On-Pump versus Off-Pump CABG
This comparative-effectiveness trial showed that clinical outcomes at 1 year were better with on-pump than with off-pump coronary-artery bypass grafting (CABG), and there was also better graft patency.
CME Exam
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Inflammatory Bowel Disease and Mutations Affecting the Interleukin-10 Receptor
Genetic analyses showed that mutations affecting the interleukin-10 receptor are associated with early-onset colitis. Treatment of an affected child by means of allogeneic hematopoietic stem-cell transplantation was successful.
Free Full Text
 November 4, 2009 (DOI: 10.1056/NEJMoa0907206)
Related Editorial: Interleukin-10 in Inflammatory Bowel Disease
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Vaccination against HPV-16 Oncoproteins for Vulvar Intraepithelial Neoplasia
In women with grade 3 vulvar intraepithelial neoplasia associated with human papillomavirus type 16, vaccination against HPV-16 infection with a peptide vaccine was related to a clinical response in 79% of patients at 1 year.
CME Exam
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A Peptide-Based Erythropoietin-Receptor Agonist for Pure Red-Cell Aplasia
Patients with pure red-cell aplasia were treated with a peptide-based erythropoietin-receptor agonist that simulates the action of erythropoietin. Of the 14 subjects, 13 achieved a hemoglobin concentration above 11 g per deciliter and over the 28-month course of the study lost the need for regular transfusions.
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Testosterone and Spermatogenesis
The presence of a partially inactivating mutation in LHB, the gene encoding the beta subunit of luteinizing hormone, in a man with normal spermatogenesis suggests that high levels of intratesticular testosterone may not be necessary for the development of sperm.
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Phosphodiesterase Type 5 Inhibitors for Pulmonary Arterial Hypertension
A 46-year-old-woman receives a diagnosis of idiopathic pulmonary arterial hypertension. Treatment with sildenafil is recommended. Phosphodiesterase type 5 inhibitors ameliorate pulmonary arterial hypertension by increasing levels of cyclic guanosine monophosphate in the smooth-muscle cells of the pulmonary artery.
CME Exam
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Myelodysplastic Syndromes
This review gives an account of the clinical and hematologic features of the myelodysplastic syndromes. It supplies the latest classification of these disorders, discusses the cytogenetic and molecular genetic changes that occur, and analyzes how some of these conditions convert to acute myeloid leukemia.
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Ankle–Brachial Index for Assessment of Peripheral Arterial Disease
Measurement of the ankle–brachial index remains a simple, reliable method for diagnosing peripheral arterial disease. This video presents the indications for use of the ankle–brachial index and demonstrates how it is measured.
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A Bloody Mystery
A 62-year-old woman presented to the urgent care clinic with gingival bleeding after periodontal scaling of her lower-right second molar 5 hours earlier.
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Figuring Out Ferroportin
A recent description of an alternative messenger RNA transcript of the iron-export protein ferroportin opens the door to understanding how duodenal cells maintain dietary-iron absorption when the body is iron deficient and how mean corpuscular volume is regulated in the contexts of iron deficiency and inflammatory disorders.
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The American Public and the Next Phase of the Health Care Reform Debate
Robert Blendon and John Benson examined data from 30 nationwide polls to assess the issues that leaders need to focus on if they want to influence public opinion about health care reform legislation.
Free Full Text
 November 4, 2009 (DOI: 10.1056/NEJMp0906394)
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Compromises and Controversies — Moving Forward on Reform
House Speaker Nancy Pelosi (D-CA) unveiled a bill on October 29 that would establish a mandate for most legal U.S. residents to obtain health insurance. Meanwhile, Senate Majority Leader Harry Reid (D-NV) was preparing to introduce the Democrats’ reform bill in the Senate. John Iglehart reports on these bills.
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November 4, 2009 (DOI: 10.1056/NEJMp0910493)
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Mandatory Vaccination of Health Care Workers
Alexandra Stewart writes that mandatory vaccination of health care workers raises important questions about a state’s power to compel individuals to engage in particular activities in order to protect the public.
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November 4, 2009 (DOI: 10.1056/NEJMp0910151)
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Not “Socialized Medicine” — An Israeli View of Health Care Reform
In 2007, the United States spent about 15% of its gross domestic product (GDP) on health care, whereas Israel’s health care spending was about 8% of its GDP. Dov Chernichovsky describes the principles of the Israeli health care system.
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November 4, 2009 (DOI: 10.1056/NEJMp0908269)
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The Emergency Use Authorization of Peramivir for Treatment of 2009 H1N1 Influenza
On October 23 the FDA issued an Emergency Use Authorization for peramivir for the treatment of suspected or confirmed cases of 2009 H1N1 influenza. Drs. Debra Birnkrant and Edward Cox discuss the limited data on safety and efficacy and the criteria for emergency use of peramivir.
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November 2, 2009 (DOI: 10.1056/NEJMp0910479)
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Doctors, Patients, and the Need for Health Care Reform
In the coming weeks, the Senate Finance Committee will work with senators and representatives to merge their work into a final package. Senator Max Baucus (D-MT) writes that this country has never been as close as we are today to bringing true stability and security to our health care system.
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Published Online October 21, 2009 (DOI: 10.1056/NEJMp0910001)
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Litigation amidst Reform — The Boston Medical Center Case
In July the Boston Medical Center filed suit in Massachusetts state court challenging the state’s Medicaid reimbursement formula. Wendy Parmet writes that this case raises critical questions about the Massachusetts model of health care reform as well as litigation’s role in health care reform debates.
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Payment Reform for Safety-Net Institutions — Improving Quality and Outcomes
Drs. C. Jason Wang, Kathleen Conroy, and Barry Zuckerman argue that safety-net institutions should be reimbursed more per patient under any pay-for-quality scheme that is implemented.
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Novel H1N1 Influenza and Respiratory Protection for Health Care Workers
Guidelines from the CDC recommend the use of an N95 filtering facepiece respirator. Drs. Kenneth Shine, Bonnie Rogers, and Lewis Goldfrank discuss the efficacy of personal respiratory protection measures, medical masks, and respirators.
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Published Online September 30, 2009 (DOI: 10.1056/NEJMp0908437)
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Published Online October 30, 2009
A Trial of Darbepoetin Alfa in Type 2 Diabetes and Chronic Kidney Disease
Published Online October 28, 2009
Primary Care and Accountable Care — Two Essential Elements
of Delivery-System Reform
Published Online October 21, 2009
A Novel Influenza A (H1N1) Vaccine in Various Age Groups
Massachusetts Health Care Reform — Near-Universal Coverage at What Cost?
Published Online October 20, 2009
Vaccination with ALVAC and AIDSVAX to Prevent HIV-1 Infection in Thailand
Published Online October 14, 2009
Balancing Innovation, Access, and Profits — Market Exclusivity for Biologics
Medicaid and National Health Care Reform
Published Online October 8, 2009
Critical Care Services and 2009 H1N1 Influenza in Australia and New Zealand
Hospitalized Patients with 2009 H1N1 Influenza in the United States,
April–June 2009
Published Online September 23, 2009
Combined Immunodeficiency Associated with DOCK8 Mutations
Published Online September 10, 2009
More articles on influenza A (H1N1) 2009 virus
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