The article is from WeChat public account: New Medical Perspective (ID: HealthHorizon) , the title picture comes from: Unsplash
Scientific discovery is often a process of “constant negation of the past.” Standing on the tail of 2019, we look back at the past year and take stock of 10 studies published in top medical journals that bring new understanding and are expected to promote changes in clinical practice.
British Medical Journal: Breakfast may not be so important
Breakfast is often considered the most important meal of the day. Some international dietary guidelines also recommend that breakfast be included in weight management and prevent obesity measures. This research challenges this view, saying that breakfast and fatness may not be related.
Analysis of a total of 13 randomized controlled trials on the effect of breakfast on body weight or daily caloric intake in the past 28 years. The study found that There is no high-quality evidence to support “eating breakfast to promote weight loss” or “not eating “Breakfast causes weight gain.” Perhaps, whether you eat breakfast regularly is more important for your overall eating habits.
“The Lancet · Diabetes and Endocrinology”: Oral basic insulin is equivalent to injections
Insulin is easily degraded by proteases in the gastrointestinal tract, and it is difficult to enter the blood through epithelial cells. The development of oral insulin to treat diabetes has always been one of the most dreamed but difficult goals.
A Phase 2 clinical trial from Novo Nordisk’s (Novo Nordisk) team has shown for the first time that after formula modification, a code name is I388’s long-acting basal insulin can be administered orally.Compared with the next injection of insulin, it brings similar blood glucose control effect to patients with type 2 diabetes. An editorial issued with the same journal praised “this is an experiment in rewriting textbooks.”
At present, the research team is continuing to optimize the development of oral insulin, overcome the limitations of excessive insulin dosage in this trial, and improve the bioavailability and production efficiency of the drug.
It is worth mentioning that Novo Nordisk’s oral GLP-1 receptor agonist, Somaglutide, was approved by the US FDA in September. The English name is Rybelsus) , which is also a breakthrough in the field of diabetes “turning injections into medicine”.
“Journal of the American Medical Association · Internal Medicine”: Is health and longevity necessary?
A lot of research supports the positive effects of physical activity on health and longevity. However, there are very few scientific data on how many steps to take. The study, from Brigham and Women’s Hospital at Harvard Medical School and its collaborating team, clarified people’s misunderstandings and reminded them that it would be good to go a little bit more.
After years of follow-up to older women, the data shows that the daily exercise related to longevity is far less than the threshold of 10,000 steps! Compared with less than 3,000 steps a day, the average person who walks an average of 4,400 steps has a 41% reduction in the risk of death. As the number of steps increased, the risk of death continued to decrease, but after reaching 7,500 steps / day, the risk leveled off.
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“The Lancet”: Existing vaccines target bacteria. Is the virus the main cause of pneumonia in children? Zh
Pneumonia is one of the leading causes of death in children under 5 years of age. Many pathogen infections can cause pneumonia. Traditionally, pneumonia caused by pneumococci is the most common. Pneumonia vaccine is an important means to prevent pneumonia. Currently, there are many varieties of pneumonia vaccines on sale, such as 7-, 13-, and 23-valence, which can prevent pneumonia caused by a variety of serotype pneumococcal infections.
However, the results of this multi-center study across seven countries in two continents of Asia and Africa show that respiratory syncytial virus > The main virus has become the main cause of severe childhood pneumonia in low- and middle-income countries. Current pneumococcal vaccines against pneumococcus do not stop childhood pneumonia and death from these viruses. The results of this research suggest that on the basis of existing vaccines, we need to develop new vaccines to prevent viral pneumonia in children caused by RSV-based viruses.
Lancet: No bowel cleansing may be required before bowel surgery
For colorectal surgery, preoperative bowel preparation is usually required, which mainly includes diet preparation and mechanical preparation. And oral antibiotics to clean the bowel, facilitate surgery, and avoid complications such as postoperative infections. However, bowel preparation is a stressful process for patients.
This randomized trial included nearly 400 patients who needed colon surgery, and the results showed that taking bowel cleansers and antibiotics did not reduce the number of cases of surgical site infections or surgical complications compared with no bowel preparation. Or severity, and there was no difference in the length of stay of patients. This undoubtedly sparked a discussion of the need for bowel preparation, but an editorial with the journal also pointed out that whether these “subversive” conclusions are generally valid and can be extended to clinical applications remains to be seen.
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New England Journal of Medicine: Myocardial viability cannot predict long-term prognosis for patients with coronary heart disease
For patients with ischemic cardiomyopathy that can benefit from surgical revascularization, the role of myocardial viability assessment is still controversial. In addition, although improving left ventricular function is one of the goals of revascularization, its impact on subsequent outcomes is unclear.
This randomized trial included 601 suitable for coronary artery bypass grafting (CABG) and with a left ventricular ejection fraction ≤35% Patients with coronary heart disease were evaluated prospectively for myocardial viability. Patients were divided into groups to receive CABG in combination with medication or to receive medication alone.
After a median follow-up of 10.4 years, all-cause mortality was 27% lower in the CABG plus drug treatment group, but the data do not support that myocardial survival in patients was associated with long-term benefits of CABG. At the same time, No matter which treatment was received, surviving myocardium was associated with improved left ventricular systolic function, but these improvements were not associated with long-term survival.
“The Lancet”: Prevention of stroke myocardial infarction, four-in-one antihypertensive and lipid-lowering drugs show potential
The risk of cardiovascular disease is often related to multiple factors such as blood pressure and blood lipids. Managing multiple indicators for a long time and insisting on taking a variety of drugs for a long time according to regulations is a great challenge for patient compliance. “Multi-effect tablets” containing four cardiovascular drug ingredients are bringing new solutions.
This large-scale, long-term, practical randomized trial demonstrated in nearly 7,000 subjects that compared with lifestyle interventions, fixed-dose combination therapy can reduce the risk of cardiovascular events by 34%, including the ischemic heart The preventive effects of diseases and strokes are particularly pronounced. Drug compliance and safety performed well.
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“The Lancet”: the first-line treatment of diabetes, the classic model of metformin is challenged
Metformin is one of the most widely used hypoglycemic agents and the first choice for the treatment of type 2 diabetes. Newly diagnosed patients usually receive metformin monotherapy first, and other drugs are added after poor glycemic control or disease progression.
The VERIFY trial in 254 clinical centers in 34 countries challenged this classic model of medication. Large-scale international research for 5 years shows for the first time that the combination of early treatment for newly diagnosed patients can achieve better long-term glycemic control than metformin monotherapy and delay insulin use, which is also important for delaying complications of diabetes.
New England Medical Journal: Asymptomatic severe aortic stenosis, conservative treatment or early surgery?
The timing and indications of surgical intervention in asymptomatic patients with severe aortic stenosis remain controversial. This multicenter trial randomized 145 subjects and recommended early surgery or conservative treatment according to current guidelines. There were no surgical deaths in the surgery group. (dies during or 30 days after surgery) . In the follow-up period of 4.5 to 7.3 years, compared with the conservative treatment group, the risk of surgical death or cardiovascular death in the early surgery group was 91% lower, and the risk of all-cause death was 67% lower.
Data show that early surgery to replace aortic valves in patients with severe aortic stenosis can reduce the risk of death, even without symptoms.
Picture source: Pixabay
An update to the 2018 challenge textbook study list:
In 2018, a study in Nature found that nearly one-third of the cells in the placenta contained bacteria, challenging the idea that the placenta and uterus are sterile. After more research, Nature published a paper in July 2019 from the University of Cambridge in the United Kingdom that believes that there are no microorganisms in the human placenta, but it may be a potential place for perinatal pathogen infection.
Finally, I would like to thank my readers and friends for their love and support for new medical perspectives during the year. In 2020, we will focus on more exciting new discoveries in medicine and health.
References
[1] 15 Studies That Challenged Medical Dogma in 2019. Retrieved Dec 30, 2019, from https://www.medscape.com/viewarticle/923150 < / p>
[2] Katherine Sievert, et al., (2019). Effect of breakfast on weight and energy intake: systematic review and meta-analysis of randomised controlled trials. BMJ, https : //doi.org/10.1136/bmj.l42
[3] Inge B Halberg, et al., (2019). Efficacy and safety of oral basal insulin versus subcutaneous insulin glargine in type 2 diabetes: a randomised, double-blind, phase 2 trial. The Lancet Diabetes & Endocrinology, 10.1016 / S2213-8587 (18) 30372-3
[4] I-Min Lee, et al., (2019). Association of Step Volume and Intensity With All-Cause Mortality in Older Women. JAMA Internal Medicine., 10.1001 /jamainternmed.2019.0899
[5] PERCH Study Group. (2019). Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study The Lancet, 10.1016 / S0140-6736 (19) 30721-4
[6] Laura Koskenvuo, et al., (2019). Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE): a multicentre, randomised, parallel , single-blinded trial. The Lancet, 10.1016 / S0140-6736 (19) 31269-3
[7] Julio A. Panza, et al., (2019). Myocardial Viability andLong-Term Outcomes in Ischemic Cardiomyopathy. N Engl J Med, 10.1056 / NEJMoa1807365
[8] Gholamreza Roshandel, et al., (2019). Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial. The Lancet, 10.1016 / S0140-6736 (19) 31791-X
[9] David R Matthews, et al., (2019). Glycaemic durability of an early combination therapy with vildagliptin and metformin versus sequential metformin monotherapy in newly diagnosed type 2 diabetes ( VERIFY): a 5-year, multicentre, randomised, double-blind trial. The Lancet, 10.1016 / S0140-6736 (19) 32131-2
[10] Duk-Hyun Kang, et al., (2019). Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis. N Engl J Med, 10.1056 / NEJMoa1912846
[11] de Goffau, et al., (2019). Human placenta has no microbiome but can contain potential pathogens. Nature, 10.1038 / s41586-019-1451-5
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Article from WeChat public account: New Medical Perspective (ID: HealthHorizon)