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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Risk-reducing salpingo-oophorectomy is often considered by carriers of BRCA mutations who have completed childbearing. However, there are limited data supporting the efficacy of this approach. We prospectively compared the effect of risk-reducing salpingo-oophorectomy with that of surveillance for ovarian cancer on the incidence of subsequent breast cancer and BRCA-related gynecologic cancers in women with BRCA mutations. ⋯ Salpingo-oophorectomy in carriers of BRCA mutations can decrease the risk of breast cancer and BRCA-related gynecologic cancer.