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A 4-Year Trial of Tiotropium in COPD
These investigators compared outcomes in patients with chronic obstructive pulmonary disease treated with once-daily inhalation of tiotropium or placebo. There was no benefit of treatment on the rate of loss of lung function over time, although benefits were observed in some secondary end points.
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 October 5, 2008 (DOI: 10.1056/NEJMoa0805800), in Print October 9, 2008
Related Editorial: COPD and Declining FEV1 — Time to Divide and Conquer?
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Harnessing Employer Inventiveness in U.S. Health Care Reform
The pressures employers face have worsened as health care costs have grown faster than wages. Dr. Robert Galvin writes that although the business community has been a reluctant actor in this arena, it remains skeptical that its interests will be served by solutions arising from the provider community or from increased government control.
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Executive Physicals — Bad Medicine on Three Counts
Many executives take part in one of modern medicine’s most expensive and least proven approaches to care: the executive physical. Dr. Brian Rank argues that executive physicals are not good for the patients who undergo them, for the companies that pay for them, or for the health care system overall.
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The Statins in Preventive Cardiology
By inhibiting the biosynthesis of endogenous cholesterol, the statin drugs lower elevated blood cholesterol levels much more effectively than any dietary or other drug regimen. Dr. Daniel Steinberg describes how statins have revolutionized preventive cardiology.
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Lethal Injection and the Constitution
In the 2008 U.S. Supreme Court case, Baze v. Rees, the Court ruled that Kentucky’s three-drug protocol for lethal injection does not constitute cruel and unusual punishment and does not violate the U.S. Constitution. The author summarizes the seven separate opinions written by the justices and discusses the implications of the decision.
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Autosomal Dominant Polycystic Kidney Disease
Shortly after being elbowed in the flank during a basketball game, a 35-year-old healthy man has severe, colicky abdominal pain followed by gross hematuria. A renal ultrasound scan reveals bilateral polycystic kidneys and liver cysts. How should his case be further evaluated and managed?
CME Exam
 Listen to the full text of this article.
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Hepatitis B Virus Infection
Profound, durable, therapeutic HBV DNA suppression to slow and reverse the progression of chronic HBV infection is important, given the evidence linking high-level HBV replication and the late consequences of chronic HBV infection. This article reviews strategies for treating HBV infection.
CME Exam
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Variations on a Theme
A 57-year-old man presented to the emergency department with a 2-week history of progressive dyspnea on exertion, edema of the legs, a nonproductive cough, and scant hemoptysis.
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Maraviroc for Previously Treated Patients with R5 HIV-1 Infection
The CCR5 coreceptor may be a therapeutic target to block HIV infection. In two studies, maraviroc (a CCR5 antagonist) significantly lowered the HIV-1 viral load and increased the CD4 cell count at 48 weeks.
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Subgroup Analyses of Maraviroc in Previously Treated R5 HIV-1 Infection
In key subgroups of HIV-infected patients, a consistent treatment benefit of maraviroc over placebo was seen at 48 weeks. These subgroups include patients with a low baseline CD4 cell count and a high HIV viral load at screening and those receiving no active background antiretroviral agents.
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Toll-like Receptor 3 and Geographic Atrophy in Age-Related Macular Degeneration
A variant of the toll-like receptor 3 (TLR3) provides protection against geographic atrophy, or “dry” age-related macular degeneration, and reduces apoptosis of cultured retinal pigment epithelial cells on exposure to TLR3 ligand.
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| Published Online August 27, 2008 (DOI: 10.1056/NEJMoa0802437) |
Continuous Glucose Monitoring and Intensive Treatment of Type 1 Diabetes
Continuous glucose monitoring was associated with improved glycemic control in adults but not in children and adolescents with type 1 diabetes.
CME Exam
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| Published Online September 8, 2008 (DOI: 10.1056/NEJMoa0805017) |
Computer-Aided Detection for Screening Mammography
This trial compared the rate of detection of breast cancer achieved by the use of two readers for each mammogram with that of a single reader using computer-aided detection. The detection rates were virtually the same for both methods, but the recall rate was slightly but significantly higher for mammograms read by a single reader with computer-aided detection.
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| October 1, 2008 (DOI: 10.1056/NEJMoa0803545), in Print October 16, 2008 |
A Case of Conjugal Azathioprine-Induced Contact Hypersensitivity
A man in his early 30s presented with an intermittent eczematous eruption over the shaft of his penis and scrotum. A careful history-taking revealed that the rash coincided with his wife’s intermittent courses of azathioprine for Crohn’s disease.
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A New Class of Anti-HIV Therapy and New Challenges
Intensive Glucose Control in Type 2 Diabetes Free Full Text
Rhythm Control versus Rate Control for Atrial Fibrillation
In Utero and Early-Life Conditions and Adult Health and Disease
Dengue Hemorrhagic Fever Transmitted by Blood Transfusion
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