The New England journal of medicine
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To study the association of histocompatibility (HLA) genes in black persons with juvenile-onset diabetes, we determined HLA-A, HLA-B, HLA-C and HLA-DR specificities in 40 black Americans with this disease and in 67 unaffected black Americans. Marked increases in the frequencies of HLA-DRw3 and HLA-DRw4 were found in the patients as compared with the unaffected persons: DRw3 was found in 72.5 per cent of patients versus 29.9 per cent of unaffected persons and DRw4 in 72.5 per cent versus 25.4 per cent (corrected P values each less than 0.0007). ⋯ By contrast, no meaningful differences were found in the frequencies of A, B, or C locus antigens. Studies in white persons with juvenile-onset diabetes have suggested that the reported HLA-B associations are due to HLA-D region specificities, and our results also support the premise that D region specificities are the primary associations with juvenile-onset diabetes.
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Randomized Controlled Trial Clinical Trial
Streptokinase in acute myocardial infarction.
In a controlled trial of streptokinase in acute myocardial infarction, 512 of 2338 patients at 11 European centers were stratified according to clinical severity. Three hundred fifteen patients allocated to medium-risk and high-risk groups were randomized to a 24-hour infusion of streptokinase or glucose. There were no essential differences in the severity of illness in the two groups before infusion. ⋯ The treatment was generally well tolerated. We tolerated. We conclude that streptokinase given under the conditions of this trial -- to medium-risk patients admitted to a coronary-care unit within 12 hours of onset of symptoms -- reduces mortality at six months. (N Engl J Med 301:797-802, 1979)
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The direct costs of residency training in the United States are over $1 billion per year. These educational programs have been organized predominantly around hospital services and supported by hospital revenues. ⋯ Debate over the current sources of financing reveals several troublesome issues: the presence of residents allegedly decreases the productivity of professionals and leads to overusage of ancillary services, proposed methods to pay for faculty salaries and services have created confusion and concern, and the financing of ambulatory-care training has been insufficient and poorly coordinated. The medical-education community must resolve these professional and educational problems so that financing issues can be debated and properly defended.