New England Journal of Medicine最新文献

{"title":"Alteplase for Posterior Circulation Ischemic Stroke at 4.5 to 24 Hours.","authors":"Shenqiang Yan, Ying Zhou, Maarten G Lansberg, David S Liebeskind, Changzheng Yuan, Han Yu, Fujian Chen, Hongfang Chen, Bing Zhang, Lingqun Mao, Xiaoling Zhang, Xiaona Wang, Xuting Zhang, Yi Chen, Huan Zhou, Wansi Zhong, Yaode He, Kun Chen, Jianbing Wang, Hui Chen, Yuhui Huang, Bruce C V Campbell, Min Lou","doi":"10.1056/NEJMoa2413344","DOIUrl":"10.1056/NEJMoa2413344","url":null,"abstract":"<p><strong>Background: </strong>The effects and risks of the use of intravenous thrombolysis between 4.5 and 24 hours after the onset of a posterior circulation ischemic stroke are not well studied.</p><p><strong>Methods: </strong>In a trial conducted in China, we randomly assigned patients with posterior circulation stroke, without extensive early hypodensity on computed tomography and with no planned thrombectomy, to receive alteplase (0.9 mg per kilogram of body weight; maximum dose, 90 mg) or standard medical treatment 4.5 to 24 hours after the onset of symptoms. The primary outcome was functional independence (defined as a score of 0 to 2 on the modified Rankin scale; scores range from 0 to 6, with higher scores indicating greater disability) at 90 days. The key safety outcomes were symptomatic intracranial hemorrhage and death.</p><p><strong>Results: </strong>A total of 234 patients were enrolled; 117 were assigned to the alteplase group and 117 to the standard-treatment group. The median score on the National Institutes of Health Stroke Scale was 3 (interquartile range, 2 to 6) (scores range from 0 to 42, with higher scores indicating greater neurologic deficit). A higher percentage of patients in the alteplase group than in the standard-treatment group had functional independence at 90 days (89.6% vs. 72.6%; adjusted risk ratio, 1.16; 95% confidence interval [CI], 1.03 to 1.30; P = 0.01). The incidence of symptomatic intracranial hemorrhage within 36 hours was 1.7% in the alteplase group and 0.9% in the standard-treatment group. At 90 days, 5.2% of the patients in the alteplase group and 8.5% of those in the standard-treatment group had died.</p><p><strong>Conclusions: </strong>Among Chinese patients with mainly mild posterior circulation stroke who did not receive thrombectomy, alteplase administered 4.5 to 24 hours after stroke onset resulted in a higher frequency of functional independence at 90 days than standard medical care. (Funded by the National Natural Science Foundation of China; EXPECTS ClinicalTrials.gov number, NCT05429476.).</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"392 13","pages":"1288-1296"},"PeriodicalIF":96.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774946","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":"NEJM at AHA - Left Atrial Appendage Closure after Ablation for Atrial Fibrillation.","authors":"Eric J Rubin, Jane Leopold, Stephen Morrissey","doi":"10.1056/NEJMe2414475","DOIUrl":"10.1056/NEJMe2414475","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":"e36"},"PeriodicalIF":96.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649436","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":"Association between Wealth and Mortality in the United States and Europe.","authors":"Sara Machado, Ilias Kyriopoulos, E John Orav, Irene Papanicolas","doi":"10.1056/NEJMsa2408259","DOIUrl":"10.1056/NEJMsa2408259","url":null,"abstract":"<p><strong>Background: </strong>Amid growing wealth disparity, we have little information on how health among older Americans compares with that among older Europeans across the distribution of wealth.</p><p><strong>Methods: </strong>We performed a longitudinal, retrospective cohort study involving adults 50 to 85 years of age who were included in the Health and Retirement Study and the Survey of Health, Ageing, and Retirement in Europe between 2010 and 2022. Wealth quartiles were defined according to age group and country, with quartile 1 comprising the poorest participants and quartile 4 the wealthiest. Mortality and Kaplan-Meier curves were estimated for each wealth quartile across the United States and 16 countries in northern and western, southern, and eastern Europe. We used Cox proportional-hazards models that included adjustment for baseline covariates (age group, sex, marital status [ever or never married], educational level [any or no college education], residence [rural or nonrural], current smoking status [smoking or nonsmoking], and absence or presence of a previously diagnosed long-term condition) to quantify the association between wealth quartile and all-cause mortality from 2010 through 2022 (the primary outcome).</p><p><strong>Results: </strong>Among 73,838 adults (mean [±SD] age, 65±9.8 years), a total of 13,802 (18.7%) died during a median follow-up of 10 years. Across all participants, greater wealth was associated with lower mortality, with adjusted hazard ratios for death (quartile 2, 3, or 4 vs. quartile 1) of 0.80 (95% confidence interval [CI], 0.76 to 0.83), 0.68 (95% CI, 0.65 to 0.71), and 0.60 (95% CI, 0.57 to 0.63), respectively. The gap in survival between the top and bottom wealth quartiles was wider in the United States than in Europe. Survival among the participants in the top wealth quartiles in northern and western Europe and southern Europe appeared to be higher than that among the wealthiest Americans. Survival in the wealthiest U.S. quartile appeared to be similar to that in the poorest quartile in northern and western Europe.</p><p><strong>Conclusions: </strong>In cohort studies conducted in the United States and Europe, greater wealth was associated with lower mortality, and the association between wealth and mortality appeared to be more pronounced in the United States than in Europe.</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"392 13","pages":"1310-1319"},"PeriodicalIF":96.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774950","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":"Cervical Cancer.","authors":"Linda Harris","doi":"10.1056/NEJMc2501310","DOIUrl":"https://doi.org/10.1056/NEJMc2501310","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"392 13","pages":"1350"},"PeriodicalIF":96.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774957","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":"Neonatal Lupus.","authors":"Jing Mao, Chao Ji","doi":"10.1056/NEJMicm2415348","DOIUrl":"https://doi.org/10.1056/NEJMicm2415348","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"392 13","pages":"e35"},"PeriodicalIF":96.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774970","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":"Application Overload - A Call to Reduce the Burden of Applying to Medical School.","authors":"Rochelle P Walensky, Loren D Walensky","doi":"10.1056/NEJMp2414572","DOIUrl":"10.1056/NEJMp2414572","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":"1251-1254"},"PeriodicalIF":96.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756105","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":"Medical School Grading - Is \"Good Enough\" Good Enough?","authors":"Alexander A Iyer, David A Hirsh, Richard M Schwartzstein","doi":"10.1056/NEJMp2415777","DOIUrl":"10.1056/NEJMp2415777","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":"1254-1257"},"PeriodicalIF":96.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756156","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":"Clearance of Driver Mutations in Myelofibrosis.","authors":"Elisa Rumi, Oscar Borsani","doi":"10.1056/NEJMc2501559","DOIUrl":"https://doi.org/10.1056/NEJMc2501559","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"392 13","pages":"1348-1349"},"PeriodicalIF":96.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774962","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":"A \"Hot\" Cardiomyopathy.","authors":"Gautam Sen, Elizabeth Wilson, Daniel Sado, Rachel Bastiaenen, Stefania Rosmini","doi":"10.1056/NEJMcps2401333","DOIUrl":"https://doi.org/10.1056/NEJMcps2401333","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"392 13","pages":"1335-1342"},"PeriodicalIF":96.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774942","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":"Clearance of Driver Mutations in Myelofibrosis. Reply.","authors":"Nico Gagelmann, Nicolaus Kröger","doi":"10.1056/NEJMc2501559","DOIUrl":"https://doi.org/10.1056/NEJMc2501559","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"392 13","pages":"1349"},"PeriodicalIF":96.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774963","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}