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Data from the Cassini spacecraft identify strong electron acceleration as the solar wind approaches the magnetosphere of Saturn. This so-called bow shock unexpectedly occurs even when the magnetic field is roughly parallel to the shock-surface normal. Knowledge of the magnetic dependence of electron acceleration will aid understanding of supernova remnants.

Imaging biomarkers (IBs) are used extensively in drug development and cancer research, but important differences exist between IBs and biospecimen-derived biomarkers. A tailored 'roadmap' is required for the development of new IBs to be used either in clinical research or for decision-making in healthcare. In this Consensus statement, a group of experts assembled by CRUK and the EORTC present 14 key recommendations for accelerating the clinical translation of IBs.

The male sex-determining chromosome has lost only one gene in 25 million years.

Sacked virologist faces lawsuit from Nevada institute.

In this Viewpoint article, Alastair Buchan and James Kennedy evaluate emerging options for the treatment of acute ischemic stroke and discuss the difficulties associated with choosing the patients who might benefit most from them.

In this Viewpoint, Markus Schürks and Hans-Christoph Diener make the case that patent foramen ovale closure should not be used as a treatment for migraine. They argue that the causal link between patent foramen ovale and migraine has not been verified and highlight shortcomings in the existing data.

The standard of adjuvant therapy for colorectal cancer is still evolving. This is because different combinations of cytotoxic therapies, including 5-FU, oxaliplatin and irinotecan, and biologic therapies, such as bevacizumab and cetuximab, are currently being evaluated. This Viewpoint focuses on the use of shorter durations of adjuvant treatment in order to limit toxicity.

Randomized, blinded, controlled experiments have often been considered the highest level of evidence in the methodological hierarchy. This Viewpoint discusses the strengths and limitations of both observational studies and randomized controlled trials, and the benefits that can be gained by researchers and clinicians through the appreciation of both methods.

Many issues surround the treatment of patients with idiopathic normal pressure hydrocephalus by use of shunting. In this Viewpoint, Sachin Batra and Daniele Rigamonti advise on how to achieve the best results with this procedure—including use of appropriate patient selection methods, and accurate monitoring after surgery. They believe that many patients can have good outcomes from shunting but urge physicians to actively work to maintain high standards.

The 2017 American Thyroid Association thyroid and pregnancy guidelines provide an exhaustive review of a rapidly evolving literature and comprehensive recommendations. Although agreeing with most of the recommendations, I present an alternative perspective on the normal range of TSH in pregnancy, management of women on levothyroxine preconception and universal screening for thyroid disorders during pregnancy.

Because octogenarian patients have not been adequately represented in randomized trials comparing CABG and PCI, the most appropriate method of revascularization for this group of patients has not been determined. In this paper the authors performed a systematic review and a meta-analysis of 66 studies of coronary revascularization in patients aged over 80 years. Their data shows that revascularization can be performed in octogenarians with acceptable short-term and long-term outcomes. Furthermore, it is unclear whether octogenarians derive greater survival benefit from CABG or from PCI because preprocedural risk profiles differ between intervention types.

The authors provide a comprehensive survey of international legislation and policies guiding the return of whole-genome-sequencing-based genetic testing results to patients or study participants, within the context of both clinical and research settings.

Animal models are vital tools in the development of therapies for orphan diseases, given the small populations of patients available to evaluate the therapies. Here, Sepodes and colleagues from the European Medicines Agency's Committee for Orphan Medicinal Products harness their experience to provide an overview of the animal models used to support regulatory applications for metabolic, neuromuscular and ophthalmological rare diseases.

Current guidelines for classification of symptoms of neuropsychiatric systemic lupus erythematosus have not proven helpful for the dissection of pathological mechanisms of this disorder or the identification of appropriate therapy. A reclassification of symptoms is proposed in this Viewpoint; the new scheme is based on pathoanatomic localization of the disease.

The 2017 ASCO guidelines present six well-reasoned recommendations for the management of small renal masses. We expand these recommendations to contextualize the use of renal tumour biopsy, clarify when active surveillance could be more inclusive, and highlight nuances in surgical decision making for patients with anatomically complex tumours and a normal contralateral kidney.

Scientists call for project led by Natural History Museum to cut ties with Israeli company.

Resistance to infections is suppressed to prevent inflammation from bacterial colonization.

Public consultation and safety assessment would pave the way for embryo manipulation to treat genetic diseases.

As the value of legacies plummets, Cancer Research UK says it must cut spending.

Study could help researchers developing a human vaccine.

Reprogrammed cells suggest path towards early diagnosis and drug development.

Alex's final experiments reveal a talent for numbers that was on a par with chimpanzees.

Mitochondria are the powerhouses of the cell, providing energy through oxidative respiration. Possibly owing to their similarities with bacteria, however, mitochondria extruded from cells promote inflammation. New research demonstrates that in systemic lupus erythematosus, mitochondrial respiration is critical in neutrophil extracellular trap formation, and that mitochondria released by neutrophils induce inflammatory cytokine production.

Echocardiographic screening for rheumatic heart disease (RHD) over the past 5 years has revealed a higher RHD disease burden than previously imagined and, globally, at least 15 million people are estimated to be affected by this disease. In this article, an international advisory group of experts in RHD screening and echocardiographic manifestations of RHD present the 2012 World Heart Federation criteria for echocardiographic diagnosis of RHD.

The effect of biological therapies on cancer risk in JIA is controversial owing to confounding factors such as the use of concomitant immunosuppressants. A study has shed new light on this association, but questions still remain on the effect of the disease itself and biological therapies on cancer risk.

The contribution of nutrition to bone health has been heavily debated for many years resulting in unclear recommendations for patients regarding prevention of bone loss and subsequent fractures. A recent cohort study has examined the relationships between magnesium intake, BMD and fractures.

Osteoarthritis (OA) is a heterogeneous group of diseases with different pathogenesis in different joints. What effect do metabolic factors, inflammation and obesity have on OA in non-loadbearing structures? A new study reports that, in the absence of knee OA, systemic processes are important in the pathogenesis of hand OA.

Sudden cardiac death in elderly patients with recent myocardial infarction and reduced left ventricular ejection fraction can be substantially reduced using implantable cardioverter–defibrillators (ICDs) in appropriately selected, high-risk cardiac patients. Increased use of ICD therapy among eligible elderly patients will save lives.

A magnetosensing bacterium bends its internal magnet to weaken it before cell division.

Crohn's disease is a life-long illness, with patients increasingly being exposed to diagnostic medical radiation. Diagnostic strategies are being re-evaluated after concerns were raised over the long-term effects of medical radiation. A recent study explored the cost-effectiveness of a magnetic resonance enterography program in patients with Crohn's disease, which could reduce the risk of radiation-induced neoplasia.

In this Training Matters article, the author discusses the importance of encouraging empathy skills in neurology residents, and offers practical guidance on how this can be achieved.

Bladder cancer risk assessment is currently based on an individual's age and history of exposure to known carcinogens. A new report illustrates how interactions between cigarette smoking and germline genetic variation can identify those at particularly high risk, who could be targeted in future bladder cancer prevention and screening efforts.

The recent TOPIC trial found that teriflunomide could prevent relapses in patients with clinically isolated syndrome (CIS). Many other multiple sclerosis (MS) therapies are effective for CIS, because CIS is the first clinical manifestation of MS for most patients. Questions remain over the utility of future trials like TOPIC.

Improved treatments offer hope for eradication of viral liver infection.

An HbA_1c level ≥6.5% is recommended as a criterion for the diagnosis of diabetes mellitus. A recent study has assessed the sensitivity and specificity of HbA_1c levels for distinguishing between new onset type 1 diabetes mellitus and transient hyperglycemia in children. Do the results have implications for current pediatric clinical practice?

Testosterone supplementation therapy is an effective therapy for hypogonadism but can lead to the suppression of spermatogenesis. A new study investigated the effects of enclomiphene citrate, the trans isomer of clomiphene, on serum hormone levels and sperm counts in men with secondary hypogonadism.