Starting soon: Join us for Judgment Calls: Navigating Uncertainty in Clinical Practice, a panel discussion bringing together experts from internal medicine, emergency medicine, and OB/GYN. Join us live or sign up for the recording: https://events.nejm.org/events/790?promo=OCAYTN26&query=cli-social&utm_source=x&utm_medium=social&utm_campaign=2026_clievent0310
Images in Clinical Medicine: Expiratory Central Airway Collapse https://www.nejm.org/doi/full/10.1056/NEJMicm2503296
#Neurology #Pulmonology
Emily Hill, DO, a family physician in rural Maine now doing a fellowship in palliative care, describes a diabetic patient of hers, often dismissed as noncompliant when it turns out her living situation prevent her from consistently storing her insulin.
Hear more from Dr. Hill in the latest episode of the Not Otherwise Specified podcast hosted by NEJM National Correspondent Lisa Rosenbaum, MD: https://not-otherwise-specified-podcast.nejm.org/e/of-trust-ai-and-green-beans/
Listen to past episodes and subscribe to the podcast: https://not-otherwise-specified-podcast.nejm.org/
The Corporatization of U.S. Health Care by Ruqaiijah Yearby, JD, MPH, and Marcella Alsan, MD, PhD, MPH: Private Equity’s Transformation of American Medicine — Implications for Health Equity https://www.nejm.org/doi/full/10.1056/NEJMp2415615
#HealthPolicy
Correspondence: Blinatumomab in Combined Immune Thrombocytopenia and Antiphospholipid Syndrome https://www.nejm.org/doi/full/10.1056/NEJMc2516228
#Hematology #Immunology
In adults with type 1 diabetes and chronic kidney disease with albuminuria, the decrease in the urinary albumin-to-creatinine ratio was significantly greater with finerenone than with placebo. Full phase 3 FINE-ONE trial results and Research Summary: https://www.nejm.org/doi/full/10.1056/NEJMoa2512854
From a Case Record of the Massachusetts General Hospital published March 13, 1969:
A seventy-year-old man was admitted to the hospital because of weakness and a cough.
Thirty years previously, because of pulmonary tuberculosis, he spent three years in a sanatorium. Twenty years before entry a pneumothorax was performed. Isoniazid therapy was begun five years later and continued for eight years. During the five years before entry he remained in a nursing home, where he took no medication. During the year before admission he lost 15 pounds in weight. Three weeks before entry a cough productive of small amounts of sputum developed, without hemoptysis or pleurisy. The urinary output decreased, and he experienced mild thirst and malaise. During the three days before entry he became increasingly weak. He had had no hypertension, recent fever, hematuria or renal stones, and there had been no symptoms suggestive of urinary-tract obstruction.
On admission the patient was thin. Examination of the optic fundi showed mild narrowing of the arterioles, without hemorrhages or exudates. The neck was supple, the cervical pulses were normal, and the thyroid gland was not enlarged. The diaphragmatic leaves were low, and wheezes and rales were audible throughout the lung fields. The point of maximum cardiac impulse could not be felt; a Grade 3, high-pitched systolic ejection murmur at the xiphisternum and a Grade 2 rumble were audible; a pericardial friction rub was not heard. The edge of the liver, which was nontender, was felt 4 fingerbreadths below the right costal margin; the estimated length of the liver was 9 cm. The tip of the spleen was palpable at the left costal margin. The pulses were normal. The prostate gland was normal. Neurologic examination was negative.
Continue reading “Renal Failure in a Seventy-Year-Old Man with Healed Pulmonary Tuberculosis,” a case record from 1969, in the NEJM Archive: https://www.nejm.org/doi/full/10.1056/NEJM196903132801108
New episode of Not Otherwise Specified 👉 https://not-otherwise-specified-podcast.nejm.org/e/of-trust-ai-and-green-beans/
@ProfEmilyOster, an economist @BrownUniversity and an author of several books on pregnancy and parenting, discusses the trade-offs people make regarding their health and the values they bring to weighing any given set of choices.
Hear more from Prof. Oster in the latest episode of the Not Otherwise Specified podcast hosted by NEJM National Correspondent Lisa Rosenbaum, MD: https://not-otherwise-specified-podcast.nejm.org/e/of-trust-ai-and-green-beans/
Listen to past episodes and subscribe to the podcast: https://not-otherwise-specified-podcast.nejm.org/
In this RCT of hospitalized patients with chronic hyponatremia, targeted correction of plasma sodium levels did not reduce a composite outcome of 30-day mortality and rehospitalization rates compared with standard of care. Full results: https://eviden.cc/4rH3PKY
With an increasing prevalence of long-term survival among patients with cancer, understanding, managing, and reducing the effects of radiotherapy on benign tissues are of critical importance and warrant continuous reexploration and consideration. Learn more: https://www.nejm.org/doi/full/10.1056/NEJMra2506017
A video shows a patient with Dravet syndrome performing activities of daily living before and after treatment with zorevunersen.
Watch the full video and read the full report: https://www.nejm.org/doi/full/10.1056/NEJMoa2506295
Phase 2–3 ZSAB-neoGOLP trial: Patients with resectable high-risk intrahepatic cholangiocarcinoma have a high risk of recurrence after surgery. Findings on neoadjuvant GOLP (gemcitabine–oxaliplatin, lenvatinib, and an anti–PD-1 antibody) are summarized in a new Quick Take video. https://www.nejm.org/do/10.1056/NEJMdo008393/full/
A 74-year-old man presented to the hospital for the third time in three weeks with recurrent fever, muscle aches, and vomiting. In the prior two hospitalizations, symptoms had self-resolved and broad work-up was unremarkable. He had traveled to Yosemite National Park one week prior to symptom onset. Physical examination was notable for rigors and diaphoresis. Peripheral blood smears are shown. What is the most likely diagnosis? Submit your answer or see how others responded: https://www.nejm.org/image-challenge?ci=20260305
𝐀𝐥𝐭𝐞𝐫𝐧𝐚𝐭𝐢𝐯𝐞 𝐬𝐩𝐥𝐢𝐜𝐢𝐧𝐠 is the use of different exons in the formation of messenger RNA from initially identical transcripts, which can result in the generation of related proteins from one gene, often in a manner specific to a type of tissue or a developmental stage.
To learn more about this NEJM Illustrated Glossary term, read the editorial “Toward a Disease-Modifying Therapy for Dravet Syndrome” by Gemma L. Carvill, PhD, and Heather C. Mefford, MD, PhD, from @NUFeinbergMed and @StJudeResearch: https://www.nejm.org/doi/full/10.1056/NEJMe2515874
Explore more terms: https://illustrated-glossary.nejm.org/index.html
𝗕𝗶𝗼𝗹𝗼𝗴𝗶𝗰 𝗨𝗻𝗱𝗲𝗿𝗽𝗶𝗻𝗻𝗶𝗻𝗴𝘀 𝗼𝗳 𝗦𝗶𝗱𝗲 𝗘𝗳𝗳𝗲𝗰𝘁𝘀 𝗼𝗳 𝗥𝗮𝗱𝗶𝗮𝘁𝗶𝗼𝗻
Radiobiologic models developed with the use of characteristics such as mitotic capacity, tissue hierarchy, and differentiation state can predict responses in normal tissue at the levels of the cell, tissue, and organ. For example, the interaction of the dose and volume of radiation with the risk of effects in normal tissue is tissue- or organ-specific and dependent on the organization of the smallest functional subunits (e.g., nephrons, neurons, or alveoli) within the tissue. For some organs in which the functional subunits are organized in parallel (e.g., nephrons in the kidney), approximately a third of the total volume of the organ must be spared from receiving a relatively low threshold dose to maintain functional organ viability. The remaining two thirds of the organ constitutes a functional reserve. In contrast, when functional subunits are arranged in series (e.g., spinal cord neurons), even a focal injury threatens organ function (e.g., spinal cord myelopathy). Tissues with parallel organization generally have a higher tolerance for radiation than tissues with serial organization. Ablative treatments such as stereotactic ablative radiotherapy are more likely to have an acceptable safety profile when applied in and around tissues with parallel organization or in tissues capable of compensatory hyperplasia after injury than in serially functioning tissues (seen in figure).
Learn more in the Review Article “Effects of Radiotherapy in Normal Tissue” by @DeborahCitrin, MD, and Robert D. Timmerman, MD (@BobTimmermanMD), from the National Cancer Institute and @UTSWMedCenter: https://www.nejm.org/doi/full/10.1056/NEJMra2506017
A 47-year-old man was transported to the ED by EMS after being found dyspneic in his car. An initial CT angiogram of the chest shows bibasilar atelectasis. Note that the dark box in the upper right corner obscures equipment associated with the ventilator. Full case details: https://www.nejm.org/doi/full/10.1056/NEJMcps2508044
iMODERN trial: For patients with STEMI and multivessel disease, the preferred timing of treatment of nonculprit lesions remains uncertain. Research findings comparing iFR-guided PCI and deferred MRI–guided PCI are summarized in a new Quick Take video. https://www.nejm.org/doi/full/10.1056/NEJMdo008391
Original Article: Neoadjuvant GOLP in Resectable High-Risk Intrahepatic Cholangiocarcinoma (phase 2–3 ZSAB-neoGOLP trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2513918
#Oncology #Gastroenterology
In a case from @NEJM, a 91-year-old man had shortness of breath, weight loss, and eosinophilia. He also had pulmonary infiltrates on radiography. Read more: https://nej.md/4b0ZUSn
Medical credit cards have emerged as a popular financing tool for patients seeking care they might otherwise be unable to afford, write the authors of a new Perspective. But these cards may ultimately increase financial burdens on patients. Read the Perspective by Alexandra Alvarez, MD, Caroline E. Sloan, MD, and Peter A. Ubel, MD (@peterubel): https://www.nejm.org/doi/full/10.1056/NEJMp2514612
A woman presented with a 1-year history of a crawling sensation on her chin that caused her to scratch the area. An irregular ulcer was present on the right side of her chin, with reduced sensation around the mouth, lip, and chin.
Read the full case details in the Images in Clinical Medicine article “Trigeminal Trophic Syndrome,” from @pennmedicine: https://www.nejm.org/doi/full/10.1056/NEJMicm2512031
Ruqaiijah Yearby, JD, MPH, discusses recent trends in health care markets and their implications for health equity. Listen to the full interview with NEJM Executive Managing Editor Stephen Morrissey (@srm128): https://www.nejm.org/doi/full/10.1056/NEJMdo008435
Original Article: Efficacy and Safety of Obinutuzumab in Active Systemic Lupus Erythematosus (phase 3 ALLEGORY trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2516150
#SLEuro | @SLEuroSociety
Clinical Decisions: Blood-Pressure Targets in Hypertension Management https://www.nejm.org/doi/full/10.1056/NEJMclde2505268
#Cardiology #MedEd
Finerenone improves kidney and cardiovascular outcomes in patients with chronic kidney disease and type 2 diabetes, but its efficacy in type 1 diabetes is unknown. The phase 3 FINE-ONE trial involving patients with CKD and type 1 diabetes is summarized in a new Quick Take video. https://www.nejm.org/doi/full/10.1056/NEJMdo008389
Original Article: Immediate or Deferred Nonculprit-Lesion PCI in Myocardial Infarction (iMODERN trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2512918
Editorial: Assessing Nonculprit Coronary-Artery Lesions in STEMI https://www.nejm.org/doi/full/10.1056/NEJMe2517834
#Cardiology
A 74-year-old man presented to the hospital for the third time in three weeks with recurrent fever, muscle aches, and vomiting. In the prior two hospitalizations, symptoms had self-resolved and broad work-up was unremarkable. He had traveled to Yosemite National Park one week prior to symptom onset. Physical examination was notable for rigors and diaphoresis. Peripheral blood smears are shown. What is the most likely diagnosis? https://www.nejm.org/image-challenge?ci=20260305
In a new Perspective, Jose F. Figueroa, MD, MPH (@joefigs2), and Ellen Meara, PhD, write that the AHEAD model was intended to slow health care cost growth, improve population health, and advance health equity. But under the new administration, its focus has shifted from equity to efficiency. Learn more: https://www.nejm.org/doi/full/10.1056/NEJMp2514355
Presented at the 15th European Lupus Meeting:
In patients with SLE without advanced lupus nephritis, obinutuzumab plus standard therapy was superior to placebo plus standard therapy in conferring and sustaining a clinically meaningful reduction in disease activity over 52 weeks. Full phase 3 ALLEGORY trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2516150
#SLEuro | @SLEuroSociety
Advances in the planning and delivery of radiation treatments have come from efforts to simultaneously reduce negative effects in normal tissues and enhance tumor control (seen in figure). Learn more: https://www.nejm.org/doi/full/10.1056/NEJMra2506017
Emily Hill, DO, who recently finished her family medicine residency, discusses a case that turned out to be one of her most gratifying she had as a resident.
Hear more from Dr. Hill in the latest episode of the Not Otherwise Specified podcast hosted by NEJM National Correspondent Lisa Rosenbaum, MD: https://not-otherwise-specified-podcast.nejm.org/e/of-trust-ai-and-green-beans/
Listen to past episodes and subscribe to the podcast: https://not-otherwise-specified-podcast.nejm.org/
The authors of a new Perspective argue that private equity firms have gained increasing control of U.S. health care infrastructure. Along with other potential consequences, this growth threatens to undermine progress in health equity. Read the latest in the Corporatization of U.S. Health Care series: https://www.nejm.org/doi/full/10.1056/NEJMp2415615
A CD19-targeted therapy induced remission in a woman with refractory immune thrombocytopenia and antiphospholipid syndrome by stabilizing platelet counts, eliminating pathogenic antibodies, and enabling safer long-term anticoagulation. Read the full report: https://www.nejm.org/doi/full/10.1056/NEJMc2516228
A 47-year-old man was brought to the ED by EMS after being found dyspneic in his car. He reported having been drinking for 6 hours before presentation. He noted a sensation of tongue swelling and difficulty breathing.
Read the full case details in the Clinical Problem-Solving article “The Eyes Have It” by S.M.A. Gayed et al., from the University of North Carolina at Chapel Hill (@unc): https://www.nejm.org/doi/full/10.1056/NEJMcps2508044
New in the March 5, 2026, issue of NEJM:
Finerenone in Type 1 Diabetes and CKD (phase 3 FINE-ONE trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2512854
Nonculprit-Lesion PCI in Myocardial Infarction (iMODERN trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2512918
Zorevunersen in Children with Dravet Syndrome https://www.nejm.org/doi/full/10.1056/NEJMoa2506295
Neoadjuvant GOLP in Intrahepatic Cholangiocarcinoma (phase 2–3 ZSAB-neoGOLP trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2513918
Subscribe to NEJM for the latest medical research: https://store.nejm.org/nejm/subscribe/choice
A woman with asthma and obstructive sleep apnea presented with a 1-month history of worsening dyspnea and dry cough. CT of the chest showed anterior bowing of the posterior wall of the intrathoracic trachea during expiration.
Read the full case details in the Images in Clinical Medicine article “Expiratory Central Airway Collapse,” from University of Iowa Hospitals and Clinics (@uihealthcare): https://www.nejm.org/doi/full/10.1056/NEJMicm2503296
A new review summarizes advances in radiotherapy that reduce injury to normal tissue, including improvements in the precision of imaging and delivery, and outlines strategies to prevent and manage treatment-related side effects.
Read the Review Article “Effects of Radiotherapy in Normal Tissue” by @DeborahCitrin, MD, and Robert D. Timmerman, MD (@BobTimmermanMD), from the National Cancer Institute and @UTSWMedCenter: https://www.nejm.org/doi/full/10.1056/NEJMra2506017
Neoadjuvant gemcitabine–oxaliplatin, lenvatinib, and anti–PD-1 antibody led to longer event-free survival than surgery alone in resectable high-risk intrahepatic cholangiocarcinoma, with mainly low-grade adverse events. Full phase 2–3 ZSAB-neoGOLP trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2513918
Gemma L. Carvill, PhD, and Heather C. Mefford, MD, PhD, describe the scientific foundations of a study of zorevunersen, an antisense oligonucleotide, for the treatment of a severe epilepsy syndrome.
Learn more about the science behind the study in the editorial “Toward a Disease-Modifying Therapy for Dravet Syndrome,” from @NUFeinbergMed and @StJudeResearch: https://www.nejm.org/doi/full/10.1056/NEJMe2515874
This report describes the effects of zorevunersen, an antisense oligonucleotide designed to up-regulate NaV1.1 sodium channels, in patients with Dravet syndrome, which is a severe developmental and epileptic encephalopathy. Read the full report: https://www.nejm.org/doi/full/10.1056/NEJMoa2506295
Science behind the Study: Toward a Disease-Modifying Therapy for Dravet Syndrome https://www.nejm.org/doi/full/10.1056/NEJMe2515874