NEJM✓

𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 infection is an infectious disease, and treatment regimens should ideally be guided by antimicrobial-susceptibility testing whenever possible. 🔗 Both phenotypic (culture-based) and molecular methods of antimicrobial-susceptibility testing are available (seen in figure). Culture-based testing remains the reference standard because it is the only method that can ascertain the susceptibility of isolates to all antibiotics commonly used for eradication. Molecular antimicrobial-susceptibility testing offers greater efficiency than culture-based testing by eliminating the need for 𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 culture. Molecular-based testing can be conducted with fresh or formalin-fixed gastric-tissue samples (used for histopathological examination) and successfully cultured isolates. More recently, gastric-fluid samples obtained from a swallowed gastric string have emerged as a cost-effective alternative culture-based testing method. Stool-based molecular antimicrobial-susceptibility testing is now available, which avoids invasive endoscopy. Commercial polymerase-chain-reaction–based kits are now available for identifying 𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 resistance to clarithromycin and levofloxacin by detecting specific mutations in the 𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 23S ribosomal RNA and gyrA genes, respectively. A meta-analysis reported high accuracy of these molecular methods for detecting antibiotic resistance in gastric-biopsy samples, with sensitivity and specificity of 96% and 96%, respectively, for clarithromycin resistance and 97% and 99% for quinolone resistance. Learn more in the Review Article “𝘏𝘦𝘭𝘪𝘤𝘰𝘣𝘢𝘤𝘵𝘦𝘳 𝘱𝘺𝘭𝘰𝘳𝘪 Infection — Advances, Challenges, and the Road Ahead” by Hong Li, MD, PhD, Francis Megraud, MD, and Barry J. Marshall, MD:

RT @NEJMClinician: Current type 1 narcolepsy treatment is challenging, often requiring multiple medications with limited relief. Oveporexton, a new twice-daily treatment, improved symptoms in two randomized trials. Read the key results from the @NEJM study:

Presented at #ScientificSessions26: In patients with an out-of-hospital cardiac arrest, a strategy of dispatcher training, training in CPR, and expanded defibrillator use did not provide a benefit over usual care for survival to discharge with a good neurologic outcome. Full RACE-CARS trial results: @AHAScience

Original Article: Intensive Blood-Pressure Lowering in Patients with Type 2 Diabetes (OPTIMAL-DIABETES trial) #ScientificSessions26 | @AHAScience

Presented at #ScientificSessions26: In patients with atrioventricular block, left bundle-branch pacing resulted in a lower incidence of a composite of death, hospitalization for heart failure, or pacing-induced cardiomyopathy than right ventricular pacing. Full OptimPacing trial results: @AHAScience

Presented at #TLM26: A single dose of an siRNA targeting liver expression of 𝘊𝘐𝘋𝘌𝘉 was associated with a reduction in liver fat of 58 to 80% at week 36 after treatment in persons with metabolic dysfunction–associated steatotic liver disease. Full trial results: @AASLDtweets

Original Article: Discontinuing Statins in Older Adults without Cardiovascular Disease (STREAM trial) #ScientificSessions26 | @AHAScience

Original Article: Intensive Blood-Pressure Control in Patients with Previous Ischemic Stroke (OPTIMAL-STROKE trial) #ScientificSessions26 | @AHAScience

Original Article: Prehospital Extracorporeal Life Support in Refractory Out-of-Hospital Cardiac Arrest (OnScene study) Editorial: Bringing Rapid Reperfusion to More Patients with Out-of-Hospital Cardiac Arrest #ScientificSessions26 | @AHAScience

Presented at #ACR26: The WOMAC pain score and body weight decreased significantly more with retatrutide than with placebo in patients with painful knee osteoarthritis and obesity. Full results of the phase 3 TRIUMPH-4 and TRIUMPH-1-OA trials: @ACRheum

Original Article: Pelacarsen and Cardiovascular Outcomes in Patients with High Lipoprotein(a) (phase 3 Lp(a)HORIZON trial) #ScientificSessions26 | @AHAScience

Original Article: Interleukin-6 Inhibition with Ziltivekimab for Atherosclerotic Disease (ZEUS trial) #ScientificSessions26 | @AHAScience

Correspondence: Hyperaldosteronism Remission after Extended Aldosterone Synthase Inhibition #ScientificSessions26 | @AHAScience

Case Record of the Massachusetts General Hospital (@MassGeneralNews): A 42-year-old pregnant woman presented to the labor and delivery triage unit of the hospital at 20 weeks’ gestation because of recurrent heavy vaginal bleeding. 🔗 Macroscopic examination showed a post-trachelectomy gravid hysterectomy specimen (weighing 487 g) with an in situ placenta (measuring 8.5 cm by 7.4 cm) with greater than 90% adherence to the posterior endometrial surface (Panel A). On sectioning, the placenta invaded the myometrium predominantly in the posterior wall (to a depth of up to 0.3 cm in a 2.6-cm wall) and extended to the lower uterine segment (Panel B). On microscopic examination, there were areas with no decidua between the chorionic villi of the placenta and the myometrium, a finding consistent with placental invasion (Panels C and D). Grading of placenta accreta spectrum disorder is based on the extent of invasion and destruction of local tissues. Given the presence of placental invasion with preservation of more than 25% of the total myometrial wall thickness, the criteria were met for placenta accreta spectrum disorder of grade 1–2. Learn more about the disorder and read more about the case in “A 42-Year-Old Pregnant Woman with Vaginal Hemorrhage,” a Case Record of the Massachusetts General Hospital, by M. Prabhu et al.:

Presented at #ScientificSessions26: In patients with type 2 diabetes and high cardiovascular risk, a systolic blood-pressure target below 120 mm Hg did not result in fewer major cardiovascular events than a target below 140 mm Hg. Full OPTIMAL-DIABETES trial results: @AHAScience

Presented at #ScientificSessions26: In older adults with at least two chronic conditions and no known atherosclerotic cardiovascular disease, statin discontinuation was noninferior to continuation for a composite of myocardial infarction, stroke, or death at 2 years. Full STREAM trial results: @AHAScience

Presented at #ScientificSessions26: In patients with previous ischemic stroke or transient ischemic attack, a systolic blood-pressure target below 120 mm Hg was associated with fewer major cardiovascular events than a target below 140 mm Hg. Full OPTIMAL-STROKE trial results: @AHAScience

Original Article: Targeted Use of Computed Tomographic Coronary Angiography in Acute Chest Pain (TARGET-CTCA trial) Editorial: From Detection to Action in Computed Tomographic Coronary Angiography #ESCCongress #Cardiology

Correspondence: Chemogenetic Neuromodulation for Refractory Epilepsy #Neurology

Presented at #ScientificSessions26: In patients 50 years of age or younger with refractory out-of-hospital cardiac arrest, the percentage surviving to hospital discharge was higher with prehospital extracorporeal cardiopulmonary resuscitation than with conventional care. Full OnScene study results: Editorial: Bringing Rapid Reperfusion to More Patients with Out-of-Hospital Cardiac Arrest @AHAScience

Irene Papanicolas, PhD, discusses the role of profit in the U.S. health insurance sector and policy lessons from other countries. Listen to the full interview with NEJM Executive Managing Editor Stephen Morrissey (@srm128):