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November 15, 2007  Vol. 357 No. 20

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Perspective
1993-1996
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The Hatch–Waxman Act set the rules under which generic pharmaceutical products could compete with brand-name products. Richard Frank writes that market participants have responded to the regulations in ways that serve their own interests. Richard Frank ...

1996-1999

Many medications remain unaffordable in low- and middle-income countries. Dr. Robert Steinbrook writes that although there are many strategies for closing the affordability gap, each drug and disease poses unique challenges that require nuanced ...

Original Articles
2001-2015

Antiplatelet therapy with aspirin and a thienopyridine is a key component in the management of acute coronary syndromes. This trial compared a novel, potent thienopyridine (prasugrel) with the standard thienopyridine (clopidogrel) in patients with acute coronary syndromes scheduled to have a coronary intervention. Prasugrel led to better cardiovascular outcomes, but at the expense of more bleeding, including fatal bleeding.

2016-2027

Chitinases, a family of hydrolases, have been associated with animal models of asthma. In this cross-sectional study, circulating levels of YKL-40, a human chitinase-like protein, were examined in three cohorts of patients with asthma. Although there was overlap between controls and patients with asthma, on average, circulating YKL-40 levels were higher in patients with asthma, with the highest levels in the patients with the most severe disease.

2028-2039

This study compared teriparatide, an anabolic agent, with alendronate in an 18-month randomized, double-blind, controlled trial involving patients who had received glucocorticoids for at least 3 months and were at high risk for fracture. Bone mineral density increased more in patients receiving teriparatide than in those receiving alendronate, though increased calcium levels occurred more often in the teriparatide group. Teriparatide may prove to be useful in patients with glucocorticoid-induced osteoporosis.

2040-2048
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This open-label trial of the treatment of colorectal cancer with cetuximab, a chimeric monoclonal antibody against the epidermal growth factor receptor (EGFR), showed that among patients with colorectal cancer that expressed EGFR and that had failed to respond to other treatments, overall survival and progression-free survival were better in those receiving cetuximab than in those receiving best supportive care alone.

Special Article
2049-2056
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This study of patenting by faculty members at academic medical centers documented a large increase in patent activity during the period from 1981 through 2000. Medical school faculty members were more likely to be patent holders if they had Ph.D. degrees and if they had received recent funding from the National Institutes of Health.

Clinical Practice
2057-2066
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A previously healthy 45-year-old man presents with severe lower abdominal pain on the left side, which started 36 hours earlier. He has noticed mild discomfort in this region periodically before but has not sought medical treatment. He reports nausea, anorexia, and vomiting associated with any oral intake. On physical examination, his temperature is 38.5°C and his heart rate is 110 beats per minute. He has abdominal tenderness on the left side without peritoneal signs. How should his case be managed?

Images in Clinical Medicine
2067
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An 81-year-old woman with rheumatoid arthritis, Sjögren's syndrome, and hypertension presented with swelling and pain in the area of the left heel, which had developed suddenly a week after a short course of levofloxacin for acute bronchitis. She reported ...

e22
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This healthy woman presented with a history of flushing on the left side of her face and upper trunk after vigorous exercise.

Case Records of the Massachusetts General Hospital
2068-2076

    A 30-year-old Moroccan man with a history of inflammatory bowel disease was admitted to the hospital because of fever, abdominal pain, and bloody diarrhea. He had last traveled to Morocco 5 months before admission. On admission to the hospital, his temperature was 40.5°C and the heart rate was 70 beats per minute. There was atypical lymphocytosis in the blood, and serum levels of aminotransferases were slightly elevated. A diagnostic procedure was performed.

    Editorials
    2078-2081

    In Greek mythology, Scylla was a ferocious beast and Charybdis was a monstrous whirlpool. The wily Odysseus successfully navigated between these two dangers by steering closer to Scylla, though he did lose a few crew members to her. In a similar manner, ...

    2082-2084

    Chitin — the second-most abundant biologic polymer, after cellulose — is a tough, cross-linked polysaccharide (see Figure 1) found in the exoskeleton of insects and crustaceans, the cell wall of fungi, and the pharynx, microfilarial sheath, and egg of ...

    2084-2086

    Glucocorticoids are widely used because of their important and efficacious immunosuppressive and antiinflammatory properties. However, glucocorticoid-induced osteoporosis, a major adverse event, is a common clinical problem. The risk of osteoporosis with ...

    Correspondence
    2087-2088

    To the Editor: The study of hemophilia prophylaxis by Manco-Johnson et al. (Aug. 9 issue)1 overestimates the annual cost of factor VIII treatment in young children. The authors state that the yearly cost “for a child weighing 50 kg could reach $300,000.” ...

    2088-2089

    To the Editor: Clinicians with access to echocardiography in regions in which rheumatic fever is endemic have been aware for decades that echocardiography is more sensitive and specific than auscultation in detecting acute carditis.13 In New Zealand, an ...

    2089

    To the Editor: In his Perspective article on rheumatic heart disease in developing countries, Carapetis (Aug. 2 issue)1 correctly notes the important contribution of improved living conditions to the decline in the incidence of acute rheumatic fever over ...

    2090

    To the Editor: In his review of skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA), Daum (July 26 issue)1 cites a study2 indicating that intravenous trimethoprim–sulfamethoxazole (TMP-SMX) is significantly less ...

    2090-2092

    To the Editor: The video and accompanying text by Ortega et al. on positive-pressure ventilation with a face mask and a bag-valve device (July 26 issue)1 identify the tongue as the most common cause of airway obstruction. Although this concept is ...

    2092-2093

    To the Editor: Infliximab (Remicade) is a humanized mouse monoclonal antibody that blocks tumor necrosis factor α.1 It down-regulates type 1 helper T-cell (Th1) immune responses and increases type 2 helper T-cell (Th2) responses, thereby favoring ...

    Book Reviews
    2094-2095

    The Oxford Handbook of Bioethics endeavors to take the pulse of contemporary bioethics. The avowed aim of the editor, Bonnie Steinbock, is to “provide an up-to-date picture of the state of the art in bioethics.” The book does not purport to address every ...

    2095-2096

    Neuroethics is the name recently applied to the ethical issues that arise from advances in neuroscience — particularly brain science. During the past 5 years, neuroethics has grown from an obscure area of interest to a defined discipline with its own ...

    2096

    In her new book, Perri Klass brings literary depth to bear on the ambiguities of medicine and family. Written to her son Orlando as he applies to medical school, the book belongs to the long tradition of books titled Letters to a Young ______. By choosing ...

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