In a multicenter, randomized trial, ticagrelor — a reversible inhibitor of the adenosine diphosphate receptor P2Y12 — was compared with clopidogrel in patients who had an acute coronary syndrome with or without ST-segment elevation. At 12 months, the primary end point of death from vascular causes, myocardial infarction, or stroke occurred less often with ticagrelor. Ticagrelor was not associated with an increase in the risk of major bleeding.

A comparison of the genomic sequence of a tumor sample from a patient with acute myeloid leukemia (AML) and that of a normal skin sample from the same patient revealed an estimated 750 somatic mutations, of which 12 were in the coding sequences of genes and 52 were in conserved regions or regions with regulatory potential. Four mutations were found to be recurrent in AML, including mutations in NRAS, NPM1, IDH1, and a conserved region on chromosome 10.

Progressive multifocal leukoencephalopathy (PML) is a rare complication of natalizumab treatment and is caused by the JC virus. In this study of 19 patients with multiple sclerosis who had no symptoms of PML, the prevalence of JC virus in blood and urine increased after treatment with natalizumab. JC virus regulatory-region sequences were similar to those usually found in PML.

This report describes a 52-year-old patient with multiple sclerosis in whom progressive multifocal leukoencephalopathy developed after 12 months of natalizumab therapy. He was treated with plasma exchange and immunoadsorption to eliminate natalizumab. After initial clinical improvement, immune-reconstitution inflammatory syndrome developed and the patient deteriorated clinically, but he survived and improved neurologically.

This report describes progressive multifocal leukoencephalopathy in a patient who was receiving natalizumab therapy for multiple sclerosis. Plasma exchange was used to accelerate the clearance of natalizumab. Three weeks after plasma exchange, the patient's condition worsened neurologically because of the development of an immune-reconstitution inflammatory syndrome, but his condition improved after several weeks.