In a randomized trial, patients with a history of myocardial infarction and spontaneous ventricular arrhythmia underwent defibrillator implantation with assignment to catheter ablation of arrhythmogenic tissue or no intervention. At 22 months, 12% of patients assigned to ablation and 33% of control patients had received appropriate defibrillator therapy at least once.

This trial tested the effect of adding bevacizumab, a monoclonal antibody against vascular endothelial growth factor A, to the taxane paclitaxel for the initial treatment of metastatic breast cancer. As compared with paclitaxel alone, the combination increased progression-free survival but not overall survival. The results are a demonstration of the potential benefit of antiangiogenic treatment for breast cancer.

This study explored the safety, tolerability, and dystrophin-restoring effect of a single, intramuscular dose of an antisense oligonucleotide, PRO051, to induce specific exon skipping during messenger RNA splicing and to restore dystrophin expression in patients with Duchenne's muscular dystrophy. Four patients, selected on the basis of mutational status, muscle condition, and a positive exon-skipping response to PRO051 in vitro, received the drug. Intramuscular injection of this compound induced local dystrophin synthesis.

The collagen genes COL4A3, COL4A4, and COL4A5 have been implicated in inherited nephropathies. The authors show that glycine mutations in COL4A1, which encodes procollagen type IV 1, result in autosomal dominant hereditary angiopathy with nephropathy, aneurysm, and muscle cramps (HANAC). Thus, COL4A1 mutations should be sought in patients who have unexplained familial syndromes with these features.

A 68-year-old man presents with newly diagnosed prostate cancer. Over the past 3 years, his prostate-specific antigen level has slowly and steadily increased. His digital rectal examination is normal, the estimated prostate volume is 48 ml, and a needle-biopsy specimen reveals an adenocarcinoma with a Gleason score of 6 involving 10% of 1 of the 12 cores. He otherwise is well. How should his case be managed?

A 38-year-old, right-handed man was seen in the neuromuscular unit because of weakness of the hands. Shaking of the hands had begun 8 months earlier and was followed by cramping and progressive weakness of the hands as well as weakness of the arms and legs. Electrophysiological studies showed changes suggestive of motor neuron disease.

More than 18,000 injured soldiers serving in Iraq and Afghanistan have been cared for at Landstuhl Regional Medical Center in Germany. The Senior Visiting Surgeons Program is bringing leaders of civilian trauma care to Landstuhl to participate in the care of injured soldiers and to serve as mentors and advisors to those in the military care system. This report provides a view of the collaborative efforts to optimize trauma care for critically injured soldiers.

Dr. Thomas Lee discusses the goals, stumbling blocks, and applications of quality and efficiency measurement in a video interview available at www.nejm.org.