In this five-year placebo-controlled trial involving patients who had a recent stroke or transient ischemic attack and baseline low-density lipoprotein cholesterol levels of 100 to 190 mg per deciliter (3 to 5 mmol per liter), atorvastatin (80 mg daily) resulted in an absolute reduction in nonfatal or fatal stroke of 2.2 percent and of major cardiovascular events of 3.5 percent.

There are now many published examples of gene-expression–based methods to aid in the determination of prognosis, and some of these methods are available to the clinician. This study of five models shows that four of the five classified cancers concordantly, despite minimal overlap in the gene sets used.

This study showed that a predictor based on gene expression provides prognostic information beyond that provided by traditional clinical predictors. It sets the stage for a prospective trial to determine whether the predictor could be used to guide the treatment of patients with stage IA non–small-cell lung cancer.

Among patients with neonatal-onset multisystem inflammatory disease — a disorder characterized by fever, urticarial rash, aseptic meningitis, deforming arthropathy, hearing loss, and mental retardation — treatment with the interleukin-1 antagonist anakinra markedly improved clinical and radiologic manifestations of disease (including central nervous system manifestations) and decreased serum markers of inflammation. Anakinra withdrawal resulted in a flare of disease within days; retreatment led to rapid improvement.

A 69-year-old man reports increasing pain in the right leg. Physical examination reveals warmth and anterolateral bowing of the right shin. The serum alkaline phosphatase level is 260 U per liter (normal, 38 to 126 U per liter). A skeletal scintigraphic scan reveals enhanced uptake in only the deformed tibia, where a radiograph shows changes indicative of Paget's disease. His sister, whose alkaline phosphatase level is 160 U per liter, has asymptomatic Paget's disease confined to the left iliac wing. How should their cases be managed?

A 40-year-old woman was transferred to the emergency department of this hospital because of hypotension. Seven hours earlier she had ingested 100 sample tablets of amlodipine (10 mg) in a suicide attempt. She was taken to an emergency department, where her blood pressure fell from 100/60 mm Hg to 58/38 mm Hg despite the use of pressors.

In this Sounding Board, the author examines potential reasons for the limited availability of new drugs and proposes four solutions to this problem.