NEJM This Week — April 9, 2026

欢迎收看《新英格兰医学杂志》本周资讯。

Welcome to NEJM This Week.

我是医生。

I'm Doctor.

丽莎·约翰逊。

Lisa Johnson.

本周，我们将介绍关于强化低密度脂蛋白胆固醇目标、基于团队的血压控制策略、免疫和肿瘤疾病的新疗法，以及新一代黄热病疫苗的研究进展。

This week, we present new research on intensive LDL cholesterol targets, team based strategies to improve blood pressure control, emerging therapies for immune and oncologic diseases, and a next generation yellow fever vaccine.

我们还将综述乳糜泻，并追踪一例术后并发症的典型案例。

We review celiac disease and follow a compelling case of post procedural complications.

观点栏目探讨了健康不平等现象，以及加强弱势群体医疗照护的努力。

Perspectives explore health disparities and efforts to strengthen care in vulnerable communities.

由韩国首尔延世大学医院的李永俊及其合作者撰写的《动脉粥样硬化性心血管疾病中的强化低密度脂蛋白胆固醇目标》。

Intensive LDL cholesterol targeting in atherosclerotic cardiovascular disease by Young Joon Lee from the Severance Hospital, Seoul, South Korea and co authors.

尽管有指南推荐，但针对动脉粥样硬化性心血管疾病患者二级预防中低密度脂蛋白胆固醇（LDL-C）目标值的随机试验证据仍然有限。

Despite guideline recommendations, evidence from randomized trials evaluating the appropriate low density lipoprotein LDL cholesterol target for secondary prevention in patients with atherosclerotic cardiovascular disease has remained limited.

在这项由韩国进行的试验中，3048名动脉粥样硬化性心血管疾病患者被随机分配至强化靶向组（LDL胆固醇目标低于55毫克/分升）或常规靶向组（LDL胆固醇目标低于70毫克/分升）。

In this trial conducted in South Korea, three thousand and forty eight patients with atherosclerotic cardiovascular disease were randomly assigned to a target LDL cholesterol level of less than 55 milligrams per deciliter, the intensive targeting group, or less than 70 per deciliter, the conventional targeting group.

在三年随访期间，强化靶向组中有6.6%的患者发生主要终点事件（包括心血管原因死亡、非致死性心肌梗死、非致死性卒中、任何血运重建或不稳定性心绞痛住院），而常规靶向组中这一比例为9.7%。

A primary endpoint event of a composite of death from cardiovascular causes, non fatal myocardial infarction, non fatal stroke, any revascularization, or hospitalization for unstable angina at three years occurred in six point six percent of patients in the intensive targeting group and in nine point seven percent of the patients in the conventional targeting group.

两组预设的安全性终点事件发生率相似，仅强化靶向组的肌酐升高发生率较低。

The incidence of pre specified safety endpoints was similar in the two trial groups, except for a lower incidence of creatinine elevation in the intensive targeting group.

华盛顿大学医学院西雅图分校的杰弗里·普罗布斯菲尔德和凯莉·布兰奇在社论中指出，李及其同事的试验数据为当前国际血脂指南提供了有力支持，并进一步证实了在动脉粥样硬化性心血管疾病二级预防中，LDL胆固醇水平越低越好。

Jeffrey Probsfield and Kelly Branch from the University of Washington School of Medicine Seattle write in an editorial that the data from the trial by Lee and coauthors lend firm support to current international lipid guidelines and further advance the idea that a lower LDL cholesterol level is better for secondary prevention of atherosclerotic cardiovascular disease.

当前试验的结果是否可推广至其他非东亚人群，仍需进一步研究。

Whether the findings from the current trial can be extrapolated to other non East Asian populations requires additional study.

这些数据也未能完全回答：在一级预防人群中，LDL胆固醇目标是否应设定为70毫克/分升或更低。

These data also do not fully answer the question of whether the target LDL cholesterol level should be 70 milligrams per deciliter or less in a primary prevention population.

该试验可能为未来开展更明确的试验铺平道路，以评估其他人群、其他治疗组合以及一级预防中不同LDL胆固醇目标的效果。

The trial potentially paves the way for more definitive trials to evaluate targeted LDL cholesterol levels in other populations with other treatment combinations and with other LDL cholesterol goals for primary prevention.

低收入患者高血压控制的多方面策略，作者为新奥尔良杜兰大学公共卫生与热带医学学院的凯瑟琳·米尔斯及其合作者。

Multifaceted Strategies for Hypertension Control in Low Income Patients by Katherine Mills from the Tulane University School of Public Health and Tropical Medicine, New Orleans and coauthors.

未受控制的高血压在健康状况差异显著的人群中更为普遍。

Uncontrolled hypertension disproportionately affects populations that have substantial health disparities.

本研究中，路易斯安那州和密西西比州的36家联邦合格健康中心被随机分配使用多层面实施策略或强化常规护理对照组来控制高血压。

In this study, 36 federally qualified health center clinics in Louisiana and Mississippi were randomly assigned to use either a multi faceted implementation strategy or enhanced usual care control group for hypertension control.

干预措施包括基于团队的强化血压管理、血压审计与反馈、生活方式改变和药物依从性的健康指导，以及家庭血压监测。

The intervention included team based intensive blood pressure management, blood pressure audit and feedback, health coaching on lifestyle changes and medication adherence, and home blood pressure monitoring.

强化常规护理包括向医生传授高血压临床指南。

Enhanced usual care involved educating physicians about clinical guidelines for hypertension.

1272名患者的平均年龄为58.8岁。

The mean age of the twelve seventy two patients was 58.8 years.

56.7%为女性，63.4%为非裔美国人，75.9%为失业人员，73.4%的家庭年收入低于25,000美元。

Fifty six point seven percent were women, sixty three point four percent were black, seventy five point nine percent were unemployed, and seventy three point four percent had a family income of less than $25,000 per year.

在这些患有高血压的低收入患者中，多层面的团队式实施策略相比强化常规护理，显著降低了收缩压。

Among these low income patients with hypertension, the multi faceted team based implementation strategy resulted in a significantly greater reduction in systolic blood pressure than enhanced usual care.

来自芝加哥西北大学费恩伯格医学院的萨迪娅·汗和来自圣路易斯华盛顿大学医学院的马克·赫夫曼。

Sadiya Khan from the Northwestern University Feinberg School of Medicine Chicago and Mark Huffman from Washington University School of Medicine St.

路易斯在社论中指出，米尔斯及其合作者的这项试验结果为在联邦合格健康中心成功实施基于系统的策略提供了迫切需要的证据。

Louis write in an editorial that the findings in this trial by Mills and coauthors provide much needed evidence for systems based strategies that can be successfully applied in federally qualified health centers.

该试验标志着在临床试验中常被低估的低收入患者中，安全有效地实施SPRINT治疗方案的重要进展。

The trial represents an important step forward in showing effective and safe implementation of the SPRINT treatment protocol among low income patients who are often underrepresented in clinical trials.

下一个合乎逻辑的问题是：如何调整、维持并扩大这种多层次的团队协作策略，以应用于美国目前运营的超过16,000家联邦合格健康中心组织中的所有诊所。

The next logical question is how to adapt, sustain, and scale this multilevel team based strategy for hypertension management across the more than 16,000 clinics among at least 1,400 federally qualified health center organizations currently operating in The United States.

将这一策略推广到新机构，需要评估并解决关键障碍，包括变革准备度、临床医生对实现更低血压目标的信心，以及实施成本。

Expansion of this strategy to new sites will require assessing and addressing key barriers, including readiness for change, clinicians' confidence in achieving lower blood pressure targets, and implementation costs.

由马萨诸塞州总医院波士顿的戴维·库德及其合作者开展的关于美佐吉他单抗在原发性免疫性血小板减少症中的II期随机试验。

A phase II randomized trial of mezogitamab in Primary Immune Thrombocytopenia by David Kuder from Massachusetts General Hospital Boston and coauthors.

免疫性血小板减少症（ITP）是一种以血小板破坏增加和生成减少为特征的疾病，与出血风险升高和生活质量下降相关。

Immune thrombocytopenia, ITP, is a disorder of increased platelet destruction and reduced platelet production and is associated with an increased bleeding risk and a compromised quality of life.

现有疗法在至少百分之二十的病例中无效。

Available therapies are ineffective in at least twenty percent of cases.

本试验评估了美扎吉他单抗（一种靶向浆细胞、浆母细胞和自然杀伤细胞的抗CD38抗体）的安全性和有效性。

This trial evaluated the safety and efficacy of mezagitamab, an anti CD38 antibody that targets plasma cells, plasmablasts, and natural killer cells.

41名患有持续性或慢性免疫性血小板减少症的成年人被随机分配接受每剂100毫克、300毫克或600毫克的mezagitamab，或安慰剂，每周皮下注射一次，持续八周。

Forty one adults with persistent or chronic ITP were randomly assigned to receive mezagitamab at a dose of one hundred milligrams, three hundred milligrams, or six hundred milligrams, or placebo, administered subcutaneously once weekly for eight weeks.

使用mezagitamab治疗可提高血小板计数，其安全性特征在持续性或慢性免疫性血小板减少症患者中与安慰剂相似。

Treatment with mezagitamab led to increased platelet counts with a safety profile that appeared to be similar to that of placebo among participants with persistent or chronic ITP.

黄热病疫苗VYF的免疫原性与安全性研究，一项二期临床试验，由法国里昂赛诺菲公司的Emmanuel Faroldi及其合作者开展。

Immunogenicity and safety of a yellow fever vaccine, VYF, a phase two trial by Emmanuel Faroldi from Sanofi, Lyon, France and co authors.

黄热病是一种由受感染的伊蚊或血蚊传播的急性病毒性出血热，每年导致约29,000至60,000人死亡。

Yellow fever is an acute viral hemorrhagic disease that is transmitted by infected aedes or haemagogus mosquitoes and causes approximately twenty nine thousand to sixty thousand deaths annually.

世界卫生组织建议，居住在黄热病流行或暴发地区的人群，以及前往这些地区的旅行者均应接种疫苗。

The World Health Organization recommends vaccination of persons living in areas where yellow fever is endemic or epidemic, as well as travelers visiting these areas.

为应对2015年和2016年黄热病的暴发，启动了大规模黄热病疫苗接种运动，耗尽了全球应急疫苗储备。

In response to outbreaks of yellow fever in 2015 and 2016, a mass yellow fever vaccination campaign was launched, which exhausted global emergency stockpiles.

为确保黄热病疫苗的充足供应，科学家们研发了一种新型减毒活疫苗VYF。

To help ensure a sufficient supply of yellow fever vaccine, scientists have developed a generation live attenuated vaccine, VYF.

本二期研究评估了VYF与已获批的黄热病疫苗YF Vax在安全性及免疫反应方面的对比情况。

The safety of and immune response to VYF as compared with those of the licensed yellow fever vaccine, YF Vax, was assessed in this phase two study.

568名18至60岁的健康成年人被随机按2:1的比例分配接受VYF或YF Vax单剂疫苗注射。

Five sixty eight healthy adults 18 to 60 years of age were randomly assigned in a two to one ratio to receive VYF or YF Vax as a single vaccine injection.

实验性黄热病疫苗VYF诱导的免疫反应与已获批疫苗YF Vax相似。

The investigational yellow fever vaccine, VYF, induced an immune response similar to that of the licensed vaccine YF Vax.

Cetadagrasib在晚期非小细胞肺癌和胰腺癌中的应用，作者为纽约纪念斯隆凯特琳癌症中心的Woon Ki Park及其合作者。

Cetadagrasib in Advanced Non Small Cell Lung Cancer and Pancreatic Cancer by Woon Ki Park from the Memorial Sloan Kettering Cancer Center, New York and coauthors.

KRAS G12D变异见于5%的非小细胞肺癌患者，是胰腺导管腺癌中最常见的取代变异，发生率高达40%。

The KRAS PG12D variant occurs in five percent of patients with non small cell lung cancer and is the most common substitution variant in pancreatic ductal adenocarcinoma, occurring in forty percent of patients.

目前尚无针对该变异的靶向治疗药物获得临床批准。

No targeted therapies directed against this variant are currently approved for clinical use.

这项一期研究评估了cetadagrasib——一种首创的KRAS G12D靶向蛋白降解剂——在203例既往接受过治疗的携带KRAS G12D变异的晚期实体瘤患者中的安全性、药代动力学、药效学及抗肿瘤活性。

This phase one study evaluated the safety, pharmacokinetics, pharmacodynamics, and antitumor activity of cetadagrasib, a first in class KRAS G12D targeted protein degrader in two zero three patients with previously treated advanced solid tumors harboring KRAS PG12D variants.

93%的患者出现了与治疗相关的不良事件。

Treatment related adverse events occurred in ninety three percent of the patients.

最常见的不良反应为短暂的输液相关反应和恶心。

The most common were transient infusion related reactions and nausea.

在这些患者中，Cetadagrasib显示出抗肿瘤活性，且因不良事件导致的治疗中断率较低。

Cetadagrasib was associated with antitumor activity and a low incidence of treatment discontinuation due to adverse events in these patients.

乳糜泻，一篇综述文章，作者为明尼苏达州罗切斯特梅奥诊所的约瑟夫·默里和南丹麦大学的斯蒂芬·赫佩，乳糜泻是一种常见自身免疫性疾病，约影响1%的人群，可在任何年龄因接触麸质而发病。

Celiac disease, a review article by Joseph Murray from the Mayo Clinic, Rochester, Minnesota, and Stefan Huspey from the University of Southern Denmark, Celiac disease, a common autoimmune condition affecting approximately one percent of the population, can develop with exposure to gluten at any age.

诊断包括血清学检测，尤其是针对组织转谷氨酰胺酶的IgA抗体检测，也可能包括确认内肌膜抗体的存在或十二指肠活检，尽管由于IgA检测在许多情况下已能提供可靠的诊断，后者正变得越来越不必要。

Diagnosis involves serologic testing, especially for IgA antibodies against tissue transglutaminase, and may include tests to confirm the presence of endomysial antibodies or even duodenal biopsies, although the latter are becoming less necessary since IgA testing provides a reliable diagnosis in many cases.

编码HLA-DQ2或HLA-DQ8的基因是该病发生的先决条件。

The presence of genes encoding HLA DQ2 or HLA DQ8 is a prerequisite for the disease.

无麸质饮食是主要的治疗方法，但部分成人患有非反应性乳糜泻，需密切监测，因其恶性病变风险增加。

A gluten free diet is the mainstay of treatment, but some adults have non responsive celiac disease, which warrants closer monitoring because of an increased risk of malignant conditions.

乳糜泻也常与其他自身免疫性疾病共存，例如1型糖尿病和自身免疫性甲状腺疾病。

Celiac disease also frequently occurs with other autoimmune disorders, such as type one diabetes mellitus and autoimmune thyroid disease.

许多患者难以坚持无麸质饮食，仍会暴露于足以引发持续炎症的麸质水平，从而面临症状和并发症的风险。

Many patients struggle to adhere to a gluten free diet and are exposed to gluten at a level sufficient to cause ongoing inflammation, placing them at risk for symptoms and complications.

一位70岁女性，出现心悸、疲劳和呼吸困难。

A 70 year old woman with a racing heart, fatigue, and dyspnea.

马萨诸塞州总医院的病例记录，作者托马斯·瓦尔格斯 Jr.

A case record of the Massachusetts General Hospital by Thomas Varguis Jr.

以及同事们。

And colleagues.

一位70岁的女性因心房颤动接受了导管消融术，但第二天她致电心脏科医生，报告称术后体重增加，并出现双下肢新发水肿。

A 70 year old woman underwent catheter ablation for atrial fibrillation, but the next day the patient called her cardiologist to report weight gain since the procedure and new edema in both legs.

液体潴留引发了一系列症状恶化，包括胸闷、心悸、疲劳和呼吸困难，最终在手术约四周后，患者被收入心脏重症监护室。

The fluid retention began a cascade of worsening symptoms including chest discomfort, palpitations, fatigue, and shortness of breath that culminated in the patient's admission to the cardiac ICU approximately four weeks after the procedure.

影像学检查提供了关键线索。

Imaging provided a critical clue.

胸部X光片显示胸腔积液和心脏周围出现新气体，CT检查揭示了心包积液伴气胸以及左心房旁食管增厚。

Chest radiographs showed pleural effusions and new air around the heart, and CT revealed hydropneumopericardium and esophageal thickening adjacent to the left atrium.

这些发现，结合她近期接受的导管消融术和吞咽困难，使临床医生怀疑并确诊为食管心包瘘。

These findings, together with her recent catheter ablation and dysphasia, led clinicians to suspect and confirm an esophageal pericardial fistula.

患者接受了紧急手术，术后需长期接受重症监护、机械通气和肠内营养。

The patient underwent urgent surgery requiring prolonged intensive care, mechanical ventilation, and enteral feeding.

康复过程缓慢，经历了数周的康复训练，但在随访时，她已恢复了进食、独立行走并重返日常活动的能力。

Recovery was slow with weeks of rehabilitation, but by follow-up she had regained the ability to eat, walk independently, and return to her usual activities.

《改变饮食以重塑癌症：一项临床意义的基础研究》，作者为澳大利亚悉尼Mindaroo儿童综合癌症中心的米歇尔·哈伯和默里·诺里斯。

Altering the Diet to Rewire Cancer, a Clinical Implications of Basic article by Michelle Haber and Murray Norris from the Mindaroo Children's Comprehensive Cancer Centre, Sydney, Australia.

饮食干预可能提升癌症治疗效果的可能性，已引起患者、临床医生和研究人员的广泛关注。

The possibility that dietary interventions could enhance cancer treatment outcomes has generated considerable interest among patients, clinicians, and researchers alike.

新兴的机制研究表明，特定的饮食可能影响肿瘤代谢和肿瘤微环境，并可能增强对化疗和放疗等传统疗法的反应。

Emerging mechanistic studies suggest that specific dietary may influence tumor metabolism and the tumor microenvironment and potentially enhance responses to conventional therapies such as chemotherapy and radiation.

然而，尽管这种生物学上的合理性以及有前景的临床前证据存在，但将其转化为临床实践仍受到关键知识空白的阻碍。

However, despite this biologic plausibility and promising preclinical evidence, translation to clinical practice has been hampered by a critical knowledge gap.

大多数饮食干预试验规模小、持续时间短，且关注的是非特异性结局，而非临床癌症终点。

Most trials of dietary interventions have been small and short term and have focused on nonspecific outcomes rather than clinical cancer endpoints.

当前该领域面临的挑战是，超越广泛的饮食建议，通过设计严谨、样本充足、长期的随机对照试验，严格测试特定饮食因素，以建立基于证据的肿瘤学营养指南。

The field now faces the challenge of moving beyond broad dietary recommendations to rigorously testing specific dietary factors in adequately powered, long term, randomized controlled trials to establish evidence based nutritional guidelines for oncology care.

尽管如此，精心设计的临床前研究仍有助于识别和细化需要在临床中解决的问题。

Carefully designed preclinical studies are nevertheless valuable in helping to identify and refine questions to be addressed clinically.

奇尔科维（Chircowy）等人近期在被广泛应用的MYCN驱动神经母细胞瘤小鼠模型中开展了一项研究，该研究揭示了精准的饮食调控如何重编程癌症的生物学特征。

A recent study by Chircowy et al, conducted in a widely used mouse model of MYCN driven neuroblastoma, showed how precise dietary manipulation can reprogram the biologic characteristics of cancer.

他们的研究表明，将限制特定氨基酸的饮食方案与一种抑制多胺代谢的药物联合使用，可通过一种全新机制有效治疗快速进展的病症：这种机制能重编程癌细胞，使其停止增殖并分化为更成熟的细胞。

Their work showed that combining dietary restriction of specific amino acids with a pharmacologic agent inhibiting the metabolism of polyamines can effectively treat rapidly progressive disease by means of a novel mechanism that reprograms cancer cells to stop proliferating and differentiate into more mature cells.

本周，我们将带来‘迈向公平’系列中的几则简短病例分享。

This week, we present the following brief cases from our Efforts Toward Equity series.

该系列带大家了解各类不同的倡议，这些倡议旨在解决医疗健康领域某一具体的歧视表现，并介绍了相关的共同研究人员。

The series offers glimpses of various initiatives that address a particular manifestation of discrimination in medicine or health and coauthors.

许多美国

Many U.

的

S.

患者面临住房不稳定、食品短缺、交通不便以及长期遭受歧视的问题。

Patients face unstable housing, food insecurity, transportation barriers, and cumulative harms of discrimination.

但家庭医生在切实解决这些健康社会决定因素时，往往会遇到诸多阻碍。

Yet family physicians frequently face obstacles to meaningfully addressing these social determinants of health.

认识到这些障碍后，美国家庭医师学会开发了一套实用工具，以加强临床联动并促进健康公平。

Recognizing these obstacles, the American Academy of Family Physicians developed a set of practical tools to enhance clinical linkages and advance health equity.

《人人参与》工具包聚焦四个领域：筛查和识别社会决定健康因素、建立联系、倡导与合作，以及识别和减少隐性偏见。

The Every One Project Toolkit focuses on four domains: screening for and recognizing social determinants of health, making connections, advocating and partnering, and recognizing and reducing implicit bias.

美国家庭医师学会2017年和2022年调查的比较结果显示，社会决定健康因素的筛查率保持稳定，分别为52%和54.2%，转介至当地资源的比例为51.1%和49.5%。

Comparative findings from the American Academy of Family Physicians 2017 and 2022 surveys showed consistent screening rates for social determinants of health, fifty two percent and fifty four point two percent respectively, and referrals to local resources, 51.149.5%.

而社区健康工作者的使用率则显著从9.8%上升至27.9%。

Whereas use of community health workers increased markedly from 9.8% to 27.9%.

利用学校系统作为数据合作伙伴以促进健康公平。

Leveraging school systems as data partners to advance health equity.

来自弗吉尼亚州塞勒姆罗阿诺克学院的伊丽莎白·阿克利的观点。

A perspective by Elizabeth Ackley from Roanoke College, Salem, Virginia.

社区发展策略可以解决健康不平等的根源，但其有效性受到数据系统的限制，这些系统未能充分捕捉边缘化人群的需求。

Community development strategies can address root causes of health disparities, yet their effectiveness is constrained by data systems that inadequately capture the needs of marginalized populations.

罗阿诺克谷社区健康生活指数是一项由文理学院与当地公立学校系统合作开展的倡议，通过将学校系统作为数据合作伙伴，动员超过5500名小学生及其家庭参与三年一次的数据收集工作，以指导以健康为导向的社区发展策略。

The Roanoke Valley Community Healthy Living Index is a collaborative initiative of a liberal arts college and a local public school system that addresses key gaps in understanding of inequities by leveraging the school system as a data partner, engaging more than 5,500 elementary students and their families in triennial data efforts to inform health focused community development strategies.

平均而言，RV CHLI 能够获取76%的小学生年龄别BMI数据，以及15%符合条件家庭的调查回复。

On average, the RV CHLI captures BMI for age from seventy six percent of elementary school aged children and survey responses from fifteen percent of eligible families.

持续的三年一次实施使我们能够长期追踪对社区环境状况的感知变化。

Sustained triennial implementation allows for longitudinal tracking perceptions of neighborhood conditions.

这些数据记录了重大事件（如新冠疫情和多项社区发展项目）的影响，并为及时的政策建议提供了依据。

These data have documented the impact of major events, such as the COVID-nineteen pandemic and a variety of community development projects, and informed timely policy recommendations.

在来自边缘化种族、民族和语言背景的患者中，使用数字糖尿病技术（如连续血糖监测仪CGM）的比例较低，这一挑战因医疗保险政策仅覆盖已使用胰岛素的患者而进一步加剧。

Rates of access to and use of digital diabetes technologies, such as continuous glucose monitors, CGMs, are lower among patients from marginalized racial, ethnic, and language backgrounds, a challenge compounded by health insurance policies limiting CGM coverage to patients who are already using insulin.

从2023年8月至2024年5月，亚洲健康服务——一家提供医疗、牙科和行为健康服务的联邦合格健康中心——实施了一项多语言质量改进项目，为35名未使用胰岛素但血糖控制不佳的成年糖尿病患者提供CGM（可穿戴设备，可实时提供血糖数据以支持糖尿病自我管理）。

From August 2023 to May 2024, the Asian Health Services, a federally qualified health center providing medical, dental, and behavioral health services, implemented a multilingual quality improvement project to provide CGMs, wearable devices providing real time glucose data enabling diabetes self management to thirty five adult patients with uncontrolled diabetes who are not using insulin.

80%的参与者糖化血红蛋白水平下降，其中51%的参与者下降幅度至少达到0.5个百分点，这一变化被认为具有临床意义。

Reductions in the glycated hemoglobin level occurred in eighty percent of participants with fifty one percent having a reduction of at least 0.5 percentage points, a change that was considered to be a clinically meaningful improvement.

在54%的参与者中，仅通过使用CGM和生活方式调整，就达到了目标糖化血红蛋白水平，无需升级为糖尿病药物治疗。

In fifty four percent of the participants, the target glycated hemoglobin level was achieved with a CGM and lifestyle modifications alone without the need to advance to diabetes medications.

医学教育中的反种族主义教学法。

Anti racism pedagogy in medical education.

作者：哈尼亚·阿巴西（纽约市卫生与心理卫生局）及其合作者。

A perspective by Hania Abbasi from the New York City Department of Health and Mental Hygiene and coauthors.

美国医学教育体系对种族的社会根源缺乏准确理解，常常未能将种族主义视为健康的社会决定因素，并教授基于种族的医学和种族本质主义——即认为种族差异是生物性且固定不变的，从而加剧了种族健康不平等。

The US medical education system lacks an accurate understanding of the social origins of race, often fails to acknowledge racism as a social determinant of health, and teaches race based medicine and race essentialism, the belief that racial differences are biologic and fixed, perpetuating racial health inequities.

将反种族主义实践——即主动识别、反对和改变医疗政策中的种族主义——融入医学课程仍然具有挑战性。

Integrating anti racism praxis, the active process of identifying, opposing, and changing racism in medical policies into medical curricula remains challenging.

纽约市卫生部举办了两场研讨会，面向学生、教职员工和医疗专业人员，以启动关于种族本质主义、种族偏见和系统性种族主义危害的持续学习。

The New York City Health Department hosted two symposia for students, faculty, and health professionals to launch ongoing learning about the harms of race essentialism, racial biases, and systemic racism.

从2023年到2024年参会人数的增加表明，健康科学教育中对反种族主义的需求正在增长。

An increase in registrants from the 2023 event to the 2024 event suggests that there is growing demand for anti racism in health science education.

承诺声明揭示了宝贵的收获。

The commitment statements revealed valuable takeaways.

详见nejm.org上的主题。

See the themes at nejm.org.

但提交此类声明的参会者比例较低，这表明未来此类项目应考虑采用其他成果衡量指标。

But the proportion of registrants who returned such statements was low, highlighting that alternative outcome metrics should be considered for future programs of this type.

广泛移民执法对儿童健康的影响。

Effects of pervasive immigration enforcement on children's health.

由华盛顿特区乔治城大学的尼赫尔·帕特尔撰写的观点。

A perspective by Nikhil Patel from Georgetown University, Washington DC.

在过去一年中，美国内陆的移民执法行动越来越多地发生在儿童生活、学习和接受照料的场所，如家庭、学校和托儿中心。

Over the past year, Interior US immigration enforcement actions have increasingly unfolded in spaces where children live, learn, and are cared for, homes, schools, and childcare centers.

这些事件导致多重创伤性暴露，包括与照顾者突然的身体分离，以及目睹国家授权的暴力行为。

These incidents cause overlapping forms of traumatic exposure, abrupt physical separation from a caregiver, and witnessing of state sanctioned violence.

将父母和照顾者与幼儿分离，会造成可预防的、由政策驱动的创伤，并对儿童的健康和发展产生长期影响。

Separating parents and caregivers from young children causes preventable policy driven trauma with long term consequences for child health and development.

对幼儿而言，分离不仅仅是压力源。

And separation is not merely stressful for young children.

它是有毒的。

It is toxic.

对拘留和驱逐的恐惧弥漫在整个社区，导致焦虑增加、躯体症状增多、缺课率上升，以及疫苗接种遗漏和医疗护理延迟。

Fear of detention and deportation permeates entire communities with increased anxiety, somatic symptoms, and school absenteeism, and missed vaccinations and deferred medical care.

应将创伤知情护理设为标准，临床医生需要接受培训，以识别与移民相关的创伤。

Trauma informed care should become standard and clinicians need training to recognize immigration related trauma.

扩大医疗法律合作可以为家庭提供协调的法律服务，而学校和早期儿童照护机构可成为心理健康支持的可信赖接入点。

Expanded medical legal partnerships can provide families with coordinated legal services, and schools and early childhood care settings can become trusted access points for mental health support.

联邦移民机构应从广泛无差别的逮捕转向以公共安全为重点的针对性执法，以减少对儿童造成的创伤影响，并在公共安全和国家安全不要求的情况下优先使用替代拘留措施。

Federal immigration agencies should shift from sweeping indiscriminate arrests to targeted public safety focused enforcement that lessens the traumatic effects on children, and alternatives to detention should be used whenever public safety and national security do not require otherwise.

儿童健康不应被视为附带损害，而应成为公共政策的核心考量。

Children's health should be treated not as collateral damage but as a central consideration in public policy.

在临床医学的案例中，一位83岁的女性患有进展性2型糖尿病，出现持续六个月的疼痛性皮疹。

In our images in clinical medicine, an 83 year old woman with worsening type two diabetes presented with a six month history of painful rash.

可见色素沉着斑块，伴有融合性糜烂和水疱。

Hyperpigmented plaques with coalescing erosions and blisters were seen.

腹部CT显示胰尾部有肿块。

Abdominal CT revealed a mass in the tail of the pancreas.

诊断为由胰高血糖素瘤引起的坏死性迁移性红斑。

A diagnosis of necrolytic migratory erythema due to a glucagonoma was made.

在另一张图像中，一位68岁男性在插管25天后拔管出现吞咽困难。

In another image, a 68 year old man who had undergone intubation twenty five days earlier had difficulty swallowing after extubation.

吞咽检查显示液体进入气管，但未引发咳嗽反射，相关视频见nejm.org。

A swallowing study showed fluid penetrating into the trachea without triggering a cough reflex shown in a video at nejm.org.

诊断为无症状误吸。

A diagnosis of silent aspiration was made.

无症状误吸是指没有明显咳嗽或窒息表现的误吸，是长期气管插管的并发症。

Defined as aspiration without overt signs of coughing or choking, silent aspiration is a complication of prolonged endotracheal intubation.

更多内容请访问nejm.org阅读我们的期刊。

Read more from our issue at nejm.org.

告诉我们您对我们播客的看法。

Tell us what you think about our podcast.

任何评论或建议请发送至audioNEJM.org。

Any comments or suggestions may be sent to audioNEJM dot org.

感谢收听。

Thank you for listening.