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New England Journal of Medicine

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January 14, 2019: New England Journal of Medicine
Marie Scully, Spero R Cataland, Flora Peyvandi, Paul Coppo, Paul Knöbl, Johanna A Kremer Hovinga, Ara Metjian, Javier de la Rubia, Katerina Pavenski, Filip Callewaert, Debjit Biswas, Hilde De Winter, Robert K Zeldin
BACKGROUND: In acquired thrombotic thrombocytopenic purpura (TTP), an immune-mediated deficiency of the von Willebrand factor-cleaving protease ADAMTS13 allows unrestrained adhesion of von Willebrand factor multimers to platelets and microthrombosis, which result in thrombocytopenia, hemolytic anemia, and tissue ischemia. Caplacizumab, an anti-von Willebrand factor humanized, bivalent variable-domain-only immunoglobulin fragment, inhibits interaction between von Willebrand factor multimers and platelets...
January 9, 2019: New England Journal of Medicine
Robert T Croyle, Glen D Morgan, Michael C Fiore
Despite making great progress in caring for people with cancer, the oncology community has often neglected to capitalize on a highly feasible, readily available, and cost-effective strategy for increasing the success of cancer treatment and rates of recovery — smoking cessation. Effective..
January 2, 2019: New England Journal of Medicine
Michael L Barnett, Andrew Wilcock, J Michael McWilliams, Arnold M Epstein, Karen E Joynt Maddox, E John Orav, David C Grabowski, Ateev Mehrotra
BACKGROUND: In 2016, Medicare implemented Comprehensive Care for Joint Replacement (CJR), a national mandatory bundled-payment model for hip or knee replacement in randomly selected metropolitan statistical areas. Hospitals in such areas receive bonuses or pay penalties based on Medicare spending per hip- or knee-replacement episode (defined as the hospitalization plus 90 days after discharge). METHODS: We conducted difference-in-differences analyses using Medicare claims from 2015 through 2017, encompassing the first 2 years of bundled payments in the CJR program...
January 2, 2019: New England Journal of Medicine
Emily E Groopman, Maddalena Marasa, Sophia Cameron-Christie, Slavé Petrovski, Vimla S Aggarwal, Hila Milo-Rasouly, Yifu Li, Junying Zhang, Jordan Nestor, Priya Krithivasan, Wan Yee Lam, Adele Mitrotti, Stacy Piva, Byum H Kil, Debanjana Chatterjee, Rachel Reingold, Drew Bradbury, Michael DiVecchia, Holly Snyder, Xueru Mu, Karla Mehl, Olivia Balderes, David A Fasel, Chunhua Weng, Jai Radhakrishnan, Pietro Canetta, Gerald B Appel, Andrew S Bomback, Wooin Ahn, Natalie S Uy, Shumyle Alam, David J Cohen, Russell J Crew, Geoffrey K Dube, Maya K Rao, Sitharthan Kamalakaran, Brett Copeland, Zhong Ren, Joshua Bridgers, Colin D Malone, Caroline M Mebane, Neha Dagaonkar, Bengt C Fellström, Carolina Haefliger, Sumit Mohan, Simone Sanna-Cherchi, Krzysztof Kiryluk, Jan Fleckner, Ruth March, Adam Platt, David B Goldstein, Ali G Gharavi
BACKGROUND: Exome sequencing is emerging as a first-line diagnostic method in some clinical disciplines, but its usefulness has yet to be examined for most constitutional disorders in adults, including chronic kidney disease, which affects more than 1 in 10 persons globally. METHODS: We conducted exome sequencing and diagnostic analysis in two cohorts totaling 3315 patients with chronic kidney disease. We assessed the diagnostic yield and, among the patients for whom detailed clinical data were available, the clinical implications of diagnostic and other medically relevant findings...
December 26, 2018: New England Journal of Medicine
Jocelyn Samuels, Mara Keisling
No abstract text is available yet for this article.
December 19, 2018: New England Journal of Medicine
Richard Miech, Lloyd Johnston, Patrick M O'Malley, Jerald G Bachman, Megan E Patrick
No abstract text is available yet for this article.
December 16, 2018: New England Journal of Medicine
Megan L Ranney, Marian E Betz, Cedric Dark
No abstract text is available yet for this article.
December 5, 2018: New England Journal of Medicine
Gunter von Minckwitz, Chiun-Sheng Huang, Max S Mano, Sibylle Loibl, Eleftherios P Mamounas, Michael Untch, Norman Wolmark, Priya Rastogi, Andreas Schneeweiss, Andres Redondo, Hans H Fischer, William Jacot, Alison K Conlin, Claudia Arce-Salinas, Irene L Wapnir, Christian Jackisch, Michael P DiGiovanna, Peter A Fasching, John P Crown, Pia Wülfing, Zhimin Shao, Elena Rota Caremoli, Haiyan Wu, Lisa H Lam, David Tesarowski, Melanie Smitt, Hannah Douthwaite, Stina M Singel, Charles E Geyer
BACKGROUND: Patients who have residual invasive breast cancer after receiving neoadjuvant chemotherapy plus human epidermal growth factor receptor 2 (HER2)-targeted therapy have a worse prognosis than those who have no residual cancer. Trastuzumab emtansine (T-DM1), an antibody-drug conjugate of trastuzumab and the cytotoxic agent emtansine (DM1), a maytansine derivative and microtubule inhibitor, provides benefit in patients with metastatic breast cancer that was previously treated with chemotherapy plus HER2-targeted therapy...
December 5, 2018: New England Journal of Medicine
Marc Carrier, Karim Abou-Nassar, Ranjeeta Mallick, Vicky Tagalakis, Sudeep Shivakumar, Ariah Schattner, Philip Kuruvilla, Danny Hill, Silvana Spadafora, Katerine Marquis, Mateya Trinkaus, Anna Tomiak, Agnes Y Y Lee, Peter L Gross, Alejandro Lazo-Langner, Robert El-Maraghi, Glenwood Goss, Gregoire Le Gal, David Stewart, Timothy Ramsay, Marc Rodger, Debra Witham, Philip S Wells
BACKGROUND: Patients with active cancer have an increased risk of venous thromboembolism, which results in substantial morbidity, mortality, and health care expenditures. The Khorana score (range, 0 to 6, with higher scores indicating a higher risk of venous thromboembolism) has been validated to identify patients with cancer at elevated risk for this complication and may help select those who could benefit from thromboprophylaxis. METHODS: We conducted a randomized, placebo-controlled, double-blind clinical trial assessing the efficacy and safety of apixaban (2...
December 4, 2018: New England Journal of Medicine
Léon Tshilolo, George Tomlinson, Thomas N Williams, Brígida Santos, Peter Olupot-Olupot, Adam Lane, Banu Aygun, Susan E Stuber, Teresa S Latham, Patrick T McGann, Russell E Ware
BACKGROUND: Hydroxyurea is an effective treatment for sickle cell anemia, but few studies have been conducted in sub-Saharan Africa, where the burden is greatest. Coexisting conditions such as malnutrition and malaria may affect the feasibility, safety, and benefits of hydroxyurea in low-resource settings. METHODS: We enrolled children 1 to 10 years of age with sickle cell anemia in four sub-Saharan countries. Children received hydroxyurea at a dose of 15 to 20 mg per kilogram of body weight per day for 6 months, followed by dose escalation...
December 1, 2018: New England Journal of Medicine
Stephen J Schuster, Michael R Bishop, Constantine S Tam, Edmund K Waller, Peter Borchmann, Joseph P McGuirk, Ulrich Jäger, Samantha Jaglowski, Charalambos Andreadis, Jason R Westin, Isabelle Fleury, Veronika Bachanova, S Ronan Foley, P Joy Ho, Stephan Mielke, John M Magenau, Harald Holte, Serafino Pantano, Lida B Pacaud, Rakesh Awasthi, Jufen Chu, Özlem Anak, Gilles Salles, Richard T Maziarz
BACKGROUND: Patients with diffuse large B-cell lymphoma that is refractory to primary and second-line therapies or that has relapsed after stem-cell transplantation have a poor prognosis. The chimeric antigen receptor (CAR) T-cell therapy tisagenlecleucel targets and eliminates CD19-expressing B cells and showed efficacy against B-cell lymphomas in a single-center, phase 2a study. METHODS: We conducted an international, phase 2, pivotal study of centrally manufactured tisagenlecleucel involving adult patients with relapsed or refractory diffuse large B-cell lymphoma who were ineligible for or had disease progression after autologous hematopoietic stem-cell transplantation...
December 1, 2018: New England Journal of Medicine
Jennifer A Woyach, Amy S Ruppert, Nyla A Heerema, Weiqiang Zhao, Allison M Booth, Wei Ding, Nancy L Bartlett, Danielle M Brander, Paul M Barr, Kerry A Rogers, Sameer A Parikh, Steven Coutre, Arti Hurria, Jennifer R Brown, Gerard Lozanski, James S Blachly, Hatice G Ozer, Brittny Major-Elechi, Briant Fruth, Sreenivasa Nattam, Richard A Larson, Harry Erba, Mark Litzow, Carolyn Owen, Charles Kuzma, Jeremy S Abramson, Richard F Little, Scott E Smith, Richard M Stone, Sumithra J Mandrekar, John C Byrd
BACKGROUND: Ibrutinib has been approved by the Food and Drug Administration for the treatment of patients with untreated chronic lymphocytic leukemia (CLL) since 2016 but has not been compared with chemoimmunotherapy. We conducted a phase 3 trial to evaluate the efficacy of ibrutinib, either alone or in combination with rituximab, relative to chemoimmunotherapy. METHODS: Patients 65 years of age or older who had untreated CLL were randomly assigned to receive bendamustine plus rituximab, ibrutinib, or ibrutinib plus rituximab...
December 1, 2018: New England Journal of Medicine
Lisa B Haddad, Denise J Jamieson, Sonja A Rasmussen
On August 1, 2018, the Ministry of Health of the Democratic Republic of Congo (DRC) reported the emergence of another Ebola virus outbreak, the 10th in the DRC since the virus was discovered in 1976. As of November 13, 2018, there were 341 cases and 215 deaths, making this the world’s third-largest..
November 28, 2018: New England Journal of Medicine
Jennifer B Nuzzo, Thomas V Inglesby
Before 2014, it seemed unimaginable to many experts that Ebola would rip through dense urban areas, ultimately sickening nearly 30,000 people and killing more than 13,000. Four years later, Ebola is again spreading in urban areas, this time in the Democratic Republic of Congo (DRC). Though there..
November 28, 2018: New England Journal of Medicine
Ryan Matlow, Daryn Reicherter
On June 26, 2018, a federal judge ordered the Trump administration to reunite families that it had separated at the U.S.–Mexico border. As of mid-October, however, an analysis by the American Civil Liberties Union showed that 245 children were still in government custody. About half those children..
November 21, 2018: New England Journal of Medicine
Amir M Mohareb, Louise C Ivers
No abstract text is available yet for this article.
November 21, 2018: New England Journal of Medicine
John J P Kastelein, Erik S G Stroes
No abstract text is available yet for this article.
November 16, 2018: New England Journal of Medicine
Stacie B Dusetzina, Michelle M Mello
No abstract text is available yet for this article.
November 14, 2018: New England Journal of Medicine
Corey S Davis
Opioid-overdose deaths have increased every year for the past two decades, driving a drug-overdose epidemic that killed more than 72,000 Americans in 2017. Thanks in large part to sustained efforts by health advocates, medical professionals, and affected people, Congress has acted on several..
November 14, 2018: New England Journal of Medicine
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