{"id":310,"date":"2007-08-12T12:00:07","date_gmt":"2007-08-12T11:00:07","guid":{"rendered":"http:\/\/resource.bmj.com\/bmj\/2007\/08\/12\/nejm-9-aug-2007-vol-357\/"},"modified":"2007-08-12T12:00:07","modified_gmt":"2007-08-12T11:00:07","slug":"nejm-9-aug-2007-vol-357","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2007\/08\/12\/nejm-9-aug-2007-vol-357\/","title":{"rendered":"NEJM  9 Aug 2007  Vol 357"},"content":{"rendered":"<p>Severe haemophilia A damages joints in young boys through repeated haemarthroses which are treated as they occur with injections of recombinant factor VIII.<!--more--> Fortunately, after the disasters of hepatitis and HIV-contaminated cryoprecipitate in the 1980s, this provides a completely safe treatment. <a href=\"http:\/\/content.nejm.org\/cgi\/content\/abstract\/357\/6\/535\">This trial<\/a> assesses whether in boys under 30 months of age, prophylactic factor VIII given by injection on alternate days might provide better joint protection, and it does.<\/p>\n<p>Age-related macular degeneration is mostly a disease of elderly people who have smoked; we know that complement 3 is important in its pathogenesis but we don\u2019t know much about the genetics involved. Here a <a href=\"http:\/\/content.nejm.org\/cgi\/content\/abstract\/357\/6\/553\">genetic study<\/a> identified a complement 3 polymorphism in a southern English cohort with MD; this was then cross-checked with a cohort from another country \u2013 Scotland. And the association holds. Aye.<\/p>\n<p>There have been enough trials of neuroprotective agents for stroke over the last decade to fill a large book. They all begin with promising results in animal models, yield possible benefits in small pilot studies, and then flop when tried in larger randomised trials. Here <a href=\"http:\/\/content.nejm.org\/cgi\/content\/abstract\/357\/6\/562\">the trials<\/a> used an agent called NXY-059 and were known as the SAINT I and SAINT II trials respectively. The drug didn\u2019t work, and these SAINTs will join all the others who from their labours rest.<\/p>\n<p>In fact we don\u2019t really have a good intervention for acute ischaemic stroke, judging from a short <a href=\"http:\/\/content.nejm.org\/cgi\/content\/extract\/357\/6\/572\">clinical review <\/a>here. Intravenous thrombolysis using rt-PA (alteplase) provides very modest benefits if administered in the first 3 hours, and it\u2019s possible that clot retrieval and\/or intra-arterial thrombolysis may produce better results but possibly at the expense of more haemorrhage.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Severe haemophilia A damages joints in young boys through repeated haemarthroses which are treated as they occur with injections of recombinant factor VIII. [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmj\/2007\/08\/12\/nejm-9-aug-2007-vol-357\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38363,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[111],"tags":[],"class_list":["post-310","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-lehmans-weekly-review-of-medical-journals"],"jetpack_featured_media_url":"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/310","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=310"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/310\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media\/38363"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=310"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=310"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=310"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}