NEJM evidence最新文献

{"title":"Adolescent Blood Pressure and Stroke - Measurements Matter.","authors":"Sarah Gorey, Jane A Leopold","doi":"10.1056/EVIDe2400399","DOIUrl":"https://doi.org/10.1056/EVIDe2400399","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 12","pages":"EVIDe2400399"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Source-Specific PM_2.5 and Atherosclerotic Cardiovascular Disease Mortality.","authors":"Tszshan Ma, Pablo Knobel, Michael Hadley, Elena Colicino, Heresh Amini, Alex Federman, Joel Schwartz, Kyle Steenland, Maayan Yitshak Sade","doi":"10.1056/EVIDoa2400182","DOIUrl":"10.1056/EVIDoa2400182","url":null,"abstract":"<p><strong>Background: </strong>Fine particulate matter (PM_2.5) exposure is adversely linked to atherosclerotic cardiovascular disease (ASCVD). However, most studies focused on PM_2.5 mass rather than its chemical composition and specific sources. Particulate pollution sources can have distinct, cumulative, and potentially synergistic health impacts. We investigated the associations of source-specific PM_2.5 exposure with ASCVD mortality in the United States, considering the combined associations and regional variations.</p><p><strong>Methods: </strong>We used data from the Centers for Medicare & Medicaid Services (including data from 65,838,403 participants) from 2000 to 2016. We estimated PM_2.5 exposure using machine-learning models and attributed components to five source categories. We used Poisson survival models to assess the associations with the source categories.</p><p><strong>Results: </strong>Higher ASCVD mortality rate (rate ratio [95% confidence interval (CI)] per interquartile range increase) was associated with oil combustion (1.051 [1.049 to 1.052]), industrial pollution (1.054 [1.052 to 1.056]), coal and biomass burning (1.065 [1.062 to 1.067]), and motor vehicle pollution (1.044 [1.042 to 1.046]). These associations persisted even after limiting our sample to ZIP code-years with PM_2.5<9 μg/m³ - the current National Ambient Air Quality Standard. In these areas the observed rate ratio for a one-unit increase in PM_2.5 mass was 1.028 (95% CI, 1.026 to 1.029).</p><p><strong>Conclusions: </strong>We found higher ASCVD mortality rate associated with PM_2.5, with differential effects across sources. These data highlight the importance of considering local population characteristics and exposure patterns when assessing health risks associated with PM_2.5.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 12","pages":"EVIDoa2400182"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leg Cycle Ergometry in Critically Ill Patients - An Updated Systematic Review and Meta-Analysis.","authors":"Heather K O'Grady, Hibaa Hasan, Bram Rochwerg, Deborah J Cook, Alyson Takaoka, Rucha Utgikar, Julie C Reid, Michelle E Kho","doi":"10.1056/EVIDoa2400194","DOIUrl":"10.1056/EVIDoa2400194","url":null,"abstract":"<p><strong>Background: </strong>Cycle ergometry is a rehabilitation strategy used in the intensive care unit (ICU) which may help mitigate post-ICU impairments. We aimed to systematically review and summarize evidence examining the efficacy and safety of cycle ergometry in the ICU.</p><p><strong>Methods: </strong>We included randomized controlled trials (RCTs) of critically ill adults with any diagnosis admitted to the ICU for >24 hours, comparing cycling interventions to control (no cycling). The primary outcome was physical function, using a hierarchical approach to standardize this outcome across trials. We performed random-effects meta-analyses and assessed the certainty of effect estimates using the Grading of Recommendations Assessment, Development, and Evaluation approach.</p><p><strong>Results: </strong>We included 33 RCTs that enrolled 3274 patients. Cycling may improve physical function at ICU discharge (12 RCTs, 1291 patients, standardized mean difference [SMD], 0.33 [95% confidence interval (CI), 0.05 to 0.62], low certainty) and posthospital discharge (8 RCTs, 865 patients, SMD, 0.23, [95% CI, 0.04 to 0.42], low certainty). Cycling may decrease ICU length of stay (29 RCTs, 2575 patients, mean difference [MD], 1.06 days fewer [95% CI, 0.33 to 1.80 days fewer], low certainty) and probably decreases hospital length of stay (22 RCTs, 2060 patients, MD, 1.48 days fewer [95% CI, 0.47 to 2.49 days fewer], moderate certainty). Cycling may have no effect on ICU mortality (17 RCTs, 2039 patients, risk ratio, 12 fewer deaths per 1000 [95% CI, 43 fewer to 23 more], low certainty). The pooled rate of adverse events in the intervention group was 1% (11 RCTs, 4623 sessions, [95% CI, 0 to 2%], low certainty) and in the comparison group, 2% (6 RCTs, 3365 sessions, [95% CI, 0 to 5%], low certainty).</p><p><strong>Conclusions: </strong>In this meta-analysis, we found that cycling with critically ill patients may improve physical function at ICU discharge and after hospital discharge, may reduce ICU length of stay, and probably reduces hospital length of stay, with no effect on other outcomes including mortality. We observed low to very low certainty of evidence for all but one outcome of interest. Adverse events were uncommon. (PROSPERO number, CRD 42018092132.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDoa2400194"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Should Elevated Blood Pressure Be Managed in Hospital?","authors":"Linnea M Wilson, Kaleab Z Abebe, Timothy S Anderson","doi":"10.1056/EVIDtt2400202","DOIUrl":"10.1056/EVIDtt2400202","url":null,"abstract":"<p><p>AbstractDuring hospitalization, patients' blood pressure often varies substantially from their outpatient steady state and many patients experience marked fluctuations. Given a lack of guidelines for inpatient blood pressure management, treatment patterns vary and recent observational studies demonstrate intensive inpatient blood pressure treatment may be been associated with harm. This article reviews current knowledge in inpatient blood pressure management and proposes a randomized trial to compare clinical outcomes of more versus less restrictive blood pressure goals.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 12","pages":"EVIDtt2400202"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pedaling Through Uncertainty - Evaluating the Impact of Cycle Ergometry in Critical Care.","authors":"Michelle Paton, Carol L Hodgson","doi":"10.1056/EVIDe2400372","DOIUrl":"https://doi.org/10.1056/EVIDe2400372","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 12","pages":"EVIDe2400372"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atherosclerotic Cardiovascular Disease Mortality and PM_2.5 Air Pollution - Role of Pollution Sources?","authors":"C Arden Pope, Joshua S Apte","doi":"10.1056/EVIDe2400371","DOIUrl":"https://doi.org/10.1056/EVIDe2400371","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 12","pages":"EVIDe2400371"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intact Fish Skin Graft to Treat Deep Diabetic Foot Ulcers.","authors":"Dured Dardari, Alberto Piaggesi, Louis Potier, Ariane Sultan, Holger Diener, Maude Francois, Bernhard Dorweiler, Benjamin Bouillet, Jocelyne M'Bemba, Lucy Chaillous, Giacomo Clerici, Laurence Kessler, Walter Wetzel-Roth, Martin Storck, Olafur Birgir Davidsson, Baldur Baldursson, Hilmar Kjartansson, John C Lantis, Guillaume Charpentier","doi":"10.1056/EVIDoa2400171","DOIUrl":"10.1056/EVIDoa2400171","url":null,"abstract":"<p><strong>Background: </strong>Diabetic foot ulcers are chronic, difficult to heal, and potentially life-threatening. Few medical devices have been studied in diabetic ulcers penetrating to bone or tendon.</p><p><strong>Methods: </strong>We conducted an international, open-label randomized controlled trial, randomly assigning patients with diabetic ulcers penetrating to bone, joint, or tendon 1:1 to intact fish skin graft or standard wound care, with assigned treatment applied through 14 weeks. The primary end point was the proportion of ulcers healed at 16 weeks, defined as reepithelization as identified by the investigator, and confirmed 14 days later. A blinded adjudication committee confirmed healing at both time points. Healing was also assessed at 20 and 24 weeks.</p><p><strong>Results: </strong>Between July 2020 and November 2022, 255 patients were randomly assigned to intact fish skin graft (n=129) or standard of care (n=126). Healing was achieved in 44% of patients at 16 weeks with intact fish skin graft compared with 26% for standard of care (P<0.001, unadjusted), with additional healing at 20 weeks (46% vs. 32%) and 24 weeks (55% vs. 38%). Mean (SD) time to healing was 17.3 (0.69) weeks (95% confidence interval [CI], 15.5 to 18.7) for the intact fish skin graft group and 19.4 (0.66) weeks (95% CI, 18.1 to 20.7) for the standard of care group. In a Cox regression, intact fish skin graft was associated with faster time to healing (hazard ratio, 1.59; 95% CI, 1.07 to 2.36). Primary wound infections were the most common adverse event, occurring in 39 (30.2%) of patients in the intact fish skin graft group and 31 (24.6%) of patients in the standard of care group.</p><p><strong>Conclusions: </strong>Among patients with deep diabetic foot ulcers, treatment with intact fish skin graft was superior to standard of care in proportion of wounds healed at 16 weeks and was associated with faster time to healing. (Funded by European Commission Fast Track to Innovation Horizon 2020, and Kerecis Ltd. ClinicalTrials.gov NCT04257370.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDoa2400171"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent Blood Pressure and Early Age Stroke.","authors":"Boris Fishman, Adi Vinograd, Avishai M Tsur, Aya Bardugo, Cole D Bendor, Carmit Libruder, Inbar Zucker, Miri Lutski, Amit Ram, Yael Hershkovitz, Omri Orr, Ariel Furer, Maxim Perelman, Gabriel Chodick, Gal Yaniv, David Tanne, Estela Derazne, Dorit Tzur, Arnon Afek, Josef Coresh, Ehud Grossman, Gilad Twig","doi":"10.1056/EVIDoa2400193","DOIUrl":"10.1056/EVIDoa2400193","url":null,"abstract":"<p><strong>Background: </strong>Underdiagnosis of relevant risk factors has contributed to the increasing stroke incidence in young adults. Blood pressure cut-off values for adolescents are neither sex specific nor based on cardiovascular outcomes.</p><p><strong>Methods: </strong>This nationwide, population-based, retrospective cohort study included all Israeli adolescents 16-19 years of age who were medically evaluated before compulsory military service from 1985 to 2013, including routine blood pressure measurements. The primary outcome was the first occurrence of a stroke (ischemic or hemorrhagic) at a young age (≤52 years), as documented in the Israeli National Stroke Registry. Cox proportional hazard models were stratified by sex and adjusted for birth year, sociodemographic variables, and adolescent body mass index.</p><p><strong>Results: </strong>The cohort comprised 1,897,048 adolescents (42.4% women). During 11,355,476 person-years of follow-up, there were 1470 first stroke events at a young age. In men, an adolescent diastolic blood pressure value of ≥80 mmHg, compared with the reference group (diastolic blood pressure value of <70 mmHg), was associated with an increased risk of stroke (adjusted hazard ratio 1.28; 95% confidence interval [CI], 1.04 to 1.58), while a diastolic blood pressure value of 70-79 mmHg was not associated with an increased risk of stroke (adjusted hazard ratio 1.11; 95% CI 0.90 to 1.34). Among women, an adolescent diastolic blood pressure value of ≥80 mmHg, compared with the reference group (diastolic blood pressure value of <70 mmHg) was associated with an increased risk of stroke at a young age (adjusted hazard ratio 1.38; 95% CI 1.03 to 1.88), as was a diastolic blood pressure value of 70-79 mmHg (adjusted hazard ratio 1.41; 95% CI 1.09 to 1.81). Elevated adolescent systolic blood pressure values (≥120 mmHg) were not associated with an increased risk of stroke.</p><p><strong>Conclusions: </strong>Diastolic blood pressure values of ≥80 mmHg in adolescence were associated with an increased risk of stroke at a young age in both men and women. No similar association was observed for elevated systolic blood pressure.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDoa2400193"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Searching for Answers - My Experience in the IDENTIFY Study.","authors":"Naseem Khorram","doi":"10.1056/EVIDpp2400203","DOIUrl":"https://doi.org/10.1056/EVIDpp2400203","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 12","pages":"EVIDpp2400203"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hooked on Healing - Fish Skin Grafts for Diabetic Foot Ulcers.","authors":"Lucas Castellani, Sylvia Arruda","doi":"10.1056/EVIDe2400373","DOIUrl":"https://doi.org/10.1056/EVIDe2400373","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 12","pages":"EVIDe2400373"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}