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September 16, 2010  Vol. 363 No. 12

Audio Summary of this Issue

Perspective
1097-1099
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Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide, and the rate of COPD-related death is increasing.1 No current drug therapy alters the progressive decline in lung function that characterizes this disease. In 2004, the ...

1099-1103
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Advances in genomic technologies permit the simultaneous analysis of millions of variants across the genome and may soon allow for meaningful estimation of one's risks of developing cancer, diabetes, and other common diseases. These advances are ...

1100-1101
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Geneticists have long cited the risks of direct-to-consumer (DTC) genetic testing, highlighting the danger for consumers who make complex medical decisions without adequate clinical guidance. On May 10, 2010, the Food and Drug Administration (FDA) voiced ...

1103-1105

Like so many recent British governments, the new Conservative–Liberal Democrat coalition government is making structural changes to the National Health Service (NHS) in England. Such changes are being made despite campaign promises by the Conservative ...

Original Articles
1107-1116

The investigators induced muscle paralysis in patients with the acute respiratory distress syndrome (ARDS) by administering a neuromuscular blocking agent, cisatracurium besylate. As compared with placebo, cisatracurium resulted in a lower adjusted 90-day mortality without more severe sequelae of neuromuscular blockade.

1117-1127

The authors report on the clinical activity of a new oral inhibitor of Janus kinase 2 (JAK2) in patients with myelofibrosis. The drug improved a wide range of symptoms promptly, controlled them for >1 year, and appeared to inhibit disease progression to acute leukemia.

1128-1138

This study examined the rate of exacerbations among patients with COPD over a period of 3 years. The strongest predictor of an exacerbation in a given year was the presence of an exacerbation in the previous year.

1139-1145
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This study examined the effect of legislation that banned smoking in public places in Scotland on the incidence of severe episodes of asthma among children. The rate of hospitalization for asthma decreased among both preschool and school-age children after the institution of the ban.

1146-1155

This study assessed the relationship between initial responsiveness to darbepoetin alfa and outcomes in patients with chronic kidney disease and type 2 diabetes mellitus. A poor initial hematopoietic response was associated with an increased risk of death or cardiovascular events.

Clinical Practice
1156-1162
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At least weekly, a 62-year-old teacher has a strong sense of urgency to urinate, followed by leakage as she rushes to the bathroom. She sometimes leaks urine during exercise. She takes hydrochlorothiazide for mild hypertension. On physical examination, she is found to be obese and not to have abdominal masses or pelvic-organ prolapse.

Images in Clinical Medicine
1163
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A 70-year-old man presented with a 2-month history of intermittent hematochezia. Ten years earlier, he had undergone 6 months of radiation therapy for the treatment of prostate cancer. The total dose of radiation was 64 Gy, and the prostate cancer was ...

e17
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A 10-year-old boy was referred to the dermatology department with a 1-year history of what appeared to be extensive warts on both hands. On physical examination, multiple hyperkeratotic, erythematous, flat papules with central atrophy were present on the ...

Case Records of the Massachusetts General Hospital
1164-1173
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A 32-year-old woman, 3 weeks post partum, was seen in the emergency department because of intermittent substernal chest pain. The pain had developed suddenly during normal activity, resolved after 20 minutes, and then recurred. Diagnostic procedures were performed.

Editorials
1175-1176
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If information is not in digital form, it may as well not exist for today's researchers. That is what we have heard from those who oversee medical and scientific libraries. For several centuries, doing serious research meant spending hours in a major ...

1176-1180

In this issue of the Journal, Papazian and colleagues1 present intriguing results of their study examining neuromuscular blockade in patients with severe, early acute respiratory distress syndrome (ARDS). The investigators randomly assigned 340 patients ...

1180-1182

Myelofibrosis is a very debilitating chronic myeloproliferative neoplasm.1 It may be primary or develop late in the course of essential thrombocythemia or polycythemia vera, the two most common and benign myeloproliferative neoplasms. Patients with ...

1183-1184

Chronic obstructive pulmonary disease (COPD) is a partially reversible disorder characterized by progressive airflow obstruction, the course of which is punctuated by episodes of acute symptomatic worsening (exacerbations) of variable severity and ...

Correspondence
1185-1186

To the Editor: Sanyal and colleagues (May 6 issue)1 report the beneficial effect of natural vitamin E (800 IU per day) in patients with nonalcoholic steatohepatitis. The majority of patients with nonalcoholic steatohepatitis have preexisting metabolic ...

1187-1189

To the Editor: The Perspective article by Parens et al. (May 20 issue)1 misleads, misinforms, and is missing relevant facts. The authors imply that the increase in the diagnosis of pediatric bipolar disorder was due to a cabal of child psychiatrists ...

1189-1190

To the Editor: Erythrocytosis occurring in association with a subnormal serum erythropoietin level is indicative of underlying erythropoietin-independent erythropoiesis, in patients with polycythemia vera, or erythropoietin-hypersensitive erythropoiesis, ...

Corrections
1190

Everolimus in Patients with Autosomal Dominant Polycystic Kidney Disease Original Article, N Engl J Med 2010:363;830-840 (10.1056/NEJMoa1003491; published on June 26, 2010, at NEJM.org). The Conclusions section of the Abstract (page 1) should have read, “...

1190

Early Alzheimer's Disease Clinical Practice, N Engl J Med 2010:362;2194-2201. In the second paragraph of the Treatment Options section (page 2197), the parenthetical information given in the second sentence, regarding the Alzheimer's Disease Assessment ...

1190

Chronic Kidney Disease Predicts Cardiovascular Disease Editorial, N Engl J Med 2004:351;1344-1346. In the antepenultimate sentence of the fifth paragraph (page 1345), beginning “For example,” each of the three parenthetical instances of “mmol” should have ...