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Further insights into MARS 2 - Authors' reply. 对 MARS 2 的进一步了解--作者回复。
IF 38.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-01 DOI: 10.1016/S2213-2600(24)00247-9
Eric Lim, Chris Rogers
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引用次数: 0
Long-term outcomes of early exposure to repeated general anaesthesia in children with cystic fibrosis (CF-GAIN): a multicentre, open-label, randomised controlled phase 4 trial. 囊性纤维化儿童早期重复全身麻醉的长期效果(CF-GAIN):一项多中心、开放标签、随机对照的第 4 期试验。
IF 38.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-06-05 DOI: 10.1016/S2213-2600(24)00170-X
Claire Elizabeth Wainwright, Suzanna Vidmar, Vicki Anderson, Pierrick Bourgeat, Catherine Byrnes, John Brooke Carlin, Joyce Cheney, Peter Cooper, Andrew Davidson, Nicholas Gailer, Jasmin Grayson-Collins, Alexandra Quittner, Colin Robertson, Olivier Salvado, Diana Zannino, Floyd Daniel Armstrong
<p><strong>Background: </strong>Long-term effects of early, recurrent human exposure to general anaesthesia remain unknown. The Australasian Cystic Fibrosis Bronchoalveolar Lavage (ACFBAL) trial provided an opportunity to examine this issue in children randomly assigned in infancy to either repeated bronchoalveolar-lavage (BAL)-directed therapy with general anaesthesia or standard care with no planned lavages up to 5 years of age when all children received BAL-directed therapy under general anaesthesia.</p><p><strong>Methods: </strong>This multicentre, randomised, open-label phase 4 trial (CF-GAIN) used the original ACFBAL trial randomisation at 3·6 months (SD 1·6) to BAL-directed therapy or standard-care groups to assess the impact of general anaesthesia exposures over early childhood. Children who completed the ACFBAL trial, with a mean age of 5·1 (SD 0·18) years, received standardised neurobehavioural and health-related-quality-of-life assessment and brain MRI scans between Oct 8, 2013, and June 30, 2017, at a mean age of 12·8 (SD 1·7) years at three hospitals in Australia and one hospital in New Zealand. The primary outcome was a composite score of performance on a standardised, computer-based assessment of child attention, processing speed, and response inhibition skills (Conners Continuous Performance test, second edition). Secondary outcomes included intellectual function, other neurobehavioural measures, and brain imaging as an exploratory outcome. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12613000057785) and is completed.</p><p><strong>Findings: </strong>At 2 years, the BAL-directed therapy group (n=52) and standard-care group (n=45) had a median of 2·0 (IQR 1·0-3·0) and 0·0 (0·0-0·0) exposures, respectively. At completion of the ACFBAL trial, the BAL-directed therapy group had a median of 6·0 (4·0-9·5) exposures and the standard-care group 2·0 (1·0-4·0) exposures. At CF-GAIN completion, the BAL-directed therapy group had a median of 10·0 (IQR 6·5-14·5) exposures and the standard-care group 4·0 (3·0-7·0) exposures. Cumulative general anaesthesia exposure time was not prospectively collected but, for those with complete cumulative exposure time data to the end of the ACFBAL trial, the median cumulative exposure time for the BAL-directed therapy group (n=29) was 180 (IQR 140-285) min and for the standard-care group (n=32) was 48 (30-122) min. The mean Conners Continuous Performance test, second edition composite score was 51 (SD 8·1) in BAL-directed therapy group and 53 (8·8) in the standard-care group; difference -1·7 (95% CI -5·2 to 1·7; p=0·32) with similar performance on other neurobehavioural measures, including measures of executive function, intellectual quotient scores, and brain imaging.</p><p><strong>Interpretation: </strong>Our findings suggest that repeated general anaesthesia exposure in young children with cystic fibrosis is not related to functional impairment in attention, inte
背景:人类早期、反复接触全身麻醉的长期影响仍然未知。澳大拉西亚囊性纤维化支气管肺泡灌洗(ACFBAL)试验提供了一个机会,在婴儿期随机分配给接受全身麻醉下反复支气管肺泡灌洗(BAL)指导治疗的患儿,或在所有患儿5岁前接受全身麻醉下BAL指导治疗的标准护理(无计划灌洗)的患儿中对这一问题进行研究:这项多中心、随机、开放标签的第 4 期试验(CF-GAIN)采用最初的 ACFBAL 试验,在 3-6 个月(SD 1-6)时随机分配到 BAL 引导治疗组或标准护理组,以评估幼儿期全身麻醉暴露的影响。完成ACFBAL试验的儿童平均年龄为5-1岁(SD 0-18岁),他们在2013年10月8日至2017年6月30日期间接受了标准化神经行为和健康相关生活质量评估以及脑磁共振成像扫描,当时他们在澳大利亚的三家医院和新西兰的一家医院就诊,平均年龄为12-8岁(SD 1-7岁)。主要结果是儿童注意力、处理速度和反应抑制能力的标准化计算机评估(康纳斯连续表现测试,第二版)的综合得分。次要结果包括智力功能、其他神经行为测量和作为探索性结果的脑成像。该试验已在澳大利亚-新西兰临床试验注册中心注册(ACTRN 12613000057785),并已完成:2年后,BAL指导治疗组(52人)和标准治疗组(45人)的暴露中位数分别为2-0(IQR 1-0-3-0)和0-0(0-0-0-0)。在 ACFBAL 试验结束时,BAL 定向治疗组的中位暴露量为 6-0(4-0-9-5),标准护理组为 2-0(1-0-4-0)。CF-GAIN 试验结束时,BAL 引导治疗组的中位暴露量为 10-0(IQR 6-5-14-5)次,标准护理组为 4-0(3-0-7-0)次。累积全身麻醉暴露时间没有进行前瞻性收集,但对于到 ACFBAL 试验结束时有完整累积暴露时间数据的患者,BAL 引导治疗组(29 人)的中位数累积暴露时间为 180(IQR 140-285)分钟,标准护理组(32 人)的中位数累积暴露时间为 48(30-122)分钟。BAL指导治疗组的康纳斯连续表现测试(第二版)平均综合评分为51(SD 8-1)分,标准护理组为53(8-8)分;差异为-1-7(95% CI -5-2至1-7;P=0-32)分,其他神经行为测量的表现相似,包括执行功能测量、智商评分和脑成像:我们的研究结果表明,与累计麻醉时间较少且较短的组别相比,患有囊性纤维化的幼儿反复全身麻醉与注意力、智商、执行功能或大脑结构方面的功能障碍无关:澳大利亚国家健康与医学研究委员会、昆士兰州政府健康服务与临床创新奖学金以及昆士兰儿童医院基金会。
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引用次数: 0
Further insights into MARS 2. 对 MARS 2 的进一步了解。
IF 38.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-01 DOI: 10.1016/S2213-2600(24)00252-2
Yumna Ahmed, Agha Muhammad Hammad Khan, Calogero Casa, Ahmed Nadeem Abbasi
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引用次数: 0
Foritinib in advanced ROS1-rearranged non-small-cell lung cancer in China: a multicentre, open-label, single-arm, phase 2 study. 福瑞替尼治疗中国晚期ROS1重排非小细胞肺癌:一项多中心、开放标签、单臂2期研究。
IF 38.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-07-23 DOI: 10.1016/S2213-2600(24)00171-1
Jin-Ji Yang, Jianying Zhou, Si-Yang Maggie Liu, Mingjun Li, Zhiye Zhang, Ying Cheng, Yun Fan, Hongming Pan, Baoqing Wang, Gongyan Chen, Ke Wang, Liyan Jiang, Yanping Hu, Jianhua Shi, Xiaorong Dong, Cuimin Ding, Yunpeng Liu, Zhe Liu, Wangjun Liao, Wei Li, Jun Wang, Shanyong Yi, Qiong Zhao, Aimin Zang, Yuan Chen, Jiuwei Cui, Pengfei Luo, Xionghu Shen, Meili Sun, Changli Wang, Yi-Long Wu
<p><strong>Background: </strong>Currently approved targeted treatment for ROS1-rearranged non-small-cell lung cancer (NSCLC) has either inadequate intracranial activity or CNS-related toxicities. We evaluated the efficacy and safety of foritinib, a novel ALK and ROS1 inhibitor, in patients with advanced ROS1-rearranged NSCLC.</p><p><strong>Methods: </strong>This two-part (phase 2a and 2b), multicentre, single-arm, open-label, phase 2 study was done in 29 centres in China. Eligible participants were adults (aged ≥18 years) with histologically or cytologically confirmed ROS1-rearranged, locally advanced or metastatic stage IIIB-IV NSCLC, with an Eastern Cooperative Oncology Group performance status of 2 or less. Patients who had previously received no or one ROS1 inhibitor were enrolled into phase 2a, and patients who were naive to ROS1 inhibitor therapy were enrolled into phase 2b cohort 1. Participants in phase 2a received 80, 120, 160, or 210 mg foritinib succinate (foritinib) orally once daily over 21-day cycles; patients in phase 2b received the recommended phase 2 dose of 160 mg. The primary endpoint was objective response rate, assessed by the independent review committee in the full analysis set (ie, all participants who received at least one dose of study treatment). The safety analysis set included all participants who received at least one dose of study treatment and had available safety assessments. This study is ongoing and is registered with ClinicalTrials.gov, NCT04237805.</p><p><strong>Findings: </strong>Between March 26, 2020, and Dec 29, 2022, 104 patients were enrolled and treated. Six patients who had previously received more than one ROS1 inhibitor were enrolled in phase 2a before a protocol amendment stating that patients in this phase should have received no more than one ROS1 inhibitor; these patients were included in the safety analysis but excluded from the efficacy analysis of the ROS1-inhibitor-pretreated cohort. Therefore, the efficacy analysis set (n=98) included 42 patients from phase 2a (17 who were ROS1 inhibitor naive and 25 who had previously received ROS1 inhibitor) and 56 patients from phase 2b cohort 1. In phase 2a, the objective response rate was 94% (95% CI 71-100; 16 of 17 patients) in patients who were ROS1 inhibitor naive and 40% (21-61; ten of 25) in patients who had previously received ROS1 inhibitor. In phase 2b cohort 1, the objective response rate was 88% (95% CI 76-95; 49 of 56 patients). In a prespecified exploratory analysis in 41 patients with CNS metastases at baseline, the objective response rate was 100% (95% CI 48-100; five of five patients) in patients in phase 2a who were ROS1 inhibitor naive, 40% (16-68; six of 15) in patients in phase 2a who had previously received ROS1 inhibitor, and 90% (70-99; 19 of 21) in patients in phase 2b cohort 1. Grade 3-4 treatment-related adverse events occurred in 33 (32%) of 104 patients; the most common were hyperglycaemia (12 [12%] patients) and electrocard
背景:目前获批的ROS1重排非小细胞肺癌(NSCLC)靶向治疗要么颅内活性不足,要么存在中枢神经系统相关毒性。我们评估了新型ALK和ROS1抑制剂福替尼在晚期ROS1重排非小细胞肺癌患者中的疗效和安全性:这项由两部分组成(2a期和2b期)、多中心、单臂、开放标签的2期研究在中国的29个中心进行。符合条件的参与者为组织学或细胞学确诊为ROS1重排、局部晚期或转移性IIIB-IV期NSCLC的成人(年龄≥18岁),且东部合作肿瘤学组表现状态为2级或2级以下。既往未接受过或只接受过一种ROS1抑制剂治疗的患者被纳入2a期研究,对ROS1抑制剂治疗无知觉的患者被纳入2b期1组研究。2a期患者每天口服一次琥珀酸福替尼,每次80、120、160或210毫克,21天为一个周期;2b期患者接受2期推荐剂量160毫克。主要终点是客观反应率,由独立审查委员会对全部分析集(即所有接受过至少一剂研究治疗的参与者)进行评估。安全性分析集包括所有接受过至少一剂研究治疗并进行过安全性评估的参与者。该研究正在进行中,已在 ClinicalTrials.gov 登记,编号为 NCT04237805:2020年3月26日至2022年12月29日期间,共有104名患者入组并接受了治疗。有六名患者曾接受过一种以上的 ROS1 抑制剂治疗,在方案修订之前,他们被纳入了 2a 期研究,修订后的方案规定该期患者接受的 ROS1 抑制剂不得超过一种;这些患者被纳入了安全性分析,但被排除在 ROS1 抑制剂预处理队列的疗效分析之外。因此,疗效分析组(n=98)包括 42 名来自 2a 期的患者(17 名对 ROS1 抑制剂不了解,25 名曾接受过 ROS1 抑制剂治疗)和 56 名来自 2b 期队列 1 的患者。在 2a 期研究中,ROS1 抑制剂未激活患者的客观应答率为 94%(95% CI 71-100;17 例患者中的 16 例),曾接受过 ROS1 抑制剂治疗的患者的客观应答率为 40%(21-61;25 例患者中的 10 例)。在 2b 期队列 1 中,客观反应率为 88%(95% CI 76-95;56 例患者中有 49 例)。在对41例基线出现中枢神经系统转移的患者进行的预设探索性分析中,2a期中ROS1抑制剂未激活的患者的客观反应率为100%(95% CI 48-100;5例患者中的5例),2a期中曾接受过ROS1抑制剂治疗的患者的客观反应率为40%(16-68;15例患者中的6例),2b期队列1中患者的客观反应率为90%(70-99;21例患者中的19例)。104例患者中有33例(32%)发生了3-4级治疗相关不良事件;最常见的是高血糖(12例[12%])和心电图QT间期延长(6例[6%])。11名患者(11%)出现了与治疗相关的严重不良反应,其中最常见的是高血糖(6 例 [6%])。没有治疗相关不良事件导致死亡:福瑞替尼在ROS1抑制剂无效的ROS1重排NSCLC患者中显示出全身和颅内抗肿瘤活性和良好的耐受性。福瑞替尼对这些患者,尤其是中枢神经系统转移的患者,是一种很有前景的治疗方法:资助单位:复星医药、万邦生物制药、广东省肺癌转化医学重点实验室。
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引用次数: 0
FLiRTing with danger as SARS-CoV-2 variants evolve. 随着 SARS-CoV-2 变体的演变,FLiRT 技术面临危险。
IF 38.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-08-14 DOI: 10.1016/S2213-2600(24)00262-5
The Lancet Respiratory Medicine
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引用次数: 0
Estimated number of lives directly saved by COVID-19 vaccination programmes in the WHO European Region from December, 2020, to March, 2023: a retrospective surveillance study. 2020 年 12 月至 2023 年 3 月期间世卫组织欧洲地区 COVID-19 疫苗接种计划直接挽救的生命估计数量:一项回顾性监测研究。
IF 38.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-08-07 DOI: 10.1016/S2213-2600(24)00179-6
Margaux M I Meslé, Jeremy Brown, Piers Mook, Mark A Katz, José Hagan, Roberta Pastore, Bernhard Benka, Monika Redlberger-Fritz, Nathalie Bossuyt, Veerle Stouten, Catharina Vernemmen, Elisabet Constantinou, Marek Maly, Jan Kynčl, Ondrej Sanca, Tyra Grove Krause, Lasse Skafte Vestergaard, Tuija Leino, Eero Poukka, Kassiani Gkolfinopoulou, Kassiani Mellou, Maria Tsintziloni, Zsuzsanna Molnár, Gudrun Aspelund, Marianna Thordardottir, Lisa Domegan, Eva Kelly, Joan O'Donell, Alberto-Mateo Urdiales, Flavia Riccardo, Chiara Sacco, Viktoras Bumšteinas, Rasa Liausediene, Joël Mossong, Anne Vergison, Maria-Louise Borg, Tanya Melillo, Dragan Kocinski, Enkela Pollozhani, Hinta Meijerink, Diana Costa, João Paulo Gomes, Pedro Pinto Leite, Alina Druc, Veaceslav Gutu, Valentin Mita, Mihaela Lazar, Rodica Popescu, Odette Popovici, Monika Musilová, Maja Mrzel, Maja Socan, Veronika Učakar, Aurora Limia, Clara Mazagatos, Carmen Olmedo, Gavin Dabrera, Meaghan Kall, Mary Sinnathamby, Graham McGowan, Jim McMenamin, Kirsty Morrison, Dorit Nitzan, Marc-Alain Widdowson, Catherine Smallwood, Richard Pebody

Background: By March, 2023, 54 countries, areas, and territories (hereafter CAT) in the WHO European Region had reported more than 2·2 million COVID-19-related deaths to the WHO Regional Office for Europe. Here, we estimated how many lives were directly saved by vaccinating adults in the WHO European Region from December, 2020, to March, 2023.

Methods: In this retrospective surveillance study, we estimated the number of lives directly saved by age group, vaccine dose, and circulating variant-of-concern (VOC) period, regionally and nationally, using weekly data on COVID-19 mortality and infection, COVID-19 vaccination uptake, and SARS-CoV-2 virus characterisations by lineage downloaded from The European Surveillance System on June 11, 2023, as well as vaccine effectiveness data from the literature. We included data for six age groups (25-49 years, 50-59 years, ≥60 years, 60-69 years, 70-79 years, and ≥80 years). To be included in the analysis, CAT needed to have reported both COVID-19 vaccination and mortality data for at least one of the four older age groups. Only CAT that reported weekly data for both COVID-19 vaccination and mortality by age group for 90% of study weeks or more in the full study period were included. We calculated the percentage reduction in the number of expected and reported deaths.

Findings: Between December, 2020, and March, 2023, in 34 of 54 CAT included in the analysis, COVID-19 vaccines reduced deaths by 59% overall (CAT range 17-82%), representing approximately 1·6 million lives saved (range 1·5-1·7 million) in those aged 25 years or older: 96% of lives saved were aged 60 years or older and 52% were aged 80 years or older; first boosters saved 51% of lives, and 60% were saved during the Omicron period.

Interpretation: Over nearly 2·5 years, most lives saved by COVID-19 vaccination were in older adults by first booster dose and during the Omicron period, reinforcing the importance of up-to-date vaccination among the most at-risk individuals. Further modelling work should evaluate indirect effects of vaccination and public health and social measures.

Funding: US Centers for Disease Control and Prevention.

背景:截至2023年3月,世卫组织欧洲区域的54个国家、地区和领地(以下简称CAT)向世卫组织欧洲区域办事处报告的COVID-19相关死亡人数超过200万-200万。在此,我们估算了 2020 年 12 月至 2023 年 3 月期间,世卫组织欧洲地区通过接种成人疫苗直接挽救了多少人的生命:在这项回顾性监测研究中,我们利用 2023 年 6 月 11 日从欧洲监测系统下载的 COVID-19 死亡率和感染率、COVID-19 疫苗接种率、SARS-CoV-2 病毒各系特征的每周数据以及文献中的疫苗有效性数据,按年龄组、疫苗剂量和流行变异株 (VOC) 时期估算了地区和国家直接挽救的生命数量。我们纳入了六个年龄组(25-49 岁、50-59 岁、≥60 岁、60-69 岁、70-79 岁和≥80 岁)的数据。要纳入分析,CAT 需要同时报告四个年龄组中至少一个年龄组的 COVID-19 疫苗接种和死亡率数据。只有在整个研究期间有 90% 或以上的研究周同时报告了各年龄组 COVID-19 疫苗接种和死亡率数据的 CAT 才被纳入分析。我们计算了预期死亡人数和报告死亡人数的减少百分比:从 2020 年 12 月到 2023 年 3 月,在纳入分析的 54 个 CAT 中的 34 个中,COVID-19 疫苗总体上减少了 59% 的死亡(CAT 范围为 17-82%),这意味着 25 岁或以上的人群中约有 1600 万人的生命得到挽救(范围为 100-170 万):96%的获救者年龄在 60 岁或以上,52%的获救者年龄在 80 岁或以上;51%的首次接种获救者,60%的首次接种获救者是在 Omicron 期间获救的:在近 2-5 年的时间里,COVID-19 疫苗接种挽救的大多数生命都是首次加强接种和在 Omicron 期间接种的老年人,这加强了在高危人群中接种最新疫苗的重要性。进一步的建模工作应评估疫苗接种以及公共卫生和社会措施的间接影响:美国疾病控制和预防中心。
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引用次数: 0
Impact of COVID-19 vaccination programmes in Europe: lives saved and lessons learned. 欧洲 COVID-19 疫苗接种计划的影响:挽救的生命和吸取的教训。
IF 38.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-08-07 DOI: 10.1016/S2213-2600(24)00214-5
Oliver J Watson, Alexandra B Hogan
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引用次数: 0
Alin Gragossian: from emergency medicine resident to heart transplant recipient. Alin Gragossian:从急诊科住院医师到心脏移植受者。
IF 38.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-07-14 DOI: 10.1016/S2213-2600(24)00220-0
Tony Kirby
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引用次数: 0
Early exposure to general anaesthesia: considerations for age-related vulnerability and behavioural outcomes. 早期接触全身麻醉:考虑与年龄相关的脆弱性和行为结果。
IF 38.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-06-05 DOI: 10.1016/S2213-2600(24)00181-4
Daniil P Aksenov
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引用次数: 0
US FDA approves menthol e-cigarette products. 美国 FDA 批准薄荷电子烟产品。
IF 38.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-08-01 DOI: 10.1016/S2213-2600(24)00245-5
Bryant Furlow
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引用次数: 0
期刊
Lancet Respiratory Medicine
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