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This clinical trial of outcomes in patients with atrial fibrillation showed that lenient rate control (resting heart rate, <110 beats per minute) was not inferior to strict rate control (resting heart rate, <80 beats per minute). On the basis of the results, strict rate control may be abandoned as a therapeutic strategy in many patients with permanent atrial fibrillation.
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Two trials enrolled a total of 2701 patients who had undergone implantation of a drug-eluting coronary stent and had been receiving dual antiplatelet therapy for at least 12 months. They were randomly assigned to either continuation or discontinuation of clopidogrel therapy. At 19.2 months after randomization, the rate of myocardial infarction or death from cardiac causes did not differ significantly between the two groups.
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Pompe's disease is caused by a deficiency of acid alpha glucosidase, which degrades lysosomal glycogen. Late-onset Pompe's disease is characterized by progressive muscle weakness and loss of respiratory function, leading to early death. In this randomized, placebo-controlled trial of a recombinant human acid alpha glucosidase, walking distance improved and pulmonary function stabilized over an 18-month period in patients treated with the active drug.
A 67-year-old man presents with progressive dyspnea. He has smoked cigarettes since he was 15 years of age. Worsening breathlessness forced him to retire as a laborer. His physical examination is notable for distant breath sounds on auscultation, with a prolonged expiratory phase. Spirometry reveals severe airflow obstruction (ratio of forced expiratory volume in first second [FEV1] to forced vital capacity, 0.43; FEV1, 34% of the predicted value). How should this case be managed?
This review summarizes recent evidence concerning molecular changes in the commonest type of lymphoma, diffuse large-B-cell lymphoma. Detailed studies have revealed three subtypes, each with distinctive clinical and molecular features. The molecular dissection of these tumors is uncovering new possibilities for treatment, some of which are already in clinical trials.
A 45-year-old white man was brought to the emergency room by emergency-medical-services personnel after a syncopal event. He did not report any chest pain. He was found to have a monomorphic, wide-complex tachycardia at a rate of 240 beats per minute, ...
A 69-year-old woman presented to this hospital because of a 2-month period of increasing apathy, confusion, and depression. She had a history of connective-tissue disease and idiopathic thrombocytopenic purpura. Ten days before admission, a magnetic resonance image of the brain was obtained, which was abnormal.
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