In this randomized trial involving patients with mild cognitive impairment, vitamin E did not reduce the rate of progression to Alzheimer's disease. Although an initial benefit of donepezil was observed during the first year, over the course of the three-year study the rate of progression to Alzheimer's disease was similar in patients treated with donepezil and those treated with placebo. The side effects of donepezil included diarrhea, nausea, muscle cramps, and insomnia.

Calcific aortic stenosis, a relatively common problem in the elderly, has been found to be associated with atherosclerosis and hypercholesterolemia. This study found that, contrary to expectations, intensive lipid-lowering therapy with atorvastatin, which reduced low-density lipoprotein cholesterol levels to a mean of 63±23 mg per deciliter, had no effect on the progression of aortic stenosis (as measured by the aortic-jet velocity) or on aortic-valve calcification (as measured by helical computed tomographic scanning).

Endovascular repair of abdominal aortic aneurysms avoids much of the risk associated with conventional surgical repair. In two randomized trials, this technique has been shown to be associated with lower rates of perioperative morbidity and mortality. Longer-term follow-up data from one of these trials (the Dutch Randomized Endovascular Aneurysm Management [DREAM] trial) show that the survival advantage of endovascular repair is not sustained after the first postoperative year.

Whether individual foci in multifocal papillary thyroid cancer arise independently or are metastases of a primary tumor within the gland is uncertain. This investigation used the phenomenon of X-chromosome inactivation in women to study such foci. In five tumors, all foci had different patterns of X-chromosome inactivation, indicating their independent origin; results in five other tumors were indeterminate.

The independent origins of multiple foci of neoplasia in multifocal papillary thyroid cancer suggest environmental or inherent susceptibility to thyroid cancer. These kinds of tumors may require aggressive treatment.

Calpains are members of a large family of Ca²⁺-dependent proteolytic enzymes. Some are tissue-specific; others are ubiquitous. Poised to digest numerous intracellular proteins, their potential to cause or contribute to disease is considerable. This review outlines the structure and function of calpains and their involvement in a type of muscular dystrophy, type 2 diabetes, cataracts, and Alzheimer's disease.

A 22-year-old woman was transferred because of respiratory failure. She had a history of sickle cell anemia and had back and leg pain the day before she was admitted to another hospital, where respiratory failure developed while she was being treated for a sickle cell crisis. After transfer, assisted ventilation, nitric oxide, and exchange transfusion did not reverse the hypoxemia, and the patient died. An autopsy was performed.

A new mechanism for regulating RAS oncogenes has been uncovered, which may have relevance to the pathogenesis of lung cancer.