Related Perspective

Bortezomib, a member of a novel class of boronic acid dipeptides with the ability to inhibit the proteasome, was tested in patients with multiple myeloma whose condition was refractory to conventional chemotherapy. The drug induced responses in 35 percent of patients and was relatively nontoxic.

Any new drug for myeloma faces a severe test when tried in patients whose condition resists conventional treatment. These encouraging preliminary results require confirmation in a standard phase 3 clinical trial.

Related Perspective

The optimal approach to the treatment of patients who are discharged from the emergency room after an exacerbation of chronic obstructive pulmonary disease is not known. This study compared the patients' usual medications and antibiotics with those medications plus 10 days of prednisone at a dose of 40 mg per day. Patients receiving the corticosteroid had fewer relapses and better lung function than those receiving placebo.

Although these investigators found a benefit of corticosteroid treatment, the evidence favoring prednisone is not overwhelming. Physicians should consider prednisone as another treatment option rather than as mandatory therapy.

Related Editorial

This study followed patients who underwent rapid defibrillation after out-of-hospital cardiac arrest with ventricular fibrillation through an early-response program in Olmsted County, Minnesota. The five-year survival among these patients was similar to that among age-, sex-, and disease-matched patients who had not had out-of-hospital cardiac arrest, and the quality of life among the majority of survivors was similar to that of the general population.

These findings extend previous reports of improved short-term outcomes after early defibrillation for out-of-hospital cardiac arrest and underscore the potential benefits of wider implementation of early-defibrillation programs.

This national study of the quality of health care documents poor adherence to many recommended care practices. For example, participants did not receive 34 percent of the recommended immunizations, did not get 32 percent of the appropriate care for coronary artery disease (such as beta-blockers or aspirin after myocardial infarction), and did not get 55 percent of the recommended care for diabetes.

Deficiencies in the quality of care are common in the United States. Monitoring of national data on quality may guide efforts to improve health care delivery.

Related Editorial

This article summarizes the current understanding of the mechanisms of destruction in autoimmune thyroid disease. The authors explain the approach to the diagnosis and treatment of the most common types of thyroiditis, including Hashimoto's thyroiditis, painless postpartum thyroiditis, and painless sporadic thyroiditis. Thyroid dysfunction can also develop from treatment with medications such as amiodarone, lithium, interferon alfa, and interleukin-2.

The mitochondrial respiratory chain has the crucial function of supplying the cell with energy in the form of ATP. Mutations affecting this chain can arise in mitochondrial or nuclear DNA and cause diseases known as mitochondrial encephalomyopathies. Because the rules of inheritance of mitochondrial and nuclear DNA differ considerably, these brain–muscle syndromes often have unpredictable clinical and genetic features.

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