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  • Compelling Reasons for Repairing Human Germlines
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15
    George Church

    Researchers recently reported that, using gene-editing technology, they reduced the proportion of embryos containing a dominant disease allele. Several key advances could result in useful deployment of a high-impact technology that would improve future human health.

    更新日期:2017-11-16
  • Designing Ethical Trials of Germline Gene Editing
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15
    Bryan Cwik

    With gene-editing technology advancing rapidly, it is important to consider the ethical issues it raises for research, including those related to intergenerational monitoring — long-term follow-up monitoring of not just trial participants, but also their descendants.

    更新日期:2017-11-16
  • DACA and the Dream of Becoming a Physician
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-10-25
    Debra F. Weinstein, Fidencio Saldana

    While we wait for Congress to act to protect the “Dreamers” — the young immigrants who were covered by the Deferred Action for Childhood Arrivals program — graduate medical education programs and their potential applicants have tough decisions to make.

    更新日期:2017-11-16
  • The Code, the Cloud, and the Doppler
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15
    Alex Lion
    更新日期:2017-11-16
  • Durvalumab after Chemoradiotherapy in Stage III Non–Small-Cell Lung Cancer
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-09-08
    Scott J. Antonia, Augusto Villegas, Davey Daniel, David Vicente, Shuji Murakami, Rina Hui, Takashi Yokoi, Alberto Chiappori, Ki H. Lee, Maike de Wit, Byoung C. Cho, Maryam Bourhaba, Xavier Quantin, Takaaki Tokito, Tarek Mekhail, David Planchard, Young-Chul Kim, Christos S. Karapetis, Sandrine Hiret, Gyula Ostoros, Kaoru Kubota, Jhanelle E. Gray, Luis Paz-Ares, Javier de Castro Carpeño, Catherine Wadsworth, Giovanni Melillo, Haiyi Jiang, Yifan Huang, Phillip A. Dennis, Mustafa Özgüroğlu
    更新日期:2017-11-16
  • Tolvaptan in Later-Stage Autosomal Dominant Polycystic Kidney Disease
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-04
    Vicente E. Torres, Arlene B. Chapman, Olivier Devuyst, Ron T. Gansevoort, Ronald D. Perrone, Gary Koch, John Ouyang, Robert D. McQuade, Jaime D. Blais, Frank S. Czerwiec, Olga Sergeyeva
    更新日期:2017-11-16
  • Sudden Cardiac Arrest during Participation in Competitive Sports
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15
    Cameron H. Landry, Katherine S. Allan, Kim A. Connelly, Kris Cunningham, Laurie J. Morrison, Paul Dorian
    更新日期:2017-11-16
  • Lomustine and Bevacizumab in Progressive Glioblastoma
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15
    Wolfgang Wick, Thierry Gorlia, Martin Bendszus, Martin Taphoorn, Felix Sahm, Inga Harting, Alba A. Brandes, Walter Taal, Julien Domont, Ahmed Idbaih, Mario Campone, Paul M. Clement, Roger Stupp, Michel Fabbro, Emilie Le Rhun, Francois Dubois, Michael Weller, Andreas von Deimling, Vassilis Golfinopoulos, Jacoline C. Bromberg, Michael Platten, Martin Klein, Martin J. van den Bent

    Despite somewhat prolonged progression-free survival, treatment with lomustine plus bevacizumab did not confer a survival advantage over treatment with lomustine alone in patients with progressive glioblastoma. (Funded by an unrestricted educational grant from F. Hoffmann–La Roche and by the EORTC Cancer Research Fund; EORTC 26101 ClinicalTrials.gov number, NCT01290939; Eudra-CT number, 2010-023218-30.)

    更新日期:2017-11-16
  • Inflammatory Bowel Disease and the NLRP3 Inflammasome
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-08-16
    Elizabeth G. Phimister

    Despite somewhat prolonged progression-free survival, treatment with lomustine plus bevacizumab did not confer a survival advantage over treatment with lomustine alone in patients with progressive glioblastoma. (Funded by an unrestricted educational grant from F. Hoffmann–La Roche and by the EORTC Cancer Research Fund; EORTC 26101 ClinicalTrials.gov number, NCT01290939; Eudra-CT number, 2010-023218-30.)

    更新日期:2017-11-16
  • Diuretic Treatment in Heart Failure
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15
    Julie R. Ingelfinger
    更新日期:2017-11-16
  • “Popeye” Sign
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15
    Naoki Yoshida, Yoshihiko Tsuchida

    A 79-year-old man presented with a large bulge on his upper arm that developed when he was lifting an object. This finding on physical examination, known as the Popeye sign, suggested rupture of the biceps tendon.

    更新日期:2017-11-16
  • Falciform Ligament Sign
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15
    Po-Chen Chou, Yu-Jang Su
    更新日期:2017-11-16
  • An Unusual Cause of Leg Pain
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15
    Caren G. Solomon, Amy Miller, Bruce D. Levy, Joseph Loscalzo

    This interactive case features a 67-year-old woman who presents to her primary care physician with pain in her legs. Test your diagnostic and therapeutic skills at NEJM.org.

    更新日期:2017-11-16
  • Case 35-2017 — A 57-Year-Old Woman with Hypoesthesia and Weakness in the Legs and Arms
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15
    Richard C. Cabot, Eric S. Rosenberg, Virginia M. Pierce, David M. Dudzinski, Meridale V. Baggett, Dennis C. Sgroi, Jo-Anne O. Shepard, Allison R. Bond, Emily K. McDonald, Sally H. Ebeling
    更新日期:2017-11-16
  • Immunotherapy for Unresectable Stage III Non–Small-Cell Lung Cancer
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15
    Naiyer A. Rizvi, Solange Peters

    In this issue of the Journal, Antonia and colleagues report the results of the phase 3 PACIFIC study, which evaluated the role of immune checkpoint blockade in locally advanced, unresectable, stage III non–small-cell lung cancer (NSCLC).1 Eligible patients had disease that had not yet progressed after they had received at least two cycles of platinum-based chemotherapy concurrent with radiotherapy (chemoradiotherapy) at a dose of 54 to 66 Gy. A total of 713 patients were randomly assigned, in a 2:1 ratio, to receive an anti–programmed death ligand 1 (anti–PD-L1) antibody, durvalumab, at a dose of 10 mg per kilogram of body . . .

    更新日期:2017-11-16
  • Tolvaptan and Autosomal Dominant Polycystic Kidney Disease
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-04
    Julie R. Ingelfinger

    Approximately half the patients with autosomal dominant polycystic kidney disease (ADPKD), a condition due to deficiency in polycystin 1 or 2, have end-stage kidney disease by 60 years of age.1,2 Once progression begins, the mean decline in the estimated glomerular filtration rate (GFR) is approximately 4 to 6 ml per minute per 1.73 m2 of body-surface area per year. Therapy to prevent deterioration of GFR in patients with ADPKD has been elusive, despite mechanistic studies targeting pathogenesis. In addition, the burden of therapy in patients who have other symptoms from their ADPKD — hypertension, abdominal fullness and pain from cysts, . . .

    更新日期:2017-11-16
  • Data Sharing from Clinical Trials — A Research Funder’s Perspective
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15
    Robert Kiley, Tony Peatfield, Jennifer Hansen, Fiona Reddington

    Medical research saves lives, and as the challenges in our world continue to outweigh the resources, collaboration and cooperation among members of the global research community will be essential in maximizing the effect of funded research. It is simply unacceptable that the data from published clinical trials are not made available to researchers and used to their fullest potential to improve health.

    更新日期:2017-11-16
  • Methemoglobinemia Due to Antifreeze Ingestion
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15
    Andrew N. Farkas, Anthony Scoccimarro, Anthony F. Pizon

    Ingestion of antifreeze in suicide attempts is typically assessed in the context of polyethylene glycol poisoning, but some antifreeze also contains nitrates and nitrites that are not noted on the bottle. In one such case, methemoglobinemia was detected and successfully treated.

    更新日期:2017-11-16
  • Safety of Degludec versus Glargine in Type 2 Diabetes
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15

    To the Editor: In reporting the results of the Trial Comparing Cardiovascular Safety of Insulin Degludec versus Insulin Glargine in Patients with Type 2 Diabetes at High Risk of Cardiovascular Events (DEVOTE), Marso et al. (Aug. 24 issue)1 report a lower risk of hypoglycemia among patients who received insulin degludec than among those who received insulin glargine, without significant differences in basal insulin doses, monitored plasma glucose or glycated hemoglobin levels, or concomitant medications. Although the use of prandial insulin was similar in the two groups, no information was provided on the actual doses administered. The distribution of risk factors . . .

    更新日期:2017-11-16
  • Cognitive Function in a Randomized Trial of Evolocumab
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15

    To the Editor: In the article regarding cognitive function in patients receiving the proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitor evolocumab, Giugliano et al. (Aug. 17 issue)1 report that evolocumab does not affect neurocognition, even in patients who attained very low levels of low-density lipoprotein (LDL) cholesterol. In the EBBINGHAUS trial (Evaluating PCSK9 Binding Antibody Influence on Cognitive Health in High Cardiovascular Risk Subjects), Giugliano et al. prospectively assessed cognitive function across a wide range of domains, including memory and attention. However, no test was performed to evaluate depressive symptoms specifically. Depression negatively affects performance on cognitive tests and may . . .

    更新日期:2017-11-16
  • Advanced Non–Small-Cell Lung Cancer
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15

    To the Editor: The review article by Reck and Rabe (Aug. 31 issue)1 and other guidelines recommend pathological evaluation of the mediastinal nodes in patients with non–small-cell lung cancer (NSCLC) who are found to have abnormal mediastinal or hilar nodes on computed tomography (CT) or positron-emission tomography with CT (PET-CT). However, this practice may need to be reconsidered. Studies have indicated that surgery in patients with pathologically confirmed nodal involvement (stage N2 disease) has little proven clinical benefit and should be performed judiciously. However, a recent systematic review suggested that overall survival was longer among patients with N2 disease who . . .

    更新日期:2017-11-16
  • Health Insurance Coverage and Health
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-15

    To the Editor: The Sounding Board article by Sommers et al. (Aug. 10 issue)1 should be a clarion call to all physicians that we have an obligation to speak clearly and loudly at the state level to eliminate senseless loss of life occurring because of a lack of insurance coverage. Since it now appears, fortunately, that Congress will not eliminate the potential for states to expand Medicaid, we need to enunciate the need to solve this public health crisis by expansion of Medicaid in all states. Those of us in the 19 nonexpansion states must be specific about the human . . .

    更新日期:2017-11-16
  • The View from Puerto Rico — Hurricane Maria and Its Aftermath
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-10-11
    Carmen D. Zorrilla

    Hurricane Maria caused vast damage affecting Puerto Rico’s 3.4 million inhabitants. Loss of communication and electricity, water scarcity, isolation of residents, slow coordination of aid, and the scope of needed repairs merit a call for help from the global community.

    更新日期:2017-11-09
  • Preparing for the Next Harvey, Irma, or Maria — Addressing Research Gaps
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-10-11
    James M. Shultz, Sandro Galea

    Extreme events often cast in bold relief what we do and don’t know about medicine and public health. In recent weeks, Hurricanes Harvey, Irma, and Maria have illuminated our knowledge gaps regarding the consequences of disasters and their mitigation.

    更新日期:2017-11-09
  • Creating Healthy Communities after Disasters
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-10-11
    Reed V. Tuckson, Victor J. Dzau, Nicole Lurie

    Disasters like the recent hurricanes are a call to action for health and social service professionals to work with other stakeholders to ensure that their communities rebuild their infrastructure in a way that supports the health and welfare of all community members.

    更新日期:2017-11-09
  • Explaining Sluggish Savings under Accountable Care
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-08
    Valerie A. Lewis, Elliott S. Fisher, Carrie H. Colla
    更新日期:2017-11-09
  • Adjuvant Dabrafenib plus Trametinib in Stage III BRAF-Mutated Melanoma
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-09-10
    Georgina V. Long, Axel Hauschild, Mario Santinami, Victoria Atkinson, Mario Mandalà, Vanna Chiarion-Sileni, James Larkin, Marta Nyakas, Caroline Dutriaux, Andrew Haydon, Caroline Robert, Laurent Mortier, Jacob Schachter, Dirk Schadendorf, Thierry Lesimple, Ruth Plummer, Ran Ji, Pingkuan Zhang, Bijoyesh Mookerjee, Jeff Legos, Richard Kefford, Reinhard Dummer, John M. Kirkwood
    更新日期:2017-11-09
  • Adjuvant Nivolumab versus Ipilimumab in Resected Stage III or IV Melanoma
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-09-10
    Jeffrey Weber, Mario Mandala, Michele Del Vecchio, Helen J. Gogas, Ana M. Arance, C. Lance Cowey, Stéphane Dalle, Michael Schenker, Vanna Chiarion-Sileni, Ivan Marquez-Rodas, Jean-Jacques Grob, Marcus O. Butler, Mark R. Middleton, Michele Maio, Victoria Atkinson, Paola Queirolo, Rene Gonzalez, Ragini R. Kudchadkar, Michael Smylie, Nicolas Meyer, Laurent Mortier, Michael B. Atkins, Georgina V. Long, Shailender Bhatia, Celeste Lebbé, Piotr Rutkowski, Kenji Yokota, Naoya Yamazaki, Tae M. Kim, Veerle de Pril, Javier Sabater, Anila Qureshi, James Larkin, Paolo A. Ascierto
    更新日期:2017-11-09
  • 20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-08
    Hongchao Pan, Richard Gray, Jeremy Braybrooke, Christina Davies, Carolyn Taylor, Paul McGale, Richard Peto, Kathleen I. Pritchard, Jonas Bergh, Mitch Dowsett, Daniel F. Hayes
    更新日期:2017-11-09
  • Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-08
    Andrew B. Goldstone, Peter Chiu, Michael Baiocchi, Bharathi Lingala, William L. Patrick, Michael P. Fischbein, Y. Joseph Woo
    更新日期:2017-11-09
  • Age of Red Cells for Transfusion and Outcomes in Critically Ill Adults
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-09-27
    D. James Cooper, Zoe K. McQuilten, Alistair Nichol, Bridget Ady, Cécile Aubron, Michael Bailey, Rinaldo Bellomo, Dashiell Gantner, David O. Irving, Kirsi-Maija Kaukonen, Colin McArthur, Lynne Murray, Ville Pettilä, Craig French
    更新日期:2017-11-09
  • Monogenic Diseases of DNA Repair
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-08
    Dan L. Longo
    更新日期:2017-11-09
  • Compartment Syndrome
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-08
    Aileen F. Egan, Kevin C. Cahill
    更新日期:2017-11-09
  • Gold Thread Acupuncture for Rheumatoid Arthritis
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-08
    Young-Bin Joo, Kyung-Su Park
    更新日期:2017-11-09
  • Case 34-2017 — A 76-Year-Old Man with Fever, Weight Loss, and Weakness
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-08
    Richard C. Cabot, Eric S. Rosenberg, Virginia M. Pierce, David M. Dudzinski, Meridale V. Baggett, Dennis C. Sgroi, Jo-Anne O. Shepard, Allison R. Bond, Emily K. McDonald, Sally H. Ebeling
    更新日期:2017-11-09
  • Adjuvant Melanoma Therapy — Head-Spinning Progress
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-08
    Lynn M. Schuchter

    Every year in the United States, approximately 87,000 patients receive the diagnosis of melanoma. Although most of these patients are cured with simple excision, those with node-positive, stage III melanoma are at increased risk for distant metastasis and death. To date, the Food and Drug Administration (FDA) has approved three adjuvant therapies for such patients, all of which are immunotherapies: high-dose interferon alfa-2b, pegylated interferon alfa, and high-dose ipilimumab (10 mg per kilogram of body weight).1-3 Concerns about the marginal efficacy of these drugs (especially the interferon-based agents) and considerable toxicity (all three drugs) have limited their use. Therefore, the . . .

    更新日期:2017-11-09
  • Paving the Path toward Porcine Organs for Transplantation
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-08
    Elizabeth G. Phimister
    更新日期:2017-11-09
  • Coronary-Artery Aneurysm in Tocilizumab-Treated Children with Kawasaki’s Disease
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-08
    Tomo Nozawa, Tomoyuki Imagawa, Shuichi Ito
    更新日期:2017-11-09
  • Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-08

    To the Editor: Shroyer et al. (Aug 17 issue)1 report the 5-year outcomes of the Randomized On/Off Bypass (ROOBY) trial. They conclude that off-pump coronary-artery bypass grafting (CABG) led to lower rates of 5-year survival and event-free survival than on-pump CABG. Although the authors allude to criticism of the trial design that allowed inexperienced surgeons to participate in the off-pump part of the trial, this Achilles’ heel is inadequately explored. The sensitivity analysis, excluding numerous off-pump–to–on-pump conversions (12.4%, vs. a 2.2% national average; the higher rate is a surrogate marker of inexperience) obviated the risk from off-pump CABG. The authors . . .

    更新日期:2017-11-09
  • Levosimendan in Cardiac Surgery
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-08

    To the Editor: Landoni et al. (May 25 issue)1 examined levosimendan administration versus placebo for patients requiring hemodynamic support after cardiac surgery. In their trial (Levosimendan to Reduce Mortality in High Risk Cardiac Surgery Patients: A Multicenter Randomized Controlled Trial [CHEETAH]), they found no significant difference in mortality between the two groups. The investigators aimed to include patients with shock after cardiac surgery and cardiopulmonary bypass. However, many of the patients were likely to have distributive shock (i.e., 57.7% received epinephrine, 45.3% norepinephrine, and 15.2% dopamine) rather than cardiogenic shock (28.3% received dobutamine and 12.5% enoximone) (Table S5 in the . . .

    更新日期:2017-11-09
  • Midostaurin in FLT3-Mutated Acute Myeloid Leukemia
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-08
    更新日期:2017-11-09
  • Acute Respiratory Distress Syndrome
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-08

    To the Editor: In their review of the acute respiratory distress syndrome (ARDS) (Aug. 10 issue),1 Thompson et al. recommend that patients be placed in the prone position when the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (Pao2:Fio2) is less than 120 mm Hg. However, the guidelines for the mechanical ventilation of patients with ARDS2 recommend this strategy for patients with severe ARDS, which the guidelines define as a Pao2:Fio2 of less than 100 mm Hg. Furthermore, one of the inclusion criteria for a trial that showed a decrease in mortality with this . . .

    更新日期:2017-11-09
  • A Renewed Focus on Maternal Health in the United States
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01
    Rose L. Molina, Lydia E. Pace

    High maternal mortality in the United States as compared with other high-income countries and continued increases in deaths and severe pregnancy-related morbidity highlight gaps in our care for reproductive-age women.

    更新日期:2017-11-02
  • Dreams Deferred — The Public Health Consequences of Rescinding DACA
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-09-13
    Atheendar S. Venkataramani, Alexander C. Tsai

    The evidence indicates that rescinding the Deferred Action for Childhood Arrivals (DACA) program will have profound adverse population-level effects on mental health — effects that may be potentiated by the broader hostile political climate surrounding immigration.

    更新日期:2017-11-02
  • Primary Care Spending Rate — A Lever for Encouraging Investment in Primary Care
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01
    Christopher F. Koller, Dhruv Khullar

    The proportion of a health system’s resources that it devotes to primary care — including clinician incomes, performance payments, case-management activities, and health information technologies — could be used for assessing its orientation toward high-value care.

    更新日期:2017-11-02
  • Single-Dose Gene-Replacement Therapy for Spinal Muscular Atrophy
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01
    Jerry R. Mendell, Samiah Al-Zaidy, Richard Shell, W. Dave Arnold, Louise R. Rodino-Klapac, Thomas W. Prior, Linda Lowes, Lindsay Alfano, Katherine Berry, Kathleen Church, John T. Kissel, Sukumar Nagendran, James L’Italien, Douglas M. Sproule, Courtney Wells, Jessica A. Cardenas, Marjet D. Heitzer, Allan Kaspar, Sarah Corcoran, Lyndsey Braun, Shibi Likhite, Carlos Miranda, Kathrin Meyer, K.D. Foust, Arthur H.M. Burghes, Brian K. Kaspar

    In patients with SMA1, a single intravenous infusion of adeno-associated viral vector containing DNA coding for SMN resulted in longer survival, superior achievement of motor milestones, and better motor function than in historical cohorts. Further studies are necessary to confirm the safety and efficacy of this gene therapy. (Funded by AveXis and others; ClinicalTrials.gov number, NCT02122952.)

    更新日期:2017-11-02
  • Nusinersen versus Sham Control in Infantile-Onset Spinal Muscular Atrophy
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01
    Richard S. Finkel, Eugenio Mercuri, Basil T. Darras, Anne M. Connolly, Nancy L. Kuntz, Janbernd Kirschner, Claudia A. Chiriboga, Kayoko Saito, Laurent Servais, Eduardo Tizzano, Haluk Topaloglu, Már Tulinius, Jacqueline Montes, Allan M. Glanzman, Kathie Bishop, Z. John Zhong, Sarah Gheuens, C. Frank Bennett, Eugene Schneider, Wildon Farwell, Darryl C. De Vivo
    更新日期:2017-11-02
  • ACE Inhibitors and Statins in Adolescents with Type 1 Diabetes
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01
    M. Loredana Marcovecchio, Scott T. Chiesa, Simon Bond, Denis Daneman, Sarah Dawson, Kim C. Donaghue, Timothy W. Jones, Farid H. Mahmud, Sally M. Marshall, H. Andrew W. Neil, R. Neil Dalton, John Deanfield, David B. Dunger

    The use of an ACE inhibitor and a statin did not change the albumin-to-creatinine ratio over time. (Funded by the Juvenile Diabetes Research Foundation and others; AdDIT ClinicalTrials.gov number, NCT01581476.)

    更新日期:2017-11-02
  • Effects of Spaceflight on Astronaut Brain Structure as Indicated on MRI
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01
    Donna R. Roberts, Moritz H. Albrecht, Heather R. Collins, Davud Asemani, A. Rano Chatterjee, M. Vittoria Spampinato, Xun Zhu, Marc I. Chimowitz, Michael U. Antonucci
    更新日期:2017-11-02
  • Rosacea
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01
    Caren G. Solomon
    更新日期:2017-11-02
  • Nutritional Management of Chronic Kidney Disease
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01
    Julie R. Ingelfinger
    更新日期:2017-11-02
  • Pigmented Macule — A Skin Manifestation of Invasive Breast Cancer
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01
    Takashi Oide, Tsuyoshi Mitsuishi
    更新日期:2017-11-02
  • HIV Infection Manifesting as Proximal White Onychomycosis
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01
    Elisabeth Gómez-Moyano, Vicente Crespo-Erchiga
    更新日期:2017-11-02
  • Circling Back for the Diagnosis
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01
    Caren G. Solomon
    更新日期:2017-11-02
  • The Dilemma of Two Innovative Therapies for Spinal Muscular Atrophy
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01
    Ans T. van der Ploeg

    If you have made a diagnosis of spinal muscular atrophy (SMA) type 1 (also known as Werdnig–Hoffman disease) in a child, then you have vivid memories of informing desperate parents that there is nothing you can do for their child. Two innovative therapies for SMA may now bring some hope — but what do they mean for patients and their families? SMA, which is one of the most common inheritable neuromuscular diseases, is a degenerative motor neuron disorder that leads to muscle atrophy and respiratory failure. Patients with the most severe form rarely survive beyond 2 years of age. The . . .

    更新日期:2017-11-02
  • Liposuction for Swelling in Patients with Lymphedema
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01
    Arin K. Greene, Stephan D. Voss, Reid A. Maclellan
    更新日期:2017-11-02
  • Bioresorbable Scaffolds versus Metallic Stents in Routine PCI
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01

    To the Editor: Wykrzykowska et al. (June 15 issue)1 report the results of AIDA (Amsterdam Investigator-Initiated Absorb Strategy All-Comers Trial), in which investigators compared an everolimus-eluting bioresorbable vascular scaffold (Absorb) with an everolimus-eluting metallic stent (Xience) in patients who were undergoing percutaneous coronary intervention (PCI). The results of this trial are consistent with previous observations that have shown an increased risk of device thrombosis among patients receiving the bioresorbable scaffold.2 The causes of the higher rate of thrombosis with bioresorbable scaffolds than with metallic stents are only partly understood. Despite the use of better implantation techniques, different trials have consistently . . .

    更新日期:2017-11-02
  • Olaparib for Metastatic Germline BRCA-Mutated Breast Cancer
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01

    To the Editor: In this trial involving women with metastatic breast cancer and a BRCA mutation, Robson et al. (Aug. 10 issue)1 randomly assigned patients to receive olaparib or standard therapy. A total of 46% of patients in the olaparib group and 47% in the standard-therapy group died (hazard ratio, 0.90; 95% confidence interval, 0.63 to 1.29). This trial is presented as a major advance in the Journal and in the popular press.2 As is common practice in trials of treatment for metastatic breast cancer, the primary end point was progression-free survival, for which the results were favorable; however, time . . .

    更新日期:2017-11-02
  • Declining Risk of Sudden Death in Heart Failure
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01

    To the Editor: Shen et al. (July 6 issue)1 report declining rates of sudden death among patients with heart failure and reduced ejection fraction who were enrolled in trials spanning the period from 1995 through 2014. This message is one of hope,2 contrasting with a traditionally more pessimistic narrative.3 However, why use simple linear regression? A spline term may better fit the data in Figure 1 (available with the full text of the article at NEJM.org). The patients in the control groups of the BEST (Beta-Blocker Evaluation of Survival) trial, RALES (Randomized Aldactone Evaluation Study), and MERIT-HF (Metoprolol CR/XL Randomised . . .

    更新日期:2017-11-02
  • Post-Traumatic Stress Disorder
    N. Engl. J. Med. (IF 72.406) Pub Date : 2017-11-01

    To the Editor: The review by Shalev et al. (June 22 issue)1 highlights the need for new effective treatments for post-traumatic stress disorder (PTSD). One treatment that Shalev et al. did not describe is animal-assisted therapy. Since my first proposal and description of a case involving such therapy,2 it has come into widespread use for PTSD.3 Hundreds of organizations and chapters are now providing therapy animals for patients. More formal study is needed.4 A randomized, controlled trial of animal-assisted therapy for PTSD is currently under way (ClinicalTrials.gov number, NCT02039843). Not just dogs but horses and parrots are being used to . . .

    更新日期:2017-11-02
Some contents have been Reproduced with permission of the American Chemical Society.
Some contents have been Reproduced by permission of The Royal Society of Chemistry.
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