JAMA Network Open最新文献

Importance: Preterm infants are at high risk of developing brain injury, and near-infrared spectroscopy (NIRS) offers the ability to measure cerebral oxygenation. The impact of using a standardized treatment guideline combined with a single NIRS device manufacturer (Nonin Medical Inc) and neonatal sensor on cerebral oxygenation has not been previously examined.

Objective: To investigate whether cerebral oximetry with a dedicated treatment guideline improves cerebral oxygenation stability.

Design, setting, and participants: This was a single-blinded, 2-arm randomized clinical trial conducted from October 2021 to July 2024 at 5 tertiary neonatal intensive care units across Australia, New Zealand, and the US. Infants born at less than 29 weeks' gestation and aged younger than 6 hours underwent 1:1 random allocation stratified by gestational age (<26 weeks and ≥26 weeks) and study site.

Intervention: The intervention group received cerebral oximetry and dedicated guideline-based treatment when cerebral oxygenation was outside the range of 65% to 90%. The control group had blinded cerebral oximetry and treatment guided by standard clinical monitoring.

Main outcomes and measures: The burden of cerebral hypoxia and hyperoxia during the first 5 days after birth expressed as percentage hours was the primary outcome. Key secondary outcomes were mortality, morbidities before discharge, and NIRS-related skin injury.

Results: Of 149 screened infants (53 randomized to the intervention and 51 randomized to standard care), 100 infants were included in the final analysis (median [IQR] gestational age, 27 [25-28] weeks; 48 male [48.0%]). The median (IQR) birth weight was 883 (709-1079) g. The intervention group (50 infants) had a significantly lower median (IQR) burden of hypoxia and hyperoxia of 5.7% hours (2.8% hours to 15.0% hours) compared with 39.6% hours (6.5% hours to 82.3% hours) in the standard care group (50 infants), with an adjusted reduction of 42.8% hours (95% CI, 35.6% hours to 53.3% hours; P < .001). Mortality, morbidities before discharge, and safety outcomes were comparable between groups.

Conclusions and relevance: In this study, treatment guided by cerebral oximetry with a single device manufacturer and a neonatal sensor significantly improved the stability of cerebral oxygenation in extremely preterm infants. Larger multicenter trials are warranted to determine if this finding leads to improved survival without brain injury.

Trial registration: Australian New Zealand Clinical Trials Registry registration number ACTRN12621000778886.

Importance: The impact of late onset in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is still controversial.

Objective: To investigate the association of late onset MOGAD with moderate disability and relapse in Korean patients.

Design, setting, and participants: This nationwide, multicenter, retrospective cohort study included adult patients with a diagnosis of MOGAD according to the 2023 international diagnostic criteria between August 2018 and September 2024 across 28 hospitals in South Korea.

Exposure: Age at onset of MOGAD, categorized into adult-onset MOGAD (AO-MOGAD; 18-49 years) and late-onset MOGAD (LO-MOGAD; ≥50 years).

Main outcomes and measures: The primary outcomes were time to first relapse in patients with a disease duration of 12 or more months and moderate disability, defined as Expanded Disability Status Scale (EDSS) score of 3 or greater at last follow-up.

Results: A total of 350 patients (mean [SD] age at onset, 43.2 [15.0] years; 189 female [54.0%]) with a median (IQR) baseline EDSS of 3.0 (2.0-4.0) were included, with 124 patients (35.4%) with LO-MOGAD and 226 patients (64.6%) with AO-MOGAD. The LO-MOGAD group had less frequent brain involvement than the AO-MOGAD group at onset (26 patients [21.0%] vs 75 patients [33.2%]; P = .02) and during the disease course (28 patients [22.6%] vs 95 patients [42.0%]; P < .001), while optic neuritis or myelitis was comparable between the 2 groups. The LO-MOGAD group showed more frequent monophasic course (55 of 95 patients [57.9%] vs 75 of 188 patients [39.9%]; P = .004), but higher EDSS score at last follow-up (median [IQR], 2.0 [1.0-2.0] vs 1.0 [0.0-2.0]; P < .001) compared with those in the AO-MOGAD group. However, late onset was not significantly associated with the time to first relapse in multivariable analysis (adjusted hazard ratio, 0.72; 95% CI, 0.48-1.08; P = .11), which was consistent after propensity score matching. By contrast, late onset was associated with a significantly higher risk of moderate disability at the last follow-up (adjusted odds ratio, 2.84; 95% CI, 1.39-5.80; P = .004).

Conclusions and relevance: In this cohort study of MOGAD, late onset was not associated with a risk of relapse but with a higher risk of moderate disability at follow-up. Prospective studies with longer follow-up periods are warranted to better understand and manage patients with late-onset disease.

Importance: West Nile virus (WNV), a mosquito-borne orthoflavivirus, represents an increasing public health threat in Europe. In July 2025, WNV lineage 2 (WNV-L2) was associated with the first autochthonous cases ever detected in the metropolitan area around Paris, France; understanding the dispersal dynamics and geographic origin of these emergence events is critical for public health preparedness.

Objectives: To characterize the spatial and temporal dynamics of WNV circulation in France from 2022 to 2025 and to determine the origin of the virus lineages responsible for the 2025 emergence in the Paris metropolitan area.

Design, setting, and participants: This study was a genomic epidemiology assessment combining human, veterinary, and entomological monitoring, with viral genome sequencing and time-resolved, bayesian phylogenetic analysis. Surveillance was conducted across metropolitan France, with a focus on areas with documented WNV circulation (Eastern and Western Mediterranean, South Atlantic, and Paris). Surveillance included patients with confirmed WNV infection, avian and equine cases, and mosquito collections.

Exposures: Natural exposure to WNV through mosquito vectors in affected areas.

Main outcomes and measures: Phylogenetic relationships between emergence events across regions in France were inferred using a bayesian approach.

Results: Genomic data from this epidemiological assessment encompassed 52 WNV-positive samples (6 human, 21 veterinary, and 25 entomological samples). WNV-L2 was the only lineage detected in France between 2022 and 2025. In 2024, Western Mediterranean strains were closely related to those from 2023 from the French South Atlantic area, suggesting west-to-south introduction, whereas Eastern Mediterranean strains represented genetically distinct clades associated with Northern Italy. The phylogenetic analysis of 2025 WNV sequences from the Paris area revealed that the outbreak virus strains all grouped together and originated from the L2 clade of sequences from the South Atlantic area in the 2023 to 2024 period.

Conclusions and relevance: In this study, genomic data from an epidemiologic assessment of 52 WNV-positive samples highlight the combined influence of local virus maintenance and long-distance dispersal in shaping WNV circulation in France. Strengthened genomic surveillance across ecological and administrative boundaries would be essential to anticipate further viral spread, inform response strategies, and protect populations at risk.