This randomized trial of women with early pregnancy failure showed that 800 µg of vaginal misoprostol (with the dose repeated if needed) resulted in expulsion of all products of conception and was safe in the majority of women (84 percent, as compared with 97 percent of the vacuum-aspiration group at 30 days). These results support the use of misoprostol in the management of early pregnancy failure.

Renal transplantation is the standard of care for patients with end-stage renal disease, but current immunosuppressive regimens, particularly those with calcineurin inhibitors, cause renal injury. In this noninferiority study, belatacept, an investigational selective costimulation blocker, and cyclosporine resulted in similar rates of acute rejection at six months, but belatacept may have better preserved renal function and prevented allograft nephropathy.

This study measured vitreous levels of erythropoietin and vascular endothelial growth factor (VEGF) in proliferative diabetic retinopathy and other eye diseases. Increased levels of erythropoietin and VEGF were independently associated with proliferative diabetic retinopathy. In vitro studies indicated that erythropoietin blockade inhibits retinal neovascularization. These data suggest that erythropoietin is a potent ischemia-induced angiogenic factor acting independently of VEGF during retinal angiogenesis in proliferative diabetic retinopathy.

In a pooled analysis of nine clinical trials involving almost 5000 women with breast cancer who underwent examination of the bone marrow for metastatic cancer cells, the presence of metastases in the bone marrow at the time of diagnosis of breast cancer was associated with a poor prognosis.

A 46-year-old woman has a 15-year history of difficulty in falling asleep and staying asleep. It takes her two hours to fall asleep most nights, and when she falls asleep rapidly, she wakes at 2 a.m. and cannot go back to sleep. Her bedtime is 11 p.m., and going to bed later does not help her fall asleep more easily. She has no symptoms of sleep-disordered breathing or the restless legs syndrome and is otherwise well. How should her case be managed?

Little progress has been made in the treatment of gliomas during the past 25 years. One reason is our poor understanding of the cell of origin in these tumors and of the mechanisms that bring that cell into a malignant state. This review argues that gliomas arise from neural stem cells and discusses the clinical implications of this concept.

A man, approximately 40 years of age, fell while jogging, losing consciousness and striking his head. Emergency-medical-services technicians found hypertension, tachycardia, and normal blood sugar and noted spontaneous arm movements. In the emergency department, a physical examination showed only a scalp laceration; computed tomography of the head showed no intracranial bleeding.