NEJM Group

Dr. Asaf Bitton, a primary care physician at Brigham and Women's Hospital and an associate professor at Harvard Medical School, talks about valuing the critical role of primary care docs.    Hear more from Dr. Britton in “Alive and Kicking,” the first episode of Not Otherwise Specified season 3, hosted by NEJM National Correspondent Dr. Lisa Rosenbaum: https://nej.md/3W416gK    Listen to past episodes and subscribe to the podcast: https://nej.md/NOS    #ClinicalMedicine #PrimaryCare 

In early-stage cervical cancer, could sentinel-lymph-node biopsy alone be noninferior to lymphadenectomy with respect to disease-free survival and reduced surgical complications? 👉 https://nej.md/4oaZled     Sentinel-lymph-node biopsy is less invasive than lymphadenectomy in early-stage cervical cancer, but evidence on whether it is associated with similar survival outcomes has been limited.    In the PHENIX phase 3 trial, patients with stage IA1 (with lymphovascular invasion), IA2, IB1, or IIA1 cervical cancer underwent sentinel-node mapping. Patients with negative sentinel lymph nodes were randomly assigned intraoperatively to undergo biopsy only or full pelvic lymphadenectomy. All patients underwent hysterectomy and received adjuvant therapy per protocol.     The primary end point was 3-year disease-free survival, assessed in a noninferiority analysis (noninferiority margin, 5 percentage points). Retroperitoneal nodal recurrence and cancer-specific survival were key secondary end points.    In patients with early-stage cervical cancer and negative sentinel nodes, sentinel-node biopsy alone was noninferior to pelvic lymphadenectomy for disease-free survival at 3 years and was associated with fewer complications.    Read the full PHENIX trial results and Research Summary: https://nej.md/4oaZled     #Oncology #ClinicalTrials  

Female-pattern hair loss increases with age and varies according to age at onset and hormone status. Treatments include minoxidil, antiandrogens, and nondrug options such as platelet-rich plasma or light or laser therapy. 👉 https://nej.md/4ojMkOX    Female-pattern hair loss is the most common cause of hair loss in women. The prevalence of this condition is 3 to 12% among women of European descent in their 20s and 30s, 14 to 28% among those in their 50s, and 56% among those older than 70 years of age.     The prevalence is lower among Asian women — 12 to 25% among those older than 70 years of age — and is unknown among women of African descent owing to the common overlap of the clinical findings of female-pattern hair loss with those of early central centrifugal cicatricial alopecia.     It is unclear whether the decrease in hair density or diameter (or both) commonly seen in older persons, known as senescent or involutional alopecia, is a distinct entity or a part of pattern hair loss (i.e., pattern hair loss that occurs in men or women).    Both male-pattern hair loss and female-pattern hair loss are characterized by progressive miniaturization of the hair follicle, a shortened anagen (growth) phase, and a prolonged latent phase.     Scalp hair is arranged in follicular units of two to four terminal hairs (>60 μm in diameter) and one or two vellus hairs (<30 μm in diameter), with the degree of miniaturization specific to each individual hair.     This miniaturization process leads to a progressive, but variable, decrease in the caliber, length, and number of hairs in an affected follicular unit. Female-pattern hair loss manifests as decreased hair density in a diffuse central or frontal accentuation pattern but without baldness (seen in figure).     The rare manifestation of female-pattern hair loss in women that mimics that of male-pattern hair loss is usually related to marked hyperandrogenemia and, if accompanied by virilization, should arouse suspicion for a tumor.     Female-pattern hair loss may first manifest between puberty and the late 20s (early-onset female-pattern hair loss) or in the late 40s through menopause (late-onset female-pattern hair loss).    Learn more in the Clinical Practice article “Hair Loss in Women” by Elise A. Olsen, MD, from Duke University Health System: https://nej.md/4ojMkOX    #Dermatology  

𝐑𝐞𝐚𝐜𝐭𝐢𝐯𝐞 𝐨𝐱𝐲𝐠𝐞𝐧 𝐬𝐩𝐞𝐜𝐢𝐞𝐬 are hydroxyl radicals, produced by the metabolism of oxygen, that are extremely reactive and immediately remove electrons from any molecule with which they interact. Such free radicals may play a role in signal transduction, but in excess they are capable of damaging — and rendering mutant or inactive — DNA, RNA, proteins, fats (lipid peroxidation), and enzyme cofactors. To learn more about this NEJM Illustrated Glossary term, read the editorial “Defanging the Neutrophil to Treat Bronchiectasis” by Adam T. Hill, MD, from The University of Edinburgh: https://nej.md/4cANv89    Explore more terms: https://nej.md/glossary    #Pediatrics #Pulmonology

In patients with uncontrolled or resistant hypertension, could baxdrostat added to background therapy lead to a lower seated systolic blood pressure at 12 weeks? 👉 https://nej.md/4my7xUZ    Hard-to-control hypertension is often driven by aldosterone dysregulation. Baxdrostat is a highly selective, potent aldosterone synthase inhibitor that has been associated with mixed results in trials involving patients with uncontrolled or resistant hypertension. Additional data are needed.    In the BaxHTN phase 3 trial, adults with hard-to-control hypertension despite treatment with maximally tolerated doses of either two antihypertensive medications (uncontrolled hypertension) or three or more such medications (resistant hypertension) were enrolled.     After a 2-week placebo run-in period, patients who had a seated systolic blood pressure of 135 mm Hg or more were assigned to receive baxdrostat (1 mg or 2 mg) or placebo once daily for 12 weeks.     The primary efficacy end point was the change in seated systolic blood pressure from baseline to week 12.    In adults with uncontrolled or resistant hypertension, the addition of once-daily baxdrostat to background antihypertensive therapy resulted in significantly greater reductions in seated systolic blood pressure at 12 weeks than placebo.    Read the full BaxHTN trial results and Research Summary: https://nej.md/4my7xUZ    #Cardiology #ClinicalTrials  

Idiopathic intracranial hypertension — high cerebrospinal fluid pressure most common in women of reproductive age with obesity — threatens vision. Treatment includes weight loss, medication, and surgery. Learn more: https://nej.md/3KJlVvk    In the early 20th century, soon after the technique of lumbar puncture was devised, Max Nonne, a German neurologist, described a syndrome of headache accompanied by swollen optic disks in patients with raised cerebrospinal fluid pressure.     He called the condition “pseudotumor cerebri,” because none of the patients proved to have a brain tumor. This name is still used, although it has largely been supplanted by the term “idiopathic intracranial hypertension.”     A new review by Jonathan C. Horton, MD, PhD, explores current ideas about the disease, with emphasis on the importance of dural venous sinus stenosis and new treatment options.    Figure 1 from the review shows papilledema (an important symptom of idiopathic intracranial hypertension) before and after surgical treatment.    A 46-year-old woman with a body-mass index of 33.7 had new onset of headaches followed by transient visual obscurations. A lumboperitoneal shunt had been implanted 20 years earlier after a diagnosis of idiopathic intracranial hypertension was made.     The funduscopic images in Panel A show severe papilledema in the right and left eyes with hemorrhages and exudates. A shunt study revealed no drainage of a radioactive tracer into the abdomen, which confirmed shunt occlusion.     Panel B shows the right and left fundi 3 months later, with resolving papilledema after reduction in intracranial pressure by venous sinus stenting followed by shunt repair.    Read the Review Article “Idiopathic Intracranial Hypertension” by Jonathan C. Horton, MD, PhD, from the University of California, San Francisco: https://nej.md/3KJlVvk    #Neurology #Ophthalmology  

Most fragility fractures occur in patients without osteoporosis. Should we rethink who gets treated? And could just one or two IV infusions (spread years apart) of zoledronate prevent fractures for years? Have the concerns about bisphosphonates been overblown? 🎧 Listen to the latest episode of Beyond Journal Club, a collaboration between CORE IM and NEJM Group: https://nej.md/4q7hOK3    📖 Further reading   Original Article by M.J. Bolland et al.: Fracture Prevention with Infrequent Zoledronate in Women 50 to 60 Years of Age https://nej.md/4g6wlz3 #MedicalResearch #ClinicalTrials

Plague is a high-consequence infectious disease with epidemic potential. Treatment guidelines for bubonic plague in Madagascar include recommendations for a 3-day course of an injectable aminoglycoside followed by a 7-day course of oral ciprofloxacin. However, aminoglycosides have many shortcomings, including delivery by injection, unacceptable side effects, and poor intracellular penetration. Whether oral ciprofloxacin alone is an effective alternative is unclear. This video, in our partnership with Will Flanary (a.k.a. Dr. Glaucomflecken), summarizes new research evaluating ciprofloxacin versus aminoglycoside–ciprofloxacin for bubonic plague in Madagascar. View the Original Article for free: https://nej.md/DrG27 #InfectiousDisease

With increasing pressures to deliver higher quality, safer, affordable care that is more equitable and accessible, U.S. health systems are looking hopefully at AI tools as a means of transforming medical care while alleviating workforce stresses.     These AI technologies require substantial energy and water consumption as well as other resources to develop, deploy, and maintain.     When considered at scale, AI technologies have the potential to impact the energy utilization of health systems and their ability to maintain their sustainability commitments, including the 2022 U.S. Department of Health and Human Services’ Health Sector Climate Pledge.     Multiple factors determine the energy requirements of a given AI tool, and health system leaders will have a critical window of opportunity to align AI implementation with larger considerations of appropriate resource utilization, sustainability, and cost.     The authors of a new article offer a framework — Sustainably Advancing Health AI (SAHAI) — for optimizing AI-related energy consumption and emissions in health care settings.     Through an example of a generative AI use case — AI patient messaging — they calculate carbon emissions across various scenarios that could substantially affect the emissions profile of a major health system using such a tool.     The authors discuss key takeaways for health systems implementing new AI technologies and offer concrete next steps for a coalition to advance health AI sustainably.    Learn more in the article “Sustainably Advancing Health AI: A Decision Framework to Mitigate the Energy, Emissions, and Cost of AI Implementation” by A. Ramachandran et al. in the October 2025 issue of NEJM Catalyst Innovations in Care Delivery: https://nej.md/3VN8X1Y    Explore the full issue: https://nej.md/3IiAYLN    #HealthCare #ArtificialIntelligence 

Among adults with pulmonary arterial hypertension who had received the diagnosis less than 1 year earlier, could the addition of sotatercept to background therapy result in a lower risk of clinical worsening? 👉 https://nej.md/4mzuaY1    Despite available therapies, disease progression and death can still occur in patients with pulmonary arterial hypertension.    In previous trials, add-on therapy with the activin-signaling inhibitor sotatercept was effective in treating longstanding pulmonary arterial hypertension. Whether add-on sotatercept is effective when started within 1 year after diagnosis is unknown.    In the HYPERION phase 3 trial, adults with WHO functional class II or III pulmonary arterial hypertension who had received the diagnosis in the past year, had an intermediate or high risk of death, and were receiving double or triple background therapy were randomly assigned to receive add-on subcutaneous sotatercept or placebo every 21 days.     The primary end point was clinical worsening, a composite of death from any cause, hospitalization for worsening of pulmonary arterial hypertension, atrial septostomy, lung transplantation, or deterioration in performance in exercise testing due to pulmonary arterial hypertension, assessed in a time-to-first-event analysis.    Among patients with pulmonary arterial hypertension who had received the diagnosis in the past year, the addition of sotatercept to standard background therapy reduced the risk of clinical worsening events.    Read the full HYPERION phase 3 trial results and Research Summary: https://nej.md/4mzuaY1    #Pulmonology #Cardiology