Drakenterprises
CardiologyDiabetesFamily MedicineEmergencyOrthopaedicsOtolaryngologyOncologyCross-cutting

Not clinical advice. Clinical Evidence is a current-awareness feed. It is not a clinical decision-support system, not medical advice, and not a substitute for clinical judgment, institutional protocols, or the original sources. Full text, NCCN recommendations, and Cochrane review bodies are not reproduced here.

Specialty

Cross-cutting

Sources: NEJM, JAMA, JAMA Network Open, Nature, Nature Medicine, Cochrane. Society hubs are outbound links, not scraped bodies.

Indexed items

Showing 80 of 13950 matching items (19450 indexed).

CochraneSystematic review

The Cochrane database of systematic reviews · Cochrane

Treatment for symptomatic hypermobility in childhood.

This is a protocol for a Cochrane review (intervention). The objectives are as follows: To evaluate the benefits and harms of conservative, pharmacological, surgical, and multi-component interventions for musculoskeletal symptoms in children with hypermobility-associated conditions.

CochraneSystematic review

The Cochrane database of systematic reviews · Cochrane

Interventions for replacing missing teeth: antibiotic prophylaxis for dental implant placement with bone augmentation procedures.

This is a protocol for a Cochrane review (intervention). The objectives are as follows: To evaluate the benefits and harms of systemic prophylactic antibiotics versus no antibiotics or placebo in people undergoing dental implant placement with concomitant bone augmentation procedures, and to assess whether the effects of systemic prophylactic antibiotics differ according to the dosage, duration, timing of administration, and type of antibiotic.

CochraneSystematic review

The Cochrane database of systematic reviews · Cochrane

Long-term hormone therapy for perimenopausal and postmenopausal women.

BACKGROUND: Hormone therapy is widely provided to control menopausal symptoms and has been used for the management and prevention of cardiovascular disease, osteoporosis and dementia in older women. This is an updated version of a Cochrane review first published in 2005. OBJECTIVES: To assess the long-term effects of prolonged use (at least one year) of hormone therapy on mortality, cardiovascular outcomes, cancer, gallbladder disease, fractures and cognition in perimenopausal and postmenopausal women. SEARCH METHODS: We used the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, three other databases and two trial registers, together with reference checking, citation searching and contact with study authors to identify the studies included in the review. The latest search date was 26 September 2024. SELECTION CRITERIA: We included randomised, double-blind trials in which peri- or postmenopausal women took hormone therapy or placebo for at least one year. We included various oestrogen formulations, with or without progestogens. We focused on studies assessing hormone therapy's effects on long-term clinical outcomes, including death, coronary events and cancer. Hormone therapy's efficacy in managing menopausal symptoms was beyond the scope of this review, and is assessed in other Cochrane reviews. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed risk of bias and extracted data. We calculated risk ratios (RRs) for dichotomous data and mean differences (MDs) for continuous data, along with 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE. MAIN RESULTS: We included 24 studies - with two newly added in this update - involving 45,660 participants. We derived nearly 70% of the data from two well-conducted studies: the Heart and Estrogen/progestin Replacement Study (HERS 1998) and the large, multi-component Women's Health Initiative research programme, which included two hormone therapy arms (WHI 1998). Across all the studies, most participants were postmenopausal American women with one or more comorbidities. The mean participant age in most studies was over 60 years. Only one included study focused on perimenopausal women. We present full results for all included studies with available data in the main review. The results presented below are drawn from WHI 1998, in which the combined hormone therapy arm and the oestrogen-only arm were run concurrently, with women assigned to the appropriate trial based on their uterus status. One study with 16,608 postmenopausal women with an intact uterus compared combined continuous hormone therapy (conjugated equine oestrogen and medroxyprogesterone acetate) to placebo, and measured outcomes at an average of 5.6 years of follow-up. Based on this study, combined continuous hormone therapy probably makes little to no difference to the risk of a coronary event (RR 1.17, 95% CI 0.95 to 1.44; moderate-certainty evidence). It may increase the risk of stroke (RR 1.39, 95% CI 1.09 to 2.09; low-certainty evidence) and venous thromboembolism (RR 2.03, 95% CI 1.55 to 6.64; low-certainty evidence). Compared to placebo, combined continuous hormone therapy probably increases the risk of breast cancer (RR 1.27, 95% CI 1.03 to 1.56; moderate-certainty evidence) and probably makes little to no difference to the risk of lung cancer (RR 1.06, 95% CI 0.77 to 1.46; moderate-certainty evidence). It may increase gallbladder disease requiring surgery (RR 1.64, 95% CI 1.30 to 2.06; 14,203 participants; low-certainty evidence), and probably reduces the risk of all clinical fractures (RR 0.78, 95% CI 0.71 to 0.86; moderate-certainty evidence). One study including 10,739 postmenopausal women who had undergone a hysterectomy compared oestrogen-only (conjugated equine oestrogen) hormone therapy to placebo, and measured outcomes at an average of seven years' follow-up. Based on this study, oestrogen-only hormone therapy probably makes little to no difference to the risk of coronary events (RR 0.94, 95% CI 0.78 to 1.13), venous thromboembolism (RR 1.32, 95% CI 1.00 to 1.74) and breast cancer (RR 0.79, 95% CI 0.61 to 1.01), all with moderate-certainty evidence. It may make little to no difference to the risk of lung cancer (RR 1.04, 95% CI 0.73 to 1.48; low-certainty evidence). Oestrogen-only hormone therapy probably increases the risk of stroke (RR 1.33, 95% CI 1.06 to 1.67) and gallbladder disease requiring surgery (RR 1.78, 95% CI 1.42 to 2.24), and probably reduces the risk of all clinical fractures (RR 0.73, 95% CI 0.65 to 0.80), all with moderate-certainty evidence. We judged most included studies to have a low risk of bias for most domains. The overall certainty of evidence for the main comparisons was moderate. The main limitation was that only about 30% of women were 50 to 59 years old at baseline, the age group most likely to consider hormone therapy for vasomotor symptoms. AUTHORS' CONCLUSIONS: Long-term follow-up of women using hormone therapy suggests that the risk profiles vary between combined hormone therapy and oestrogen-only therapy. Oestrogen-only hormone therapy probably makes little to no difference to coronary events, and probably increases the risk of stroke and gallbladder disease. It probably makes little to no difference in the risk of breast cancer, and probably reduces the risk of all fractures. Combined hormone therapy may increase the risk of thromboembolism and probably increases the risk of breast cancer. These results should be interpreted with caution as they are based on one study using oral hormone therapy, which may not represent the risks of the hormone therapy currently used in clinical practice.

Nature MedicineArticle

Nature Medicine

Prediction of maternal and infant outcomes from longitudinal electronic health records with a Mother-Child AI agent

Nature Medicine, Published online: 04 September 2026; doi:10.1038/s41591-026-04694-y An LLM-based clinical assistant that orchestrates multiple tools to integrate sequential electronic health record data can forecast maternal and infant conditions, opening a window of opportunity to enhance risk-stratified care for mothers and infants.

NEJMRCT

The New England journal of medicine

Azacitidine-Venetoclax or Induction Chemotherapy for Acute Myeloid Leukemia.

BACKGROUND: Induction chemotherapy has long been a key component of curative therapy for fit patients with acute myeloid leukemia (AML), despite its frequently severe side effects and substantial health care utilization. For patients who are ineligible for induction chemotherapy, hypomethylating therapy plus venetoclax is the standard treatment owing to its efficacy and side-effect profile. METHODS: In this multicenter, phase 2 trial, we randomly assigned, in a 1:1 ratio, previously untreated adults with AML who were eligible for induction chemotherapy to receive either azacitidine plus venetoclax or induction chemotherapy. Patients with core binding factor fusions, mutations in the gene encoding FMS-like tyrosine kinase 3 (), or mutations in the gene encoding nucleophosmin-1 (; unless the patient was ≥60 years of age) were excluded. The primary end point was event-free survival. RESULTS: A total of 172 patients underwent randomization, with 86 patients assigned to each group. The median age of the patients was 64 years. A total of 72% of the patients had adverse-risk disease according to the European LeukemiaNet 2022 classification. At a median follow-up of 21.9 months, the median event-free survival was 14.5 months (95% confidence interval [CI], 10.4 to 24.4) in the azacitidine-venetoclax group, as compared with 6.2 months (95% CI, 4.1 to 10.1) in the induction chemotherapy group, corresponding to a hazard ratio for event or death of 0.57 (95% CI, 0.39 to 0.84; P = 0.002 by the stratified log-rank test). Infection of grade 3 or higher occurred in 28% of the patients (95% CI, 19 to 39) receiving azacitidine-venetoclax and in 41% of those (95% CI, 30 to 52) receiving induction chemotherapy; hemorrhage of grade 3 or higher occurred in 2% (95% CI, 0.3 to 8) and 12% (95% CI, 6 to 20), respectively. CONCLUSIONS: In this phase 2, randomized trial, azacitidine-venetoclax therapy led to significantly longer event-free survival than induction chemotherapy among induction-eligible patients with AML. (Funded by AbbVie and others; PARADIGM ClinicalTrials.gov number, NCT04801797.).

JACCArticle

Journal of the American College of Cardiology · ACC

Clinical Considerations for the Care of the Tactical Athlete With Cardiovascular Abnormalities: A Scientific Statement From the American College of Cardiology and the American Heart Association.

AIM: The American College of Cardiology/American Heart Association Scientific Statement, "Clinical Considerations for the Care of the Tactical Athlete With Cardiovascular Abnormalities," was written to provide guidance and education for clinicians caring for the tactical athlete (ie, firefighters, law enforcement officers, military) with cardiovascular disease or risk for cardiovascular disease, and for the organizations overseeing the care and wellness of these athletes. The considerations are shaped by the interaction between occupational demands and fit for full duty assessments, including risk discussions about how a cardiovascular event in a tactical athlete could impact teammates' well-being, community safety, and overall mission success. METHODS: This scientific statement is organized into 11 sections focused on cardiovascular disease processes and other topics that are relevant when considering the potential risks and benefits of performing tasks specific to the tactical athlete. Task forces, comprised of experts in tactical athlete domains, sports cardiology, and the respective topics covered, were assigned to each section, and specific "Clinical Considerations Tables" for clinicians to reference were prepared. Comprehensive literature reviews and an emphasis on tactical athlete-focused data, as available, were integral in the writing of all clinical considerations presented. The framework mirrors that of the recently published, "Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities: A Scientific Statement From the American Heart Association and American College of Cardiology." STRUCTURE: The specific sections in this document include: Section 1: Tactical Tasks Classification; Section 2: The Tactical Athlete Preparticipation Cardiac Evaluation; Section 3: Ethical and Legal Aspects of Tactical Clinical Management; Section 4: Genetic Cardiomyopathies; Section 5: Myocarditis and Other Acquired Cardiac Conditions; Section 6: Congenital Heart Disease; Section 7: Aortopathy, Bicuspid Aortic Valve, and Spontaneous Coronary Artery Dissection; Section 8: Syncope, SCA, Arrhythmias, and Devices; Section 9: Cardiac Channelopathies; Section 10: Older Tactical Athlete; Section 11: Environmental Exposures, PED/S, and Additional Cardiac Conditions and Considerations. Each section provides a summary detailing the rationale for key clinical considerations and the respective Clinical Considerations Table(s).

NEJMArticle

The New England journal of medicine

Daraxonrasib for Previously Treated-Mutant Non-Small-Cell Lung Cancer.

BACKGROUND: mutations, as a group, are the most common oncogenic drivers of non-small-cell lung cancer (NSCLC), and they occur in approximately 30% of patients. Whether daraxonrasib (RMC-6236) - an oral RAS(ON) multiselective, tri-complex inhibitor of guanosine triphosphate-bound mutant and wild-type RAS protein isoforms - is safe and effective in patients with-mutant NSCLC is unknown. METHODS: In this phase 1-2, multicenter, dose-escalation and dose-expansion study of daraxonrasib, we enrolled patients with previously treated advanced-mutant NSCLC and administered daraxonrasib in doses of 10 to 400 mg orally once daily in 21-day cycles. The primary end point was safety. Secondary end points included investigator-assessed objective response (complete or partial response) and the duration of response, with response assessed according to Response Evaluation Criteria in Solid Tumors, version 1.1. RESULTS: As of the data-cutoff date of July 21, 2025, a total of 136 patients with NSCLC who had been enrolled and treated with daraxonrasib at doses of 300 mg or less had been evaluated for safety and efficacy. Adverse events of any grade occurring with a dose of 300 mg or less, regardless of attribution, were reported in 99% of the patients, with rash, diarrhea, nausea, vomiting, and mucositis or stomatitis occurring in at least 30% of patients. Adverse events of grade 3 or higher were reported in 54% of the patients, with pneumonia (in 10%), diarrhea (in 9%), rash (in 8%), and anemia (in 5%) occurring in at least 5% of patients; four grade 5 adverse events occurred. The percentage of patients who had an objective response was 31% with daraxonrasib at a dose of 120 mg or less, 34% at doses of 160 to 220 mg, and 37% at a dose of 300 mg. CONCLUSIONS: Among patients with previously treated metastatic-mutant NSCLC receiving daraxonrasib at a dose of 300 mg or less daily, 54% had adverse events of grade 3 or higher, and antitumor activity was reported in more than 30%. (Funded by Revolution Medicines; RMC-6236-001 ClinicalTrials.gov number, NCT05379985.).

Nature MedicineArticle

Nature medicine

Gene alteration in human brain suggests genetic and epigenetic roots of major depression.

Nature Medicine, Published online: 03 September 2026; doi:10.1038/s41591-026-04682-2 A large, multimodal molecular characterization of the adult human hippocampus provides evidence for sustained neurogenesis and identifies a stalled neurogenic process in major depressive disorder (MDD). Cell- and circuit-specific genetic, epigenetic, stress, immune, metabolic and synaptic mechanisms are identified

Nature MedicineArticle

Nature Medicine

Induced proximity comes of age

Nature Medicine, Published online: 03 September 2026; doi:10.1038/d41591-026-00045-z The first approved PROTAC for breast cancer validated the idea that medicines can work by bringing proteins together rather than by simply blocking them. Now, a new generation of proximity-based therapies is pushing that principle further.

CochraneSystematic review

The Cochrane database of systematic reviews · Cochrane

Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus.

BACKGROUND: Magnesium sulphate is a common therapy in perinatal care. Its benefits when given to women at risk of preterm birth for fetal neuroprotection (prevention of cerebral palsy for children) were shown in a 2009 Cochrane review. Internationally, use of magnesium sulphate for preterm cerebral palsy prevention is now recommended practice. As new randomised controlled trials (RCTs) and longer-term follow-up of prior RCTs have since been conducted, this review updates the previously published version. OBJECTIVES: To assess the effectiveness and safety of magnesium sulphate as a fetal neuroprotective agent when given to women considered to be at risk of preterm birth. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) on 17 March 2023, as well as reference lists of retrieved studies. SELECTION CRITERIA: We included RCTs and cluster-RCTs of women at risk of preterm birth that assessed prenatal magnesium sulphate for fetal neuroprotection compared with placebo or no treatment. All methods of administration (intravenous, intramuscular, and oral) were eligible. We did not include studies where magnesium sulphate was used with the primary aim of preterm labour tocolysis, or the prevention and/or treatment of eclampsia. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed RCTs for inclusion, extracted data, and assessed risk of bias and trustworthiness. Dichotomous data were presented as summary risk ratios (RR) with 95% confidence intervals (CI), and continuous data were presented as mean differences with 95% CI. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included six RCTs (5917 women and their 6759 fetuses alive at randomisation). All RCTs were conducted in high-income countries. The RCTs compared magnesium sulphate with placebo in women at risk of preterm birth at less than 34 weeks' gestation; however, treatment regimens and inclusion/exclusion criteria varied. Though the RCTs were at an overall low risk of bias, the certainty of evidence ranged from high to very low, due to concerns regarding study limitations, imprecision, and inconsistency. Primary outcomes for infants/children: Up to two years' corrected age, magnesium sulphate compared with placebo reduced cerebral palsy (RR 0.71, 95% CI 0.57 to 0.89; 6 RCTs, 6107 children; number needed to treat for additional beneficial outcome (NNTB) 60, 95% CI 41 to 158) and death or cerebral palsy (RR 0.87, 95% CI 0.77 to 0.98; 6 RCTs, 6481 children; NNTB 56, 95% CI 32 to 363) (both high-certainty evidence). Magnesium sulphate probably resulted in little to no difference in death (fetal, neonatal, or later) (RR 0.96, 95% CI 0.82 to 1.13; 6 RCTs, 6759 children); major neurodevelopmental disability (RR 1.09, 95% CI 0.83 to 1.44; 1 RCT, 987 children); or death or major neurodevelopmental disability (RR 0.95, 95% CI 0.85 to 1.07; 3 RCTs, 4279 children) (all moderate-certainty evidence). At early school age, magnesium sulphate may have resulted in little to no difference in death (fetal, neonatal, or later) (RR 0.82, 95% CI 0.66 to 1.02; 2 RCTs, 1758 children); cerebral palsy (RR 0.99, 95% CI 0.69 to 1.41; 2 RCTs, 1038 children); death or cerebral palsy (RR 0.90, 95% CI 0.67 to 1.20; 1 RCT, 503 children); and death or major neurodevelopmental disability (RR 0.81, 95% CI 0.59 to 1.12; 1 RCT, 503 children) (all low-certainty evidence). Magnesium sulphate may also have resulted in little to no difference in major neurodevelopmental disability, but the evidence is very uncertain (average RR 0.92, 95% CI 0.53 to 1.62; 2 RCTs, 940 children; very low-certainty evidence). Secondary outcomes for infants/children: Magnesium sulphate probably resulted in little to no difference in severe intraventricular haemorrhage (grade 3 or 4) (RR 0.81, 95% CI 0.64 to 1.04; 6 RCTs, 6542 infants; moderate-certainty evidence) and may have resulted in little to no difference in chronic lung disease/bronchopulmonary dysplasia (average RR 0.92, 95% CI 0.77 to 1.10; 5 RCTs, 6689 infants; low-certainty evidence). Primary outcomes for women: Magnesium sulphate may have resulted in little or no difference in severe maternal outcomes potentially related to treatment (death, cardiac arrest, respiratory arrest) (RR 0.32, 95% CI 0.01 to 7.92; 4 RCTs, 5300 women; low-certainty evidence). However, magnesium sulphate probably increased maternal adverse effects severe enough to stop treatment (average RR 3.21, 95% CI 1.88 to 5.48; 3 RCTs, 4736 women; moderate-certainty evidence). Secondary outcomes for women: Magnesium sulphate probably resulted in little to no difference in caesarean section (RR 0.96, 95% CI 0.91 to 1.02; 5 RCTs, 5861 women) and postpartum haemorrhage (RR 0.94, 95% CI 0.80 to 1.09; 2 RCTs, 2495 women) (both moderate-certainty evidence). Breastfeeding at hospital discharge and women's views of treatment were not reported. AUTHORS' CONCLUSIONS: The currently available evidence indicates that magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus, compared with placebo, reduces cerebral palsy, and death or cerebral palsy, in children up to two years' corrected age. Magnesium sulphate may result in little to no difference in outcomes in children at school age. While magnesium sulphate may result in little to no difference in severe maternal outcomes (death, cardiac arrest, respiratory arrest), it probably increases maternal adverse effects severe enough to stop treatment. Further research is needed on the longer-term benefits and harms for children, into adolescence and adulthood. Additional studies to determine variation in effects by characteristics of women treated and magnesium sulphate regimens used, along with the generalisability of findings to low- and middle-income countries, should be considered.

CochraneSystematic review

The Cochrane database of systematic reviews · Cochrane

Multisensory stimulation for promoting development and preventing morbidity in preterm infants.

RATIONALE: Multisensory stimulation is a structured, developmentally appropriate intervention that provides simultaneous or sequential stimulation of two or more senses (e.g. tactile, auditory, visual, or vestibular) in a controlled and non-stressful manner, with the aim of supporting early neurodevelopment in preterm infants. It has the potential to enhance physiological regulation in preterm infants by stabilizing key functions, such as respiratory patterns, heart rate, and oxygen saturation; reducing the need for respiratory support; and improving feeding performance and sleep regulation. Targeted multisensory interventions have also been associated with improved neurodevelopmental outcomes, including enhanced psychomotor development and visual function. OBJECTIVES: To assess the benefits and harms of multisensory stimulation compared to any single sensory intervention or standard care on major neurodevelopmental disability, mortality, and growth in preterm infants. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Emcare, CINAHL, Epistemonikos, two trial registries, and conference abstracts up to 28 November 2025. We checked reference lists of included trials, and systematic reviews on sensory interventions. ELIGIBILITY CRITERIA: We included 18 randomized controlled trials (RCTs) comparing multisensory stimulation in preterm infants with no intervention (placebo or standard care), and one RCT comparing multisensory stimulation with single-sense stimulation (tactile stimulation). OUTCOMES: Our critical outcomes were major neurodevelopmental disability at 18 to 24 months: cerebral palsy (CP), developmental delay, intellectual impairment, blindness, sensorineural deafness; death during initial hospitalization; and total weight gain (grams), assessed at discharge. When comparing multisensory stimulation with single-sense intervention, we also included weight gain during the intervention, an outcome added during the post-hoc analysis. Important outcomes were duration of hospital stay, of NICU stay, and of respiratory support; and time until full oral feeding. RISK OF BIAS: We used the Cochrane tool, RoB 2. SYNTHESIS METHODS: We conducted meta-analyses using fixed-effect models to calculate risk ratios (RR) for dichotomous data, and mean differences (MDs) for continuous data, each with its 95% confidence intervals (CIs). We assessed statistical heterogeneity by calculating the Istatistic when we included more than two trials in a meta-analysis. We evaluated the certainty of evidence using GRADE. INCLUDED STUDIES: We included 19 trials (1554 newborn infants): 18 studies compared multisensory stimulation with standard care; one compared multisensory stimulation with single-sensory stimulation (tactile). In 10 studies, the primary aim was to assess the neurobehavioral outcomes of multisensory stimulation on preterm neo-nates. The other nine studies aimed to assess the impact of multisensory stimulation on weight gain during the intervention, weight gain until hospital discharge, length of neonatal intensive care unit (NICU) stay, length of hospital stay, time until full oral feeding, length of respiratory support, or a combination. In the abstract we report results for the critical outcomes only. We identified 13 ongoing studies. Four studies are awaiting assessment. SYNTHESIS OF RESULTS: Multisensory stimulation compared to standard care No studies reported on these major neurodevelopmental disabilities, assessed at 18 to 24 months' corrected age (CA): developmental delay, intellectual impairment, blindness, or sensorineural deafness. One study reported on rates of CP at 12 months of age. The evidence is very uncertain about the effect of multisensory stimulation on CP (RR 0.67, 95% CI 0.28 to 1.58; I² not applicable; 1 study, 18 participants; very low-certainty evidence). The evidence suggests that multisensory stimulation may result in little to no difference in death during initial hospitalization (RR 0.97, 95% CI 0.54 to 1.73; I² not applicable; 1 study, 395 participants; low-certainty evidence). Multisensory stimulation may increase total weight gain prior to discharge (MD 72.67, 95% CI 68.23 to 77.12; I² = 0%; 3 studies, 474 participants; low-certainty evidence). Multisensory stimulation compared to single-sense (tactile) stimulation No studies reported on major neurodevelopmental disability, assessed at 18 to 24 months' CA, or death during initial hospitalization. The evidence is very uncertain about the effect of multisensory stimulation compared to tactile stimulation on weight gain during the intervention (MD -175.00, 95% CI -376.60 to 26.60; I² not applicable; 1 study, 20 participants; very low-certainty evidence). The certainty of the evidence was low to very low across outcomes, primarily due to risk of bias, imprecision from small sample sizes and wide CIs, and in some cases, inconsistency. The evidence base was also limited by the lack of reporting of relevant outcomes and reliance on surrogate outcomes or shorter follow-up periods. AUTHORS' CONCLUSIONS: The available evidence on multisensory stimulation in preterm infants is limited and of low to very low certainty. No included studies reported on major neurodevelopmental disabilities at 18 to 24 months' CA, which represented a critical outcome for this review. Evidence regarding the effect of multisensory stimulation on CP is very uncertain, as it is based on a single small study reporting a surrogate outcome at 12 months. Multisensory stimulation may result in little to no difference in mortality during the initial hospitalization. It may increase total weight gain prior to discharge. However, the clinical significance of this finding is uncertain, particularly given the low certainty of the evidence and the multifactorial nature of growth in preterm infants. The evidence is very uncertain about the effect of multisensory stimulation compared to single-sense (tactile) stimulation on weight gain during the intervention. The only included study did not report major neurodevelopmental disabilities at 18 to 24 months' CA, mortality during the initial hospitalization, or total weight gain prior to discharge, which represented the critical outcomes for this review. Overall, the current evidence does not allow firm conclusions about the effectiveness of multisensory stimulation in promoting development or preventing morbidity in preterm infants. Future studies on multisensory stimulation should use more rigorous designs, larger samples, and report interventions using the template for intervention description and replication (TIDieR) checklist to ensure transparency. They should also report essential outcomes, such as neonatal death, major neurodevelopmental disabilities, length of hospital and NICU stay, time to full oral feeding, duration of respiratory support, and weight gain, to better assess the long‑term effects of multisensory stimulation in preterm infants. FUNDING: This Cochrane review had no dedicated funding. REGISTRATION: Protocol available via DOI: 10.1002/14651858.CD016073.

NEJMArticle

The New England journal of medicine

Pulmonary Nodules.

Pulmonary nodules are classified as solid or subsolid, with subsolid nodules further classified as part-solid or pure ground-glass. Management strategies differ according to the type of nodule. A comparison of current and previous imaging studies, when available, is essential to assess the risk of the nodule being malignant. Solid nodules that have been stable for 2 years are considered to be benign, whereas subsolid nodules require a longer period of stability to be considered benign. Prediction models to stratify the risk of the nodule being malignant can be used to guide the management of solid nodules. Computed tomographic (CT) surveillance is indicated for low-risk nodules; positron-emission tomography-CT, biopsy, or both for intermediate-risk nodules; and surgical resection for selected high-risk nodules. Subsolid nodules are often slower growing than solid nodules but are associated with a higher risk of being malignant, especially if a solid component develops or progressively enlarges. Biopsy methods include transthoracic needle biopsy and navigational bronchoscopy. Optimal overall management balances timely diagnosis in persons who have cancer with the avoidance of unnecessary invasive procedures in persons who have benign disease.

Diabetes CareArticle

Diabetes care · ADA

SGLT Inhibitors for Heart and Kidney Disease in Type 1 Diabetes.

Developing a path forward for sodium-glucose cotransporter (SGLT) inhibitor treatment for heart and kidney disease in people with type 1 diabetes (T1D) is essential. This article offers the perspective of experts from the fields of endocrinology, nephrology, and cardiology on available data for the efficacy and safety of SGLT inhibitors in T1D, how the far more extensive data from people with type 2 diabetes (T2D) and people without diabetes would be expected to translate to T1D, and what steps are required to advance toward regulatory approvals and clinical uptake of SGLT inhibitors in T1D for heart and kidney disease. Our conclusion is that the mechanisms driving efficacy of SGLT inhibitors for heart and kidney disease in T2D and nondiabetic disease are likely applicable to T1D and that in light of the data supporting efficacy in these populations, registrational trials in T1D might not require powering for traditional event-based outcomes and investigators may instead rely on suitable surrogate end points, allowing for more feasible trials. Investigators in these trials must also carefully collect data associated with diabetic ketoacidosis (DKA), the critical risk of SGLT inhibitor use in T1D. DKA risk mitigation is essential for SGLT inhibitor use in T1D; protocols to mitigate risk have been developed, but rigorous data on their effectiveness are lacking. We describe a roadmap to advance SGLT inhibitors for T1D heart and kidney disease, which includes the use of feasible trial designs based on surrogate end points and rigorous safety protocols to minimize DKA events.

NatureArticle

Nature

3D epigenome of glial cell types in developing human cortex.

The human cortex is complex and heterogeneous, undergoing extensive expansion during development. Our prior study of neurogenesis, including radial glia (RG), intermediate progenitor cells, excitatory neurons and interneurons demonstrated that chromatin looping underlies transcriptional regulation for lineage-specific genes, shedding light on how non-coding genetic variants contribute to neuropsychiatric disorders by means of cell-type-specific gene regulation. RG have a crucial role in generating cellular diversity through both neurogenesis and gliogenesis and can be further classified into ventricular RG (vRG) and outer RG (oRG). Given their significance in cortical development, we conducted a comprehensive three-dimensional (3D) epigenomic analysis of four main glial populations, including vRG, oRG, oligodendrocyte precursor cells and microglia, from the mid-gestational human neocortex. By integrating gene expression, chromatin accessibility, DNA methylation and 3D chromatin interactions, we identified cell-type-specific candidate cis-regulatory elements (cCREs) and validated their regulatory function using transgenic mouse embryos. Using machine learning, we prioritized 112 schizophrenia risk variants within glia cCREs and further confirmed the predicted vRG enhancer disruption by the rs4449074 risk allele in vivo. Finally, oRG cCREs are enriched for human accelerated regions compared with other cCREs and a subset of human accelerated regions show activity differences from their chimpanzee orthologues that interact with genes involved in neuronal development. Our findings advance the understanding of human-specific gene regulation during corticogenesis.

NatureArticle

Nature

Aquatic invertebrates contribute substantially to global nutrient supplies.

Nature, Published online: 02 September 2026; doi:10.1038/d41586-026-02541-1 An analysis of the nutritional content of aquatic invertebrate species suggests that their global production is a rich source of nutrients that are crucial for human health. The work provides a foundation for better recognition of these valuable invertebrate nutrients and incorporate them into conservation, management and

CochraneSystematic review

The Cochrane database of systematic reviews · Cochrane

Assistive technologies (lumbar supports and other devices) for treating chronic low back pain.

RATIONALE: Low back pain (LBP) is a major global health problem. It is the most common cause of activity limitation amongst individuals younger than 45 years, and one of the most frequent reasons for visits to a doctor. The 2019 Global Burden of Disease study named LBP as the leading cause of the need for rehabilitation, estimated to affect 568 million people. Its socioeconomic burden is substantial, with LBP-related costs from productivity loss and healthcare services utilisation making a significant impact on national gross domestic products. In particular, chronic LBP (CLBP)-defined as pain, muscle tension, or stiffness lasting longer than 12 weeks-results in long-term suffering and a considerable increase in healthcare expenditure. A wide variety of assistive technologies are utilised to manage CLBP. These aim to provide mechanical support, using diverse modalities and levels of assistance. OBJECTIVES: To assess the benefits and harms of assistive technologies (i.e. non-rigid and rigid lumbar braces, belts, supports, and devices to assist mobility and gait) in adults with chronic low back pain (CLBP). SEARCH METHODS: We searched CENTRAL, MEDLINE (PubMed), Embase, CINAHL, and trials registries up to 7 January 2025. We also searched the reference lists of included studies and any relevant systematic reviews. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs) involving adults with CLBP comparing all types of assistive technologies versus placebo/sham, no intervention, or usual care. We planned to include non-randomised studies of interventions (NRSIs) in the absence of RCT evidence for some types of assistive devices. OUTCOMES: Our critical outcomes were pain, disability, health-related quality of life, participant-reported treatment success, falls, adverse events, and withdrawals due to any adverse events. Our important outcomes were depression, anxiety, social participation, and reduced use of painkillers. We did not assess the certainty of the evidence for important outcomes; thus, their results are not included in the abstract. RISK OF BIAS: We used the Cochrane tool RoB 1 to assess the risk of bias in the studies. SYNTHESIS METHODS: We conducted meta-analysis using the random-effects model to calculate the mean difference (MD) or standardised mean difference (SMD) with 95% confidence interval (CI) for all outcomes. We assessed the certainty of the evidence using the GRADE approach. When pooling was not possible, we calculated effect estimates for individual studies; when data were not available, we summarised the results narratively. INCLUDED STUDIES: We included eight RCTs involving a total of 501 participants. We did not identify any NRSIs meeting the inclusion criteria. Participants in the eight studies were adults of both sexes who had CLBP of at least one year's duration being treated in the outpatient rehabilitation setting. All eight studies investigated the effects of lumbar supports; no eligible studies assessed other assistive technologies, such as mobility or gait aids. Seven of the studies added lumbar supports to 'usual care'. Five of the studies were conducted in low- and middle-income countries and three in high-income countries. Most of the included studies were at high or unclear risk of bias due to lack of blinding, incomplete outcome data, and selective reporting. We judged the certainty of the evidence to be low or very low. SYNTHESIS OF RESULTS: The available evidence mainly addresses pain intensity and disability. We found some limited data on health-related quality of life. None of the included studies reported participant-reported treatment success, falls, adverse events, withdrawals due to any adverse events, or any of our other prespecified outcomes. Compared to no intervention, lumbar supports may result in little to no difference in pain intensity in the intermediate term (three months), if we consider a minimum clinically meaningful change on the 0-to-100 pain scale to be 15 points (MD -8.00, 95% CI -15.02 to -0.98; 1 study, 107 participants), and may result in little to no difference in disability (MD -0.10, 95% CI -1.11 to 0.91; 1 study, 107 participants) (both low-certainty evidence). Compared with usual care (non-steroidal anti-inflammatory drugs (NSAIDs)), lumbar supports plus usual care (NSAIDs) may result in a small reduction in short-term pain intensity (after three to four weeks), if we consider a minimum clinically meaningful change on the 0-to-100 pain scale to be 15 points (MD -17.66, 95% CI -24.22 to -11.09; I= 30%; 2 studies, 149 participants; low-certainty evidence). However, the effect of lumbar supports added to usual care (NSAIDs) on disability is very uncertain (SMD -0.63, 95% CI -1.43 to 0.17; I= 76%; 2 studies, 149 participants; very low-certainty evidence). The evidence is very uncertain about the effect of lumbar supports plus usual care (education and exercise) compared with usual care (education and exercise) on pain intensity (MD -4.50, 95% CI -20.98 to 11.98; 1 study, 25 participants), disability (MD 2.80, 95% CI -21.58 to 27.18; 1 study, 24 participants), and health-related quality of life (1 study, 25 participants) in the short term (six weeks) (all very low certainty evidence). The evidence is also very uncertain about the effect of lumbar supports plus usual care (routine physical therapy) compared with usual care (routine physical therapy) on pain intensity (MD 3.10, 95% CI -5.89 to 12.09; 1 study, 41 participants) and disability (MD -4.27, 95% CI -7.71 to -0.83; 1 study, 41 participants) in the short term (four weeks) (both very low certainty evidence). AUTHORS' CONCLUSIONS: Lumbar supports may result in a small reduction in pain intensity when provided in addition to NSAIDs, but may offer little to no benefit for pain intensity and disability when used alone. The evidence regarding health-related quality of life is very uncertain. No included studies reported on our other outcomes of interest or on adverse events, leaving uncertainty about the potential harms and broader functional impact of lumbar supports. Therefore, there is insufficient evidence to support the routine use of lumbar supports for managing CLBP. The absence of research on other assistive devices commonly used in clinical practice, particularly amongst people with disabilities or mobility limitations, is an evidence gap for future research to fill. FUNDING: This Cochrane review had no dedicated funding. REGISTRATION: Protocol (2024) DOI: 10.1002/14651858.CD015492.

NatureArticle

Nature

Atmospheric CHplateau sustained by NOemission rise and southward shift.

Methane exhibits decadal variability in atmospheric growth rates. During the 1990s, atmospheric methane growth slowed relative to the 1980s, largely attributed to the stabilization or decline in anthropogenic emissions. By contrast, economic expansion in the early 2000s (ref. ) led to an increase in anthropogenic methane emissions. The anticipated rise in atmospheric methane concentrations, however, was not detected by global monitoring networks. Instead, almost no atmospheric methane growth was observed between 1999 and 2006 (ref. ). Several hypotheses have been proposed to explain this methane plateau, but the underlying causes remain uncertain. Here we combine model simulations with methane and isotopic observations and attribute the plateau to a 1.4 ± 0.4% hydroxyl radical (OH) increase during 2000-2006 relative to 1999, mostly occurring in the tropics. We find that the tropical OH enhancement was primarily driven by a global rise and spatial redistribution of nitrogen oxides (NO) emissions towards developing regions and the oceans, spurred by economic growth in tropical countries and increased shipping emissions linked to global trade expansion. These changes led to an amplified global methane loss of 2.2 ± 0.7% during 2000-2006 and 3.7 ± 1.3% in 2006 relative to 1999, with the 2000-2006 enhancement equivalent to 136% [90%, 184%] of the contemporaneous anthropogenic methane emission growth, thereby sustaining the observed methane plateau.

NatureArticle

Nature

Biomarkers that predict improved outcomes after perioperative immune-based therapy for lung cancer.

Nature, Published online: 02 September 2026; doi:10.1038/d41586-026-02486-5 Comprehensive exploratory analyses of biomarkers were done in the phase III CheckMate 77T study of pre- and post-surgical treatment with the immunotherapy nivolumab in individuals with surgically resectable non-small-cell lung cancer. The analyses indicate that pre-surgical clearance of circulating tumour DNA, among other

NatureArticle

Nature

Blood cells replace the immune cells of the ageing human brain.

Nature, Published online: 02 September 2026; doi:10.1038/d41586-026-02694-z At birth, the brain contains its own immune cells, called microglia, that are thought to persist throughout life without being replaced by cells from outside the brain. Studies that trace cell lineage now show that these cells are replaced by circulating immune cells during ageing, revealing a previously unappreciated inte

Clinical Evidence