New England Journal of Medicine最新文献

{"title":"Intravenous Amino Acids and Kidney Protection.","authors":"Samuel N Heyman, Zaid Abassi","doi":"10.1056/NEJMc2412012","DOIUrl":"https://doi.org/10.1056/NEJMc2412012","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 20","pages":"1964-1965"},"PeriodicalIF":96.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Middle Meningeal Artery Embolization for Nonacute Subdural Hematoma.","authors":"Jianmin Liu, Wei Ni, Qiao Zuo, Heng Yang, Ya Peng, Zhiqing Lin, Zhenbao Li, Jiyue Wang, Yong Zhen, Jing Luo, Yuanxiang Lin, Jian Chen, Xuming Hua, Hua Lu, Ming Zhong, Mingfa Liu, Jianmin Zhang, Yang Wang, Jieqing Wan, Yi Li, Tianxiao Li, Guohua Mao, Wenyuan Zhao, Liang Gao, Conghui Li, E Chen, Xin Cheng, Ping Zhang, Zigao Wang, Lei Chen, Yongxin Zhang, Bing Tian, Fang Shen, Yu Lei, Yina Wu, Yanjiang Li, Guoli Duan, Liquan Xu, Nan Lv, Jian Yu, Xiaolong Xu, Zhuoying Du, Hongjian Zhang, Jin Hu, Zifu Li, Qiang Yuan, Yu Zhou, Gang Wu, Lei Zhang, Chao Gao, Dongwei Dai, Xuehai Wu, Yongwei Zhang, Hanqiang Jiang, Rui Zhao, Jiabin Su, Yi Xu, Johanna Maria Ospel, Charles B L M Majoie, Mayank Goyal, Qiang Li, Pengfei Yang, Yuxiang Gu, Ying Mao","doi":"10.1056/NEJMoa2401201","DOIUrl":"https://doi.org/10.1056/NEJMoa2401201","url":null,"abstract":"<p><strong>Background: </strong>The effect of embolization of the middle meningeal artery in patients with subacute or chronic subdural hematoma is uncertain.</p><p><strong>Methods: </strong>We performed a multicenter, open-label, randomized trial in China, involving patients with symptomatic nonacute subdural hematoma with mass effect. Patients were assigned to undergo burr-hole drainage or receive nonsurgical treatment at the surgeon's discretion, and patients in each group were then randomly assigned, in a 1:1 ratio, to undergo middle meningeal artery embolization with liquid embolic material or to receive usual care. Patients whose condition warranted craniotomy were excluded. The primary outcome was symptomatic recurrence or progression of subdural hematoma within 90 days after randomization. Secondary outcomes included clinical and imaging outcomes. The main safety outcome was any serious adverse event (including death).</p><p><strong>Results: </strong>The analysis included 722 patients, of whom 360 were assigned to the embolization group and 362 to the usual-care group. Burr-hole drainage was performed in 78.3% of the enrolled patients; among the patients who underwent burr-hole drainage, the procedure occurred after embolization in 99.6%. Symptomatic recurrence or progression of subdural hematoma within 90 days occurred in 24 patients (6.7%) in the embolization group and in 36 (9.9%) in the usual-care group (between-group difference, -3.3 percentage points; 95% confidence interval, -7.4 to 0.8; P = 0.10). The incidence of serious adverse events was lower in the embolization group than in the usual-care group (6.7% vs. 11.6%, P = 0.02).</p><p><strong>Conclusions: </strong>Among patients with symptomatic nonacute subdural hematoma (of whom 78% underwent burr-hole drainage), middle meningeal artery embolization resulted in a 90-day incidence of symptomatic recurrence or progression similar to that with usual care but was associated with a lower incidence of serious adverse events. (Funded by Shanghai Shenkang Hospital Development Center and others; MAGIC-MT ClinicalTrials.gov number, NCT04700345.).</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 20","pages":"1901-1912"},"PeriodicalIF":96.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Complexity in Monoclonal Gammopathy of Thrombotic Significance.","authors":"Adam J Kanack, Nelson Leung, Anand Padmanabhan","doi":"10.1056/NEJMc2409428","DOIUrl":"https://doi.org/10.1056/NEJMc2409428","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 20","pages":"1961-1963"},"PeriodicalIF":96.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetics of Chronic Kidney Disease.","authors":"Bertrand Knebelmann, Ludwig Haydock","doi":"10.1056/NEJMc2411473","DOIUrl":"https://doi.org/10.1056/NEJMc2411473","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 20","pages":"1967-1968"},"PeriodicalIF":96.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invisible Deaths - Mortality among People Experiencing Homelessness.","authors":"Katherine A Koh","doi":"10.1056/NEJMp2405441","DOIUrl":"10.1056/NEJMp2405441","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":"1868-1870"},"PeriodicalIF":96.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Saint Didacus, Fetal Death, and the Problem of Dual Loyalty.","authors":"Natalie Posever","doi":"10.1056/NEJMp2402783","DOIUrl":"10.1056/NEJMp2402783","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":"1872-1875"},"PeriodicalIF":96.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjunctive Middle Meningeal Artery Embolization for Subdural Hematoma.","authors":"Jason M Davies, Jared Knopman, Maxim Mokin, Ameer E Hassan, Robert E Harbaugh, Alexander Khalessi, Jens Fiehler, Bradley A Gross, Ramesh Grandhi, Jason Tarpley, Walavan Sivakumar, Mark Bain, R Webster Crowley, Thomas W Link, Justin F Fraser, Michael R Levitt, Peng Roc Chen, Ricardo A Hanel, Joe D Bernard, Mouhammad Jumaa, Patrick Youssef, Marshall C Cress, Mohammad Imran Chaudry, Hakeem J Shakir, Walter S Lesley, Joshua Billingsley, Jesse Jones, Matthew J Koch, Alexandra R Paul, William J Mack, Joshua W Osbun, Kathleen Dlouhy, Jonathan A Grossberg, Christopher P Kellner, Daniel H Sahlein, Justin Santarelli, Clemens M Schirmer, Justin Singer, Jesse J Liu, Aniel Q Majjhoo, Thomas Wolfe, Neil V Patel, Christopher Roark, Adnan H Siddiqui","doi":"10.1056/NEJMoa2313472","DOIUrl":"https://doi.org/10.1056/NEJMoa2313472","url":null,"abstract":"<p><strong>Background: </strong>Subacute and chronic subdural hematomas are common and frequently recur after surgical evacuation. The effect of adjunctive middle meningeal artery embolization on the risk of reoperation remains unclear.</p><p><strong>Methods: </strong>In a prospective, multicenter, interventional, adaptive-design trial, we randomly assigned patients with symptomatic subacute or chronic subdural hematoma with an indication for surgical evacuation to undergo middle meningeal artery embolization plus surgery (treatment group) or surgery alone (control group). The primary end point was hematoma recurrence or progression that led to repeat surgery within 90 days after the index treatment. The clinical secondary end point was deterioration of neurologic function at 90 days, which was assessed with the modified Rankin scale in a noninferiority analysis (margin for risk difference, 15 percentage points).</p><p><strong>Results: </strong>A total of 197 patients were randomly assigned to the treatment group and 203 to the control group. Surgery occurred before randomization in 136 of 400 patients (34.0%). Hematoma recurrence or progression leading to repeat surgery occurred in 8 patients (4.1%) in the treatment group, as compared with 23 patients (11.3%) in the control group (relative risk, 0.36; 95% confidence interval [CI], 0.11 to 0.80; P = 0.008). Functional deterioration occurred in 11.9% of the patients in the treatment group and in 9.8% of those in the control group (risk difference, 2.1 percentage points; 95% CI, -4.8 to 8.9). Mortality at 90 days was 5.1% in the treatment group and 3.0% in the control group. By 30 days, serious adverse events related to the embolization procedure had occurred in 4 patients (2.0%) in the treatment group, including disabling stroke in 2 patients; no additional events had occurred by 180 days.</p><p><strong>Conclusions: </strong>Among patients with symptomatic subacute or chronic subdural hematoma with an indication for surgical evacuation, middle meningeal artery embolization plus surgery was associated with a lower risk of hematoma recurrence or progression leading to reoperation than surgery alone. Further study is needed to evaluate the safety of middle meningeal artery embolization in the management of subdural hematoma. (Funded by Medtronic; EMBOLISE ClinicalTrials.gov number, NCT04402632.).</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 20","pages":"1890-1900"},"PeriodicalIF":96.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetics of Chronic Kidney Disease.","authors":"Kai-Ting Chang, Chien-Chih Chiu, Hugo Y-H Lin","doi":"10.1056/NEJMc2411473","DOIUrl":"https://doi.org/10.1056/NEJMc2411473","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 20","pages":"1966-1967"},"PeriodicalIF":96.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous Amino Acids and Kidney Protection.","authors":"Raphaël Mottale, Fabio S Taccone, Stéphane Gaudry","doi":"10.1056/NEJMc2412012","DOIUrl":"https://doi.org/10.1056/NEJMc2412012","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 20","pages":"1964"},"PeriodicalIF":96.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Climate Change, Floods, and Human Health.","authors":"Yao Wu, Bo Wen, Danijela Gasevic, Jonathan A Patz, Andy Haines, Kristie L Ebi, Virginia Murray, Shanshan Li, Yuming Guo","doi":"10.1056/NEJMsr2402457","DOIUrl":"https://doi.org/10.1056/NEJMsr2402457","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"391 20","pages":"1949-1958"},"PeriodicalIF":96.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}