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October 7, 2010  Vol. 363 No. 15

Audio Summary of this Issue

Perspective
1389-1391

The Patient Protection and Accountable Care Act (ACA) requires the secretary of health and human services to establish a program within Medicare in which savings from efficient, high-value care are shared with accountable care organizations (ACOs). No ...

1391-1393
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In August 2009, President Barack Obama traveled to Grand Junction, Colorado, touting that community's health care system as a model for the provision of low-cost, high-quality care. According to the Dartmouth Atlas of Health Care, average per capita ...

1393-1395
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Employer-sponsored health insurance is the cornerstone of the U.S. health insurance system. David Blumenthal, among others, has described this system as an “accident of history,” and he quotes Uwe Reinhardt, a leading authority on health care economics, ...

e23
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Under the Affordable Care Act, Medicare will launch a Shared Savings Program for groups of health care providers that join forces, with or without hospitals or health plans, to form legal entities that agree to take responsibility for the quality, cost, ...

Original Articles
1397-1409

Dermal fibroblasts were obtained from members of a family with the long-QT syndrome and from controls and were used to generate pluripotent stem cells, which were then directed to differentiate into cardiac myocytes. The cells recapitulated characteristics of the long-QT syndrome.

1410-1418

In this secondary analysis of data from ADVANCE, severe hypoglycemia in patients with type 2 diabetes was associated with increased risks of macrovascular events, microvascular events, and death. Hypoglycemia may contribute directly or may be a marker of vulnerability.

1419-1428

Acute heart failure is a serious disorder often associated with progressive renal dysfunction. In this clinical trial, rolofylline, an adenosine A1–receptor antagonist, did not appear to benefit patients with acute heart failure and renal dysfunction.

1429-1437

A functional dystrophin transgene was delivered to skeletal muscle in patients with Duchenne's muscular dystrophy, an X-linked disorder resulting in progressive muscle weakness. The results showed a potential for T-cell immunity to self and nonself dystrophin epitopes.

Review Articles
1438-1450

Profound hearing loss in childhood has far-reaching consequences for children and their families. Recent interdisciplinary developments such as cochlear implants are transforming outcomes and offering many more opportunities for deaf children.

1451-1462

This review gives an account of our current understanding of the mechanisms of rejection of renal allografts. New immunosuppressive agents show promise, but graft survival beyond 5 years has not improved substantially.

Images in Clinical Medicine
1463

A 14-year-old girl presented for evaluation of 3 years of intermittent episodes of acute pain in the hands and feet. She had no other medical history. These episodes of pain were frequently triggered by physical exercise and bathing. During physical ...

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A 33-year-old woman presented with stereotypic choreic movements (see video). These uncontrollable movements, which had begun 6 years earlier, initially affected only her limbs but later extended to include her trunk and neck. The abnormal movement was ...

Clinical Problem-Solving
1464-1469
  • CME

A 73-year-old man presented with a history of progressive, symmetric edema that began in the lower extremities and extended to involve his thighs, scrotum, and arms. He had dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea, as well as chest pressure on mild exertion.

Editorials
1471-1472

A classic joke often used to illustrate the nature of scientific investigation describes a drunk searching for his keys under a lamppost, even though he dropped them some distance away, because “that's where the light is.” Similarly, since the time of ...

1473-1475

The development of gene therapy that is based on recombinant adeno-associated virus (rAAV) has had a checkered history. Recently, it has been marked by a number of clinical successes, including partial restoration of retinal function in patients with ...

Clinical Implications of Basic Research
1476-1478

The presence of intestinal microflora in mice facilitates hatching of the whipworm Trichuris muris (a model of the human-infecting T. trichiura), which in turn leads to T-cell responses.

Correspondence
1479-1482

To the Editor: The investigators of the United Kingdom Endovascular Aneurysm Repair (EVAR) trials (Current Controlled Trials number, ISRCTN55703451) (May 20 issue)1,2 present data highlighting the importance of perioperative risk stratification to ...

1482-1484

To the Editor: Peleg and Hooper (May 13 issue)1 stress the importance of preventive measures for ventilator-associated pneumonia. Table 3 of their article lists evidence-based guidelines for the prevention of this infection. We respectfully disagree with ...

1484-1485

To the Editor: In their Perspective article, Kesselheim and Solomon (June 3 issue)1 note that the approval of oral colchicine (Colcrys) by the Food and Drug Administration (FDA) resulted in a substantial increase in the drug's price. Because URL Pharma ...

1485-1486

To the Editor: Accurate hand-off communication among health care providers has been a focus of quality improvement and hospital accreditation.1 Although much emphasis has been placed on in-hospital transfers of care, there is a growing focus on ...

Corrections
1486

Icatibant, a New Bradykinin-Receptor Antagonist, in Hereditary Angioedema Original Article, N Engl J Med 2010;363:532-541. In the End Points subsection of Methods (page 534), the first sentence of the third paragraph should have begun, “Secondary efficacy ...

1486

Infectious Mononucleosis Clinical Practice, N Engl J Med 2010;362:1993-2000. The title for Figure 1 (page 1996) should have ended with “(Wright–Giemsa)” rather than “(Hematoxylin and Eosin).” The article has been corrected at NEJM.org.

1486

Fractional Flow Reserve for Guiding PCI Correspondence, N Engl J Med 2009;360:2024-2027. In Table 1 of the authors' reply (page 2026), the percentages given for “Patients with high SYNTAX score” should have been 21.5 for angiography-guided PCI and 8.8 for ...