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Table of contents for

December 2, 2010  Vol. 363 No. 23

Audio Summary of this Issue

Perspective
2181-2183
Government Payment for Health Care — Causes and Consequences
V.R. Fuchs
  • Free Full Text

Government's role in paying for health care has expanded greatly in all high-income countries, including the United States. But most other high-income countries have national health insurance and spend far less on health care than the United States does.

2183-2185
Influenza Vaccine — Safe, Effective, and Mistrusted
K.M. Harris, J. Maurer, and A.L. Kellermann

    On August 10, 2010, the World Health Organization (WHO) declared an end to the 2009 influenza A (H1N1) pandemic. It is fortunate that the virus that had spread worldwide so quickly turned out to be less severe than was first feared. It is worth ...

    2185-2187
    The Emerging Importance of Patient Amenities in Hospital Care
    D.P. Goldman, M. Vaiana, and J.A. Romley
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    In crowded hospital markets, hotel-like amenities for patients play an increasing role in the competition for market share. This development raises important questions about the definition of hospital quality and its benefits and costs to patients and society.

    2187-2189
    Becoming a Physician: Gratitude, Memories, and Meaning in Medicine
    H. Bazari

      The card, with its picture of a bouquet of flowers, was on my desk when I arrived at the hospital on Monday morning. I opened it, assuming it was a thank-you note from an interviewee for our residency program. But the handwriting was that of an elderly ...

      e34
      Residents' Perspectives on ACGME Regulation of Supervision and Duty Hours — A National Survey
      B.C. Drolet, L.B. Spalluto, and S.A. Fischer
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      The Accreditation Council for Graduate Medical Education has released new requirements for residents' supervision and duty hours. Surveyed residents predict the effects on their lifestyle, education, and preparation for supervisory roles, as well as patient safety.

      Original Articles
      2191-2199
      Mutations in GNA11 in Uveal Melanoma
      C.D. Van Raamsdonk and Others
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      A specific amino acid in the Gα11 subunit of heterotrimeric G proteins was mutated in 32% of primary uveal melanomas and in 57% of uveal melanoma metastases analyzed in this study. This variant was found to activate the mitogen-activated protein kinase pathway.

      2200-2210
      Adjuvant Docetaxel for High-Risk, Node-Negative Breast Cancer
      M. Martín and Others
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      As compared with the standard regimen, the combination of docetaxel, doxorubicin, and cyclophosphamide reduced the risk of recurrence of node-negative early-stage breast cancer, but it offered no survival advantage and was associated with significantly higher rates of toxicity.

      2211-2219
      Body-Mass Index and Mortality among 1.46 Million White Adults
      A. Berrington de Gonzalez and Others
      • Free Full Text
      • CME

      Pooled data from 19 prospective studies showed that after adjustments for age, physical activity, alcohol consumption, education, and marital status, both overweight and obesity were associated with increased mortality, which was lowest with a BMI between 20 and 25.

      2220-2227
      Brief Report: Exome Sequencing, ANGPTL3 Mutations, and Familial Combined Hypolipidemia
      K. Musunuru and Others
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      Two family members with combined hypolipidemia (low HDL and LDL cholesterol and low triglycerides) were evaluated and found to be compound heterozygotes, each for a different nonsense mutation in ANGPTL3, the gene encoding the angiopoietin-like 3 protein.

      Special Article
      2228-2232
      Shattuck Lecture: Innovation, Regulation, and the FDA
      M.A. Hamburg
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      FDA Commissioner Margaret Hamburg outlines key events that have shaped the FDA, reviews recent legal cases challenging the authority of the FDA, and proposes an approach to decisions about drug safety and efficacy through the promotion of regulatory science.

      Review Article
      2233-2247
      Medical Progress: Airway Mucus Function and Dysfunction
      J.V. Fahy and B.F. Dickey
      • CME

      Pulmonary defense against environmental injury depends on airway mucus, which traps inhaled toxins that are then cleared from the lungs by ciliary beating and cough. This review examines the normal and abnormal formation and clearance of mucus, as well as the therapy of mucus dysfunction.

      Images in Clinical Medicine
      2248
      Chorioretinal Granuloma in Tuberculosis
      D.G. Ezra and C.E. Pavesio
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      A 17-year-old boy presented to the emergency room with a 48-hour history of deterioration in the vision of his right eye. Visual acuity was measured at 6/24 in the right eye and 6/6 in the left eye. In the right eye, a small subhyaloid hemorrhage and an ...

      e35
      Flail Chest
      P. Alexander
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      • Video

      A 20-year-old man was injured while riding a tractor that fell into a gorge. He was taken to the hospital within an hour. On admission, he was normotensive and responsive to commands, and the oxygen saturation was 90% while he was receiving 4 liters of ...

      Clinical Problem-Solving
      2249-2254
      In Search of . . .
      K. Brizendine, J.M. Wells, S.A. Flanders, S. Saint, and R.M. Centor
      • CME

      A 61-year-old man was admitted with a week-long history of nausea, vomiting, nocturia, and polyuria. During the previous 6 months, he had noted progressive fatigue and a 7-kg (15-lb) weight loss.

      Editorial
      2256-2257
      Taking the Guesswork Out of Uveal Melanoma
      M. Herlyn and K.L. Nathanson

        Therapy for melanoma is making remarkable progress. Only 8 years after the initial discovery of mutations in the BRAF oncogene, a new small-molecule inhibitor specific for mutant BRAF, PLX4032 (also known as RG7204), induced tumor shrinkage in more than ...

        Clinical Implications of Basic Research
        2258-2260
        Reversing the Hemoglobin Switch
        V.G. Sankaran and D.G. Nathan

          Natural observations can often provide important clues for how therapies can be developed to ameliorate disease. Disorders of β-hemoglobin, including sickle cell disease and β-thalassemia, are good examples of this maxim, since a variety of clinical ...

          Correspondence
          2261-2262
          Inhibition of Mutated BRAF in Melanoma
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          To the Editor: In their phase 1 trial, Flaherty and colleagues (Aug. 26 issue)1 report that treatment with a BRAF inhibitor was effective for the majority of patients with metastatic melanomas carrying the BRAF V600E mutation. Despite encouraging results,...

          2262-2263
          Diarrhea from Ipilimumab in Melanoma
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          To the Editor: Hodi and colleagues (Aug. 19 issue)1 report that among patients with previously treated metastatic melanoma, overall survival was increased with ipilimumab, with or without a glycoprotein 100 (gp100) peptide vaccine, as compared with gp100 ...

          2263-2265
          Early Palliative Care in Non–Small-Cell Lung Cancer
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          To the Editor: The surprising and encouraging study by Temel and colleagues (Aug. 19 issue)1 suggests that the early introduction of palliative care prolongs survival among patients with metastatic non-small-cell lung cancer. However, two essential ...

          2265-2267
          A Randomized Trial of Tai Chi for Fibromyalgia
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          To the Editor: Although the study by Wang and colleagues (Aug. 19 issue)1 showed a benefit of tai chi in improving the outcome of patients with fibromyalgia, it should be noted that there were many possible differences between the tai chi treatment and ...

          2267
          Early-Stage Hodgkin's Lymphoma
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          To the Editor: We think that the paragraph on infection with the human immunodeficiency virus (HIV) in the review article by Armitage (Aug. 12 issue)1 requires some important corrections and clarifications. First, according to the classification of the ...

          2267-2268
          Colchicine's Other Indication — Effect of FDA Action
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          To the Editor: The decision by the Food and Drug Administration (FDA) to approve and grant exclusive licensing of an expensive brand-name formulation (Colcrys) of the decades-old generic drug colchicine, has generated much surprise and discussion, as ...

          2268-2270
          Amenorrhea from Breast Cancer Therapy — Not a Matter of Dose
          • Free Full Text

          To the Editor: In our article on concurrent versus sequential administration of chemotherapy drugs for women with operable, node-positive, early-stage breast cancer (June 3 issue),1 we report that premenopausal women in whom amenorrhea developed as a ...

          2270-2272
          Paroxysmal Nocturnal Hemoglobinuria — Hemolysis before and after Eculizumab
          • Free Full Text

          To the Editor: The letter to the Editor by Berzuini et al. (Sept. 2 issue)1 shows in a single example that in patients with paroxysmal nocturnal hemoglobinuria (PNH) who are receiving eculizumab, intravascular hemolysis is abrogated, but extravascular ...

          Corrections
          2272
          Case 27-2010: A 73-Year-Old Woman with Chronic Anemia
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          Case 27-2010: A 73-Year-Old Woman with Chronic Anemia Case Records of the Massachusetts General Hospital, N Engl J Med 2010;363:1060-1068. In the first paragraph of the Treatment Goals subsection of Discussion of Management (page 1065), the fourth ...

          2272
          Performance of Common Genetic Variants in Breast-Cancer Risk Models
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          Performance of Common Genetic Variants in Breast-Cancer Risk Models Original Article, N Engl J Med 2010;362:986-993. In Table 3 (page 990), the chromosome listed for the RS3803662 SNP should have been 16q, rather than 10q, and the chromosome listed for ...

          2272
          Mortality Attributable to Smoking in China
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          Mortality Attributable to Smoking in China Special Article, N Engl J Med 2009;360:150-159. In the sixth paragraph of the Discussion section, beginning “Ezzati and Lopez estimated . . .” (page 156), the parenthetical information should have been given in ...

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