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Among patients with impaired glucose tolerance, the short-acting insulin secretagogue nateglinide did not reduce the incidence of diabetes over the course of 5 years. Nateglinide also did not reduce the risk of cardiovascular events. Therefore, nateglinide does not have a place in the management of impaired glucose tolerance.
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In this large clinical trial, the angiotensin-receptor blocker valsartan reduced the risk of diabetes in patients with impaired glucose tolerance. However, the effect was small, and there was no reduction in the rate of cardiovascular events. Thus, impaired glucose tolerance is probably best managed with lifestyle intervention.
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A 30-year-old pregnant woman is undergoing induction of labor and is experiencing severe pain despite intravenous opioid administration. Epidural analgesia is recommended. Epidural analgesia involves the injection of a local anesthetic agent and an opioid analgesic agent into the lumbar epidural space. These agents diffuse across the dura and act on the spinal nerve roots. Rates of cesarean delivery are not increased with epidural analgesia.
Neisseria meningitidis remains a leading cause of meningitis and sepsis. This review provides an update on our understanding of immunity against meningococcal infection. Knowledge of the meningococcal genome has led to identification of novel antigens. A major challenge is to improve the immunogenicity of vaccines in infants, who are especially vulnerable to this infection.
Internal jugular vein cannulation is performed to establish central venous access for a variety of purposes, such as monitoring of central venous pressure, inserting pulmonary-artery catheters, administering intravenous therapeutic agents and nutrition, performing hemodialysis, and placing cardiac pacemakers. The increased use of ultrasonography to guide internal jugular vein cannulation has improved success rates and reduced complications. This video demonstrates ultrasound-guided internal jugular vein cannulation.
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An 89-year-old man was admitted to the hospital because of progressive dyspnea for 6 months, worsening over the past 3 days. He had a history of exposure to asbestos and had smoked cigarettes for many years. Imaging studies revealed a pleural plaque and pulmonary interstitial fibrosis with superimposed ground-glass opacities. Hypoxemia and intermittent hypotension occurred. Despite oxygen supplementation, mechanical ventilation, and pressor administration, a cardiac arrest occurred, and the patient died on the eighth hospital day. An autopsy was performed.
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