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September 15, 2005 Vol. 353 No. 11
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In acute coronary syndromes without ST-segment elevation, an early invasive strategy (early angiography followed by revascularization if appropriate) is recommended over a conservative strategy (angiography only if medical therapy fails) for high-risk patients. In this trial, such patients did not benefit from early invasive treatment.
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Medullary thyroid carcinoma is so common among patients with multiple endocrine neoplasia and familial medullary thyroid carcinoma that prophylactic thyroidectomy is often performed. This study involved 50 patients who had undergone prophylactic thyroidectomy after identification of the RET mutation that is characteristically associated with this lesion. Five to 10 years later, 88 percent had no evidence of persistent or recurrent medullary thyroid carcinoma.
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Abatacept is a recombinant fusion protein that modulates T-cell activation. In this trial in patients with rheumatoid arthritis who had an inadequate response to tumor necrosis factor a (TNF-a) inhibitors, 50.4 percent of these patients in the abatacept group had clinical improvement of at least 20 percent at six months, as compared with 19.5 percent of those in the placebo group. The incidence of serious infections was 2.3 percent in each group.
This large study of a nationally representative cohort of men and women 40 years of age or older in China shows that vascular disease and cancer have become the leading causes of death among Chinese adults and that control of hypertension, smoking cessation, increased physical activity, and improved nutrition will probably be important public health strategies.
β-Thalassemia, which is caused by a decrease in the production of β-globin chains, affects multiple organs and is associated with considerable morbidity and mortality. Lifelong care is required, and the costs of proper treatment are substantial. This review discusses current approaches to the management of β-thalassemia.
A 42-year-old man who had had steroid-dependent asthma for three years, weight loss for eight months, hematuria for two months, and rash, weakness, and hemoptysis for several days was admitted to the hospital. He had pedal edema; palpable purpura on the hands, feet, and lower legs; and motor weakness of the legs with sensory abnormalities.
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In this report, the authors describe the deterioration of China's health care system in the 1980s and 1990s in the context of privatization of the Chinese economy. They discuss the Chinese government's current efforts to address the crisis in order to improve access to and delivery of health care.
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