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Table of contents for

September 9, 2010  Vol. 363 No. 11

Audio Summary of this Issue

Perspective
997-999
Screening Student Athletes for Sickle Cell Trait — A Social and Clinical Experiment
V.L. Bonham, G.J. Dover, and L.C. Brody

    On April 13, 2010, the legislative council for Division I of the National Collegiate Athletic Association (NCAA) approved mandatory testing for sickle cell carrier status (sickle cell trait) for all student athletes participating in Division I sports. ...

    999-1001
    Defining Medical Expenses — An Early Skirmish over Insurance Reforms
    J.K. Iglehart
    • Free Full Text

    The Affordable Care Act (ACA) vests state insurance regulators with enormous power as they partner with the federal government to determine how the act is implemented. The stringency with which state and federal governments draw their implementation plans ...

    1001-1003
    Patient Safety beyond the Hospital
    T.K. Gandhi and T.H. Lee
    • Free Full Text

    The vast majority of health care is delivered in ambulatory settings, yet we are only just beginning to understand the safety risks that exist outside of hospital walls. There are 900 million visits to physicians' offices in the United States each year, ...

    Original Articles
    1005-1015
    Rapid Molecular Detection of Tuberculosis and Rifampin Resistance
    C.C. Boehme and Others
    • Free Full Text

    Samples from patients with suspected TB were assayed for TB and drug resistance with several different techniques. An automated molecular test showed a sensitivity of 98% in smear-positive, culture-positive samples and a sensitivity of 72–90% in smear-negative, culture-positive samples, and it identified rifampin resistance >97% of the time.

    1016-1024
    E2-2 Protein and Fuchs's Corneal Dystrophy
    K.H. Baratz and Others
    • Free Full Text

    In this genomewide association study of age-related corneal dystrophy, there was a significant association with variants of TCF4, which encodes the E2-2 transcription factor. The risk variant of the most strongly associated genetic marker had an odds ratio of approximately 5.

    1025-1037
    Persistent Malignant Stem Cells in del(5q) Myelodysplasia in Remission
    R. Tehranchi and Others
    • Free Full Text
    • CME

    This study shows that even in patients with del(5q) myelodysplastic syndrome who become transfusion-independent in response to lenalidomide, a myelo-dysplastic syndrome stem cell persists that is lenalinomide-resistant, continues to acquire genetic defects, and can cause relapse.

    1038-1049
    Gentamicin–Collagen Sponge for Infection Prophylaxis in Colorectal Surgery
    E. Bennett-Guerrero and Others
    • Free Full Text

    The gentamicin–collagen sponge is used outside the U.S. to prevent surgical-site infection. In this trial of patients undergoing colorectal surgery, patients who had such sponges inserted above the fascia had higher, not lower, rates of infection.

    Review Article
    1050-1058
    Current Concepts: MDR Tuberculosis — Critical Steps for Prevention and Control
    E. Nathanson and Others
    • Free Full Text
    • CME

    In 2008, there were an estimated 440,000 new cases of MDR-TB globally. This review describes critical challenges to be addressed and policy changes to be made for progress worldwide in preventing and controlling MDR-TB.

    Images in Clinical Medicine
    1059
    Miliary Tuberculosis
    X.-D. Mu and G.-F. Wang
    • Free Full Text

    A 20-year-old man who was negative for infection with the human immunodeficiency virus was admitted to the hospital with a 20-day history of fever (temperature of 103.6°F [39.8°C]). Chest radiography performed 9 days before presentation was reported to be ...

    e16
    Ocular Loiasis
    A.N. Shah and M. Saldana
    • Free Full Text
    • Video

    A 21-year-old woman presented to our hospital with the sensation of something moving in her eye. She reported having no systemic or visual symptoms. Her medical history was notable only for a trip abroad to Nigeria 6 years earlier. On examination, a live ...

    Case Records of the Massachusetts General Hospital
    1060-1068
    Case 27-2010 — A 73-Year-Old Woman with Chronic Anemia
    E.C. Attar and R.P. Hasserjian
    • CME

    A 73-year-old woman was seen in the cancer center at this hospital for management of a myelodysplastic syndrome. She had had anemia for 2 years, and a diagnosis of a myelodysplastic syndrome with isolated del(5q) had been made 1 year earlier. She required red-cell transfusions every 2 months to maintain a hematocrit of 30%; she did not have recurrent infections or bleeding. A management decision was made.

    Editorials
    1070-1071
    Tuberculosis Diagnosis — Time for a Game Change
    P.M. Small and M. Pai
    • Free Full Text

    The effective treatment of tuberculosis is a lifesaving intervention. The global scale-up of tuberculosis therapy has averted 6 million deaths over the past 15 years, making it one of the greatest public health interventions of our lifetime.1 ...

    1072-1075
    Major Progress in Fuchs's Corneal Dystrophy
    A.F. Wright and B. Dhillon

      The expected outcomes of the almost 800 genomewide association studies of common biomedical traits that have been reported so far1 have rarely been made explicit but might include the identification of statistically robust genetic associations, the ...

      Sounding Board
      1076-1079
      Lessons from the Mammography Wars
      K.H. Quanstrum and R.A. Hayward
      • Free Full Text

      In this article, the authors argue that any intervention produces a continuous gradient of benefit versus harm. Subjective thresholds can vary, even if the data are agreed upon. Should we rely solely on expert panels to make arbitrary judgments, especially in the gray areas?

      Clinical Implications of Basic Research
      1080-1082
      Basophils and Nephritis in Lupus
      S.V. Kaveri, L. Mouthon, and J. Bayry

        Activated basophils in the circulation, lymph nodes, and spleen may augment the risk of nephritis in systemic lupus erythematosus.

        Correspondence
        1083-1085
        Bisphosphonates and Atypical Femoral Fractures
        • Free Full Text

        To the Editor: We read with interest the article by Black et al. (May 13 issue)1 on the epidemiology of subtrochanteric fractures of the femoral shaft in more than 14,000 participants from randomized, controlled trials. In our view, the article has two ...

        1086-1088
        Infliximab, Azathioprine, or Combination Therapy for Crohn's Disease
        • Free Full Text

        To the Editor: The Study of Biologic and Immunomodulator Naive Patients in Crohn's Disease (SONIC) (ClinicalTrials.gov number, NCT00094458) reported on by Colombel et al. (April 15 issue)1 is considered a landmark trial of combination immunosuppressive ...

        1088-1089
        Syphilis and Social Upheaval in China
        • Free Full Text

        To the Editor: In their Perspective article, Tucker et al. (May 6 issue)1 report that rapid increases in cases of congenital syphilis in China have generated great concern. Although sexually transmitted diseases (STDs) have become major notifiable ...

        1089-1091
        Retinal Injuries from a Handheld Laser Pointer
        • Free Full Text

        To the Editor: Handheld laser pointers are commonly used in lecture halls and are considered to be harmless and safe.1 However, laser pointers can cause severe eye injury, as demonstrated by the case of a 15-year-old boy. The boy had ordered a handheld ...

        1091-1092
        Kidney Paired Donation in Live-Donor Kidney Transplantation
        • Free Full Text

        To the Editor: An estimated 6000 patients on the waiting list for kidney transplantation in the United States have suitable living donors who are not immunologically compatible.1 Both kidney paired donation (KPD) and desensitization are options for ...

        Corrections
        1092
        Effectiveness of Sensor-Augmented Insulin-Pump Therapy in Type 1 Diabetes
        • Free Full Text

        Effectiveness of Sensor-Augmented Insulin-Pump Therapy in Type 1 Diabetes Original Article, N Engl J Med 2010:363;311-320. In first paragraph of the Primary and Secondary Outcomes subsection of Results (page 315), there were two instances in which the ...

        1092
        The Path to Personalized Medicine
        • Free Full Text

        The Path to Personalized Medicine Perspective, N Engl J Med 2010:363;301-304. In the eleventh paragraph, which begins with “Increasingly, however,” (page 302), the third sentence should have read, “Since then, a laboratory has marketed a test with the ...

        1092-1093
        Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia
        • Free Full Text

        Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia Original Article, N Engl J Med 2005:353;1209-1223. In the first paragraph of the Adverse Events subsection of Results (page 1215), the last sentence should have read, “After ...

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