《新英格兰医学杂志》推荐2018年最值得收藏的论文集

这些研究和发现不仅拓展了医学知识，也改变了我们的思考，甚至在充足科学证据面前，还会改变我们现在的做法和观念。

Medicine is always changing and 2018 was no exception. Although many of the articles that were published in the Journal changed the way we think about certain things that we do, sometimes, when the evidence is strong enough, we even change what we do.

Understanding these “game changers” is critical to staying at the cutting edge of medicine. Here are a few such pieces from 2018.

For a large fraction of our professional lives, we have been telling patients who suffered from a prior major cardiovascular event, such as myocardial infarction or stroke, that daily ingestion of about 82 mg of aspirin a day could help protect against further events. 

Since the intervention was perceived to have few side effects, many of us advised previously healthy older adults to take a daily low-dose aspirin to protect against cardiovascular disease. 

This daily regimen was inexpensive, low-risk — or so we thought — and appeared to provide a benefit. But a trio of studies published last Sept. found that a daily aspirin doesn’t do much good, and may even cause harm.

Peanut allergy is another diagnosis where we were compelled to shift our mindset. 

For decades, the advice, once the allergy was confirmed, was to stay away from peanuts for the rest of your life. 

It was possible to desensitize people, but the procedures are difficult and entail substantial risk. 

However, the PALISADE trial, published in November, described a new peanut oral immunotherapy that, when introduced to patients with peanut allergy, could desensitize children and adolescents who were highly allergic to peanuts. 

Although there were side effects, the use of a highly refined and standard­ized peanut allergen provided a reasonable margin of safety.

In this year’s Notable Articles collection, we have gathered 12 articles that we believe had an impact on medicine. 

They include the studies on peanut allergy and aspirin, as well as a study on the first RNAi therapeutic for transthyretin amyloidosis, a disease where no therapy previously existed, and a trial on a new drug combination for cystic fibrosis that represents a major breakthrough, with the po­tential to improve quality of life and possibly survival in all patients who carry the most common CFTR mutation.

Among all papers published in 2018, this “most notable” collection was selected by the editors as being the most meaningful in improving medical practice and patient care. 

As always, we hope that you will take valuable insights from these articles.

Sincerely, 

Jeffrey M. Drazen, M.D.