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2024年全國醫(yī)學英語水平考試（METS四級）練習題及答案二
1). (一)■Effects of Aspirin on Risk and Severity of Early Recurrent Stroke After Transient Ischaemic Attack and Ischaemic Stroke■1Antithrombotic treatment is important in the immediate management of most acute ischaemic vascular events.Since aspirin is available in many households，public education materials recommend self-administration by patients who develop acute chest pain， in addition to seeking immediate medical attention.Prehospital self-administration of aspirin is discouraged after stroke because of concerns about possible intracerebral haemorrhage.However， haemorrhage is a rare cause of TIA (transient ischaemic attack) symptoms and it accounts for less than 5% of minor strokes.Although public education should continue to persuade people with transient neurological symptoms to seek medical attention immediately， where this is possible， self- administration of aspirin after transient unfamiliar symptoms might also be appropriate， particularly in rural settings or in less developed countries where access to medical services will be delayed.■2The risk of recurrent stroke is up to 10% in the week after a TIA or minor stroke.Urgent medical treatment seems to reduce that risk by as much as 80%， but many patients delay seeking medical attention， often for several days or weeks， even when they make a correct self- diagnosis.Public education campaigns， such as the FAST test television campaign， have decreased delays to presentation after major stroke， but there has been little improvement in presentation rates after TIA or minor stroke.In a recent population-based study in the UK， half of recurrent strokes in the days after a TIA occurred prior to medical attention being sought for the initial event， and the situation is likely to be worse in many parts of the developing world in which access to emergency services is poor.■3There are， however， few published data from randomised trials for the effect of aspirin on risk of early recurrent stroke after TIA or minor stroke， and no data for its effect on severity； evidence of apparently major benefits of urgent medical treatment generally comes only from observational studies.Randomised trials of aspirin versus placebo in longer-term secondary prevention showed only a 13%relative reduction in risk of recurrent stroke with aspirin.Trials of short-term treatment of hospitalised acute stroke also reported a 13% reduction in the 4 week risk of recurrent stroke or intracerebral haemorrhage， but the effect of aspirin on risk or severity of recurrence after more minor stroke was not reported.Yet，observational studies suggest potentially substantial early benefits of aspirin after TIA or minor stroke.In the EXPRESS study， urgent treatment with antiplatelet drugs， blood pressure-lowering drugs， and statins reduced the early risk of stroke by 80%； much of this decrease was hypothesised to have been due to aspirin.Severity of recurrent cerebral events was also reduced in EXPRESS， which might also have been due to aspirin.■4 In the absence of published randomised evidence of the effect of aspirin on risk and severity of early recurrent stroke after TIA or minor stroke，we reanalysed individual patient data and reviewed original paper records on early outcomes from all available trials of aspirin versus placebo in secondary prevention after TIA or ischaemic stroke.To inform on possible mechanisms of action， we also aimed to study the time course of the interaction between effects of aspirin and dipyridamole in secondary prevention of stroke.Aiming to more reliably estimate the very early time course of onset of effects of aspirin， we also studied risk of recurrent ischaemic stroke in trials of aspirin in treatment of acute stroke，stratified by severity of the pre-randomisation neurological deficit.■5Pooling the individual patient data from all randomised trials of aspirin versus control in secondary prevention after TIA or ischaemic stroke， we studied the effects of aspirin on the risk and severity of recurrent stroke， stratified by the following time periods： less than 6 weeks， 6-12 weeks， and more than 12 weeks after randomisation.We compared the severity of early recurrent strokes between treatment groups with shift analysis of modified Rankin Scale (mRS) score.To understand possible mechanisms of action， we also studied the time course of the interaction between effects of aspirin and dipyridamole in secondary prevention of stroke.In a further analysis we pooled data from trials of aspirin versus control in which patients were randomised less than 48h after major acute stroke，stratified by severity of baseline neurological deficit， to establish the very early time course of the effect of aspirin on risk of recurrent ischaemic stroke and how this differs by severity at baseline.■6We pooled data for 15，778 participants from 12 trials of aspirin versus control in secondary prevention.Aspirin reduced the 6 week risk of recurrent ischaemic stroke by about 60% and disabling or fatal ischaemic stroke by about 70%， with greatest benefit noted in patients presenting with TIA or minor stroke.The effect of aspirin on early recurrent ischaemic stroke was due partly to a substantial reduction in severity.These effects were independent of dose， patient characteristics， or aetiology of TIA or stroke.Some further reduction in risk of ischaemic stroke accrued for aspirin only versus control from 6-12 weeks， but there was no benefit after 12 weeks.By contrast， dipyridamole plus aspirin versus aspirin alone had no effect on risk or severity of recurrent ischaemic stroke within 12 weeks， but dipyridamole did reduce risk thereafter (0.76， 0.63-0.92， p=0.005)， particularly of disabling or fatal ischaemic.We pooled data for 40，531 participants from three trials of aspirin versus control in major acute stroke.The reduction in risk of recurrent ischaemic stroke at 14 days was most evident in patients with less severe baseline deficits， and was substantial by the second day after starting treatment.■7Our analyses of data from trials of aspirin in secondary prevention after TIA or ischaemic stroke show that the effect of aspirin on risk of early recurrent events has been underestimated.We show substantial reductions in the early risk of all stroke， ischaemic stroke， and acute myocardial infarction.We also found that a major part of the early benefit of aspirin was due to a previously unrecognized reduction in severity of early recurrent ischaemic stroke， resulting in 80%～90%reductions in the early risk of disabling or fatal recurrent ischaemic stroke after TIA or minor stroke.Although these trials recruited few patients in first few days after TIA or stroke， we found similar reductions in risk of recurrent ischaemic stroke with aspirin in trials of acute ischaemic stroke.■8Our findings confirm that medical treatment substantially reduces the risk of early recurrent stroke after TIA or minor stroke and identify aspirin as the key intervention.Medical services should give aspirin as soon as possible and public education should be aimed at self-administration after unfamiliar transient neurological symptoms suggestive of threatened stroke.The considerable early benefit from aspirin warrants public education about self-administration after possible TIA.The previously unrecognised effect of aspirin on severity of early recurrent stroke， the diminishing benefit with longer-term use， and the contrasting time course of effects of dipyridamole have implications for understanding mechanisms of action.■(二)Aspirin is recommended for ( )prevention after transient ischaemic attack (TIA) or minor stroke.However， the risk of major stroke is very high for only the first few days afterwards， and observational studies show substantially greater benefits of ( ) medical treatment with aspirin in the acute phase.The randomized trials show a relative ( )in risk of recurrent stroke with aspirin.The authors hypothesised that the short-term benefits of early aspirin have been ( )So the time course of the interaction between effects of aspirin and dipyridamole in preventing stroke was also studied.They conclude that medical treatment can greatly reduce the risk of early ( )stroke and stress the importance of( ) of aspirin.The considerable early benefit from aspirin can help public get the knowledge and apply aspirin by themselves after possible TIA.( )
A.self-administration
B.absorption
C.overestimated
D.recurrent
E.fatal
F.underestimated
G.acute
H.reduction
I.secondary
J.primary
A.early
A.increase

正確答案：H