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Table of contents for

February 9, 2012  Vol. 366 No. 6

Audio Summary of this Issue

Perspective
485-487
The Emerging Threat of Untreatable Gonococcal Infection
G.A. Bolan, P.F. Sparling, and J.N. Wasserheit

    Gonorrhea, which disproportionately affects marginalized populations, is the second most commonly reported communicable disease in the United States. Over the past 3 years, the gonococcus has shown decreased susceptibility to our last line of antimicrobial defense.

    487-489
    All Heat, No Light — The States' Medicaid Claims before the Supreme Court
    S. Rosenbaum and T.S. Jost
    • Free Full Text
    • Comments

    In appealing to the Supreme Court, 26 states are arguing that the Affordable Care Act unconstitutionally coerces them into expanding their Medicaid programs. But although states may face a hard choice about participating in Medicaid, that's not a constitutional matter.

    489-491
    Preparing for Precision Medicine
    R. Mirnezami, J. Nicholson, and A. Darzi
    • Free Full Text

    Precision medicine uses clinicopathological indexes and molecular profiling to create diagnostic, prognostic, and therapeutic strategies tailored to the patient. Its success depends on establishing frameworks for regulating, compiling, and interpreting key information.

    Original Articles
    493-501
    Antenatal Thyroid Screening and Childhood Cognitive Function
    J.H. Lazarus and Others
    • CME
    • Comments

    In this randomized trial, antenatal screening (at a median gestational age of 12 weeks 3 days) and treatment for hypothyroidism did not result in improved cognitive function in children at 3 years of age.

    502-510
    Memory Enhancement and Deep-Brain Stimulation of the Entorhinal Area
    N. Suthana and Others

      Subjects underwent deep-brain stimulation through electrodes implanted to identify the foci of their epileptic seizures. The efficiency with which they navigated a virtual environment supports the conclusion that deep-brain stimulation improved memory in these persons.

      511-519
      Tai Chi and Postural Stability in Patients with Parkinson's Disease
      F. Li and Others
      • CME

      In this randomized trial, tai chi was more effective than resistance-training or stretching programs in improving the postural stability of patients with Parkinson's disease. Tai chi also was more effective than the stretching program in reducing the number of falls.

      520-529
      Everolimus in Postmenopausal Hormone-Receptor–Positive Advanced Breast Cancer
      J. Baselga and Others

        Resistance to hormone therapy through activation of cellular pathways involving mTOR can develop in postmenopausal hormone-receptor–positive breast cancer. Adding an mTOR inhibitor to an aromatase inhibitor improved outcomes in patients who had disease progression during hormone therapy.

        Special Article
        530-538
        Sources of Regional Variation in Medicare Part D Drug Spending
        J.M. Donohue and Others
        • Free Full Text

        This analysis of 2008 Medicare data shows that regional variation in drug spending is driven primarily by the use of more expensive drugs (i.e., brand-name rather than generic drugs) in the highest-spending geographic areas.

        Review Article
        539-551
        Mechanisms of Disease: IgG4-Related Disease
        J.H. Stone, Y. Zen, and V. Deshpande

          A number of autoimmune diseases that affect diverse organ systems have recently been noted to be related to IgG4 autoantibodies. The authors review the spectrum of IgG4-related disease and the current status of diagnostic and management approaches.

          Images in Clinical Medicine
          552
          Deep Sulcus Sign
          S. Sabbar and E.J. Nilles
          • Free Full Text

          A 23-year-old man who been a passenger in a minivan was brought to the ER after a high-speed road accident. He had transient hypotension and tachycardia, which improved after the administration of intravenous fluids.

          e10
          Pyogenic Granuloma of the Finger
          T. Badri and F. Ishak
          • Free Full Text

          A healthy 14-year-old boy presented with a 1-week history of a well-circumscribed, fleshy, nonpulsating growth at the proximal nail fold of his left third finger. The nail plate was absent under the growth.

          Interactive Medical Case
          e11
          A Startling Decline
          A. Vaidya, B.M. Dolan, B.L. Edlow, M.L. Rinne, and S.M. McGinnis
          • Free Full Text
          • CME

          An 89-year-old man was brought to the ER for evaluation of changes in his cognition and personality. He exhibited poor memory for recent events and difficulty expressing himself. Test your diagnostic and therapeutic skills at NEJM.org.

          Case Records of the Massachusetts General Hospital
          553-560
          Case 4-2012 — A 37-Year-Old Man with Muscle Pain, Weakness, and Weight Loss
          E.P. Rhee, J.A. Scott, and A.S. Dighe
          • CME

          A 37-year-old man was admitted to this hospital because of 12 hours of muscle pain and weakness, resulting in the inability to rise from bed. Brief episodes of similar symptoms had occurred during the past month. He reported blurred vision, gynecomastia, and weight loss.

          Editorials
          562-563
          The Debate over Thyroid-Function Screening in Pregnancy
          G.A. Brent

            Maternal hypothyroidism in pregnancy has been associated with a range of adverse outcomes, most importantly miscarriage, preterm delivery, and reduced cognitive function in offspring.1 In surveys, almost half the obstetricians in private practices in ...

            563-565
            Brain Stimulation, Learning, and Memory
            S.E. Black

              Advances in electrophysiology and high-resolution brain imaging have improved our understanding of the neural circuitry of episodic memory, including differential contributions of the hippocampus and the rhinal cortices. These advances are timely: the ...

              566
              Reviewers for the Journal, July–December 2011

                Each year thousands of reviewers contribute their expertise to peer review, a process that contributes critically to the quality of the Journal. The editors and the authors of the papers submitted to the Journal are grateful for the help of all our ...

                Clinical Implications of Basic Research
                567-569
                Gene Therapy Meets Stem Cells
                R.A. Sandhaus

                  The holy grail of gene therapy is the treatment of disease caused by genetic mutations. A recent study in mice provides proof of principle that alpha1-antitrypsin deficiency can be corrected, if not cured, by the infusion of autologous induced pluripotent stem cells.

                  Correspondence
                  570-571
                  Budesonide in Preschool-Age Children with Recurrent Wheezing
                  • Free Full Text

                  To the Editor: In the Maintenance and Intermittent Inhaled Corticosteroids in Wheezing Toddlers (MIST) trial (ClinicalTrials.gov number, NCT00675584), Zeiger et al. (Nov. 24 issue)1 suggest that intermittent high-dose budesonide was equal in efficacy to ...

                  572-573
                  Mycophenolate or Azathioprine Maintenance in Lupus Nephritis
                  • Free Full Text

                  To the Editor: Dooley et al. (Nov. 17 issue)1 report the efficacy of mycophenolate mofetil versus azathioprine as maintenance therapy for lupus nephritis and declare mycophenolate superior. Yet azathioprine was prescribed according to body weight, ...

                  573-574
                  Systemic Lupus Erythematosus
                  • Free Full Text

                  To the Editor: In the Mechanisms of Disease article on systemic lupus erythematosus (SLE), Tsokos (Dec. 1 issue)1 notes that a lack of C1q leads to deficient clearance of waste material. I would like to add the role of C1q in the regulation of interferon-...

                  575-576
                  Extracorporeal Membrane Oxygenation for ARDS in Adults
                  • Free Full Text

                  To the Editor: While summarizing the use of extracorporeal membrane oxygenation (ECMO) in the acute respiratory distress syndrome (ARDS), Brodie and Bacchetta (Nov. 17 issue)1 suggest venoarterial ECMO as an alternative approach to standard venovenous ...

                  576-578
                  Relationship between Cerebrospinal Fluid Glucose and Serum Glucose
                  • Free Full Text

                  The relationship between levels of serum and cerebrospinal fluid glucose in children is carefully examined in this study, which included more than 19,000 children.

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