This large trial compared the angiotensin-receptor blocker telmisartan, the angiotensin-converting–enzyme inhibitor ramipril, and combination therapy with both drugs in patients with vascular disease or high-risk diabetes. Outcomes were the same with telmisartan and ramipril, and there were more adverse events with combination therapy.

Infection with herpes simplex virus type 2 (HSV-2) is associated with an increased risk of infection with the human immunodeficiency virus (HIV). In this randomized, double-blind, placebo-controlled trial, the suppression of HSV-2 with acyclovir did not decrease the rate of newly diagnosed HIV infection in Tanzanian women at high risk for acquiring HIV.

In the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial of 334 patients with carotid-artery disease, carotid-artery stenting was not inferior to endarterectomy at 30 days or at 1 year. Most patients were followed for an additional 2 years. There was no significant difference between the two groups in the composite end point of death, stroke, or myocardial infarction within 30 days or death or ipsilateral stroke between 31 days and 3 years.

In 2006, the United States had the largest mumps outbreak in two decades. A total of 6584 cases were reported, with an estimated incidence of 2.2 cases per 100,000 persons. In patients for whom vaccination status was known, 63% had received two doses of the mumps vaccine. The same mumps strain that caused a recent outbreak in the United Kingdom caused the 2006 outbreak.

HIV-1 has evolved multiple mechanisms to elude immune control. The view of virus as classifiable into distinct subtypes needs to reflect the reality of the constant emergence of new strains. This review discusses the implications of subtype diversity in HIV-1 for possible differential rates of disease progression, responses to antiretroviral therapy (including the development of resistance), and vaccine development.

A 45-year-old man with end-stage liver disease due to chronic infection with hepatitis B and C viruses and alcohol use was admitted to this hospital for liver transplantation. Nine days later, fever and headache developed, followed by confusion, slurred speech, photophobia, and neck stiffness. A diagnostic procedure was performed.

This interactive Journal feature presents the case of a 67-year-old man with a history of hypertension and hyperlipidemia who is found to have an asymptomatic unilateral carotid stenosis of 70 to 80%. Three possible treatment options, any of which could be considered correct, are presented. Which option do you recommend? At www.nejm.org you can vote for one and then, if you wish, submit a comment about your clinical decision. Voting results and a broad selection of comments will be posted on the Web site.

Outsourcing of health care services, such as the reading of imaging studies by offshore radiologists, has become common and has raised a number of regulatory issues related to reimbursement, patient privacy, health care quality, and malpractice. The authors review the legal context and challenges relevant to medical outsourcing.

Experiments in mice indicate that local production of activated protein C sustains the glomerular endothelial cell and is pivotal to protection against diabetic nephropathy.