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[Correspondence] Simultaneous outbreaks of Ebola, cholera, mpox, and measles in DR Congo in 2025

On Sept 4, 2025, the DR Congo Government and Ministry of Health announced a new Ebola virus disease outbreak in the Bulape health zone (Kasai province), marking the end of over 15 years without any reported cases of Ebola virus disease in this region. As of Sept 14, 2025, there were 35 confirmed Ebola virus disease cases and 16 deaths, representing a case fatality rate of 45·7%.1,2 This unexpected resurgence in a region with insufficient preparedness capacity raises serious concerns about potential regional spread, including towards neighbouring Angola.

[Correspondence] First clinical pregnancy following AI-based microfluidic sperm detection and recovery in non-obstructive azoospermia

Male factor infertility accounts for up to 40% of infertility cases,1 with azoospermia and cryptozoospermia (conditions characterised by absent or extremely rare sperm in the ejaculate) comprising approximately 10–15% of these cases.2 For affected couples, diagnosis and treatment often involve years of repeated failed interventions, invasive procedures, and emotional distress. Management options typically include testicular sperm extraction3 or prolonged manual sperm searches by skilled embryologists, followed by intracytoplasmic sperm injection.

[Perspectives] Epistemic dignity

“The opposite of love”, as the saying goes, “is not hate, but indifference.” That is, as intense emotions, love and hate are so close they can easily shift one into another—so close they belong together on the same side of a divide, with indifference on the other side. But the subtext of this saying is, really, epistemic. It is about knowledge, about knowing and not knowing. It is about the ethical responsibility to be aware, to pay attention, to not look away, to have respectful regard for the lives of other and othered people, to affirm their dignity as knowers, to attend to their knowledge, sensemaking, experiences, and aspirations, on their own terms.

[Perspectives] Coordinating health AI to prevent defensive escalation

Artificial intelligence (AI) systems that can analyse medical images, records, and claims are becoming accessible to everyone. Although these systems outperform physicians at specific tasks, such as detecting cancer on CT scans, they are still imperfect. But as AI performance progresses from occasionally correct to reliably superior, there will be increasing pressure to conform to algorithmic outputs.

[Comment] Offline: The death of globalism (part 2)

The only stable future for the world is through strong nation states, argues Philip Cunliffe in his book The National Interest: Politics after Globalization (2025). The invasion of Ukraine on Feb 24, 2022, was an inflection point that drew political attention to the importance of protecting and strengthening the nation state. Cunliffe observes that political systems are now being slowly renationalised—eg, the re-shoring of supply chains. Enemies of this project of renationalisation must be defeated, purged, or erased: the institutions of globalism—associations and unions of nation states, global governance mechanisms, and international humanitarian laws.

[Comment] New perspectives on semaglutide in cardiovascular disease

The prevalence of overweight and obesity has reached pandemic proportions, affecting more than 1 billion people worldwide; it represents a major driver of cardiovascular morbidity, mortality, and health-care costs.1 Excess adiposity triggers a complex cascade of metabolic and vascular disturbances which increase the risk of atherosclerotic cardiovascular disease, heart failure, and mortality.2,3 GLP-1 receptor agonists have emerged as an important therapy at an intersection of obesity and cardiovascular disease.

[Comment] Three-month dual antiplatelet therapy after percutaneous coronary intervention: time for a new standard

After percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) is recommended for 6 months in stable coronary artery disease1,2 and 12 months in acute coronary syndromes.3,4 Over the past decade, several trials have tested shorter regimens.5 Most of these trials were non-inferiority trials powered for composite endpoints combining ischaemic and bleeding events—so-called net adverse clinical events. This design often suggested non-inferiority of abbreviated DAPT, but uncertainty remains regarding true protection from major adverse cardiac or cerebrovascular events.

[Comment] The arrival of antibody drug conjugates in nasopharyngeal cancer

Nasopharyngeal cancer has long been known for its high sensitivity to chemotherapy.1 In the first randomised phase 3 trial reported in recurrent or metastatic nasopharyngeal cancer,2 the combination of cisplatin and gemcitabine was established as the standard first-line chemotherapy after resulting in superior overall survival than the comparator cisplatin and 5-fluorouracil.3,4

[Comment] Front-line durvalumab and BCG in the treatment of non-muscle-invasive bladder cancer

Over the past 5 years, systemic therapy for urothelial carcinoma has changed considerably throughout the clinical stages.1 In addition to regulatory approvals of immune-checkpoint inhibitor (ICI)-based therapies for muscle-invasive or metastatic disease, advances have also been made for non-muscle-invasive bladder cancer (NMIBC). Nadofaragene firadenovec-vncg, nogapendekin alfa inbakicept-pmln, and gemcitabine intravesical system (TAR-200) have been approved by the US Food and Drug Administration and cretostimogene grenadenorepvec has been granted fast-track and breakthrough therapy designation for the treatment of BCG-unresponsive NMIBC with a carcinoma in situ component; pembrolizumab is the only approved ICI treatment for these tumours.

Pseudoxanthoma Elasticum and the Logic of its Ocular Manifestations

Pseudoxanthoma elasticum (PXE) is a fascinating disease. Its hallmark clinical findings, salient changes in the skin, cardiovascular system, and eyes, seemed at odds with the biology of the causative gene-encoding adenosine-binding cassette protein C6, ABCC6, which is expressed predominantly in the liver and, to a lesser degree, the kidneys. The paradox of gene expression in one organ but disease manifestations in entirely different organs slowed conceptual progress for years. Calcification and fragmentation of elastic fibers in the skin results in yellow papules, cobblestone plaques, and laxity, especially in flexural areas. Blood vessel involvement causes early-onset vascular calcification and atherosclerosis, contributing to complications like claudication, ischemic heart disease, and an increased risk of gastrointestinal bleeding from vascular brittleness and fragility. Ocular involvement often leads to loss of central vision and will be the focus of most of this commentary. The intriguing aspect of PXE was how was the laundry list of disparate pathological findings tied together?

[Personal View] Overlooked determinants and unequal outcomes: rethinking metabolic dysfunction-associated steatotic liver disease beyond the biomedical model

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a public health priority due to its high prevalence, silent clinical course, and liver and systemic outcomes. With an estimated prevalence of 30% in the general population, MASLD is the most common chronic liver disease worldwide. Apart from the underlying metabolic factors, MASLD development and progression are strongly influenced by social and commercial determinants of health, and an associated stigma, which perpetuate inequities and hinder access to high-quality clinical management.

[Review] Reducing alcohol-associated liver disease burden in the general population

The prevalence of alcohol use disorder (AUD) and alcohol-associated liver disease (ALD) is rising. The National Institute on Alcohol Abuse and Alcoholism organised a multistakeholder workshop focused on reducing the burden of ALD. Decreasing ALD morbidity and mortality requires a multipronged approach, including increased population-based screening for AUD, early recognition of ALD, and multidisciplinary treatment. Recommended screening tools for alcohol use include the alcohol use disorders identification test for consumption (AUDIT-C).

[Articles] Efficacy of behavioural therapies for irritable bowel syndrome: a systematic review and network meta-analysis

Several behavioural therapies are efficacious for global symptoms in IBS, although the most evidence exists for those classed as brain–gut behaviour therapies. However, certainty in the evidence for all direct and indirect comparisons across the network were rated as either low or very low confidence, due in part to publication bias and the risk of bias of the included trials.

[Articles] Endoscopic versus surgical gastroenterostomy for palliation of malignant gastric outlet obstruction (ENDURO): a randomised controlled trial

In patients with malignant gastric outlet obstruction, palliative treatment with endoscopic gastroenterostomy was superior to surgical gastroenterostomy for time to resumption of solid oral intake and was non-inferior for the rate of persistent or recurrent obstructive symptoms requiring re-intervention. Based on these results, endoscopic gastroenterostomy should be the preferred palliative treatment for patients with malignant gastric outlet obstruction.

[News] Research in Brief

Low-dose aspirin reduces the risk of colorectal cancer recurrence in patients with resected PI3K-altered localised disease, according to the ALASCCA trial. Anna Martling and colleagues randomly assigned patients with prespecified PIK3CA hotspot mutations in exon 9 or 20 (group A) or other moderate-to-high impact variants in PIK3CA, PIK3R1, or PTEN (group B) to receive either aspirin 160 mg (157 in group A, 156 in group B) or placebo (157 in group A, 156 in group B) once daily for 3 years. 3-year cumulative incidence of recurrence in group A was 7·7% with aspirin versus 14·1% with placebo (hazard ratio [HR] 0·49, 95% CI 0·24–0·98; p=0·04).