New England Journal of Medicine - Clinical Medicine

1. Pathobiology — Can We Do Without It?

   With changes to preclinical curricula, some medical schools have eliminated certain freestanding subject-based courses, such as histology and pathobiology.

2. Medical AI and Clinician Surveillance — The Risk of Becoming Quantified Workers

   Many AI innovations could benefit patients and clinicians. Yet medicine should heed lessons from industries in which AI adoption has resulted in reduced autonomy for workers and inferior working conditions.

3. Tongue Atrophy and Fasciculations in Advanced Motor Neuron Disease

   A 32-year-old woman was brought to the hospital with a 3-year history of progressive weakness of the limbs and trunk. On examination, marked atrophy of the tongue with scalloping and fasciculations (shown in a video) was noted.

4. Unrest

   Suddenly plagued by insomnia, a physician loses her optimism and sense of her own power to help suffering patients and families. As she recovers, she places greater emphasis on everyone’s need for sleep.

5. Intravenous Rehydration for Severe Acute Malnutrition with Gastroenteritis

   A trial involving children with severe acute malnutrition and gastroenteritis showed no evidence of a difference in mortality at 96 hours between oral and intravenous rehydration strategies.

6. Proportional-Assist Ventilation for Minimizing the Duration of Mechanical Ventilation

   In this randomized trial, proportional-assist ventilation with load-adjustable gain factors did not differ significantly from pressure-support ventilation with respect to the time to liberation from mechanical ventilation.

7. Nerandomilast in Patients with Progressive Pulmonary Fibrosis

   In this randomized trial involving patients with progressive pulmonary fibrosis, treatment with nerandomilast led to a smaller decline in the forced vital capacity than placebo over a period of 52 weeks.

8. Nerandomilast in Patients with Idiopathic Pulmonary Fibrosis

   In this randomized trial, nerandomilast slowed disease progression in patients with idiopathic pulmonary fibrosis as compared with placebo.

9. A Randomized Trial of Acute Normovolemic Hemodilution in Cardiac Surgery

   In this trial involving adult patients undergoing elective cardiac surgery, acute normovolemic hemodilution did not reduce the number of patients receiving allogeneic red-cell transfusion.

10. Once-Weekly Mazdutide in Chinese Adults with Obesity or Overweight

    Once-weekly mazdutide, a glucagon-like peptide-1 and glucagon receptor dual agonist, provided clinically relevant reduction in body weight in Chinese adults with obesity or overweight.

11. A Crossover Trial of Hospital-Wide Lactated Ringer’s Solution versus Normal Saline

    In this cluster-randomized, crossover trial, hospital-wide use of lactated Ringer’s solution as compared with normal saline did not alter the incidence of death or hospital readmission within 90 days.

12. Ramsay Hunt Syndrome

    A 48-year-old woman presented with a 1-day history of a rash on her right ear that was preceded by 2 days of ear pain and an inability to move the right side of her face.

13. John Collins Warren — Journal Founder, Institution Builder, and Racial Theorist

    John Collins Warren’s central position in 19th-century American medicine makes him an apt focus for studying the influence of racist theories on critical medical institutions, including the Journal.

14. Overweight and Obesity — Capturing the Whole Picture

    Overweight and obesity represent addressable proximal drivers of chronic disease.1 The prevalence of overweight and obesity is increasing around the world; by 2050, projections indicate that more than half the adult population worldwide will be living with overweight and obesity, most prominently in China (an estimated 627 million...

15. Cardiac Injury Detected by Smartwatch

    A 76-year-old retired cardiovascular nurse presented to the ED with 2 hours of chest pain triggered by severe emotional distress and associated with changes in the electrocardiogram on her smartwatch.

16. Progress through Persistence — Turning the Page in Pulmonary Fibrosis Clinical Trials

    The field of pulmonary fibrosis has come a long way in the past 25 years, with the approach to patient care evolving from a predominantly experience-based decision-making model to a more data-driven model. Along that journey, we have learned that certain practices that were considered to be standards of care...

17. Acknowledging Racism, Building Trust — Conversations That Matter in Maternal Medicine

    Recognizing their increased risks during pregnancy and frustrated by the slow pace of change, an Ob/Gyn decides to discuss racism and risks with Black and Indigenous patients at their first visit.

18. Case 16-2025: A 34-Year-Old Man with a Nasopharyngeal Mass

    A 34-year-old man was admitted to the hospital because of left ear pain with hearing loss and facial droop on the left side. Computed tomography showed a nasopharyngeal mass. A diagnosis was made.

19. Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes

    In this trial in persons with chronic kidney disease and type 2 diabetes, combination therapy with finerenone and empagliflozin led to a greater reduction in the urinary albumin-to-creatinine ratio than either drug alone.

20. Navigational Bronchoscopy or Transthoracic Needle Biopsy for Lung Nodules

    In this randomized trial, biopsy of indeterminate pulmonary lesions with navigational bronchoscopy was noninferior to that with transthoracic needle biopsy and led to fewer complications.