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Table of contents for

November 3, 2011  Vol. 365 No. 18

Audio Summary of this Issue

Perspective
1653-1655
The Shortage of Essential Chemotherapy Drugs in the United States
M.L. Gatesman and T.J. Smith
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  • Comments

Some essential oncology drugs are in short supply in the United States, raising concern about safety, cost, and availability of life-saving treatments. The causes are economic: manufacturers don't make big profits on generics, and oncologists make money on drug markups.

1655-1657
The Central Question for Health Policy in Deficit Reduction
H.J. Aaron
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Health policy debates will bulk large in deliberations of the super committee tasked with proposing deficit reductions. But the importance of specific spending cuts for overall health policy pales beside that of whether a deficit-reduction plan includes tax increases.

1657-1659
Medicare Drug Prices and the Deficit
R.G. Frank
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Central to President Obama's proposal for health care cuts is a plan to require that drug makers offer Medicare beneficiaries who qualify for low-income subsidies for prescription-drug coverage under Part D the same prices offered to the Medicaid program.

1659-1661
Lessons from the Physician Group Practice Demonstration — A Sobering Reflection
G.R. Wilensky
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The mixed results of the Centers for Medicare and Medicaid Services' Physician Group Practice Demonstration project should dampen unreasonable expectations, particularly in terms of potential savings, for accountable care organizations.

Original Articles
1663-1672
A CFTR Potentiator in Patients with Cystic Fibrosis and the G551D Mutation
B.W. Ramsey and Others
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Ivacaftor, a potentiator of CFTR, was studied in patients with cystic fibrosis (CF) who had mutations that reduced the function of the CFTR protein. Ivacaftor significantly improved FEV1 and reduced pulmonary exacerbations; it holds promise in the treatment of selected patients with CF.

1673-1683
Inducible Apoptosis as a Safety Switch for Adoptive Cell Therapy
A. Di Stasi and Others
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The introduction of a transgene into human donor T cells that can kill the cells when dimerization is induced by a pharmacologic agent has improved prospects for the exploitation of T-cell graft-versus-tumor effects while controlling graft-versus-host disease.

1684-1692
Anti-Inhibitor Coagulant Complex Prophylaxis in Hemophilia with Inhibitors
C. Leissinger and Others
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  • CME

In patients with hemophilia A in whom inhibitors of factor VIII develop, the prophylactic use of a factor VIII bypassing agent (anti-inhibitor coagulant complex) three times a week significantly reduced the risk of bleeding.

1693-1703
Host and Pathogen Factors for Clostridium difficile Infection and Colonization
V.G. Loo and Others
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In this prospective cohort study of patients admitted to hospitals in Quebec and Ontario, 2.8% of patients had Clostridium difficile infection and 3.0% had asymptomatic C. difficile colonization during hospitalization. Most patients with C. difficile infection had the NAP1 strain.

Special Article
1704-1712
Results of the Medicare Health Support Disease-Management Pilot Program
N. McCall and J. Cromwell
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The Medicare Health Support Pilot Program was a study of eight commercial disease-management programs for patients with heart failure, diabetes, or both. The programs did not reduce ER visits or hospitalizations and achieved only small improvements in 14 of 40 measures.

Review Article
1713-1725
Medical Progress: Ulcerative Colitis
S. Danese and C. Fiocchi
  • CME

Ulcerative colitis is the most common form of inflammatory bowel disease. Its course is often mild, with few complications, and it can be cured by colectomy. Our current understanding of its pathophysiology, diagnosis, and treatment is reviewed.

Images in Clinical Medicine
1726
Lingual Zoster
C.-K. Lee and B.J. Baek
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A 72-year-old woman presented to the ER with white patches on the right side of her tongue and slight palsy on the right side of her face, reporting that the symptoms had developed 4 days earlier. She also reported dizziness, otalgia, nausea, and vomiting.

e38
Metastasis of Renal-Cell Carcinoma
F. Pugliese and V. Pagliuca
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Four years after a right nephrectomy for renal-cell carcinoma, an 89-year-old man was referred for evaluation of a pulsating mass on the fourth digit of the right hand. The mass had increased in size during the preceding 3 months after minor trauma to the finger.

Clinical Problem-Solving
1727-1732
A Bird's-Eye View of Fever
A.I. Lee, S. Koo, A. Vaidya, J.T. Katz, and J. Loscalzo
  • Comments

A 78-year-old man presented with a 4-month history of worsening fatigue, weakness, and anorexia, with an unintentional weight loss of 11.4 kg. He reported fevers, chills, night sweats, dry mouth, nonproductive cough, dyspnea with minimal exertion, nausea, and postural light-headedness.

Editorials
1734-1735
Therapy for Cystic Fibrosis — The End of the Beginning?
P.B. Davis

    Over the past four decades, implementation of therapies directed entirely at symptoms have improved the quality of life in patients with cystic fibrosis and have increased the median survival age from 11 years to 37 years. Now, in this issue of the ...

    1735-1737
    Eliminating Cells Gone Astray
    M. Sadelain

      The therapeutic use of cells from healthy donors or patients is increasing. Decades ago, transfusion medicine and bone marrow transplantation provided the first successful cell therapeutics and established the foundations for cell delivery. Clinical ...

      Clinical Implications of Basic Research
      1738-1739
      Calcium Handling in the Failing Heart and SUMO — Weighing the Evidence
      J.J.V. McMurray and G.L. Smith

        Heart failure has been attributed to a deficiency in a calcium ATPase. A recent study shows that tweaking this enzyme may boost its levels and thus guard against heart failure.

        Correspondence
        1740
        Wnt Signaling and Dupuytren's Disease
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        To the Editor: Dolmans et al. (July 28 issue)1 report significant associations between susceptibility to Dupuytren's disease and genetic markers implicating WNT2, WNT4, and WNT7B. It seems feasible that variant Wnt signaling critically enhances risk by ...

        1741-1743
        CYP24A1 Mutations in Idiopathic Infantile Hypercalcemia
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        To the Editor: Schlingmann et al. (Aug. 4 issue)1 report that mutations in CYP24A1 are associated with increased sensitivity to vitamin D in patients with idiopathic infantile hypercalcemia. Since CYP24A1 encodes 25-hydroxyvitamin D 24-hydroxylase, the ...

        1743-1745
        Constrictive Bronchiolitis in Soldiers
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        To the Editor: King and colleagues (July 21 issue)1 note that the group of soldiers who were not exposed to a sulfur-mine fire in Iraq arouse particular concern, since their constrictive bronchiolitis was attributed to common exposures shared by many ...

        1745-1747
        Bardoxolone Methyl, Chronic Kidney Disease, and Type 2 Diabetes
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        To the Editor: Pergola et al. (July 28 issue)1 describe the beneficial effect of the new synthetic triterpenoid, bardoxolone methyl, on the glomerular filtration rate (GFR) in patients with diabetes and chronic kidney disease (CKD). The main mechanism of ...

        1747-1748
        Hemophilia A Induced by Ipilimumab
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        A case is reported in which ipilimumab therapy for melanoma was followed by the development of an autoantibody to factor VIII.

        Correction
        1749
        Robot-Assisted Therapy for Long-Term Upper-Limb Impairment after Stroke
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        Robot-Assisted Therapy for Long-Term Upper-Limb Impairment after Stroke Original Article, N Engl J Med 2010;362:1772-1783. In the Cost Analysis subsection of Results (page 1779), the dollar values given in the first two sentences were incorrect. The ...

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