The New England journal of medicine
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Randomized Controlled Trial Multicenter Study Clinical Trial
A controlled trial of natalizumab for relapsing multiple sclerosis.
In patients with multiple sclerosis, inflammatory brain lesions appear to arise from autoimmune responses involving activated lymphocytes and monocytes. The glycoprotein alpha4 integrin is expressed on the surface of these cells and plays a critical part in their adhesion to the vascular endothelium and migration into the parenchyma. Natalizumab is an alpha4 integrin antagonist that reduced the development of brain lesions in experimental models and in a preliminary study of patients with multiple sclerosis. ⋯ In a placebo-controlled trial, treatment with natalizumab led to fewer inflammatory brain lesions and fewer relapses over a six-month period in patients with relapsing multiple sclerosis.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients.
Some observational studies suggest that the use of pulmonary-artery catheters to guide therapy is associated with increased mortality. ⋯ We found no benefit to therapy directed by pulmonary-artery catheter over standard care in elderly, high-risk surgical patients requiring intensive care.