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August 29, 2002 Vol. 347 No. 9
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Respiratory distress is common in premature infants. Many of these infants require mechanical ventilatory support for the first few weeks of life, but the best way to deliver this support is not known. In this randomized trial performed in the United Kingdom, there was no difference between the two ventilatory strategies in terms of survival, the need for oxygen treatment at 28 days of life, or other benefits or complications of ventilation.
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This randomized study, performed at multiple centers in the United States, compared high-frequency oscillatory ventilation with synchronized intermittent mandatory ventilation in babies who required mechanical ventilatory assistance. Ventilators were adjusted according to strict validated protocols. Among 234 infants assigned to high-frequency oscillatory ventilation, as compared with 250 assigned to synchronized intermittent mandatory ventilation, a small but significantly greater proportion were alive and not requiring supplemental oxygen at 36 weeks of postmenstrual age (P=0.046); there was no significant difference in the incidence of adverse events between the two groups.
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Nephrogenic adenomas are benign growths in the urothelial mucosa that can cause hematuria or dysuria. Their origin is unknown. This detailed study of nephrogenic adenomas from recipients of kidney grafts showed that in all cases the adenoma had the sex chromosomes of the donor kidney and the immunohistochemical features of renal tubular cells.
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This study assessed associations between state requirements for insurance coverage of in vitro fertilization services and the utilization and outcomes of such services. Fertility clinics in states that required complete coverage performed significantly more in vitro fertilization cycles involving the transfer of fresh embryos than clinics in states that required partial coverage or none. The percentage of cycles that resulted in live births was lower in the states that required complete or partial coverage, but these states also had a lower number of embryos transferred per cycle and a lower rate of pregnancies with three or more fetuses.
A 16-year-old boy is brought by his parents to his primary care physician because of a decline in school performance, which began at least three years earlier but has become more severe in the past year. He reports boredom, a lack of enjoyment and motivation, poor selfesteem, a feeling of hopelessness, difficulty sleeping, poor concentration, and passive thoughts of suicide without a plan or intent. How should he be treated?
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