The New England journal of medicine
-
Randomized Controlled Trial Multicenter Study Comparative Study
Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis.
Since anecdotal series and small, prospective, controlled trials suggest that mycophenolate mofetil may be effective for treating lupus nephritis, larger trials are desirable. ⋯ In this 24-week trial, mycophenolate mofetil was more effective than intravenous cyclophosphamide in inducing remission of lupus nephritis and had a more favorable safety profile.
-
Randomized Controlled Trial Multicenter Study
High-dose acetylcysteine in idiopathic pulmonary fibrosis.
Idiopathic pulmonary fibrosis is a chronic progressive disorder with a poor prognosis. ⋯ Therapy with acetylcysteine at a dose of 600 mg three times daily, added to prednisone and azathioprine, preserves vital capacity and DL(CO) in patients with idiopathic pulmonary fibrosis better than does standard therapy alone.
-
Randomized Controlled Trial Multicenter Study
Sildenafil citrate therapy for pulmonary arterial hypertension.
Sildenafil inhibits phosphodiesterase type 5, an enzyme that metabolizes cyclic guanosine monophosphate, thereby enhancing the cyclic guanosine monophosphate-mediated relaxation and growth inhibition of vascular smooth-muscle cells, including those in the lung. ⋯ Sildenafil improves exercise capacity, WHO functional class, and hemodynamics in patients with symptomatic pulmonary arterial hypertension.
-
Randomized Controlled Trial Multicenter Study Clinical Trial
Continuous positive airway pressure for central sleep apnea and heart failure.
The Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure trial tested the hypothesis that continuous positive airway pressure (CPAP) would improve the survival rate without heart transplantation of patients who have central sleep apnea and heart failure. ⋯ Although CPAP attenuated central sleep apnea, improved nocturnal oxygenation, increased the ejection fraction, lowered norepinephrine levels, and increased the distance walked in six minutes, it did not affect survival. Our data do not support the use of CPAP to extend life in patients who have central sleep apnea and heart failure.
-
Multicenter Study Comparative Study Clinical Trial
First-trimester or second-trimester screening, or both, for Down's syndrome.
It is uncertain how best to screen pregnant women for the presence of fetal Down's syndrome: to perform first-trimester screening, to perform second-trimester screening, or to use strategies incorporating measurements in both trimesters. ⋯ First-trimester combined screening at 11 weeks of gestation is better than second-trimester quadruple screening but at 13 weeks has results similar to second-trimester quadruple screening. Both stepwise sequential screening and fully integrated screening have high rates of detection of Down's syndrome, with low false positive rates.