𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 infection is an infectious disease, and treatment regimens should ideally be guided by antimicrobial-susceptibility testing whenever possible. 🔗 nej.md/4Bj3O58

Both phenotypic (culture-based) and molecular methods of antimicrobial-susceptibility 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: nej.md/4Bj3O58

Correspondence: Chemogenetic Neuromodulation for Refractory Epilepsy nej.md/4Agtyhz

#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 nej.md/4AaJgdO

Editorial: Bringing Rapid Reperfusion to More Patients with Out-of-Hospital Cardiac Arrest nej.md/47XmDxE

@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): nej.md/48hnzNz

𝐉𝐮𝐬𝐭 𝐩𝐮𝐛𝐥𝐢𝐬𝐡𝐞𝐝!

Original Article by S.E. Nissen et al.: Extended Analyses of Pelacarsen and Cardiovascular Outcomes in Patients with High Lipoprotein(a) eviden.cc/4eQEutM

#ScientificSessions26 | @AHAScience

Presented at #ScientificSessions26:

Among patients with cardiovascular disease and high lipoprotein(a) levels, pelacarsen lowered the lipoprotein(a) level, but the risk of major cardiovascular events was similar with pelacarsen and placebo. Full phase 3 Lp(a)HORIZON trial Ak0pcXAOC

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Presented at #ScientificSessions26:

In patients with atherosclerotic cardiovascular disease, chronic kidney disease, and inflammation, ziltivekimab decreased interleukin-6 levels but did not result in fewer cardiovascular events than placebo. Full ZEUS trial results: nej.md/3UCOqQC

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Among patients with hypertension due to primary aldosteronism, reductions in blood pressure and the aldosterone-to-renin ratio persisted for 2 years after completion of an extended course of aldosterone synthase inhibition. Full study results: nej.md/4jXjULO | @AHAScience

Trending on NEJM.org:

𝐓𝐀𝐕𝐑 𝐢𝐧 𝐏𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐰𝐢𝐭𝐡 𝐌𝐨𝐝𝐞𝐫𝐚𝐭𝐞 𝐀𝐨𝐫𝐭𝐢𝐜 𝐒𝐭𝐞𝐧𝐨𝐬𝐢𝐬 𝐰𝐢𝐭𝐡 𝐀𝐭-𝐑𝐢𝐬𝐤 𝐅𝐞𝐚𝐭𝐮𝐫𝐞𝐬 (𝐏𝐑𝐎𝐆𝐑𝐄𝐒𝐒 𝐓𝐫𝐢𝐚𝐥) by P. Généreux et al.

In patients with moderate aortic stenosis and at-risk e who died or had a heart-failure event within 2 years was lower with transcatheter aortic-valve replacement than with surveillance (16.7% vs. 23.9%).

Read the article: nej.md/4eUv9kA

Among the biggest changes in intravenous thrombolysis practice in the past 5 years has been the increased use of tenecteplase over alteplase. Tenecteplase, a slightly modified form of tissue plasminogen activator, has more fibrin specificity and longer half-life than alteplase ven more conveniently as a single bolus rather than the one-hour infusion needed for alteplase. In the past decade, tenecteplase has been tested in comparison with alteplase in patients with acute ischemic stroke. Although tenecteplase may result in higher rates of recanalization, trials have shown that clinical outcomes are essentially equivalent between the two drugs — or at least the conclusion can be made that tenecteplase is noninferior to alteplase in terms of benefit and safety. Largely on the basis of these noninferiority results, in 2025, the FDA approved the use of tenecteplase in patients with acute ischemic stroke. Although accurate patient weight is important to establish doses for both alteplase and tenecteplase, the tiered dosing of tenecteplase that was approved by the FDA (seen in table) makes rapid determination of the appropriate dose easier.

Read the Review Article “Intravenous Thrombolysis for Acute Ischemic Stroke — New Directions”: nej.md/4iuL5Lr

Original Article: Retatrutide, a Triple Hormone Receptor Agonist, for Treatment of Obesity (phase 3 TRIUMPH-1 trial) nej.md/4ycgSHz

Editorial: A Triple Incretin Agonist for Obesity, Osteoarthritis, and Sleep Apnea nej.md/4izSuJs

#Endocrinology #Rheumatology

Many patients with suspected acute coronary syndrome in whom MI has been ruled out remain at risk for cardiovascular events; whether further investigation reduces risk is unknown. Research findings from the TARGET-CTCA trial are summarized in a new Quick Take video. nej.md/4faiQAK

#ESCCongress

In a new NEJM Voices blog post, Dr. Theodore Iwashyna discusses the things he does every morning before rounds. Read “My Pre-Rounding Routines” and sign up for email alerts: nej.md/4Ac4R5z

An 81-year-old man with a smoking history of approximately 60 pack-years was found to have a flank bulge. Twenty years earlier, he underwent surgical resection of three left ribs and a segment of lung for treatment of mesothelioma. He reported onset of the bulge as well as rs after the surgery. The protrusion was soft and compressible, and moved inward during inspiration and outward during expiration. Vesicular breath sounds were heard over the area. What is the most likely diagnosis? Submit your answer and see how others responded: nej.md/IC11052026

Learn how Peking University First Hospital used the IQEQS model to overcome fragmented repair and materials-management processes, weak links between operational and financial data, and increasing demands for cost stewardship and safety governance: nej.md/4sHdF0P

Dr. Karol Watson and Dr. David Cohen, our guides for @American_Heart's Scientific Sessions 2026, talk to NEJM Group interviewer Dr. André Sofair about what studies they are most excited about. Full interview: nej.md/4eiJaIG

#ScientificSessions26 | @AHAScience

A 58-year-old woman initially had fever and muscle aches, followed by abdominal pain and a nonproductive cough days later. She has right-upper-quadrant tenderness and crackles at the right lung base. How would you build the differential diagnosis? eviden.cc/47B0gOl

When patients, or the parents of patients, become heavily invested in searching for someone to blame for an illness, it’s useful to ask what the search is doing for them, writes Daniel A. Brenner, MD, in a new Perspective essay. Its accuracy is rarely the point. Read “When : nej.md/4ixwJKb

D’Antiga and colleagues report 4-year follow-up data on gene therapy for the correction of hyperbilirubinemia in five patients with Crigler–Najjar syndrome. Full study results: nej.md/4jXF7oN

As a medical director, would you recommend implementing an AI scribe for residents’ clinical notes or recommend that it not be implemented? Read the case vignette and options and vote: nej.md/47WS6QA

Case Record of the Massachusetts General Hospital (@MassGeneralNews): A 42-year-old woman with a previous trachelectomy and cerclage for cervical cancer presented with vaginal hemorrhage at 20 weeks’ gestation. 👉 nej.md/4yP8kGm

The anatomical survey showed placenta e underlying vascular plexus. Owing to the surgical history, IVF pregnancy, and increased vascularity of the lower uterine segment, placenta previa with placenta accreta spectrum disorder was suspected to be the anatomical diagnosis, with vaginal bleeding resulting from the placenta previa compounded by bleeding from ruptured uterovaginal varices (seen in figures).

Read the full case details in “A 42-Year-Old Pregnant Woman with Vaginal Hemorrhage,” a Case Record of the Massachusetts General Hospital, by M. Prabhu et al.: nej.md/4yP8kGm