — Lessons for the United States nej.md/4Ag6hMK #HealthPolicy #MedicalEthics
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IgA nephropathy is associated with a progressive decrease in the eGFR, which leads to a substantial lifetime risk of kidney failure despite supportive therapies. Research findings from the RAINIER AIS-D08 trial are summarized in a new Quick Take video. nej.md/4iEIOh3
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Our latest video in partnership with @DGlaucomflecken explains a trial that evaluated the effectiveness of transcatheter tricuspid-valve repair for heart failure among patients with severe tricuspid regurgitation. Full trial results: nej.md/DrG52
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Images in Clinical Medicine: Hereditary Hemorrhagic Telangiectasia nej.md/4iysIp3 #Hematology #Gastroenterology
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