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Special Article
Sources of Regional Variation in Medicare Part D Drug Spending
There is considerable geographic variation in health care spending across the United States,– and a recent study showed regional variation in prescription-drug spending for Medicare Part D enrollees. However, the sources of regional variation in drug spending are not well understood. Prescription-…
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Correspondence
Budesonide in Preschool-Age Children with Recurrent Wheezing
To the Editor: In the Maintenance and Intermittent Inhaled Corticosteroids in Wheezing Toddlers (MIST) trial (ClinicalTrials.gov number, NCT00675584), Zeiger et al. (Nov. 24 issue) suggest that intermittent high-dose budesonide was equal in efficacy to daily low-dose budesonide in preschool-age…
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Correspondence
Relationship between Cerebrospinal Fluid Glucose and Serum Glucose
To the Editor: Levels of glucose in the cerebrospinal fluid (CSF) are used to discriminate bacterial meningitis from viral meningitis. Children with bacterial meningitis typically have low levels of CSF glucose because of glycolysis by both white cells and the pathogen and impaired CSF glucose…
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Correspondence
Mycophenolate or Azathioprine Maintenance in Lupus Nephritis
To the Editor: Dooley et al. (Nov. 17 issue) report the efficacy of mycophenolate mofetil versus azathioprine as maintenance therapy for lupus nephritis and declare mycophenolate superior. Yet azathioprine was prescribed according to body weight, despite overwhelming evidence favoring the use of…
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Correspondence
Systemic Lupus Erythematosus
To the Editor: In the Mechanisms of Disease article on systemic lupus erythematosus (SLE), Tsokos (Dec. 1 issue) notes that a lack of C1q leads to deficient clearance of waste material. I would like to add the role of C1q in the regulation of interferon-α production in response to immune complexes.…
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Correspondence
Extracorporeal Membrane Oxygenation for ARDS in Adults
To the Editor: While summarizing the use of extracorporeal membrane oxygenation (ECMO) in the acute respiratory distress syndrome (ARDS), Brodie and Bacchetta (Nov. 17 issue) suggest venoarterial ECMO as an alternative approach to standard venovenous ECMO when hemodynamic support is needed. In our…
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Correspondence
Ultraviolet A and Photosensitivity during Vemurafenib Therapy
To the Editor: Vemurafenib (PLX4032, Zelboraf) is a selective inhibitor of V600E BRAF. In phase 1, 2, and 3 clinical trials involving patients with tumors that have V600E BRAF mutations, vemurafenib was associated with consistent efficacy and improved survival. These data led to approval of…
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Correspondence
Early Liver Transplantation for Severe Alcoholic Hepatitis
To the Editor: The study reported by Mathurin et al. (Nov. 10 issue) could have a strong impact on living-donor liver transplantation. Mandatory alcohol abstinence before deceased-donor liver transplantation serves two purposes: evaluation of compliance, including the likelihood of recidivism, and…
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Correspondence
Staphylococcus aureus Reactivation Osteomyelitis after 75 Years
To the Editor: In 1934, a 10-year-old girl was hospitalized at the Children's Hospital of Boston for 1 1/2 years for Staphylococcus aureus osteomyelitis of the left femur. This was the preantibiotic era, so she did not receive any antibiotic therapy at that time but, instead, underwent multiple…
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Correspondence
Timing of Antiretroviral Therapy for HIV-1–Associated Tuberculosis
To the Editor: Three randomized trials reported by Blanc et al. Havlir et al. and Abdool Karim et al. (Oct. 20 issue) consolidate the evidence base underpinning recommendations on when to start antiretroviral therapy (ART) in patients with human immunodeficiency virus (HIV)–associated…
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Correspondence
Glucocorticoids plus N-Acetylcysteine in Alcoholic Hepatitis
To the Editor: The study by Nguyen-Khac et al. (Nov. 10 issue) sidesteps old contentious issues regarding the use of glucocorticoid therapy in alcoholic hepatitis. Among the 8 references cited in support of glucocorticoid treatment, 2 in fact concluded that the therapy was of no benefit. In…
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Correspondence
HPV Vaccine against Anal Intraepithelial Neoplasia
To the Editor: Palefsky et al. (Oct. 27 issue) report an efficacy of 74.9% for the quadrivalent human papillomavirus (HPV) vaccine against anal intraepithelial neoplasia grade 2 or 3 related to HPV-6, 11, 16, or 18 in the per-protocol population of healthy men who have sex with men. Because anal…
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Correspondence
Briakinumab versus Methotrexate for Psoriasis
To the Editor: Reich and colleagues (Oct. 27 issue) concluded that briakinumab was more effective than methotrexate in patients with moderate-to-severe psoriasis and that the higher incidence of serious infections and cancers observed in the briakinumab group was not statistically significant.…
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Correspondence
Sildenafil for Severe Lymphatic Malformations
To the Editor: Lymphatic malformations are uncommon congenital vascular anomalies that can cause complications including obstruction of vital organs and their function, recurrent infection, and disfigurement. Current procedural treatments are only partially successful, and lymphatic malformations…
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Correspondence
Influenza Vaccine in Young Children
To the Editor: Vesikari et al. (Oct. 13 issue) report an efficacy of 89% for a trivalent inactivated vaccine with an oil-in-water adjuvant (ATIV) in children 6 to 71 months of age against vaccine-matched strains. However, the efficacy of the trivalent inactivated vaccine without adjuvant (TIV) in…
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Correspondence
Long-Term Hormonal Adaptations to Weight Loss
To the Editor: Sumithran et al. (Oct. 27 issue) describe the long-term persistence of hormonal adaptations to weight loss. We believe that the results of this study could support alternative conclusions. In our opinion, the sustained hormonal changes that were observed could be explained completely…
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Correspondence
Clostridium difficile Infection and Colonization
To the Editor: Understanding the role of medications in preventing hospital-acquired Clostridium difficile infections is important. The article by Loo et al. (Nov. 3 issue) raises two questions. First, we submit that it is not only the patient's exposure to medications that may increase risk but…
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Correspondence
Repeat Expansion in C9ORF72 in Alzheimer's Disease
To the Editor: Alzheimer's disease is the most common progressive neurodegenerative disorder and a leading cause of dementia in the elderly. The genetic causes of Alzheimer's disease are complex, and only four mendelian genes have indisputably been associated with the disease. Mutations in genes…
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Correspondence
Medical Devices — Balancing Regulation and Innovation
To the Editor: The Perspective article by Curfman and Redberg (Sept. 15 issue) is much too optimistic, as is the Institute of Medicine (IOM) report on which it is based. Both fail to acknowledge that the 510(k) process that the Food and Drug Administration (FDA) uses for approving ("clearing") new…
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Correction
A Phase 3 Trial of Bevacizumab in Ovarian Cancer
A Phase 3 Trial of Bevacizumab in Ovarian Cancer Original Article, N Engl J Med 2011;365:2484-2496. In the Patients subsection of Results (page 2487), the final sentence should have read, ". . . and 26% had more than 1.0 cm of residual disease after surgical debulking," rather than ". . . and…
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