传统观点认为，由于液体丢失和血管扩张，感染性休克患者可出现循环容量的绝对和相对不足，因此，积极的液体复苏是纠正循环功能障碍和（或）组织低灌注的重要手段[1]。然而，近年来的研究提示，液体正平衡或容量负荷过多是包括感染性休克在内的重症患者不良预后甚至死亡的独立危险因素[2]。基于这些发现，限制性液体（复苏）治疗成为感染性休克临床研究的热点问题。 刚刚在线发表的CLASSIC研究旨在评价限制静脉液体对ICU中感染性休克患者的病死率及其他重要预后指标的影响[3]。这是一项前瞻随机对照试验，在8个...

ORIGINAL ARTICLE Efficacy and Safety of a Recombinant Plant-Based Adjuvanted Covid-19 Vaccine Karen J. Hager, Gonzalo Pérez Marc, Philipe Gobeil, et al N Engl J Med May 4, 2022DOI: 10.1056/NEJMoa2201300 Abstract BACKGROUND Coronavirus-like particles (CoVLP) that are produced in plants and display the prefusion spike glycoprotein of the original strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are combined with an adjuvant (Adjuvant ...

EDITORIAL Monoclonal Antibodies with Extended Half-Life to Prevent Covid-19 Jonathan Abraham N Engl J Med 2022; 386:2236-2238DOI: 10.1056/NEJMe2205563 Early treatment (i.e., soon after the onset of Covid-19 symptoms) with monoclonal antibodies that target the SARS-CoV-2 spike protein reduces the risks of Covid-19–related hospitalization and death.1-3 Yet, despite the success of these interventions, in response to continued pressure from human immune respo...

ORIGINAL ARTICLE Single-Dose Liposomal Amphotericin B Treatment for Cryptococcal Meningitis Joseph N. Jarvis, David S. Lawrence, David B. Meya, et al N Engl J Med 2022; 386:1109-1120DOI: 10.1056/NEJMoa2111904 Abstract BACKGROUND Cryptococcal meningitis is a leading cause of human immunodeficiency virus (HIV)–related death in sub-Saharan Africa. Whether a treatment regimen that includes a single high dose of liposomal amphotericin B would be efficacious i...

EDITORIALFREE PREVIEW Intravenous Fluids in Septic Shock — More or Less? Lauralyn A. McIntyre, John C. Marshall N Engl J Med June 17, 2022DOI: 10.1056/NEJMe2206160 …soon the sharpened features, and sunken eye, and fallen jaw, pale and cold, bearing the manifest impress of death’s signet, began to glow with returning animation…. “. . . 很快，瘦削的五官、凹陷的眼睛和下垂的下巴，苍白而冰冷的皮肤，这些明显的死亡迹象开始重新焕发活力。” — Dr. Thomas Latta D...

ORIGINAL ARTICLE Efficacy and Safety of the RBD-Dimer–Based Covid-19 Vaccine ZF2001 in Adults Lianpan Dai, Lidong Gao, Lifeng Tao, et al N Engl J Med May 4, 2022DOI: 10.1056/NEJMoa2202261 Abstract BACKGROUND The ZF2001 vaccine, which contains a dimeric form of the receptor-binding domain of severe acute respiratory syndrome coronavirus 2 and aluminum hydroxide as an adjuvant, was shown to be safe, with an acceptable side-effect profile, and immunogenic i...

Editorial May 5, 2022 Strategic Opportunities to Improve Stroke Systems of Care Kori S. Zachrison, Lee H. Schwamm JAMA. 2022;327(18):1765-1767. doi:10.1001/jama.2022.3820 Restoring reperfusion to the brain as quickly as possible during acute ischemic stroke is important to reduce long-term disability and optimize clinical outcomes for patients, although hospital and resource availability are frequently not well matched with patient location. Accordingly, ...

Original Investigation May 2, 2022 Association of SARS-CoV-2 Infection During Pregnancy With Maternal and Perinatal Outcomes Elisabeth McClymont, Arianne Y. Albert, Gillian D. Alton, et al JAMA. Published online May 2, 2022. doi:10.1001/jama.2022.5906 Key Points Question  Is SARS-CoV-2 infection during pregnancy associated with increased risk of adverse maternal and perinatal outcomes? Findings  This Canadian surveillan...

Editorial March 22, 2022 Thromboinflammation and Antithrombotics in COVID-19: Accumulating Evidence and Current Status Jean M. Connors, Paul M Ridker JAMA. Published online March 22, 2022. doi:10.1001/jama.2022.2361 Thrombotic complications of SARS-CoV-2 infection were recognized early in the pandemic, when infected patients often presented with abnormal coagulation findings and acute macrovascular obstruction, and evidence of pulmonary microvas...

ORIGINAL ARTICLE Restriction of Intravenous Fluid in ICU Patients with Septic Shock T.S. Meyhoff, P.B. Hjortrup, J. Wetterslev, et al N Engl J Med June 17, 2022DOI: 10.1056/NEJMoa2202707 BACKGROUND Intravenous fluids are recommended for the treatment of patients who are in septic shock, but higher fluid volumes have been associated with harm in patients who are in the intensive care unit (ICU). METHODS In this international, randomized trial, we ...