Consensus is lacking as to whether routine screening and treatment for gestational diabetes mellitus is warranted. This large randomized trial of the treatment of gestational diabetes demonstrated that serious perinatal complications were significantly less common among the offspring of women who received dietary advice, blood glucose monitoring, and insulin therapy as needed to maintain glycemic control than among the offspring of women who received routine care.

These findings provide strong support for the implementation of screening for and treatment of gestational diabetes.

Bortezomib, an inhibitor of proteasomes (sites of protein degradation in cells), has activity against advanced multiple myeloma. This study compared bortezomib with high-dose dexamethasone relatively soon after a relapse of multiple myeloma had occurred with other treatments. Bortezomib was superior to dexamethasone in all end points and prolonged overall survival.

Bortezomib is a departure from the conventional treatment of multiple myeloma with alkylating agents and vinca alkaloids. It shows promise for a disease in which progress in chemotherapy has been stalled for decades.

In this six-week randomized trial of MLN02 — a humanized antibody to the ₄₇ integrin — in patients with ulcerative colitis, MLN02 was associated with higher rates of remission than was placebo (33 percent in the group receiving 0.5 mg per kilogram, 32 percent in the group receiving 2.0 mg per kilogram, and 14 percent in the placebo group; overall P=0.03). These preliminary data suggest that blockade of the ₄₇ integrin with a humanized antibody may be an effective therapy for ulcerative colitis.

A 15-year-old girl presented with clinical rabies one month after being bitten by a bat. She was treated with ribavirin and amantadine plus agents to induce coma and suppress bursts of activity on electroencephalography. She survived and after five months was alert and communicative, although with generalized choreoathetosis, dysarthria, and an unsteady gait.

Surviving rabies is very rare, and the effectiveness of this treatment regimen will require replication. The goal of this approach is to reduce excitotoxic neural injury.

This study compared results of household surveys conducted in the United States from 1990 to 1992 and from 2001 to 2003 and found no change in the prevalence of mental disorders during that period. The prevalence of treatment increased, but most respondents with mental disorders still did not receive treatment between 2001 and 2003.

A 47-year-old man reports a six-month history of intermittent chest discomfort while playing squash. He describes lower substernal tightness with numbness of the left upper arm only during exertion. He does not smoke. His father died suddenly at the age of 49 years. His blood pressure is 138/84 mm Hg. The level of total cholesterol is 261 mg per deciliter, low-density lipoprotein cholesterol 172 mg per deciliter, and high-density lipoprotein cholesterol 50 mg per deciliter, and the triglyceride level is 113 mg per deciliter. An exercise test is positive, with pain and 1.5 mm of horizontal ST-segment depression at stage 4 of the Bruce protocol. How should the patient's case be managed?

A 45-year-old woman noted a mass in her lower abdomen that was intermittently painful. An examination disclosed a slightly tender mass, 4 cm in diameter, on the right side of the lower abdomen. Imaging studies showed a solid mass in the right lower abdominal wall. A diagnostic procedure was performed.