While breakfast is often called the most important meal of the day, your dinner should also be equally nutritious. However, late-night snacking or a meal not fit for your nighttime routine can derail your process to improving your overall health.
Two of the meals, Dr Sethi suggested in his post, are Khichdi (moong dal and rice) with sauteed bottle gourd and vegetable sambar, ragi roti, and coconut chutney. (Representative image) (Shutterstock)
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Dinner is an essential meal that contributes to your daily nutrient intake. A well-balanced dinner ensures you get the vitamins, minerals, and macronutrients your body needs to thrive before you go to sleep, which is the longest stretch in 24 hours we go without food. Therefore, having a dinner which is not only nutritious but also gut-friendly is essential.
10 doctor-approved best dinner combinations
In an Instagram post shared on August 31, Dr Saurabh Sethi, a gastroenterologist and liver specialist trained at AIIMS, Harvard and Stanford Universities, shared his 10 best dinner combinations one should try for their gut and liver health. Sharing the post, the gut and liver doctor wrote, “10 best dinner combos (doctor-approved for gut + liver).” Here are the options Dr Sethi suggested:
1. Grilled salmon, steamed asparagus with quinoa
2. Khichdi (moong dal and rice) with sauteed bottle gourd
3. Baked cod, herbed quinoa and steamed zucchini
4. Chickpea curry, rice and cabbage slaw
5. Baked chicken thighs, roasted carrots and millet
6. Vegetable sambar, ragi roti, and coconut chutney
7. Stir-fried tofu, broccoli, and cauliflower rice
8. Paneer bhurji, mixed vegetable, and buckwheat roti
9. Grilled shrimp, sweet potato mash, and sauteed kale
10. Palak sal, quinoa, and carrot and cucumber raita
The best time to have dinner
While knowing the best meals for dinner is important, eating them at the right time is essential, too. A Harvard study says eating dinner earlier is better for our appetite and energy levels and can help us maintain or even lose weight. Moreover, an earlier dinner gives you a good amount of time to digest your food and allows your blood sugar to properly rise and fall after dinner.
A report by Silverline Hospital suggests that having dinner between 7 pm and 8 pm aligns well with the circadian rhythm and gives sufficient time to metabolise the food before bedtime
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
We’re officially in that familiar late-summer rhythm: the NBA season is around the corner, training camps are almost here, and NBA 2K26 has already gone live for those who grabbed early access. Every year, 2K manages to turn the game’s rollout into an event, and this time it’s split neatly between the players who jumped in early on deluxe editions and everyone else waiting for the worldwide release.
Early access has already begun
The big news is that early access kicked off on Friday, Aug. 29, 2025 at 1 p.m. ET. That wasn’t a region-by-region rollout either — it went live simultaneously worldwide, meaning 10 a.m. for players on the West Coast, 6 p.m. for the UK, and 2 a.m. on Aug. 30 for Japan. If you were one of the people who picked up the Superstar or Leave No Doubt editions, you’re already building your MyPLAYER, testing out MyTEAM strategies, and figuring out the early meta.
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For everyone else, the full launch is coming on Thursday, Sept. 5, 2025 at 1 p.m. ET. Again, that’s a synchronized release across all supported regions, so you won’t have to watch highlight reels from other time zones before you can dive in.
Sorting through the editions
I’ll admit, one of the more confusing parts of NBA 2K every year is keeping track of the editions. For 2K26, there are three.
The Standard Edition ($69.99) is the straightforward option — it comes with the base game, 10,000 VC, and Shai Gilgeous-Alexander on the cover. The Superstar Edition ($99.99) steps things up with 100,000 VC, MyTEAM and MyCAREER boosts, an exclusive jersey, and that all-important early access. Carmelo Anthony takes the cover here. Then there’s the premium Leave No Doubt Edition ($149.99), which throws in 135,000 VC, both the Season 1 Pro Pass and the Summer Pass, extra cosmetics, and all three cover athletes — Shai, Melo, and Angel Reese — sharing the spotlight.
Here’s every edition of NBA 2K26 available to buy or preorder right now:
If you’re asking me which one makes the most sense, I’d argue the Superstar Edition is the best value. It’s not cheap, but the VC bundled in saves you from immediately opening your wallet again just to stay competitive, and you get the week of early access. The Leave No Doubt Edition, on the other hand, feels like it’s really aimed at players who plan to live in the game all year long.
Where you can play
Platform availability is another wrinkle this year, especially with Nintendo’s hardware shift. On PC, the game is digital-only through Steam or the 2K Store, but you get access to all editions. The same goes for PlayStation 5 and Xbox Series X|S, where you can pick up either a digital or physical copy. Things get more limited on Nintendo: the Switch 2 only gets the Standard Edition in physical format, while the older Switch offers the Standard Edition for $59.99.
Mashable Light Speed
Crossplay finally exists, but only between PS5 and Xbox Series X|S. PC players remain walled off, and the Nintendo versions are in their own lane entirely.
What’s new inside the game
Modes are the backbone of every 2K, and this year’s lineup sticks to the familiar framework while adding some new wrinkles. The WNBA continues to expand its footprint with The W, letting you build a full WNBA career with stars like Paige Bueckers and Angel Reese. From what I’ve seen so far, agile guard builds look like the strongest path in this mode, especially when paired with the new personality trait system.
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MyCAREER has a big hook this year: Spike Lee is back to direct a story mode titled Out of Bounds. It’s another reminder that 2K doesn’t just want this mode to feel like a progression system — it wants it to play like a basketball drama. Picking the right team for your position is still key; for example, point guards looking for minutes will have more luck joining the Spurs than a team already stacked at that spot.
The most striking change is in MyTEAM, which now combines NBA and WNBA players in the same ecosystem. This unlocks some wild possibilities — imagine Caitlin Clark feeding A’ja Wilson in a lineup anchored by Jimmy Butler and Brook Lopez. It’s not just a gameplay twist; it’s the kind of crossover that would have been unthinkable just a few years ago. And for the league-managers out there, MyNBA and MyGM now feature online Playoffs Mode, making it much easier to run fantasy-style competitions with friends.
The VC grind never ends
If you’ve played NBA 2K before, you know VC is the currency that keeps everything moving. From upgrading attributes in MyCAREER to buying MyTEAM packs, animations, and even new fits, VC isn’t optional — it’s the foundation of the grind. And if you were wondering whether 2K adjusted its pricing this year, the answer is no. The VC bundles in NBA 2K26 look exactly like they have in past years.
The smallest packs start at 5,000 VC for $1.99 and 15,000 VC for $4.99. Realistically, these are more like “starter tips” than anything else. They’ll cover a couple of attribute boosts or maybe help you ditch the dreaded brown shirt and grey sweatpants, but they won’t change your MyPLAYER’s place on the court.
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The mid-tier options are where most players tend to live. 35,000 VC runs $9.99, while 75,000 VC at $19.99 can get your build out of pure rookie status and into something resembling a contributor in The City. The real sweet spot, at least for anyone taking MyCAREER seriously, is 200,000 VC for $49.99. That’s enough to raise your player into starter territory, balance out critical ratings, and still have some left over for animations or a new jumpshot package. It’s progress — though you’ll still be a long way from a maxed-out build.
Then there are the heavy-hitter bundles: 450,000 VC for $99.99 and 700,000 VC for $149.99. These are aimed squarely at players who don’t want to wait — the ones who’d rather dominate Pro-Am or Park on day one instead of grinding badges for weeks. With this kind of purchase, you can nearly max out a build, fill in animations, and still have plenty left for cosmetics. But at that point, you’re paying more for VC than for the game itself, which is always the uncomfortable trade-off 2K has leaned on for years.
So, should you buy VC? That depends on how you want to play. If you’re aiming for the competitive side of things — whether that’s Park runs, Rec matchmaking, or Pro-Am squads — then investing in at least one of the bigger bundles can keep you from falling behind. But if you’re patient, grinding daily quests, endorsements, and event bonuses still works; it’s just much slower. The truth is, NBA 2K26 hasn’t changed the fundamental equation: the grind is possible, but your wallet still speaks loudly when it comes to performance.
Where to buy NBA 2K26 VC
Here’s where you can buy Virtual Currency for NBA 2K26:
Why this year feels like a milestone
What stands out most about NBA 2K26 isn’t just the technical upgrades or the usual slate of returning modes, but the cultural weight of its cover athletes and roster choices. Shai Gilgeous-Alexander represents the next wave of NBA superstardom, Carmelo Anthony brings nostalgia for a whole era of basketball fans, and Angel Reese embodies the WNBA’s surging influence. Pair that with the merging of NBA and WNBA talent in MyTEAM, and it feels like the series is finally acknowledging basketball culture as a whole, not just one league.
Image of a dusty disk around a young star. Among the multiple concentric rings we see a small dot of light (indicated by a white circle). This is an image of a newborn planet, likely a gas giant similar to Jupiter in our own solar system, but about 5 times more massive. These observations were taken with the ESO Very Large Telescope in near-infrared light. Credit: C. Ginski/R. van Capelleveen et al.
A young gas giant, WISPIT 2b, was detected within a multi-ringed disk around a Sun-like star. Its active formation provides a rare opportunity to study early planetary evolution.
An international team of astronomers, co-led by researchers from the University of Galway, has uncovered the surprising discovery of a previously unknown planet.
Found in its earliest stage of development around a young star similar to our Sun, the planet is estimated to be about 5 million years old and is likely a gas giant comparable in size to Jupiter.
The research, led by Leiden University in collaboration with the University of Galway and the University of Arizona, has been published in the journal Astrophysical Journal Letters.
This breakthrough was achieved using the European Southern Observatory’s Very Large Telescope (ESO’s VLT), one of the most advanced astronomical facilities in the world, located in Chile’s Atacama Desert.
To mark the publication of the study, the European Southern Observatory—widely regarded as the leading international astronomy organization—released a striking image of the discovery as its picture of the week.
The newly identified planet has been designated WISPIT 2b.
Image of a dusty disk around a young star. Among the multiple concentric rings we see a small dot of light (indicated by a white circle). This is an image of a new-born planet, likely a gas giant similar to Jupiter in our own solar system (comparison image given in upper right corner) but about 5 times more massive. These observations were taken with the ESO Very Large Telescope in near-infrared light. Credit: Ginski/R. van Capelleveen et al.
A multi-ringed dust disk
Dr. Christian Ginski, lecturer at the School of Natural Sciences, University of Galway, and second author of the study, said: “We used these really short snapshot observations of many young stars – only a few minutes per object – to determine if we could see a little dot of light next to them that is caused by a planet. However, in the case of this star, we instead detected a completely unexpected and exceptionally beautiful multi-ringed dust disk.
“When we saw this multi-ringed disk for the first time, we knew we had to try and see if we could detect a planet within it, so we quickly asked for follow-up observations.”
It is only the second time a confirmed planet has been detected at this early evolutionary stage around a young version of our Sun. The first one was discovered in 2018, by a research team also involving Dr. Ginski.
WISPIT 2b is also the first unambiguous planet detection in a multi-ringed disk, making it the ideal laboratory to study planet-disk interaction and subsequent evolution.
A newborn planet eating its way through its dusty cradle as it orbits its host star. This image, taken with ESO’s Very Large Telescope is the first clear detection of a baby planet in a disc with multiple rings. Credit: ESO/R. van Capelleveen et al.
Planet glowing in infrared
The planet was captured in near infrared light – the type of view that someone would see when using night-vision goggles – as it is still glowing and hot after its initial formation phase.
The team at Leiden University and the University of Galway captured a spectacular, clear image of the young proto-planet embedded in a disk gap. They also confirmed that the planet is orbiting its host star.
The planet was also detected in visible light by a team from the University of Arizona using a specially designed instrument. This detection at a specific wavelength or color of light indicates that the planet is still actively accreting gas as it forms its atmosphere.
WISPIT 2b was detected as part of a five-year observational research project during which the international team sought to establish whether wide orbit gas giant planets are more common around younger or older stars. This led to the unexpected discovery of the new planet.
Dust and gas-rich disks around young stars are the birth cradles of planets. They can look quite spectacular with many different structures, such as rings and spiral arms, which researchers believe are related to planets forming within them. The disk around WISPIT 2b has a radius of 380 astronomical units – about 380 times the distance between Earth and the Sun.
Dr. Ginski added, “Capturing an image of these forming planets has proven extremely challenging, and it gives us a real chance to understand why the many thousands of older exoplanet systems out there look so diverse and so different from our own solar system. I think many of our colleagues who study planet formation will take a close look at this system in the years to come.”
References:
“WIde Separation Planets In Time (WISPIT): A Gap-clearing Planet in a Multi-ringed Disk around the Young Solar-type Star WISPIT 2” by Richelle F. van Capelleveen, Christian Ginski, Matthew A. Kenworthy, Jake Byrne, Chloe Lawlor, Dan McLachlan, Eric E. Mamajek, Tomas Stolker, Myriam Benisty, Alexander J. Bohn, Laird M. Close, Carsten Dominik, Sebastiaan Haffert, Rico Landman, Jie Ma, Ignas Snellen, Ryo Tazaki, Nienke van der Marel, Lukas Welzel and Yapeng Zhang, 26 August 2025, The Astrophysical Journal Letters. DOI: 10.3847/2041-8213/adf721
Reference: “Wide Separation Planets in Time (WISPIT): Discovery of a Gap Hα Protoplanet WISPIT 2b with MagAO-X” by Laird M. Close, Richelle F. van Capelleveen, Gabriel Weible, Kevin Wagner, Sebastiaan Y. Haffert, Jared R. Males, Ilya Ilyin, Matthew A. Kenworthy, Jialin Li, Joseph D. Long, Steve Ertel, Christian Ginski, Alycia J. Weinberger, Kate Follette, Joshua Liberman, Katie Twitchell, Parker Johnson, Jay Kueny, Daniel Apai, Rene Doyon, Warren Foster, Victor Gasho, Kyle Van Gorkom, Olivier Guyon, Maggie Y. Kautz, Avalon McLeod, Eden McEwen, Logan Pearce, Lauren Schatz, Alexander D. Hedglen, Ya-Lin Wu, Jacob Isbell, Jenny Power, Jared Carlson, Emmeline Close, Elena Tonucci and Matthijs Mars, 26 August 2025, The Astrophysical Journal Letters. DOI: 10.3847/2041-8213/adf7a5
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This is a cross-sectional study, which aimed to investigate the PA and SB patterns of Tibetan and Han adolescents aged 12–18 years in Lhasa, Xizang Autonomous Region. Objective measurements were used to assess these behaviors, and ethnic differences between Tibetan and Han adolescents were compared.
Participants
Figure 1 shows the process diagram for the inclusion and exclusion of participants. This study was conducted in Lhasa from June to December 2020. Using convenience sampling, the Eighth Middle School of Lhasa and Lhasa Middle School were selected as study sites. Subsequently, a random cluster sampling method was employed to randomly select several classes of Tibetan and Han students from each grade to recruit participants. Considering that the ratio of Tibetan to Han students in these schools was approximately 3:1, to prevent sample size imbalance, three Tibetan classes and two Han classes (which had fewer students) were randomly selected from each grade.
Fig. 1
Participant Inclusion and Exclusion Process Diagram
The inclusion criteria were as follows: enrollment in junior or senior high school; aged between 12 and 18 years; in good health with no physical disabilities; and voluntary participation with written informed consent provided by parents. After enrollment, participants were provided with accelerometers and questionnaires to assess daily PA, SB, and socioeconomic status (SES). Anthropometric measurements were also recorded.
A total of 1,275 students were initially recruited. After validity checks of the accelerometer data, 19 participants with invalid data were excluded, yielding a final sample of 1,256 students: 485 Tibetan boys, 465 Tibetan girls, 154 Han Chinese boys, and 152 Han Chinese girls. The management and quality control of accelerometer data were overseen by Dr. Sun Yi.
Measures
PA and SB measurement
PA and SB were objectively assessed using ActiGraph GT3X + triaxial accelerometers (ActiGraph, Pensacola, FL, USA). Participants were instructed to wear the device continuously for seven consecutive days (five school days and two weekend days), removing it only for sleeping, swimming, and bathing. The accelerometer was positioned on the right hip, with data collected in 5-second epochs. Data collection began at 9:00 AM on the day of distribution and ended at 9:00 AM on the seventh day, after which all devices were retrieved by the investigators. Raw data were downloaded and processed using ActiLife software (version 6.10.2).
Data were deemed valid based on the following criteria: (1) a minimum of two valid weekdays and one valid weekend day; and (2) at least 600 min of wear time per day [19].
The Evenson cut-point classification method [20] was applied to categorize activity intensity levels, with thresholds defined as follows: SB (0-100 counts per minute [cpm]), LPA; 101-2,295 cpm), moderate PA (MPA; 2,296-4,011 cpm), and vigorous PA (VPA; ≥4,012 cpm). A threshold of 20 min was used to distinguish prolonged sedentary bouts; sedentary periods exceeding this duration were identified as PSB [21]. These cut-points have been validated in previous research and demonstrate high reliability and validity in assessing PA levels among children and adolescents [22].
The monitoring period was further categorized into four distinct temporal segments: weekdays versus weekends, and school hours versus out-of-school hours on weekdays. Weekdays were defined as Monday through Friday, and weekends included Saturday and Sunday. For middle school students, school hours spanned 9:00 to 18:00, with out-of-school hours defined as 18:00–24:00 and 0:00–9:00. For high school students, school hours were from 8:00 to 22:00, with out-of-school hours defined as 22:00–24:00 and 0:00–8:00.
It should be noted that although the Xizang Autonomous Region is geographically located in the sixth time zone (approximately two hours behind Beijing, which is in the eighth time zone), the entire country operates on Beijing Standard Time. Therefore, local students’ rest schedules are adjusted in accordance with natural daylight patterns to accommodate the geographical environment.
Body mass index (BMI)
Height measurements were obtained following standardized protocols. Participants stood barefoot on a stadiometer base plate with their backs against the vertical column. They were instructed to maintain an upright posture with their torso straight and head positioned in the Frankfort horizontal plane. Measurements were recorded in centimeters, precise to one decimal place, with a tolerance of ± 0.5 cm.
Body weight was measured with participants wearing light clothing and standing barefoot on the center of a calibrated weighing platform. Participants were instructed to stand naturally and maintain a stable posture. Weight was recorded in kilograms, precise to one decimal place, with an accuracy of ± 0.1 kg.
After obtaining height and weight measurements, BMI was calculated using the formula: BMI = Weight (kg)/Height (m)2.
Socioeconomic Status (SES)
In this study, family SES was assessed using a questionnaire[the questionnaire guide can be found in Supplementary Document 1] that measured parental education level, parental occupation, and household income, following the method outlined by Guo et al. [23]. Parental education was scored based on the number of years of schooling completed. Parental occupation was classified according to the International Standard Classification of Occupations (ISCO). Household monthly income was categorized into four income brackets; each assigned a score: ≤2,000 RMB = 2 points; 2,001–5,000 RMB = 5 points; 5,001–8,000 RMB = 8 points; 8,000 RMB = 10 points.
The collected data underwent screening and transformation, with missing values addressed appropriately. All variables were standardized before performing principal component analysis to derive the composite SES score.
Statistical analyses
The normality of the data was evaluated using histograms and Q-Q plots, which confirmed that the data followed a normal distribution. Consequently, a one-way analysis of covariance was conducted to examine ethnic differences in PA and SB patterns between Tibetan and Han Chinese adolescents, with age, BMI, SES, and accelerometer wear time included as covariates. All statistical analyses were performed using IBM SPSS Statistics version 23.0 (IBM Corp., Armonk, NY, USA). The significance level was set at p < 0.05. Effect sizes were interpreted according to established benchmarks: small (η2 ≤ 0.01), medium (0.01 < η2 ≤ 0.06), and large (η2 > 0.14) [24].
Acolytes of Argentine auteur Lucrecia Martel are accustomed to patience. In 25 years she’s made just five features, of which the latest, the long-gestating “Landmarks,” is her first foray into nonfiction filmmaking. A slow-burning, increasingly incensed unraveling of a horrific murder case underpinned by colonialist privilege and prejudice, it too demands patience of its viewers — though it rewards them with steadily rising emotional impact and a long view of Latin American history that transcends any true-crime trappings. Relative to Martel’s more formally radical fiction films, this is a straightforwardly constructed work, but a disciplined, clear-eyed one. Clearly a passion project for the director, it nonetheless avoids sentimentality or heated rhetoric on a high-stakes subject.
Martel’s name guarantees general arthouse exposure for a documentary that will be ubiquitous on the festival circuit following its out-of-competition premiere at Venice, with program slots in Toronto, New York and San Sebastian lined up, plus a place in London’s official competition. No prior familiarity with her oeuvre is required to engage with “Landmarks,” which is accessible and unmannered both in its humane interviewing approach and its to-the-point political commentary. The English-language title feels more oblique and drily distanced than the film is in its approach; its Spanish counterpart, “Nuestra Tierra” or “Our Land,” is closer to the mark.
It begins with an unexpectedly cosmic flourish: a satellite shot of Earth as seen from space, set to ecstatic choral music, before descending into the grassy, undulating slopes, fields and makeshift soccer pitches of northwest Argentina’s Tucumán Province, surveyed by restlessly floating drone. A fertile agricultural region historically inhabited by the Indigenous Chuschagasta people, it has also for centuries been a site of land disputes between those original custodians and settlers of European origin, with whom the Argentine authorities have long sided. These are tensions that continue to play out today, for which Martel presents as evidence the 2009 shooting of 68-year-old Chuschagasta community leader Javier Chocobar — a tragedy prompting a protracted murder trial that gives “Landmarks” its narrative spine.
The three perpetrators are wealthy local landowner Dario Luis Amín and ex-police officers Luis Humberto Gómez and José Valdivieso. Murky but upsettingly brutal candid video shows their fatal confrontation with Chocobar after they served eviction orders to him and 300-odd other Chuschaguasta residents of a sizable patch of ancestral land.
The footage is damning, but that doesn’t simplify the court proceedings, which only began in 2018, nine years after the fact, and culminate in compromised justice at best. Martel, who takes co-writing credit with Maria Alché (her onetime leading lady from 2004’s “The Holy Girl”), isn’t especially interested in fine procedural details, and the film, which mostly dispenses with onscreen names and explanatory chyrons, often leaves its audience to navigate a tangle of conflicting parties and interests, and determine the side of right.
The film’s gaze turns more intimate and particular when it probes the Chuschuaguasta community still reeling from the killing, and gives its most generous platform to Chocobar’s widow Antonia — who speaks lucidly not just about her husband, but about her upbringing as an Indigenous woman and her eternally unstable status in the Argentine population. Still photographs from her personal archive vividly illustrate her descriptions of a persecuted but enduringly proud people, and a hand-built way of life now disappearing before their eyes. Such testaments are crucial in a larger society still slow to ratify their experience: About her schooling, Antonia bemoans the fact that she was never taught Indigenous history. “Instead, they teach us about who discovered America,” she says ruefully.
Earlier in its development, “Landmarks” was conceived as more of a hybrid project built around Chocobar’s story, before Martel evidently decided an untempered documentary form would best serve the blunt facts of the case. You can occasionally feel her filmmaking chafing against the restrictions of nonfiction, or perhaps simply against frustrating truths — her restraint in this regard, however, lends the film a moving humility, not least when it defers to Chuschagasta voices to tell their own story. The director does grant herself one key poetic liberty in the film’s extensive drone photography. An overused affectation in much modern docmaking, it proves an effective and rather enrapturing device here, offering a suitably omniscient view of land that survives all those who fight over it.
Seeing a player launch into an on-court tirade is nothing unusual, but Riedi shouting at someone in his native language turned out to be different.
The incident, which was first spotted and reported by Bounces, external, came in a pivotal moment during his second-round win over Argentine 19th seed Francisco Cerundolo.
Riedi had lost the first two sets before winning the third, but had just given up a break he had earned earlier in the fourth.
One particular man – who Riedi had also spotted during his first-round victory against Spain’s Pedro Martinez – was stood in the corner of the court and bore the brunt of his frustration.
“In that moment he was saying the wrong words to me,” Riedi, who has faced online abuse from gamblers, told BBC Sport.
“He was trying to be positive but for me it was like ‘be quiet, you have nothing to do with me’, you’re just betting on me.
“He was not a Swiss guy and he was always on his phone. So for me… he’s probably a bettor.
“In that moment I just didn’t want to see or hear this guy.”
Following his outburst, Riedi told chair umpire Scotty Moore about his suspicions.
Riedi claims both Martinez and Cerundolo – who could not be contacted by BBC Sport – also thought the fan was a bettor.
The man left the court by “his own volition”, according to the United States Tennis Association (USTA), and was not escorted out by security.
“Maybe I’m wrong, but I feel I’m correct because I’ve experienced it enough – that he was betting,” said Riedi.
“If he really is a supporter and he didn’t bet then I’m truly sorry, but I have a gut feeling he was a bettor.
“I told the umpire if I lose, this guy will text and say ‘I hope your mother dies’. This has happened too many times.”
While the anticoagulant didn’t raise the odds of major bleeding, nonmajor clinically relevant bleeds did trend higher.
MADRID, Spain—For patients who experience venous thromboembolism (VTE) provoked by surgery, immobility, or other factors and who face ongoing risk factors, 12 months of low-intensity apixaban (Eliquis; Bristol Myers Squibb) therapy reduces the odds of recurrent VTE by nearly 90%, according to the HI-PRO trial.
Moreover, researchers report, the direct oral anticoagulant does so while offering a low risk of major bleeding.
Gregory Piazza, MD (Brigham and Women’s Hospital, Boston, MA), when presenting the late-breaking results this weekend at the European Society of Cardiology (ESC) Congress 2025, explained that the distinction between provoked VTE—the focus of HI-PRO—and nonprovoked VTE is relevant to the duration of anticoagulant therapy that follows.
“Unprovoked venous thromboembolism is typically treated without a predetermined stop date and provoked venous thromboembolism given time-limited anticoagulation of 3 months,” he told attendees. But observational studies have suggested that patients with provoked VTE may be at higher risk of recurrence if they have other provoking factors that persist.
Both the ESC and the International Society on Thrombosis and Haemostasis (ISTH) have stressed the need to understand this particular profile, Piazza continued. In 2019, the ESC guidelines for acute pulmonary embolism added clarity by classifying various risk levels for long-term VTE recurrence, he pointed out. “Unfortunately, no set of guidelines clearly provides recommendations on what to do about duration of anticoagulation in [this subset].”
With these data, which were simultaneously published in the New England Journal of Medicine, “we see that one more piece of the extended-duration anticoagulation puzzle has fallen into place,” he said. HI-PRO highlights “a population with provoked venous thromboembolism and enduring risk in which the risk of recurrence off anticoagulation is high enough to warrant consideration of continued [therapy].”
As the trial’s discussant in the Hot Line session, Christopher B. Granger, MD (Duke University Medical Center, Durham, NC), characterized the results as “clear and important.” He acknowledged HI-PRO does have a few limitations, most notably that it was performed at a single center and involved a “modest” number of events.
Still, said Granger, “in the context of other trials of extended treatment for provoked VTE, this trial will change my practice.”
Both Primary Endpoints Met
For the double-blind trial, investigators enrolled 600 adults (mean age 59.5 years; 57.0% women; 19.2% nonwhite) who had experienced VTE due to a transient provoking factor, had at least one enduring risk factor, and had completed at least 3 months of anticoagulation. They randomized them to receive either oral apixaban (2.5 mg twice daily) or placebo for another 12 months.
The most frequent provoking factors were surgery (33.5%), immobility (31.3%), trauma (19.2%), and acute medical illness (18.3%), while the most common enduring risk factors were chronic inflammatory or autoimmune disorder (52.2%), body mass index ≥ 30 kg/m2 (48.2%), atherosclerotic cardiovascular disease (29.3%), and chronic lung disease (22.3%).
Median number of days adhering to the assigned therapy was 350 in the apixaban group and 338 in the placebo group. Six patients in each group did not take any of their assigned regimen.
First symptomatic recurrent VTE, the primary efficacy outcome, occurred in four (1.3%) of the apixaban-treated patients and 30 (10.0%) of those given placebo (HR 0.13; 0.04-0.36). One instance of ISTH major bleeding, the primary safety outcome, developed in the apixaban group (0.3%)—it was a 3-mm parafalcine subdural hematoma that occurred when a patient fell from a horse and did not result in either hospitalization or drug discontinuation. None of the placebo group had major bleeds.
However, 14 of 294 apixaban patients (4.8%) did have clinically relevant nonmajor bleeding: most often vaginal (1.7%), hematuria (1.4%), and rectal (1.0%). Five of 294 patients (1.7%) in the placebo group had such an event, most commonly vaginal (1.0%). This difference was nonsignificant, but risk trended higher with apixaban (HR 2.68; 95% CI 0.96-7.43; P = 0.06).
One patient assigned to apixaban died, as did three assigned to placebo—no deaths were attributed to CV or hemorrhagic causes. The rate of nonfatal adverse events unrelated to bleeding was 2.0% in each group.
Considerations for Practice
Granger, in his discussion, drew attention to the clinically relevant nonmajor bleeds, which he said may be more of an issue for patients “in general practice, who may be higher risk than this population.” He also asked whether the findings apply to all patients with provoked VTE and enduring risk, or if they could be more relevant to particular subgroups within that category.
“That’s a terrific question,” said Piazza. “There are a couple of ways to think about it. First, there were patients in this study who had multiple enduring risk factors, and I think that’s an easy group of patients that we can conceive of being the right fit for this therapy.
“Future studies,” he continued, “should probably go beyond just clinical markers and look at things like polygenic risk, [artificial intelligence]-informed risk scores, and even biomarkers, if we ever get some high-quality ones, to identify and more precisely pick patients for extended-duration thromboprophylaxis.”
Neil A. Zakai, MD (University of Vermont, Burlington), who wrote an editorial for the paper, notes that the field has begun to consider the best course of action after provoked VTE.
“For decades, the guidance was simple: treat a provoked venous thromboembolism . . . for 3 to 6 months, stop, and move on. Safer anticoagulants and emerging evidence now challenge this long-held approach,” he writes. “Recurrence risk does not reset to zero after a provoked event, and bleeding risk during the receipt of anticoagulation is far from negligible.”
The HI-PRO results, says Zakai, “invite us to reconsider whether the ‘provoked’ label is a license to discontinue anticoagulation or the beginning of a more nuanced conversation with our patients.”
The binary categories of VTE—provoked versus unprovoked—“are too blunt to guide care because they group together patients with hugely different recurrence risks,” he comments. “Thus, we need to develop and validate models that integrate baseline risk factors, features of the acute event, bleeding risk, patient values, and clinician experience to determine who may benefit from extended VTE prevention.”
These factors must be better defined to ensure consistent treatment but also leave room for conversations about an individual patient’s benefits and risks with extended anticoagulation, says Zakai.
The team from Mpumalanga lost only one of their league games, against the Eagirls, to qualify for the semi-finals, where they beat Griquas by 31-22.
On the same day, the Leopards – who snuck into the top four with three wins and three defeats – upset the defending champions with a late try in their semi-final to beat SWD by 24-22 and book their spot in the decider.
The final was played at Nelspruit Rugby Club on Saturday, 30 August and although each team scored only one try, the Pumas were awarded a penalty try and slotted three penalty goals to keep the scoreboard ticking.
The host team led 13-0 at the break after two penalty goals and the penalty try, but the Leopards pulled one back to make it 13-5 early in the second half.
However, the Pumas never relinquished control of the match, adding another try and a penalty goal to cruise to the victory.
The Women’s First Division again featured seven teams who played each other over a single round of league matches. Apart from the Pumas, Leopards, SWD and Griquas, the other teams who participated in 2025 were the Griffons, Limpopo Blue Bulls, and Valke.
Three-year-old Teraysa was diagnosed with Batten disease for which there currently is no cure
The family of a three-year-old girl with a rare degenerative brain disease have said they are holding on to the hope that a cure will be found in her lifetime.
Teraysa, who lives in Christchurch, Dorset, began having seizures last December and she was fast tracked for genetic tests when they became more severe.
The results revealed that she had Batten disease, which is likened to childhood dementia, affects only about 40 children in the UK and is terminal. Life expectancy is 10-12 years for most patients.
“It is heart wrenching”, Teraysa’s mother Stacey said. “I’m not going to have Teraysa when she’s reached her teens, I won’t ever be able to take her to prom or any of those things.”
The incurable illness affects the nervous system, causing seizures, visual impairment and mobility loss and early death.
“At the time we didn’t think anything of it, we just thought that it was going to be a case of epilepsy that had come from one side of the family,” Stacey said.
“It was such a shock – but we really had no idea of how bad it was, it’s all still sinking in.”
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Teraysa’s parents, Stacey and Michael, have started a GoFundMe page to raise money so they can both be there when she undergoes brain surgery
Teraysa’s parents want more research to be carried out and say they are clinging on to the hope that a cure could be found in time to save their daughter.
“I know it’s rare but this is a killing disease,” said Stacey. “It doesn’t make it less important than any others.
“Of course, there should be more research into it – no child deserves to die and no parent should have to bury their child.”
Teraysa, who has five siblings, is due to start treatment at Great Ormond Street Hospital and it is hoped that this will slow the progression of the disease.
Her family are compiling a bucket list of adventures and have set up a GoFundMe page for her but say that the simple moments, like playing in the garden and walks in the park, are the times they treasure most.
“That’s why we have to make the most of right now, it’s all we’ve got,” said Stacey.
