Medical Journal News

There are patients you can never forget. Some because you connected unusually deeply with them as people or with their stories—some because you may have seen yourself or a loved one in their shoes, on that gurney, in that pain. On a paediatric rotation as a medical student at Kings County Hospital in East Flatbush, NY, USA, during the 1980s, I was part of team that took care of a toddler slowly succumbing to AIDS. An orphan, as so many were in those terrible years, his bedside chart read Baby M.

Neurologist who developed an integrated model of care for stroke in the UK and saw it become the standard of care nationwide. She was born in Sheffield, UK, on Sept 10, 1956, and died of bowel cancer at home in Wilmslow, UK, on Jan 1, 2025, aged 68 years.

Clinical academia is on a steep decline globally. In the UK, a 6% reduction in the number of clinical academics since 2012 has been reported, with the number of senior lecturer level researchers having decreased by 24%.1 Research is key to evidence-based medicine. Sustainable and progressive change in health research needs to come from within its clinical structure by ensuring full embedment in National Health Service (NHS) core activities.

In early 2025, Taiwan's health-care system faced an unprecedented crisis due to simultaneous outbreaks of influenza and norovirus. The emergency departments had severe overcrowding, which was exacerbated by a shortage of ward beds. A patient died of septic shock after a prolonged 143-km transfer solely for admission to an intensive care unit.1 On Feb 22, 2025, the Taiwan Society of Emergency Medicine issued an urgent statement,2 urging the government to take immediate action. Meanwhile, a government official's dismissive and sarcastic response on social media to an exhausted emergency physician intensified public outrage.

One of the key concerns in the Article by Marco Valgimigli and colleagues is the ambiguity in defining the non-inferiority margin for major adverse cardiovascular or cerebrovascular events (MACCE).1 The study sets a non-inferiority margin of 1·15 for the hazard ratio (HR), which could be considered too lenient given the potential risks associated with de-escalation therapy. A non-inferiority margin of 1·15 means that the study would deem ticagrelor monotherapy acceptable even if it increased the risk of MACCE by 15%.

We read with interest the Article by Marco Valgimigli and colleagues comparing dual antiplatelet therapy (DAPT) de-escalation to ticagrelor monotherapy versus continuing DAPT for 12 months after coronary drug-eluting stent implantation.1 The authors concluded that short-term (<3 months) DAPT and de-escalation to ticagrelor do not increase ischaemic risk and that they reduce the risk of major bleeding. Against this background, we wish to highlight the role of ticagrelor monotherapy in reducing ischaemic complications in patients with diabetes.

I read with great interest the Article by Marco Valgimigli and colleagues.1 The study provides valuable insights into balancing ischaemic protection and bleeding risks, especially in patients with acute coronary syndromes (ACS) and non-ACS. I would like to raise several points for further discussion. First, how did the authors address heterogeneity among patients across different studies, particularly in determining eligibility for de-escalation therapy? Additionally, subgroup analyses between patients with ACS and non-ACS revealed varying outcomes.

We thank our colleagues for their interest in our Article.1 Chunguang Guo and colleagues state that a non-inferiority margin of 1·15 means that the study would deem ticagrelor monotherapy acceptable even if it increased the major adverse cardiovascular or cerebrovascular event (MACCE) risk by 15%.1 This interpretation of the margin fails to consider that the upper 95% CI, not the point estimate, should not cross the margin to reject inferiority. A hazard ratio of 1·00, suggesting identical risks, would have resulted in an upper CI of 1·16 and non-inferiority claim rejection.

We read the Article on the TransMet trial by René Adam and colleagues with great enthusiasm.1 The results are unprecedented, with a staggering 5-year overall survival of 56·6% (95% CI 43·2−74·1) in the liver transplantation plus chemotherapy group compared with 12·6% (5·2–30·1) in the chemotherapy alone group. However, we question whether it is too early to say that the unmet need in patients with unresectable liver-only disease has been addressed.

We read with great interest the results of the TransMet trial1 by René Adam and colleagues showing that the combination of liver transplantation and chemotherapy prolongs survival in patients with colorectal liver metastases and, in some cases, can provide a pathway to cure. We would like to congratulate the authors for their practice-changing trial. We had a few comments regarding its design and some of its results.

We read with great interest the Article on the TransMet trial by René Adam and colleagues.1 This multicentre randomised controlled trial provides robust evidence supporting the benefits of liver transplantation for patients with unresectable colorectal liver metastases, making it an important contribution to the field. We found the study highly valuable; however, a few considerations warrant more discussion.

We thank Akhil Santhosh and colleagues, Dimitrios Moris and colleagues, and Shouhui Yi and colleagues for their positive comments and relevant questions about the practice-changing TransMet trial.1

Strunk T, Molloy EJ, Mishra A, Bhutta ZA. Neonatal bacterial sepsis. Lancet 2024; 404: 277–93—In figure 1 of this Seminar, the teal key title has been updated to “Other neonatal disorders”. This correction has been made to the online version as of April 24, 2025.

Buonfrate D, Ferrari TCA, Adegnika AA, Russell Stothard J, Gobbi FG. Human schistosomiasis. Lancet 2025; 405: 658–70—In this Seminar, Ayola Akim Adegnika's name should have appeared as Prof A A Adegnika in the affiliations. This correction has been made to the online version as of April 24, 2025.

Hu X, Zhang J, Yang S, et al. Angiography-derived fractional flow reserve versus intravascular ultrasound to guide percutaneous coronary intervention in patients with coronary artery disease (FLAVOUR II): a multicentre, randomised, non inferiority trial. Lancet 2025; 405: 1491–504—In this Article, the spelling of author Shengxian Tu's name was incorrect. This correction has been made to the online version as of April 24, 2025, and will be made to the printed version.

Amouzou A, Barros AJD, Requejo J, et al. The 2025 report of the Lancet Countdown to 2030 for women's, children's, and adolescents’ health: tracking progress on health and nutrition. Lancet 2025; 405: 1505–54—In this Review, Abdoulaye Maïga was missing from the author list and his details have been added. These corrections have been made to the online version as of April 24, 2025, and the printed version is correct.

by Naveed Sattar, Martin K. Rutter

Naveed Sattar and Martin K Rutter discuss the contributory role of obesity in the development and progression of cardiovascular disease, and prospects for tackling the obesity epidemic.

New England Journal of Medicine, Volume 392, Issue 16, Page 1609-1620, April 24, 2025.