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Current IssueJuly 24, 2008
FULL TABLE OF CONTENTS | THIS WEEK IN THE JOURNAL | Audio Icon AUDIO SUMMARY
Original Article
graphic Raltegravir with Optimized Background Therapy for Resistant HIV Infection
In two phase 3 studies, raltegravir was found to be superior to placebo, in the context of optimized background antiviral therapy, in suppressing HIV viral load at 48 weeks (62.1% vs. 32.9%).
Free Full Text   CME Exam

graphicView an interactive graphic showing HIV structure, life cycle, and drug interaction, and an AIDS timeline.

Original Article
graphic Raltegravir Therapy for Resistant HIV Infection — Subanalyses
In patients with high-risk features for failure of antiretroviral therapy, raltegravir was superior to placebo in terms of a virologic response at 48 weeks. However, among these patients, in whom antiretroviral therapy had been used previously, 23% of raltegravir recipients had virologic failure by 48 weeks.   Free Full Text
Original Article
graphic Variants of SLCO1B1 Associated with Statin-Induced Myopathy
A genomewide screen of patients with myopathy who were taking high-dose simvastatin showed a strong association between myopathy and variants of SLCO1B1, which encodes an organic anion–transporting polypeptide.

-Related Editorial: Pharmacogenomics and Drug Toxicity

Online FirstJuly 23, 2008 (DOI: 10.1056/NEJMoa0801936), in Print August 21, 2008
Original Article
graphic Detection of Mutations in EGFR in Circulating Lung-Cancer Cells
This study describes a method for capturing circulating tumor cells in patients with non–small-cell lung cancer with the use of antibody tethered to microposts.
Published Online July 2, 2008 (DOI: 10.1056/NEJMoa0800668)
Original Article
graphic Sorafenib in Advanced Hepatocellular Carcinoma
No effective therapy is available for advanced hepatocellular carcinoma. In this trial involving patients with advanced hepatocellular carcinoma, sorafenib improved median survival by 3 months, as compared with placebo.
Clinical Practice
graphic Hypoparathyroidism
A 58-year-old man is found on laboratory testing to have a serum calcium level of 6.0 mg per deciliter, an albumin level of 3.9 g per deciliter, and a phosphorus level of 6.0 mg per deciliter. His ionized calcium level is 0.75 mmol per liter. How should his case be further evaluated and treated?
CME Exam
Audio IconListen to the full text of this article.
Case Records of the Massachusetts General Hospital
graphic A Man with Back Pain and a Mass in the Lung
A 26-year-old man experienced the sudden onset of back pain. MRI disclosed a pathologic fracture of the T9 vertebral body. A chest radiograph and CT of the chest showed a mass in the upper lobe of the left lung.   CME Exam
Perspective
graphic Tier 4 Drugs and the Fraying of the Social Compact
The growing number of biologic drugs for cancers and other serious conditions is a harbinger of things to come. Drs. Thomas Lee and Ezekiel Emanuel write that recent headlines about their high costs serve as warnings about the financial and ethical challenges we will increasingly encounter throughout medicine.
Perspective
graphic The Genetic Information Nondiscrimination Act — A Half-Step toward Risk Sharing
Russell Korobkin and Dr. Rahul Rajkumar write that GINA is emblematic of this country’s piecemeal and inconsistent approach to health care policy, which makes little sense and leaves many Americans without access to care or in danger of financial ruin if they seek care.   Free Full Text

screenshot of Francis Collins Perspective Video Interview
Dr. Francis Collins discusses the provisions of the Genetic Information Nondiscrimination Act and its likely effects on patient care and clinical research. Dr. Collins is director of the National Human Genome Research Institute at the National Institutes of Health. (Originally published June 19, 2008.)

View Video Now

Correspondence
graphic Shortage of Chemotherapeutic Agents in Iraq
These authors determined the effect of the shortage of chemotherapeutic agents on the outcome of acute lymphoblastic leukemia in Iraqi children during the period of UN sanctions (1990–2002). Many of the children received less than 50% of the prescribed chemotherapy, which was associated with a significantly worse outcome.   Free Full Text

Editorials
HIV Integrase Inhibitors — Out of the Pipeline and into the Clinic  Free Full Text

Noninvasive Monitoring of Tumors
Published Online July 2, 2008 (DOI: 10.1056/NEJMe0804521)

Sorafenib in Liver Cancer — Just the Beginning

Correspondence
Stents versus Bypass Grafting for Left Main Coronary Artery Disease

Telmisartan, Ramipril, or Both in Patients at High Risk of Vascular Events

Anesthesia Awareness and the Bispectral Index

Violence-Related Mortality in Iraq, 2002–2006  Free Full Text

Slowing the Growth of Health Care Costs

Upcoming in Print
Published Online July 16, 2008
-Medicare Showdown
Published Online July 9, 2008
-Guns and Health
FULL TABLE OF CONTENTS | THIS WEEK IN THE JOURNAL | Audio Icon AUDIO SUMMARY
Image of the Week

graphic

Dynamic Tumor Staging

In this 54-year-old man with a mass in the right lower lobe, there was concern about chest-wall invasion. A real-time echo changed the diagnosis from stage IIb to stage Ib. (View video.)

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The New England Journal of Medicine (NEJM) is a weekly general medical journal that publishes new medical research findings, review articles, and editorial opinion on a wide variety of topics of importance to biomedical science and clinical practice. Material is published with an emphasis on internal medicine and specialty areas including allergy/immunology, cardiology, endocrinology, gastroenterology, hematology, kidney disease, oncology, pulmonary disease, rheumatology, HIV, and infectious diseases.

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