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Men receiving androgen-deprivation therapy for nonmetastatic prostate cancer are at high risk for bone loss and fractures. This placebo-controlled study investigated the effects of denosumab, a fully human monoclonal antibody against the receptor activator of nuclear factor-κB ligand, on bone mineral density and fractures in such men. Use of denosumab was associated with increased bone mineral density at all sites and reduction in the incidence of new vertebral fractures.
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In this trial, women between the ages of 60 and 90 with low bone mineral density received twice-yearly subcutaneous injections of denosumab, a fully human monoclonal antibody against the receptor activator of nuclear factor-κB ligand, which inhibits the development and activity of osteoclasts, or placebo. Denosumab was associated with a reduced risk of vertebral, nonvertebral, and hip fractures.
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This study of adjuvant hormonal therapy in postmenopausal women with hormone-receptor–positive early breast cancer showed that disease-free survival was similar after 5 years of treatment with letrozole alone, 2 years of treatment with letrozole followed by 3 years with tamoxifen, or 2 years of treatment with tamoxifen followed by 3 years with letrozole. Five years of letrozole monotherapy may be superior to 5 years of tamoxifen monotherapy.
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In this 12-month randomized trial involving 251 long-term heroin users, injectable diacetylmorphine (the active ingredient in heroin) was more effective than oral methadone in achieving retention in treatment for addiction and in reducing illicit-drug use and other illegal activity. As compared with methadone, injectable diacetylmorphine was associated with more serious adverse events, including seizures and drug overdoses.
A 62-year-old woman with osteoarthritis presents with a 7-month history of progressively worsening left hip pain radiating to the groin, 8 months after undergoing total left-hip arthroplasty. Physical examination reveals a sinus tract overlying her left hip. A radiograph shows loosening of the prosthesis at the bone–cement interface. How should her case be managed?
Recent years have seen major advances in our understanding of the sudden infant death syndrome (SIDS), including the discovery that the prone sleep position more than triples the risk of SIDS. This finding has led to a worldwide campaign advocating the supine sleep position for infants, which has been associated with a decrease of 50 to 90% in the SIDS rate. This review considers demographic and pathophysiological factors and current concepts about SIDS.
A 34-year-old man with cystic fibrosis was admitted to this hospital because of cough, increased dyspnea, and sputum production. Broad-spectrum antimicrobial therapy was initiated. On the fifth hospital day, fever developed, and on the eighth day, nausea, vomiting, leukocytosis, and acidosis developed. The next day, a diagnostic procedure was performed.
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