Anticoagulation for Atrial Fibrillation with Intermediate Stroke Risk.

August 28, 2026| Source: The New England journal of medicine

Current U.S. and European guidelines recommend oral anticoagulation as a class IIa indication in patients with atrial fibrillation at intermediate risk for stroke; however, evidence from randomized trials is needed. We conducted a multicenter, open-label, adjudicator-masked superiority trial in South Korea involving patients with atrial fibrillation and an intermediate risk of stroke (a score of 1 in men and 2 in women on the CHA 2 DS 2 -VASc scale; range, 0 to 9, with higher scores indicating a greater risk of stroke). Patients were randomly assigned in a 1:1 ratio to receive either direct oral anticoagulant (DOAC) therapy or no anticoagulation. The primary end point was a composite of stroke, systemic embolism, major bleeding, or death from cardiovascular causes at 24 months. Of 1803 patients who underwent randomization, 902 were assigned to receive DOAC therapy and 901 were assigned to receive no anticoagulant therapy. The mean age of the patients was 60.4 years, and 23.7% were women. At 24 months, a primary end-point event had occurred in 4 patients (cumulative incidence, 0.5%) in the DOAC group and in 13 (cumulative incidence, 1.5%) in the no-anticoagulant group (difference, -1.0 percentage points; 95% confidence interval [CI], -2.0 to -0.1; P = 0.03; hazard ratio, 0.31; 95% CI, 0.10 to 0.94). Stroke occurred in 3 patients (cumulative incidence, 0.3%) in the DOAC group and in 10 (cumulative incidence, 1.1%) in the no-anticoagulant group. The incidence of systemic embolism and major bleeding appeared to be similar in the two trial groups, and no deaths from cardiovascular causes occurred in either group. Serious adverse events occurred in 80 patients (8.9%) in the DOAC group and in 84 (9.3%) in the no-anticoagulant group. Among patients with atrial fibrillation at intermediate risk for stroke, DOAC therapy led to a lower risk of stroke, systemic embolism, major bleeding, or death from cardiovascular causes at 24 months than no anticoagulation. (Funded by the Ministry of Health and Welfare, South Korea, and others; SINGLE-AF ClinicalTrials.gov number, NCT04437654.).

Read the original source →

Indirect reciprocity with dual private assessment.

People often cooperate out of concern for their reputation. The corresponding theory of indirect reciprocity predicts that such cooperation can only evolve if people's opinions of each other are sufficiently correlated. This correlation, however, can be difficult to achieve when individuals form their opinions independently from one another, as in private assessment models. In that case, errors can generate disagreements that propagate throughout a population. Here, we identify a simple mechanis

Physical/TechSeptember 26, 2026

A genetic program for rapid initiation of axillary meristems at the onset of flowering.

Shoot branching patterns and their diversity arise from variable activities of axillary meristems (AMs). A common feature of flowering plants is delayed AM initiation and growth during the vegetative phase, followed by a sudden and rapid acceleration of apical AM initiation during the reproductive phase. The mechanisms underlying this pronounced developmental shift are poorly understood. During tomato floral transition, the primary shoot meristem (PSM) terminates in a flower after producing two

Physical/TechSeptember 26, 2026

David Botstein: A pioneering geneticist and educator 1942-2026.

David Botstein, who died on February 27, 2026, was a towering figure in the field of modern molecular genetics. His research career was largely focused on the development of methods to better understand biological systems, beginning with his early work on Salmonella phage P22 and yeast, where he exploited the use of conditional lethal mutations as suppressors to identify genes with common functions and to order them in a pathway. He is best remembered for developing restriction fragment length p

Physical/TechSeptember 26, 2026

Ultra-narrowband organic room-temperature phosphorescence achieved by boosting low-frequency vibronic coupling.

We pioneered a strategy based on low-frequency vibronic coupling to design narrowband room-temperature phosphorescent (RTP) materials. Here we select coronene derivative (CoDe) system and report that attaching aroyl group to the coronene core disrupts its intrinsic symmetry and introduces abundant low-frequency vibrational modes, thereby affording efficient room-temperature phosphorescence with a full width at half maximum (FWHM) of approximately 25 nm or narrower. In CoDe systems functionalized

Physical/TechSeptember 25, 2026

Multidomain interaction governs the filamentous assembly of the dominant-negative DNMT3A R882H mutant.

DNA methyltransferase DNMT3A-mediated de novo DNA methylation is important for proper regulation of gene expression and genomic stability in development. The DNMT3A R882H (DNMT3A R882H ) mutation, a hot-spot mutation in acute myeloid leukemia and developmental disorders, exerts a dominant-negative effect in DNMT3A-mediated DNA methylation through promoting high-order protein assembly. However, due to the lack of structural knowledge on DNMT3A homo-oligomers, the mechanism behind wild-type DNMT3A