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181. Intravenous Rehydration for Severe Acute Malnutrition with Gastroenteritis.
作者: Kathryn Maitland.;San Maurice Ouattara.;Hadiza Sainna.;Abdullahi Chara.;Oluwakemi F Ogundipe.;Temmy Sunyoto.;M Hamaluba.;Peter Olupot-Olupot.;Florence Alaroker.;Roisin Connon.;Amadou Saidou Maguina.;William Okiror.;Denis Amorut.;Eric Mwajombo.;Emmanuel Oguda.;Christabel Mogaka.;Céline Langendorf.;Juan Emmanuel Dewez.;Iza Ciglenecki.;Diana M Gibb.;Matthew E Coldiron.;Roberta Petrucci.;Elizabeth C George.; .
来源: N Engl J Med. 2025年393卷13期1257-1268页
International recommendations advise against the use of intravenous rehydration therapy in children with severe acute malnutrition because of the concern about fluid overload, but evidence to support this concern is lacking. Given the high mortality associated with the current recommendations, the adoption of intravenous rehydration strategies might improve outcomes.
182. Proportional-Assist Ventilation for Minimizing the Duration of Mechanical Ventilation.
作者: Karen J Bosma.;Karen E A Burns.;Claudio M Martin.;Yoanna Skrobik.;Jordi Mancebo Cortés.;Sorcha Mulligan.;Myriam Lafreniere-Roula.;Kevin E Thorpe.;Juan Carlos Suárez Montero.;Indalecio Morán Chorro.;Núria Rodríguez-Farré.;Ron Butler.;Tracey Bentall.;Gaëtan Beduneau.;Pauline Enguerrand.;Marlene Santos.;Thomas Piraino.;Savino Spadaro.;Federica Montanaro.;John Basmaji.;Eileen Campbell.;Alain Mercat.;François M Beloncle.;Guillaume Carteaux.;Tommaso Maraffi.;Emmanuel Charbonney.;Marie Lecronier.;Martin Dres.;Yaseen M Arabi.;Andre Carlos Kb Amaral.;Nicole Marinoff.;Neill K J Adhikari.;Anna Geagea.;Phil Shin.;Katerina Vaporidi.;Eumorfia Kondili.;Jason Shahin.;Josie Campisi.;Pablo O Rodriguez.;Mariano Setten.;Ewan C Goligher.;Niall D Ferguson.;Vito Fanelli.;Gabriela Ferreyra.;Francois Lellouche.;Stephanie Sibley.;Laurent Brochard.; .
来源: N Engl J Med. 2025年393卷11期1088-1103页
In critically ill patients, acceleration of liberation from mechanical ventilation is important in order to reduce the risk of complications and to improve long-term outcomes. Whether the use of proportional-assist ventilation with load-adjustable gain factors (PAV+) results in a shorter time to successful liberation from mechanical ventilation than pressure-support ventilation (PSV) is unclear.
183. A Crossover Trial of Hospital-Wide Lactated Ringer's Solution versus Normal Saline.
作者: Lauralyn McIntyre.;Dean Fergusson.;Tracy McArdle.;Shane English.;Deborah J Cook.;Alison E Fox-Robichaud.;Claudio Martin.;John Marshall.;Michael Pugliese.;Kusum Menon.;Kednapa Thavorn.;Ian D Graham.;Steven Hawken.;Akshai Iyengar.;Kwadwo Kyeremanteng.;Raphael Saginur.;Andrew J E Seely.;Ian G Stiell.;Daniel Bainbridge.;Charles Weijer.;Monica Taljaard.; .
来源: N Engl J Med. 2025年393卷7期660-670页
Whether lactated Ringer's solution is clinically superior to normal saline for routine intravenous administration of fluids is uncertain.
184. A Randomized Trial of Acute Normovolemic Hemodilution in Cardiac Surgery.
作者: Fabrizio Monaco.;Chong Lei.;Matteo Aldo Bonizzoni.;Sergey Efremov.;Federica Morselli.;Fabio Guarracino.;Giuseppe Giardina.;Cristina Arangino.;Domenico Pontillo.;Michelangelo Vitiello.;Alessandro Belletti.;Valentina Ajello.;Margherita Licheri.;Caetano Nigro Neto.;Gaia Barucco.;Nazar A Bukamal.;Carolina Faustini.;Lorenzo Filippo Mantovani.;Alessandro Oriani.;Cristina Santonocito.;Marta Mucchetti.;Francesco Federici.;Chiara Gerli.;Sabrina Porta.;Anna Mara Scandroglio.;Hui Zhang.;Marina Pieri.;Roman Osinsky.;Stefano Lazzari.;Elizaveta Leonova.;Maria Grazia Calabrò.;Daniele Amitrano.;Stefano Turi.;Paolo Prati.;Stefano Fresilli.;Filippo D'Amico.;Jacopo D'Andria Ursoleo.;Rosa Labanca.;Marilena Marmiere.;Alessandro Pruna.;Tommaso Scquizzato.;Kaan Kırali.;Giacomo Monti.;Maria José Carvalho Carmona.;Kenichi Tanaka.;Valery Likhvantsev.;Lian Kah Ti.;Tiziana Bove.;Gianluca Paternoster.;Karen Singh.;Mustafa Emre Gürcü.;Vladimir Lomivorotov.;Giovanni Landoni.;Rinaldo Bellomo.;Alberto Zangrillo.; .
来源: N Engl J Med. 2025年393卷5期450-460页
Patients undergoing cardiac surgery often receive red-cell transfusions, along with the associated risks and costs. Early intraoperative normovolemic hemodilution (i.e., acute normovolemic hemodilution [ANH]) is a blood-conservation technique that entails autologous blood collection before initiation of cardiopulmonary bypass and reinfusion of the collected blood after bypass weaning. More data are needed on whether ANH reduces the number of patients receiving allogeneic red-cell transfusion.
185. Sustained Clinical Benefit of AAV Gene Therapy in Severe Hemophilia B.
作者: Ulrike M Reiss.;Andrew M Davidoff.;Edward G D Tuddenham.;Pratima Chowdary.;Jenny McIntosh.;Vincent Muczynski.;Malo Journou.;Giulia Simini.;Lydia Ireland.;Saira Mohamed.;Anne Riddell.;Arnulfo J Pie.;Andrew Hall.;Alberto Quaglia.;Sarah Mangles.;Johnny Mahlangu.;Kristina Haley.;Michael Recht.;Yu-Min Shen.;Kathleen G Halka.;Gail Fortner.;Christopher L Morton.;Zhengming Gu.;Randall T Hayden.;Ellis J Neufeld.;Victoria I Okhomina.;Guolian Kang.;Amit C Nathwani.
来源: N Engl J Med. 2025年392卷22期2226-2234页
Adeno-associated virus (AAV)-mediated gene therapy has emerged as a promising treatment for hemophilia B. Data on safety and durability from 13 years of follow-up in a cohort of patients who had been successfully treated with scAAV2/8-LP1-hFIXco gene therapy are now available.
186. Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes.
作者: Rajiv Agarwal.;Jennifer B Green.;Hiddo J L Heerspink.;Johannes F E Mann.;Janet B McGill.;Amy K Mottl.;Julio Rosenstock.;Peter Rossing.;Muthiah Vaduganathan.;Meike Brinker.;Robert Edfors.;Na Li.;Markus F Scheerer.;Charlie Scott.;Masaomi Nangaku.; .
来源: N Engl J Med. 2025年393卷6期533-543页
Limited evidence exists to support the simultaneous initiation of sodium-glucose cotransporter-2 inhibitors and finerenone, a nonsteroidal mineralocorticoid receptor antagonist, in persons with chronic kidney disease and type 2 diabetes.
187. A Trial of Trimethoprim-Sulfamethoxazole in Pregnancy to Improve Birth Outcomes.
作者: Bernard Chasekwa.;Fortunate Munhanzi.;Lenin Madhuyu.;Gabriel Mbewe.;Vincent Mabika.;Dzivaidzo Chidhanguro.;Tendai Kofi.;Jonthan Munengiwa.;Hilda Mapfumo.;Mercy Musapa.;Sipho Shumba.;Elizabeth Hungwe.;Mary Nhokwara.;Nester Bushe.;Rudo Kufa.;Phatisiwe Mazula.;Muchaneta Chikombingo.;Alice Tengende.;Admire Zanga.;Asaph Ziruma.;Tsitsi Bere.;Success Munyengwa.;Charity Mudimbu.;Zvikomborero Murwira.;Shepherd Mudzingwa.;Eddington Mpofu.;Batsirai Mutasa.;Virginia Sauramba.;Elisha Masakadze.;Thompson Runodamoto.;Courage Chiorera.;Alfred Mushininga.;Claire D Bourke.;Ruairi C Robertson.;Jeniffer Perussolo.;Nikos Donos.;Chandiwana Nyachowe.;Mary Muchekeza.;Jefrey Chikunya.;Melanie Smuk.;Kuda Mutasa.;Naume V Tavengwa.;Lisa L Langhaug.;Robert Ntozini.;Stephen P Munjanja.;Andrew J Prendergast.
来源: N Engl J Med. 2025年392卷21期2125-2134页
Maternal infections underlie several adverse birth outcomes. Whether trimethoprim-sulfamethoxazole prophylaxis during pregnancy will improve birth outcomes is unknown.
188. Omitting Regional Nodal Irradiation after Response to Neoadjuvant Chemotherapy.
作者: Eleftherios P Mamounas.;Hanna Bandos.;Julia R White.;Thomas B Julian.;Atif J Khan.;Simona F Shaitelman.;Mylin A Torres.;Frank A Vicini.;Patricia A Ganz.;Susan A McCloskey.;Peter C Lucas.;Nilendu Gupta.;X Allen Li.;Beryl McCormick.;Benjamin Smith.;Rahul D Tendulkar.;Vivek S Kavadi.;Koji Matsumoto.;Samantha Andrews Seaward.;William J Irvin.;Jolinta Y Lin.;Robert W Mutter.;Thierry M Muanza.;Jannifer Stromberg.;Reshma Jagsi.;Anna C Weiss.;Walter J Curran.;Norman Wolmark.
来源: N Engl J Med. 2025年392卷21期2113-2124页
The benefit of regional nodal irradiation in the treatment of breast cancer is well established for patients with pathologically positive axillary nodes, but whether it is also beneficial for patients whose nodes become pathologically tumor free (ypN0) after neoadjuvant chemotherapy remains unclear.
189. Corynebacterium diphtheriae Outbreak in Migrant Populations in Europe.
作者: Andreas Hoefer.;Helena Seth-Smith.;Federica Palma.;Stefanie Schindler.;Luca Freschi.;Alexandra Dangel.;Anja Berger.;Joshua D'Aeth.;Rebecca Cordery.;Enrique Delgado-Rodriguez.;Eva Gruner.;Domenica Flury.;Vladimira Hinic.;Julian Kofler.;Reto Lienhard.;Rob Mariman.;Oliver Nolte.;Adrian Schibli.;Julie Toubiana.;Marianna Traugott.;Stephanie Jacquinet.;Alexander Indra.;Norman K Fry.;Daniel Palm.;Andreas Sing.;Sylvain Brisse.;Adrian Egli.; .
来源: N Engl J Med. 2025年392卷23期2334-2345页
A surge of cases of Corynebacterium diphtheriae infection was observed in reception centers for migrants in Europe beginning in the summer of 2022. Most of the cases were cutaneous, although some respiratory cases as well as one death were reported. A pan-European consortium was created to assess the clinical, epidemiologic, and microbiologic features of this outbreak.
190. Measurable Residual Disease-Guided Therapy in Newly Diagnosed Myeloma.
作者: Aurore Perrot.;Jérôme Lambert.;Cyrille Hulin.;Andrea Pieragostini.;Lionel Karlin.;Bertrand Arnulf.;Philippe Rey.;Laurent Garderet.;Margaret Macro.;Martine Escoffre-Barbe.;Julie Gay.;Thomas Chalopin.;Romain Gounot.;Jean-Marc Schiano.;Mohamad Mohty.;Xavier Leleu.;Salomon Manier.;Clara Mariette.;Carine Chaleteix.;Thorsten Braun.;Bernard De Prijck.;Hervé Avet-Loiseau.;Jean-Yves Mary.;Jill Corre.;Philippe Moreau.;Cyrille Touzeau.; .
来源: N Engl J Med. 2025年393卷5期425-437页
Measurable residual disease (MRD) is a major prognostic factor in newly diagnosed multiple myeloma. An assessment of an MRD-guided consolidation strategy in patients who are eligible for autologous stem-cell transplantation (ASCT) may be useful.
191. Tarlatamab in Small-Cell Lung Cancer after Platinum-Based Chemotherapy.
作者: Giannis Mountzios.;Longhua Sun.;Byoung Chul Cho.;Umut Demirci.;Sofia Baka.;Mahmut Gümüş.;Antonio Lugini.;Bo Zhu.;Yan Yu.;Ippokratis Korantzis.;Ji-Youn Han.;Tudor-Eliade Ciuleanu.;Myung-Ju Ahn.;Pedro Rocha.;Julien Mazières.;Sally C M Lau.;Martin Schuler.;Fiona Blackhall.;Tatsuya Yoshida.;Taofeek K Owonikoko.;Luis Paz-Ares.;Tony Jiang.;Ali Hamidi.;Diana Gauto.;Gonzalo Recondo.;Charles M Rudin.; .
来源: N Engl J Med. 2025年393卷4期349-361页
Tarlatamab, a bispecific delta-like ligand 3-directed T-cell engager immunotherapy, received accelerated approval for the treatment of patients with previously treated small-cell lung cancer. Whether tarlatamab is more effective than chemotherapy in the treatment of patients whose small-cell lung cancer has progressed during or after initial platinum-based chemotherapy is not known.
192. Vepdegestrant, a PROTAC Estrogen Receptor Degrader, in Advanced Breast Cancer.
作者: Mario Campone.;Michelino De Laurentiis.;Komal Jhaveri.;Xichun Hu.;Sylvain Ladoire.;Anne Patsouris.;Claudio Zamagni.;Jiuwei Cui.;Marina Cazzaniga.;Timucin Cil.;Katarzyna J Jerzak.;Christian Fuentes.;Tetsuhiro Yoshinami.;Alvaro Rodriguez-Lescure.;Ahmet Sezer.;Andrea Fontana.;Valentina Guarneri.;Andrea Molckovsky.;Marie-Ange Mouret-Reynier.;Umut Demirci.;Yongqiang Zhang.;Olga Valota.;Dongrui R Lu.;Marcella Martignoni.;Janaki Parameswaran.;Xin Zhi.;Erika P Hamilton.; .
来源: N Engl J Med. 2025年393卷6期556-568页
Vepdegestrant is an oral proteolysis-targeting chimera (PROTAC) estrogen receptor (ER) degrader that directly harnesses the ubiquitin-proteasome system.
193. Perioperative Durvalumab in Gastric and Gastroesophageal Junction Cancer.
作者: Yelena Y Janjigian.;Salah-Eddin Al-Batran.;Zev A Wainberg.;Kei Muro.;Daniela Molena.;Eric Van Cutsem.;Woo Jin Hyung.;Lucjan Wyrwicz.;Do-Youn Oh.;Takeshi Omori.;Markus Moehler.;Marcelo Garrido.;Sulene C S Oliveira.;Moishe Liberman.;Victor Castro Oliden.;Elizabeth C Smyth.;Alexander Stein.;Mehmet Bilici.;Maria Lorena Alvarenga.;Vadim Kozlov.;Fernando Rivera.;Akihito Kawazoe.;Olivier Serrano.;Eric Heilbron.;Alejandra Negro.;John F Kurland.;Josep Tabernero.; .
来源: N Engl J Med. 2025年393卷3期217-230页
Perioperative FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) is a standard therapy for resectable gastric and gastroesophageal junction adenocarcinomas, but recurrence rates remain high. Immunotherapy plus chemotherapy may improve outcomes.
194. Overall Survival with Neoadjuvant Nivolumab plus Chemotherapy in Lung Cancer.
作者: Patrick M Forde.;Jonathan D Spicer.;Mariano Provencio.;Tetsuya Mitsudomi.;Mark M Awad.;Changli Wang.;Shun Lu.;Enriqueta Felip.;Scott J Swanson.;Julie R Brahmer.;Keith Kerr.;Janis M Taube.;Tudor-Eliade Ciuleanu.;Fumihiro Tanaka.;Gene B Saylors.;Ke-Neng Chen.;Hiroyuki Ito.;Moishe Liberman.;Claudio Martin.;Stephen Broderick.;Lily Wang.;Junliang Cai.;Quyen Duong.;Stephanie Meadows-Shropshire.;Joseph Fiore.;Sumeena Bhatia.;Nicolas Girard.; .
来源: N Engl J Med. 2025年393卷8期741-752页
Neoadjuvant nivolumab plus chemotherapy significantly improved pathological complete response and event-free survival in patients with resectable non-small-cell lung cancer (NSCLC) in a phase 3 trial. Data are needed on overall survival.
195. Overall Survival with Inavolisib in PIK3CA-Mutated Advanced Breast Cancer.
作者: Komal L Jhaveri.;Seock-Ah Im.;Cristina Saura.;Sibylle Loibl.;Kevin Kalinsky.;Peter Schmid.;Sherene Loi.;Eirini Thanopoulou.;Noopur Shankar.;Yanling Jin.;Thomas J Stout.;Tiffany D Clark.;Chunyan Song.;Dejan Juric.;Nicholas C Turner.
来源: N Engl J Med. 2025年393卷2期151-161页
In the phase 3, double-blind, randomized INAVO120 trial, treatment with inavolisib plus palbociclib-fulvestrant led to a significant progression-free survival benefit, as compared with placebo plus palbociclib-fulvestrant, among patients with PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative locally advanced or metastatic breast cancer who had had relapse during or within 12 months after completion of adjuvant endocrine therapy.
196. Adjuvant Cemiplimab or Placebo in High-Risk Cutaneous Squamous-Cell Carcinoma.
作者: Danny Rischin.;Sandro Porceddu.;Fiona Day.;Daniel P Brungs.;Hayden Christie.;James E Jackson.;Brian N Stein.;Yungpo Bernard Su.;Rahul Ladwa.;Gerard Adams.;Samantha E Bowyer.;Zulfiquer Otty.;Naoya Yamazaki.;Paolo Bossi.;Amarnath Challapalli.;Axel Hauschild.;Annette M Lim.;Vishal A Patel.;Joanna L Walker.;Maite De Liz Vassen Schurmann.;Paola Queirolo.;Javier Cañueto.;Flavio Augusto Ferreira da Silva.;Alexander Stratigos.;Alexander Guminski.;Charles Lin.;Fernanda Damian.;Lukas Flatz.;Anne E Taylor.;David R Carr.;Samuel Harris.;Dmitry Kirtbaya.;Gaëlle Quereux.;Piotr Rutkowski.;Nicole Basset-Seguin.;Nikhil I Khushalani.;Caroline Robert.;Haisong Ju.;Camryn Joseph.;Shikha Bansal.;Chieh-I Chen.;Frank Seebach.;Suk-Young Yoo.;Israel Lowy.;Priscila Goncalves.;Matthew G Fury.; .
来源: N Engl J Med. 2025年393卷8期774-785页
Patients who have cutaneous squamous-cell carcinoma with high-risk features are at risk for recurrence after definitive local therapy. The benefit of systemic adjuvant therapy options has not been well established in clinical trials.
197. First-Line Camizestrant for Emerging ESR1-Mutated Advanced Breast Cancer.
作者: François-Clément Bidard.;Erica L Mayer.;Yeon Hee Park.;Wolfgang Janni.;Cynthia Ma.;Massimo Cristofanilli.;Giampaolo Bianchini.;Kevin Kalinsky.;Hiroji Iwata.;Stephen Chia.;Peter A Fasching.;Adam Brufsky.;Zbigniew Nowecki.;Javier Pascual.;Lionel Moreau.;Shin-Cheh Chen.;Nuri Karadurmus.;Einav Nili Gal-Yam.;Kyung Hae Jung.;Sonia Pernas.;Sasha McClain.;Wei He.;Teresa Klinowska.;Cynthia Huang-Bartlett.;Nicholas C Turner.; .
来源: N Engl J Med. 2025年393卷6期569-580页
Mutations in ESR1 are the most common mechanism of acquired resistance to treatment with an aromatase inhibitor plus a cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor for advanced breast cancer. Camizestrant, a next-generation selective estrogen-receptor (ER) degrader and complete ER antagonist, has shown antitumor activity in ER-positive advanced breast cancer.
198. Elinzanetant for Vasomotor Symptoms from Endocrine Therapy for Breast Cancer.
作者: Fatima Cardoso.;Susanne Parke.;Donal J Brennan.;Paula Briggs.;Gilbert Donders.;Nick Panay.;Nazanin Haseli-Mashhadi.;Michael Block.;Cecilia Caetano.;Maja Francuski.;Claudia Haberland.;Kaisa Laapas.;Christian Seitz.;Lineke Zuurman.
来源: N Engl J Med. 2025年393卷8期753-763页
Women receiving endocrine therapy for hormone receptor (HR)-positive breast cancer or its prevention among those at high risk for breast cancer commonly have vasomotor symptoms. Data are lacking on the effects of elinzanetant, a neurokinin-targeted therapy shown to be effective in treating vasomotor symptoms, in this population.
199. Trastuzumab Deruxtecan or Ramucirumab plus Paclitaxel in Gastric Cancer.
作者: Kohei Shitara.;Eric Van Cutsem.;Mahmut Gümüş.;Sara Lonardi.;Christelle de la Fouchardière.;Clélia Coutzac.;Jeroen Dekervel.;Daniel Hochhauser.;Lin Shen.;Wasat Mansoor.;Bo Liu.;Lorenzo Fornaro.;Min-Hee Ryu.;Jeeyun Lee.;Cátia Faustino.;Jean-Philippe Metges.;Josep Tabernero.;Fábio Franke.;Yelena Y Janjigian.;Fabricio Souza.;Lori Jukofsky.;Yumin Zhao.;Takahiro Kamio.;Aziz Zaanan.;Filippo Pietrantonio.; .
来源: N Engl J Med. 2025年393卷4期336-348页
On the basis of phase 2 studies, trastuzumab deruxtecan was approved for patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic gastric cancer or gastroesophageal junction adenocarcinoma who had previously received trastuzumab-based therapy. Ramucirumab plus paclitaxel is also a standard second-line treatment option regardless of HER2 status.
200. Structured Exercise after Adjuvant Chemotherapy for Colon Cancer.
作者: Kerry S Courneya.;Janette L Vardy.;Christopher J O'Callaghan.;Sharlene Gill.;Christine M Friedenreich.;Rebecca K S Wong.;Haryana M Dhillon.;Victoria Coyle.;Neil S Chua.;Derek J Jonker.;Philip J Beale.;Kamal Haider.;Patricia A Tang.;Tony Bonaventura.;Ralph Wong.;Howard J Lim.;Matthew E Burge.;Stacey Hubay.;Michael Sanatani.;Kristin L Campbell.;Fernanda Z Arthuso.;Jane Turner.;Ralph M Meyer.;Michael Brundage.;Patti O'Brien.;Dongsheng Tu.;Christopher M Booth.; .
来源: N Engl J Med. 2025年393卷1期13-25页
Preclinical and observational studies suggest that exercise may improve cancer outcomes. However, definitive level 1 evidence is lacking.
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