This trial compared standard multiagent chemotherapy with a single agent (capecitabine) as adjuvant therapy for breast cancer in women 65 years of age or older. Multiagent treatment yielded relapse-free and overall survival rates that were superior to those with capecitabine in all measures tested. Older women without clinically significant coexisting conditions can tolerate chemotherapy for breast cancer without undue adverse events.

A randomized trial enrolled 7554 patients with atrial fibrillation who were at increased risk of stroke but not candidates for vitamin K antagonists. Participants were assigned to aspirin or aspirin plus clopidogrel. At a median of 3.6 years, the risk of major vascular events decreased significantly with clopidogrel, primarily because of reduced risk of stroke. The risk of major bleeding increased significantly with clopidogrel.

Bronchiolitis, characterized clinically by rhinorrhea, cough, wheezing, respiratory distress, and hypoxemia, affects large numbers of children in the first year of life. There are no effective, well-established treatments. In this 2×2 factorial trial, the investigators compared the effects of treatment with nebulized epinephrine, oral dexamethasone, both medications, or placebo. To their surprise, only the group receiving the combined treatment had any clinical benefit. Additional large-scale trials are still needed to determine the best way to treat this common condition.

In this randomized trial involving 15 children with neurotoxic symptoms after a scorpion sting, children treated with a scorpion-specific antivenom had a faster resolution of neurologic signs and symptoms and received lower doses of midazolam than children treated with placebo.

Ticks can transmit several pathogens to humans, including Borrelia burgdorferi, Anaplasma phagocytophilum, and Babesia microti. Another potential pathogen found in ticks is the deer tick virus, a flavivirus closely related to Powassan virus lineage I. In this report, the deer tick virus is shown to cause fatal encephalitis in a patient with chronic lymphocytic leukemia.