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March 17, 2011  Vol. 364 No. 11

Audio Summary of this Issue

Perspective
985-987
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Successful development of future targeted therapies will require the flexibility to rapidly evaluate combination regimens involving new targeted agents in a single development program. The FDA has therefore developed draft guidance on drug co-development.

987-989
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Conflicting reports have led to confusion regarding secular trends for obesity in the United States. But even if data suggesting a plateauing of obesity rates offer some encouragement, obesity prevalence remains unacceptably high and has serious health implications.

990-991

In 2007, a bundled-payment approach to integrated chronic care was launched in the Netherlands, initially on an experimental basis with a focus on diabetes. The results provide lessons applicable to the U.S. concept of accountable care organizations.

e21

A child with chest pain or tics, a toddler who is limping, a 12-year-old girl with abdominal pain or headaches, an infant whose fever does not respond to antibiotics — these are age-old challenges that pediatricians face. I have been teaching pediatrics ...

Original Articles
993-1004

In this trial comparing prenatal repair of myelomeningocele with standard postnatal repair, the prenatal-surgery group had better outcomes and better mental and motor function at the age of 30 months. However, these benefits came with some increased risks.

1005-1015

In this study, the introduction of guidelines-based therapy in all children decreased the number of days per fortnight that children had asthma symptoms. Treatment with omalizumab resulted in fewer days with asthma symptoms than placebo.

1016-1026

In a large randomized trial, patients with three-vessel or left main CAD were assigned to undergo either CABG or PCI with drug-eluting stents. Angina frequency was reduced to a greater extent with CABG than with PCI at both 6 and 12 months, though the differences were small.

1027-1036
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High-dose cytarabine is up to 30 times the standard dose of this drug. Although more effective, the higher dose is more toxic. In this study, an intermediate dose was equally effective but considerably less toxic than a high dose.

Special Article
1037-1045
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  • CME

In this analysis of data on nurse staffing and patient mortality for nearly 200,000 admissions to a large academic medical center, actual nurse staffing below target levels was associated with increased mortality.

Review Article
1046-1060
  • CME

Autologous stem-cell transplantation and agents such as thalidomide, lenalidomide, and bortezomib have changed the management of myeloma and extended overall survival. This review discusses both the biologic features and the management of multiple myeloma.

Images in Clinical Medicine
1061
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A 29-year-old woman presented with a long-standing history of yellow-orange papules on her nose and cheeks, skin-colored papules at the proximal nail fold of several toes, and a skin-colored plaque on her back. These findings were diagnosed as facial ...

e22
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An otherwise healthy 23-year-old black man was concerned about a dark line, 1 mm in width, arising from the nail bed of his right thumb (Panels A and B). The finding had been present for approximately 2 years and had not changed. The line originated in ...

Case Records of the Massachusetts General Hospital
1062-1074

    A 32-year-old woman had seizures since childhood, myoclonus, and recent cognitive decline. Family members had an autosomal-dominant pattern of neurologic disease. Diagnostic testing was performed. Cognitive decline continued; the patient died 2 years later. An autopsy was performed.

    Editorial
    1076-1077

      The possibility of surgical repair of fetal anomalies in utero has long tantalized obstetricians and pediatric surgeons, especially since the development of high-resolution real-time ultrasonography. The presumption has been that earlier in utero repair ...

      Correspondence
      1078-1080

      To the Editor: In their article on the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) trial (ClinicalTrials.gov number, NCT00303212), Chaudhry et al. (Dec. 9 issue)1 report neutral effectiveness of remote telemonitoring in patients with heart ...

      1080-1081

      To the Editor: Bashutski et al. (Dec. 16 issue)1 report markedly improved alveolar bone regeneration after periodontal surgery plus teriparatide therapy as compared with placebo. In an accompanying editorial, Grey2 notes that the trial reported on by ...

      1081-1082

      To the Editor: Cheung and Seeman (Dec. 16 issue)1 report on the off-label use of teriparatide in a patient who had osteonecrosis of the jaw in association with alendronate therapy. Possible pharmacodynamic drug interactions are worth considering when ...

      Corrections
      1082

      Sunitinib Malate for the Treatment of Pancreatic Neuroendocrine Tumors Original Article, N Engl J Med 2011;364:501-513. The portion of the disclosure statement (page 511) pertaining to Dr. Valle should have mentioned only consulting fees from Pfizer, ...

      1082

      Intravitreal Triamcinolone for Diabetic Macular Edema Images in Clinical Medicine, N Engl J Med 2010;363:2351. The parenthetical value in the first sentence (page 2351) should have been “0.1 ml,” rather than “1 ml.” The article is correct at NEJM.org.

      1082

      Outcomes of Kidney Transplantation in HIV-Infected Recipients Original Article, N Engl J Med 2010;363:2004-2014. The list of authors (page 2004) should have ended with “for the HIV-TR Investigators.” The article is correct at NEJM.org.