NEJM evidence最新文献

{"title":"A 52-Year-Old Man with Abdominal Pain and Jaundice.","authors":"Ogaga Urhie, Kirtan Patolia, Michael Alebich","doi":"10.1056/EVIDmr2400285","DOIUrl":"https://doi.org/10.1056/EVIDmr2400285","url":null,"abstract":"<p><p>AbstractMorning Report is a time-honored tradition where physicians-in-training present cases to their colleagues and clinical experts to collaboratively examine an interesting patient presentation. The Morning Report section seeks to carry on this tradition by presenting a patient's chief concern and story, inviting the reader to develop a differential diagnosis and discover the diagnosis alongside the authors of the case. This report examines the story of a 52-year-old man who presented to the emergency department with subacute abdominal pain and jaundice. Fever, worsening liver function tests, and multi-organ failure developed. Using questions, physical examination, and testing, an illness script for the presentation emerges; the differential is refined until a final diagnosis is made.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 12","pages":"EVIDmr2400285"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717944","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":"Truncated, Not Forgotten - Handling Left Truncation in Time-to-Event Studies.","authors":"Larry Han","doi":"10.1056/EVIDe2400384","DOIUrl":"https://doi.org/10.1056/EVIDe2400384","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 12","pages":"EVIDe2400384"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718009","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":"Sedation in the ICU.","authors":"Kalynn A Northam, Kristy M Phillips","doi":"10.1056/EVIDra2300347","DOIUrl":"https://doi.org/10.1056/EVIDra2300347","url":null,"abstract":"<p><p>AbstractSedation practices are key to improving intensive care unit (ICU) outcomes. Adequate treatment of pain, minimization of sedation, delirium prevention, and improved patient interaction to ensure early rehabilitation and faster ventilator liberation are evidenced-based components of ICU care. Here we review components of appropriate ICU sedation including the use of multicomponent care bundles such as the ABCDEF bundle with a focus on changes in ICU practice that followed the Covid-19 pandemic.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 11","pages":"EVIDra2300347"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514205","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":"A 53-Year-Old Man with Persistent Epigastric Pain.","authors":"Mohamed Hassan, Ayman Zaki Azzam, Rana Abdo, Abdulmajid Alomran, Zoha Alghamdi, Rania Naguib, Khaled O Alsaad, Tarek M Amin","doi":"10.1056/EVIDmr2400027","DOIUrl":"10.1056/EVIDmr2400027","url":null,"abstract":"<p><p>AbstractMorning Report is a time-honored tradition where physicians-in-training present cases to their colleagues and clinical experts to collaboratively examine an interesting patient presentation. The Morning Report section seeks to carry on this tradition by presenting a patient's chief concern and story, inviting the reader to develop a differential diagnosis and discover the diagnosis alongside the authors of the case. This report examines the story of a 53-year-old man who had epigastric pain that he described as a sensation of burning behind his sternum. It persisted for months despite treatment with proton pump inhibitors. Using questions, physical examination, and testing, an illness script for the presentation emerges. As the clinical course progresses, the differential is refined until a diagnosis is made.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 11","pages":"EVIDmr2400027"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514181","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":"Statistical Considerations in Developing an Individualized Surveillance Algorithm.","authors":"Hyungjin Myra Kim","doi":"10.1056/EVIDe2400337","DOIUrl":"https://doi.org/10.1056/EVIDe2400337","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 11","pages":"EVIDe2400337"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514207","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":"Smoking Cessation among People with HIV in Kenya - A Sustained Impact?","authors":"Rebecca L Ashare, Billy Tsima","doi":"10.1056/EVIDe2400346","DOIUrl":"https://doi.org/10.1056/EVIDe2400346","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 11","pages":"EVIDe2400346"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514206","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":"Hepatocellular Cancer Surveillance in Patients with Advanced Chronic Liver Disease.","authors":"Wenyi Gu, Victor de Lédinghen, Christophe Aubé, Aleksander Krag, Christian Strassburg, Laurent Castéra, Jérôme Dumortier, Mireen Friedrich-Rust, Stanislas Pol, Ivica Grgurevic, Yasmin Zeleke, Michael Praktiknjo, Robert Schierwagen, Sabine Klein, Sven Francque, Halima Gottfriedová, Ioan Sporea, Philipp Schindler, Florian Rennebaum, Maximilian Joseph Brol, Martin Schulz, Frank Erhard Uschner, Julia Fischer, Cristina Margini, Wenping Wang, Adèle Delamarre, Jan Best, Ali Canbay, David Josef Maria Bauer, Benedikt Simbrunner, Georg Semmler, Thomas Reiberger, Jérôme Boursier, Ditlev Nytoft Rasmussen, Valérie Vilgrain, Aymeric Guibal, Stefan Zeuzem, Camille Vassord, Luisa Vonghia, Renata Šenkeříková, Alina Popescu, Annalisa Berzigotti, Wim Laleman, Maja Thiele, Christian Jansen, Jonel Trebicka","doi":"10.1056/EVIDoa2400062","DOIUrl":"10.1056/EVIDoa2400062","url":null,"abstract":"<p><strong>Background: </strong>Patients with advanced chronic liver disease (ACLD) are at high risk of developing hepatocellular carcinoma (HCC). Therefore, biannual surveillance is recommended. This large-scale multicenter study aimed to stratify the risk of HCC development in ACLD.</p><p><strong>Methods: </strong>From 3016 patients with ACLD screened in 17 European and Chinese centers, 2340 patients with liver stiffness measurement (LSM) determined using different techniques (two-dimensional shear-wave elastography [2D-SWE], transient elastography, and point shear-wave elastography) and with different disease severities were included. Cox regression was used to explore risk factors for HCC. We used these data to create an algorithm, named PLEASE, but referred to in this manuscript as \"the algorithm\"; the algorithm was validated in internal and two external cohorts across elastography techniques.</p><p><strong>Results: </strong>HCC developed in 127 (5.4%) patients during follow-up. LSM by 2D-SWE (hazard ratio: 2.28) was found to be associated with developing HCC, alongside age, sex, etiology, and platelet count (C-index: 0.8428). We thus established the algorithm with applicable cutoffs, assigning a maximum of six points: platelet count less than 150×10⁹/l, LSM greater than or equal to 15 kPa, age greater than or equal to 50 years, male sex, controlled/uncontrolled viral hepatitis, or presence of steatotic liver diseases. Within 2 years, with a median follow-up of 13.7 months, patients in the high-risk group (≥4 points) had an HCC incidence of 15.6% (95% confidence interval [CI], 12.1% to 18.7%) compared with the low-risk group, at 1.7% (95% CI, 0.9% to 2.5%).</p><p><strong>Conclusions: </strong>Our algorithm stratified patients into two groups: those at higher risk of developing HCC and those at lower risk. Our data provide equipoise to test the prospective utility of the algorithm with respect to clinical decisions about screening patients with ACLD for incident HCC. (Funded by the German Research Foundation and others; ClinicalTrials.gov number, NCT03389152.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 11","pages":"EVIDoa2400062"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514185","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":"Infliximab versus Cyclophosphamide for Severe Behçet's Syndrome.","authors":"David Saadoun, Georgina Maalouf, Matheus Vieira, Salim Trad, Estibaliz Lazaro, Karim Sacre, Aurelie Plessier, Thomas Sené, Isabelle Koné-Paut, Nicolas Noel, Arsène Mekinian, Marc Lambert, Emmanuel Ribeiro, Tristan Mirault, Nicolas Mele, Azeddine Dellal, Olivier Fain, Isabelle Melki, Laurent Chiche, Julien Gaudric, Alban Redheuil, Elisabeth Maillart, Amine Ghembaza, Anne-Claire Desbois, Adrien Mirouse, Fanny Domont, Gaëlle Leroux, Yasmina Ferfar, Aude Rigolet, Jean-François Viallard, Mathieu Vautier, Matthieu Resche-Rigon, Patrice Cacoub","doi":"10.1056/EVIDoa2300354","DOIUrl":"10.1056/EVIDoa2300354","url":null,"abstract":"<p><strong>Background: </strong>Cyclophosphamide and infliximab are recommended as induction therapies for severe Behçet's syndrome. Whether infliximab is safer and more effective than cyclophosphamide in treating severe Behçet's syndrome is not known.</p><p><strong>Methods: </strong>In this phase 2, Bayesian, multicenter randomized controlled trial, we assigned patients fulfilling the International Study Group's criteria for Behçet's syndrome who had major vascular or central nervous system involvement to receive either intravenous infliximab (5 mg/kg at weeks 0, 2, 6, 12, and 18) or cyclophosphamide (0.7 g/m² intravenously at weeks 0, 4, 8, 12, 16, and 20, with a maximal dose of 1.2 g/infusion). All patients received the same glucocorticoid regimen. The primary outcome was complete response (clinical, biological, and radiological remission with a daily prednisone dose ≤0.1 mg/kg) at week 22.</p><p><strong>Results: </strong>Between May 2018 and April 2021, 52 patients with severe Behçet's syndrome (n=37 [71%] with vascular Behçet's syndrome and n=15 [29%] with neuro-Behçet's syndrome) were randomly assigned to receive either infliximab or cyclophosphamide. Complete response was achieved by 22 out of 27 (81%) and 14 out of 25 (56%) patients in the infliximab and cyclophosphamide treatment groups, respectively (estimated difference, 29.8 percentage points; 95% credible interval, 6.6 to 51.7). The posterior probability that at least 70% of treated individuals achieved complete response by week 22 was 97.4% for infliximab and 6.0% for cyclophosphamide. Overall, adverse events were recorded in 8 out of 27 (29.6%) patients receiving infliximab and 16 out of 25 (64%) patients receiving cyclophosphamide (estimated difference, -32.3 percentage points; 95% credible interval, -55.2 to -6.6). Serious adverse events were reported in 15% and 12% of patients receiving infliximab and cyclophosphamide, respectively.</p><p><strong>Conclusions: </strong>Among patients with severe Behçet's syndrome, induction therapy with infliximab had a superior complete response rate at 22 weeks and fewer adverse events than induction with cyclophosphamide. (Funded by the French Ministry of Health.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 11","pages":"EVIDoa2300354"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514187","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":"A New Predictive Algorithm toward Risk-Based Surveillance for Liver Cancer.","authors":"Landon L Chan, Vincent W S Wong, Stephen L Chan","doi":"10.1056/EVIDe2400344","DOIUrl":"https://doi.org/10.1056/EVIDe2400344","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 11","pages":"EVIDe2400344"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514182","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":"Chemotherapy or Immunotherapy in Behçet's Disease?","authors":"Jan A M van Laar, Tim B van der Houwen","doi":"10.1056/EVIDe2400267","DOIUrl":"https://doi.org/10.1056/EVIDe2400267","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"3 11","pages":"EVIDe2400267"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514183","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}