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November 5, 2009  Vol. 361 No. 19

Audio Summary of this Issue

Perspective
1817-1819

In the coming weeks, the Senate Finance Committee will work with senators and representatives to merge their work into a final package. Senator Max Baucus (D-MT) writes that this country has never been as close as we are today to bringing true stability ...

1819-1821

In July the Boston Medical Center filed suit in Massachusetts state court challenging the state's Medicaid reimbursement formula. Wendy Parmet writes that this case raises critical questions about the Massachusetts model of health care reform as well as ...

1821-1823
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Drs. C. Jason Wang, Kathleen Conroy, and Barry Zuckerman argue that safety-net institutions should be reimbursed more per patient under any pay-for-quality scheme that is implemented.

1823-1825
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Guidelines from the CDC recommend the use of an N95 filtering facepiece respirator. Drs. Kenneth Shine, Bonnie Rogers, and Lewis Goldfrank discuss the efficacy of personal respiratory protection measures, medical masks, and respirators.

e38

As Democrats press to enact health care reform legislation, they have emphasized their commitment to greatly expanding coverage, slowing the growth of medical spending, and more tightly regulating private insurers, if not also creating a competing public ...

e39

In 2006, Massachusetts enacted the country's first law mandating near-universal health care coverage,1 and the state now has the lowest proportion of uninsured residents in the United States. The Massachusetts Division of Health Care Finance and Policy ...

Original Articles
1827-1837
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This comparative-effectiveness trial showed that clinical outcomes at 1 year were better with on-pump than with off-pump coronary-artery bypass grafting (CABG), and there was also better graft patency. There were no significant differences in neuropsychological outcomes.

1838-1847

In this single-group study involving women with grade 3 vulvar intraepithelial neoplasia associated with human papillomavirus type 16 (HPV-16), vaccination against HPV-16 infection with a peptide vaccine was related to a clinical response in 15 of 19 patients (79%) at 1 year. This clinical response was associated with induction of HPV-16–specific T cells.

1848-1855

This trial enlisted 14 patients with pure red-cell aplasia and antierythropoietin antibodies that were induced by treatment with conventional erythropoiesis-stimulating agents. The patients were treated with a peptide-based erythropoietin-receptor agonist that simulates the action of erythropoietin. Of the 14 subjects, 13 achieved a hemoglobin concentration above 11 g per deciliter and over the 28-month course of the study lost the need for regular transfusions.

1856-1863

The presence of a partially inactivating mutation in LHB, the gene encoding the beta subunit of luteinizing hormone, in a man with normal spermatogenesis suggests that high levels of intratesticular testosterone may not be necessary for the development of sperm.

Clinical Therapeutics
1864-1871

A 46-year-old-woman presents with exertional dyspnea and syncope and receives a diagnosis of idiopathic pulmonary arterial hypertension. Treatment with sildenafil is recommended. Sildenafil and tadalafil are phosphodiesterase type 5 inhibitors that ameliorate pulmonary arterial hypertension by increasing levels of cyclic guanosine monophosphate in the smooth-muscle cells of the pulmonary artery.

Review Article
1872-1885

This review gives an account of the clinical and hematologic features of the myelodysplastic syndromes. It supplies the latest classification of these disorders, discusses the cytogenetic and molecular genetic changes that occur, and analyzes how some of these conditions convert to acute myeloid leukemia.

Videos in Clinical Medicine
e40

Although other methods exist to assess the peripheral vasculature, measurement of the ankle–brachial index remains a simple, reliable method for diagnosing peripheral arterial disease. This video presents the indications for use of the ankle–brachial index and demonstrates how it is measured.

Images in Clinical Medicine
1886
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A 21-year-old primigravida at nearly 40 weeks' gestation presented with a spontaneous onset of pelvic pain and difficulty in walking. After a rapid delivery, the postpartum physical examination revealed pain only with weight bearing and abduction and ...

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A 13-year-old girl with type 1 diabetes mellitus presented with depressed areas of skin at the sites of insulin injection. The physical examination showed a loss of the adipose tissue layer at the injection sites.

Clinical Problem-Solving
1887-1894

    A 62-year-old woman presented to the urgent care clinic with gingival bleeding after periodontal scaling of her lower-right second molar 5 hours earlier. Bleeding had persisted despite the application of pressure and ice. The patient recalled a similar episode approximately 6 months earlier, also after a periodontal procedure.

    Editorials
    1896-1897

    Disclosure of financial associations of authors of articles published in biomedical journals has become common practice. The information provided in these disclosures helps the reader to understand the relationships between the authors and various ...

    1897-1899

    Cardiac surgery has always been a unique combination of art and science. The field is advanced by those who push the envelope by suggesting innovations. Yet promising techniques need to be rigorously evaluated before they are widely adopted. Coronary-...

    1899-1901

    Cancer immunoprevention has become synonymous with the vaccines that have been approved for the prevention of infection with highly transmissible strains of human papillomavirus (HPV) that establish chronic infection and cause cervical and other cancers.1 ...

    1901-1903

    Recombinant human erythropoietin is arguably the most successful therapeutic application of recombinant DNA technology to date. Since the initial reports — which appeared 22 and 23 years ago1,2 — documented a cure of the anemia of chronic kidney disease ...

    Clinical Implications of Basic Research
    1904-1906

    A recent description of an alternative messenger RNA transcript of the iron-export protein ferroportin opens the door to understanding how duodenal cells maintain dietary-iron absorption when the body is iron deficient and how mean corpuscular volume is regulated in the contexts of iron deficiency and inflammatory disorders.

    Correspondence
    1907-1910

    To the Editor: Lopes and colleagues (July 16 issue)1 report data on vein-graft harvesting techniques from the Project of Ex-vivo Vein Graft Engineering via Transfection IV (PREVENT IV) study and conclude that endoscopic vein-graft harvesting, as compared ...

    1910-1911

    To the Editor: Flum and colleagues (July 30 issue)1 report on the Longitudinal Assessment of Bariatric Surgery (LABS) consortium study (LABS-1) in which the rate of the composite adverse outcome by 30 days after bariatric surgery was greater among the ...

    1912-1913

    To the Editor: The medical community should be made aware of the serious potential for dosing errors in children prescribed Tamiflu (oseltamivir) oral suspension, as illustrated in the case described below.

    After the diagnosis of novel H1N1 influenza, a ...

    1913-1914

    To the Editor: On September 23, Parker et al.1 described a case in which Tamiflu (oseltamivir) for oral suspension was dispensed with pharmacy instructions to administer the drug in volume units (teaspoons), whereas the manufacturer's dosing syringe ...

    Corrections
    1914

    Long-Term Effect of Diabetes and Its Treatment on Cognitive Function Original Article, N Engl J Med 2007:356;1842-1852.. In Figure 1 (page 1849), the bars for Cognitive Domain 5 should have been inverted in all three panels to show positive changes in z ...

    1914

    Denosumab for Prevention of Fractures in Postmenopausal Women with Osteoporosis Original Article, N Engl J Med 2009:361;756-765.. In the Appendix (page 764), the names of some of the investigators were incomplete. The article has been corrected at ...

    1914

    DNA Damage, Aging, and Cancer Review Article, N Engl J Med 2009:361;1475-1485.. In Figure 3 (page 1479), the label in the top right corner of the figure should have read “RNA polymerase” rather than “DNA polymerase.” The article has been corrected at ...

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