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Many children have uncontrolled asthma symptoms when treated with low-dose inhaled corticosteroids (ICS). In this three-way crossover trial, the investigators asked whether doubling the dose of ICS, adding a leukotriene-receptor antagonist to the ICS, or adding a long-acting beta-agonist to the ICS would result in better asthma control. Most children had a best response to the long-acting beta-agonist, but some children had a best response to an increased dose of ICS or a leukotriene-receptor antagonist.
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The principal tool used to estimate a woman's risk of breast cancer is the Breast Cancer Risk Assessment Tool, or the Gail model, which includes the number of first-degree relatives with breast cancer, age at menarche, age at first live birth, and number of previous breast biopsies. In this study, the addition of data on genetic variants associated with breast cancer yielded only a minor improvement in the performance of the model.
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The mechanism of benefit of corticosteroid therapy in infantile hemangioma is unknown. In this study, hemangioma-derived stem cells showed vasculogenic activity in vivo when implanted into nude mice. Systemic treatment with dexamethasone or pretreatment of the stem cells with dexamethasone inhibited vasculogenesis. Dexamethasone suppressed the production of vascular endothelial growth factor A (VEGF-A). Silencing of VEGF-A with short hairpin RNA also inhibited vasculogenesis.
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Some insurance companies are offering patients incentives to choose lower-cost physicians. This study shows that the current methods used to generate physicians' cost profiles do not have high reliability and that the systems using these cost profiles to identify lower-cost physicians will incorrectly classify many physicians.
A 57-year-old man presents 2 weeks after prostate biopsy with fever, chills, and new lumbar back pain. His temperature is 39.7°C; he has an enlarged, tender prostate and lumbar spine tenderness. His white-cell count is 9100 per cubic millimeter, and the C-reactive protein level is 343 mg per liter. Urine and blood cultures reveal multidrug-resistant extended-spectrum β-lactamase–producing Escherichia coli susceptible to imipenem. How should he be evaluated and treated?
A 22-year-old woman was admitted to this hospital because of hypercalcemia and a pelvic mass. One month before admission, abdominal pain developed, followed by abdominal fullness, anorexia, nausea, vomiting, polydipsia, and nocturia. A computed tomographic scan of the pelvis showed a complex right adnexal mass. The serum calcium level was 17.2 mg per deciliter. A diagnostic procedure was performed.
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One of the first children I cared for after my arrival on the USNS Comfort, the U.S. Navy's floating medical treatment facility docked at Port-au-Prince, Haiti, was a 10-month-old boy who had been brought to the ship nearly dead from malnutrition. Prior ...
More than a month after the recent earthquake, the Haitian government reported that 6000 to 8000 people had lost limbs or digits, but they did not address the bigger question: What's the plan for these amputees?1
Nearly a decade ago, Sierra Leone emerged ...
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