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In a randomized trial, 2287 patients with coronary artery disease and evidence of ischemia were assigned to receive optimal medical therapy with or without percutaneous coronary intervention (PCI). At a median of 4.6 years, the rates of death and myocardial infarction were 19.0% in the PCI group and 18.5% in the medical-therapy group. The PCI group had lower rates of angina and repeat revascularization.
The expression of interleukin-1–receptor antagonist is reduced in pancreatic islets in type 2 diabetes, and high glucose concentrations induce interleukin-1β production in human pancreatic beta cells, suggesting that the interleukin-1 pathway may be a treatment target. This randomized trial showed that the interleukin-1–receptor antagonist anakinra (100 mg) improved glycemia and beta-cell secretory function and reduced markers of systemic inflammation, as compared with placebo.
This trial compared radiotherapy plus supportive care with supportive care alone in patients with glioblastoma who were 70 years of age or older. As compared with supportive care alone, radiotherapy improved survival by about 3 months and did not impair quality of life or cognition. The trial also showed that, despite some challenges, elderly patients can participate in a randomized, controlled clinical trial.
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Limited data exist on the immunogenicity of inactivated poliovirus vaccine (IPV) in tropical developing countries. As the use of the oral poliovirus vaccine diminishes, data demonstrating that IPV is effective in this setting are needed. This randomized, controlled trial of IPV in Cuba shows that IPV is immunogenic and diminishes the excretion of oral poliovirus in the stool after challenge with oral poliovirus vaccine.
The liver possesses the unique ability to regenerate within a short period of time, a feature that has led to the development of innovative strategies in liver surgery and transplantation. This review presents both established and novel methods for manipulating liver volume to attain improved liver surgery and transplantation.
A 59-year-old man was admitted to this hospital with fever and the subacute onset of progressive neurologic symptoms that included multiple cranial-nerve palsies. Magnetic resonance imaging of the brain and spine showed leptomeningeal enhancement. Analysis of the cerebrospinal fluid disclosed a lymphocytic pleocytosis and elevated protein and glucose levels. Respiratory failure developed, requiring intubation and mechanical ventilation. The result of a diagnostic test was received.
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