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Niacin or Ezetimibe and Carotid Intima–Media Thickness
In patients who have, or are at risk for, coronary artery disease, niacin added to statin therapy resulted in regression of the carotid intima–media thickness. In contrast, ezetimibe added to statin therapy paradoxically resulted in progression of the carotid intima–media thickness.
CME Exam
Published Online November 15, 2009 (DOI: 10.1056/NEJMoa0907569)
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Biventricular Pacing in Patients with Bradycardia and Normal Ejection Fraction
In this comparative-effectiveness trial, biventricular pacing prevented the reduction in left ventricular ejection fraction that is seen with right ventricular pacing.
CME Exam
Published Online November 15, 2009 (DOI: 10.1056/NEJMoa0907555)
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A Novel Antibody Associated with Autoimmune Pancreatitis
The cause of autoimmune pancreatitis is unknown, and distinguishing autoimmune pancreatitis from pancreatic cancer can be difficult. The authors identified an antibody that they were able to detect in about 95% of patients with autoimmune pancreatitis but in only about 5% of patients with pancreatic cancer.
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Rituximab, B-Lymphocyte Depletion, and Preservation of Beta-Cell Function
This phase 2 study evaluated the role of B-lymphocyte depletion with rituximab in type 1 diabetes mellitus. Rituximab partially preserved beta-cell function over a 1-year period, suggesting that B lymphocytes contribute to the pathogenesis of type 1 diabetes mellitus.
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A Sensitive Cardiac Troponin T Assay in Stable Coronary Artery Disease
This retrospective analysis used a new, highly sensitive assay for cardiac troponin T. At levels well below the limit of detection of the conventional assay, troponin T concentrations correlated significantly with the subsequent risk of cardiovascular death and heart failure but not with the risk of myocardial infarction.
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 November 25, 2009 (DOI: 10.1056/NEJMoa0805299)
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Use of Diuretics in Patients with Hypertension
This review focuses on thiazides, the diuretics most often indicated for long-term therapy for hypertension. Thiazide diuretics reduce blood pressure when administered as monotherapy; thiazides also enhance the efficacy of other antihypertensive agents and can reduce hypertension-related morbidity and mortality.
CME Exam
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A Woman with Chronic Renal Failure, Leg Swelling, and Skin Changes
A 46-year-old woman with chronic kidney disease and a history of deep venous thrombosis presented with swelling of the leg and skin changes. Thickening and erythema of the skin of both legs developed, leading to difficulty walking, sitting, and bending.
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Forestalling a Filibuster — Senate Reform Bill Cleared for Floor Debate
Senate Democrats, joined by two independents, closed ranks in a rare Saturday session on November 21 to advance consideration of a vast health care reform bill. The day-long debate offered a preview of what promises to be a bruising, full-scale war over reform. John Iglehart reports.
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 November 25, 2009 (DOI: 10.1056/NEJMp0911439)
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On Mammography — More Agreement Than Disagreement
Updated breast-cancer screening recommendations have sparked substantial controversy and have had a polarizing effect in the breast-cancer community. Drs. Ann Partridge and Eric Winer write that the intensity of the controversy is unfortunate, because there is far more agreement than disagreement.
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November 25, 2009 (DOI: 10.1056/NEJMp0911288)
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Screening Mammography and the “R” Word
New recommendations on screening for breast cancer include delaying the onset of routine screening mammography from 40 to 50 years of age. Dr. Robert Truog writes that the recommendations raise concerns about access to potentially life-saving care.
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November 25, 2009 (DOI: 10.1056/NEJMp0911447)
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Cervical-Cancer Screening — New Guidelines and the Balance between Benefits and Harms
New guidelines for cervical-cancer screening were issued on November 20. Dr. George Sawaya discusses major changes that are designed to minimize screening harms while preserving high benefit.
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November 25, 2009 (DOI: 10.1056/NEJMp0911380)
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Australia’s Winter with the 2009 Pandemic Influenza A (H1N1) Virus
Dr. James Bishop and colleagues write that key lessons from Australia’s experience with the spread of H1N1 suggest that important elements of a response were a national coordination of efforts and the use and modification of a national pandemic plan framework.
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November 25, 2009 (DOI: 10.1056/NEJMp0910445)
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The Emotional Epidemiology of H1N1 Influenza Vaccination
Dr. Danielle Ofri describes the fascinating and frustrating shift in public sentiment over the course of the H1N1 epidemic.
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November 25, 2009 (DOI: 10.1056/NEJMp0911047)
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A Difficult Balance — Pain Management, Drug Safety, and the FDA
Dr. Janet Woodcock describes the FDA’s ongoing effort to strike the right balance between two important goals: providing access to pain medications for those who need them and managing the variety of risks posed by analgesic drugs.
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Getting to the Real Issues in Health Care Reform
Paul Ginsburg writes that the House and Senate proposals are likely to differ in important details.
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Published Online November 11, 2009 (DOI: 10.1056/NEJMp0910678)
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Controlling U.S. Health Care Spending — Separating Promising from Unpromising Approaches
Peter Hussey and colleagues identify several policy options that have the potential to reduce health care spending in the United States.
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Published Online November 11, 2009 (DOI: 10.1056/NEJMp0910315)
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Published Online November 18, 2009
 Health Care Reform — A Republican View
The Consequences of “No”
Industry Influence on Comparative-Effectiveness Research
Funded through Health Care Reform
The Supreme Court, Process Patents, and Medical Innovation
Rapid-Test Sensitivity for Novel Swine-Origin
Influenza A (H1N1) Virus in Humans
Published Online November 15–17, 2009
Articles published to coincide with presentations
at the American Heart Association Scientific Sessions
Published Online November 11, 2009
Emergence of Oseltamivir-Resistant Pandemic H1N1 Virus during Prophylaxis
Published Online November 2, 2009
The Emergency Use Authorization of Peramivir
for Treatment of 2009 H1N1 Influenza
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
Published Online October 20, 2009
Vaccination with ALVAC and AIDSVAX to Prevent HIV-1 Infection in Thailand
Published Online September 10, 2009
More articles on influenza A (H1N1) 2009 virus
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Dyspnea on Exertion
A 57-year-old woman presented with a 4-month history of leg swelling and dyspnea on exertion. Physical examination revealed a grade 3/6 holosystolic murmur at the right upper sternal border and an early diastolic decrescendo murmur at the left lower sternal border. (View video.)
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A Crisis in Late Pregnancy
A 31-year-old woman in the 37th
week of pregnancy presents
with severe bitemporal headache
and shortness of breath…
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