This international randomized, controlled trial involving very-low-birth-weight infants aimed to determine whether early insulin replacement reduced hyperglycemia and affected morbidity and mortality. Infants received a continuous infusion of insulin with dextrose support or standard neonatal care for the first week of life. The results show that early insulin in very-low-birth-weight infants had little clinical benefit.

In this randomized trial of infants with a birth weight of 1000 g or less, as compared with conservative phototherapy, aggressive phototherapy did not significantly reduce the rate of death or neurodevelopmental impairment at 18 to 22 months of corrected age but did reduce the rate of neurodevelopmental impairment. Preplanned subgroup analyses suggested a possible increased mortality with aggressive phototherapy in infants weighing 501 to 750 g at birth. These results will help guide decisions about the use of aggressive phototherapy in infants of extremely low birth weight.

In a study of four cohorts of patients from Denmark, the subjects were typed for four single-nucleotide polymorphisms in the gene for C-reactive protein (CRP). The resulting genotypes were correlated with an increase in CRP levels of up to 64%, a result predicting significantly increased risks of ischemic heart disease and ischemic cerebrovascular disease. However, no such increase in risk was observed, a result suggesting that the known association between CRP levels and vascular risk is not causal.

This study aimed to test whether injections of alum-formulated glutamic acid decarboxylase 65 (GAD), a major autoantigen in type 1 diabetes mellitus, would reverse recent-onset disease. C-peptide levels declined in both the treatment group and the control group, without significant between-group differences at month 15 (the primary end point), but they had declined significantly more slowly with treatment by month 30. The authors conclude that alum-formulated GAD may help preserve residual insulin secretion in patients with recent-onset type 1 diabetes.

This study was based on a large survey of patients' experiences in the hospital. Hospitals with the highest nurse-staffing levels received the highest ratings from patients with respect to satisfaction with their care. Furthermore, hospitals that received the highest satisfaction ratings from patients provided a modestly higher quality of clinical care than those that received the lowest ratings.

Because of mutations in this opportunistic pathogen, infections with C. difficile have become both more prevalent and more virulent. This article summarizes recent changes in the epidemiology of this infection and explains what is known about the changes in disease severity and the response to therapy. The authors discuss the use of new antibiotics, probiotics, immunotherapy, and even bacteriotherapy.

A 58-year-old woman was transferred to this hospital because of severe neck pain, fever, and a spinal epidural mass extending from the level of the fourth to the seventh cervical vertebrae, with evidence of mild cord compression seen on imaging studies. Shortly before transfer to this hospital, a diagnostic test result was received.