Tom Nolan

Linwood Barclay's “Not a Word” (Morrow, 320 pages, $30) begins with a misunderstanding.

Tom Nolan reviews this week’s research Protocols for using sodium chloride 0.9% solution, often called “normal saline,” have changed over the past two decades. In part because of its not so normal levels of chloride that are associated with acute kidney injury. A pragmatic trial across five countries assessed balanced crystalloids (Ringer’s solution, Plasma-Lyte, or Hartmann’s solution) versus 0.9% saline in children treated for septic shock. Despite finding higher rates of hyperchloraemia in the 0.9% saline group, there was no difference between groups in the primary outcome of major adverse kidney events after 30 days. N Engl J Med 2026 doi:10.1056/NEJMoa2601969 In theory, neuroprotective and neuroreparative drugs such as loberamisal could improve outcomes …

Tom Nolan reviews this week’s research AI agents are in the news, with warnings that they’re going rogue and may one day bring down the internet or human civilisation. In the meantime it surely won’t be long before AI agents are delivering a big chunk of clinical work, probably well before we understand what their long term impact will be. The latest study edging us closer to an AI doctored future involved a fully “fully on-premise” diagnostic system whereby two AI agents interacted with each other: one took on the role of the physician, the other that of the patient. The agents were good at diagnosing appendicitis, but not so good at diagnosing pneumonia. Nat Med 2026 …

Tom Nolan reviews this week’s research Symptoms of hereditary angioedema can be easily mistaken for allergy. Hereditary angioedema tends to present with episodes of angioedema without urticaria, abdominal pain is often present, and antihistamines tend to be ineffective. Findings from a trial of deucrictibant, offer hope that the oral bradykinin B2 receptor antagonist could become a useful therapy. Researchers randomly allocated 134 adolescents and adults with hereditary angioedema as part of a double blind crossover trial, where participants received either deucrictibant or placebo during attacks. Time to onset of symptom relief was much shorter when participants took deucrictibant for an episode (median time 1.28 hours, 95% confidence interval 1.05 …

Plus “Dark Reading Matter” by Jasper Fforde and “An Unlikely Visitor” by Joanna Cannon.

In summary Gen Z could be poised to paint California a deeper shade of blue this November — if they turn out to vote.

Surveys show age gap across CA ballot's top issues Topline: Surveys show an age gap across the top issues on California's ballot, including taxing billionaires and requiring IDs to vote.

GEN Z COULD BE POISED to paint California a deeper shade of blue this November — if they turn out to vote.

Los jóvenes respaldan de forma amplia un impuesto a los multimillonarios y rechazan pedir identificación para votar.

Tom Nolan reviews this week’s research As most GPs know from bitter experience, requesting testosterone levels on healthy men creates a lot of extra worry and work, without clinical benefits. In July, US Defence Secretary Pete Hegseth controversially announced that US military personnel aged 30 years and older would be required to have annual testosterone screening. Researchers have estimated how many low testosterone concentration, or low T, results army medics will need to churn through, using cross sectional data from the Military Health and Nutrition Examination Study. Analysing morning testosterone levels from 479 men with a mean age of 30, they estimated that one in four active duty US Army personnel would have a morning testosterone below the American Urology Association’s cut off of 300 ng/dL (10.4 nmol/L). Scaled up to …