The New England journal of medicine
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Randomized Controlled Trial Multicenter Study Clinical Trial
Anti-CD3 monoclonal antibody in new-onset type 1 diabetes mellitus.
Type 1 diabetes mellitus is a chronic autoimmune disease caused by the pathogenic action of T lymphocytes on insulin-producing beta cells. Previous clinical studies have shown that continuous immune suppression temporarily slows the loss of insulin production. Preclinical studies suggested that a monoclonal antibody against CD3 could reverse hyperglycemia at presentation and induce tolerance to recurrent disease. ⋯ Treatment with hOKT3gamma1(Ala-Ala) mitigates the deterioration in insulin production and improves metabolic control during the first year of type 1 diabetes mellitus in the majority of patients. The mechanism of action of the anti-CD3 monoclonal antibody may involve direct effects on pathogenic T cells, the induction of populations of regulatory cells, or both.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Effects of insulin in relatives of patients with type 1 diabetes mellitus.
It is unknown whether insulin therapy can delay or prevent diabetes in nondiabetic relatives of patients with diabetes. ⋯ In persons at high risk for diabetes, insulin at the dosage used in this study does not delay or prevent type 1 diabetes.
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It is uncertain whether lower levels of staffing by nurses at hospitals are associated with an increased risk that patients will have complications or die. ⋯ A higher proportion of hours of nursing care provided by registered nurses and a greater number of hours of care by registered nurses per day are associated with better care for hospitalized patients.
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Amyotrophic lateral sclerosis (ALS) is a disease that causes progressive paralysis leading to respiratory failure. Patients with ALS may consider physician-assisted suicide. However, it is not known how many patients, if given the option, would actually decide to end their lives by physician-assisted suicide or euthanasia nor at what stage of the disease they would choose to do so. ⋯ In the Netherlands, we found that one in five patients with ALS died as a result of euthanasia or physician-assisted suicide.