Medical Journal News

AbstractObjectivesTo investigate whether a less intense antiplatelet regimen could be used for people receiving drug coated balloons.DesignMulticentre, randomised, open label, assessor blind, non-inferiority trial (REC-CAGEFREE II).Setting41 hospitals in China between 27 November 2021 and 21 January 2023.Participants1948 adults (18-80 years) with acute coronary syndrome who received treatment exclusively with paclitaxel-coated balloons according to the international drug coated balloon consensus.InterventionsParticipants were randomly assigned (1:1) to either the stepwise dual antiplatelet therapy (DAPT) de-escalation group (n=975) consisting of aspirin plus ticagrelor for one month, followed by five months of ticagrelor monotherapy, and then six months of aspirin monotherapy, or to the standard DAPT group (n=973) consisting of aspirin plus ticagrelor for 12 months.Main outcome measuresThe primary endpoint was net adverse clinical events (all cause death, stroke, myocardial infarction, revascularisation, and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding) at 12 months in the intention-to-treat population. Non-inferiority was established if the upper limit of the one sided 95% confidence interval (CI) for the absolute risk difference was smaller than 3.2%.ResultsThe mean age of participants was 59.2 years, 74.9% were men, 30.5% had diabetes, and 20.6% were at high bleeding risk. 60.9% of treated lesions were in small vessels, and 17.8% were in-stent restenosis. The mean drug coated balloon diameter was 2.72 mm (standard deviation 0.49). At 12 months, the primary endpoint occurred in 87 (8.9%) participants in the stepwise de-escalation group and 84 (8.6%) in the standard group (difference 0.36%; upper boundary of the one sided 95% CI 2.47%; Pnon-inferiority=0.013). In the stepwise de-escalation versus standard groups, BARC type 3 or 5 bleeding occurred in four versus 16 participants (0.4% v 1.6%, difference −1.19% (95% CI −2.07% to −0.31%), P=0.008), and all cause death, stroke, myocardial infarction, and revascularisation occurred in 84 versus 74 participants (8.6% v 7.6%, difference 1.05% (95% CI −1.37% to 3.47%), P=0.396). Treated as having hierarchical clinical importance by the win ratio method, more wins were noted with the stepwise de-escalation group (14.4% wins) compared with the standard group (10.1% wins) for the predefined hierarchical composite endpoint of all cause death, stroke, myocardial infarction, BARC type 3 bleeding, revascularisation, and BARC type 2 bleeding (win ratio 1.43 (95% CI 1.12 to 1.83), P=0.004). Results from the per-protocol and the intention-to-treat analysis were similar.ConclusionsAmong participants with acute coronary syndrome who could be treated by drug coated balloons exclusively, a stepwise DAPT de-escalation was non-inferior to 12 month DAPT for net adverse clinical events.Trial registrationClinicaltrials.gov NCT04971356

bmj;388/mar31_1/r624/FAF1faSt Bartholomew’s medical school had only been accepting female students for eight years when Coral Sharpe (née Knight) began studying in 1955. Sharpe was not an obvious trailblazer, but in her quiet, resolute way she was determined to study medicine and keep working as a doctor when society might have expected her to concentrate on being a wife and mother.Medicine was in Sharpe’s blood. Her father, Bryant, was a GP in north west London and the whole family was immersed in the practice—Sharpe’s mother, Gladys, was, in effect, the receptionist; the waiting room was in Sharpe’s bedroom; and Sharpe, along with her sister Heather and brother Anthony were born either above or next door to the surgery.Sharpe was, in the parlance of the time, a delicate child. She was prone to ear infections and sudden, mysterious fevers; she was also diagnosed with a heart murmur. Gladys’s letters to Bryant, who...

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

March marks Colorectal Cancer Awareness Month, with the aim of raising awareness of the third most common cancer and the second most common cause of cancer deaths worldwide. Of particular concern is the rising incidence of colorectal cancer in people younger than 50 years, but the absolute risk in most younger adults remains low. Most colorectal cancer cases in high-income countries occur in those 50 years and older, although incidence in this population has been decreasing as a result of effective screening programmes.

The pilot of patient safety initiative Martha's Rule in England ends this month with encouraging early results, but will it be extended? Jacqui Thornton reports.

Trump's ban on gender-affirming surgery and medication for minors is clashing with anti-discrimination law. Susan Jaffe reports from Washington, DC.

Countries with long health legacies from nuclear testing are leading calls for new assessments as global nuclear tensions rise. John Zarocostas reports from Geneva.

When I first spoke to Yap Boum II in January, 2025, he had recently become Deputy Incident Manager for the continental response to mpox with the Africa Centres for Disease Control and Prevention (Africa CDC) based in DR Congo. He took up the post at a “historical moment”, he says. “It is the first time that Africa CDC and WHO have decided to co-lead a response in Africa, and we are doing that together with around 28 partners, around one plan, one budget, one monitoring and evaluation framework, and, more importantly, one team.” Boum's role “is really to ensure that we have coordinated action of our partners in the different countries that are affected by mpox”, he says.

The COVID-19 pandemic showed in real time, and with the highest of stakes, how hard it can be to decide if something is true. Was the virus transmitted via surfaces or airborne particles? Which drugs were effective in reducing deaths? Were masks effective? Did the vaccines work? These all seemed like scientific questions for which one might assume there are well established methods to ascertain the answers. But often the issues were complex and the data conflicting, and politicians had only days to decide what to do, not the months or years researchers might typically demand to be sure of their conclusions.

Several months ago, I spent an afternoon at Keats House in Hampstead, London, UK. John Keats (1795–1821) began an apprenticeship to a surgeon–apothecary during his adolescence in 1810 and 5 years later became a medical student at Guy's Hospital in London. By the age of 25 years he had died of tuberculosis. In his tragically brief life, he wrote some of the most affecting works of English literature, demonstrating a steadfast openness to complexity and contradiction. He described this capacity in a letter to his brothers as “Negative Capability”—the state in which a person “is capable of being in uncertainties, Mysteries, doubts, without any irritable reaching after fact & reason”.

The spiritual leader of the Shia Ismaili Muslims and founder of the AKDN. Born in Geneva, Switzerland, on Dec 13, 1936, he died in Lisbon, Portugal, on Feb 4, 2025, aged 88 years.

On Jan 20, 2025, President Trump's decision to withdraw the USA from WHO and suspend foreign aid, including crucial funding for health initiatives targeting HIV, tuberculosis, and malaria, marked a substantial shift in US foreign policy.1 Although the suspension was later reversed following widespread public outcry, the subsequent executive order freezing aid to South Africa underscored a more transactional approach to international relations. This policy, driven by geopolitical considerations, reflects a broader trend of using global health initiatives as means to attain national security goals, rather than international cooperation.

Syria's health-care system has been devastated over a past decade of armed conflict, compounded by long-standing, systematic neglect under the Assad dictatorship. As a result, many populations have been left with minimal or no access to essential medical services.1 With the regime's fall, Syria has an unprecedented opportunity to rebuild its health-care system and tackle these pressing challenges.