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New England Journal of Medicine

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https://www.readbyqxmd.com/read/28212061/pd-1-and-pd-l1-inhibitors-as-salvage-therapy-for-urothelial-carcinoma
#1
Guru Sonpavde
No abstract text is available yet for this article.
February 17, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28212060/pembrolizumab-as-second-line-therapy-for-advanced-urothelial-carcinoma
#2
Joaquim Bellmunt, Ronald de Wit, David J Vaughn, Yves Fradet, Jae-Lyun Lee, Lawrence Fong, Nicholas J Vogelzang, Miguel A Climent, Daniel P Petrylak, Toni K Choueiri, Andrea Necchi, Winald Gerritsen, Howard Gurney, David I Quinn, Stéphane Culine, Cora N Sternberg, Yabing Mai, Christian H Poehlein, Rodolfo F Perini, Dean F Bajorin
Background Patients with advanced urothelial carcinoma that progresses after platinum-based chemotherapy have a poor prognosis and limited treatment options. Methods In this open-label, international, phase 3 trial, we randomly assigned 542 patients with advanced urothelial cancer that recurred or progressed after platinum-based chemotherapy to receive pembrolizumab (a highly selective, humanized monoclonal IgG4κ isotype antibody against programmed death 1 [PD-1]) at a dose of 200 mg every 3 weeks or the investigator's choice of chemotherapy with paclitaxel, docetaxel, or vinflunine...
February 17, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28195756/persistence-of-zika-virus-in-body-fluids-preliminary-report
#3
Gabriela Paz-Bailey, Eli S Rosenberg, Kate Doyle, Jorge Munoz-Jordan, Gilberto A Santiago, Liore Klein, Janice Perez-Padilla, Freddy A Medina, Stephen H Waterman, Carlos Garcia Gubern, Luisa I Alvarado, Tyler M Sharp
Background To estimate the frequency and duration of detectable Zika virus (ZIKV) RNA in human body fluids, we prospectively assessed a cohort of newly infected participants in Puerto Rico. Methods We evaluated samples obtained from 150 participants (including 55 men) in whom ZIKV RNA was detected on reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay in urine or blood in an enhanced arboviral clinical surveillance site. We collected serum, urine, saliva, semen, and vaginal secretions weekly for the first month and then at 2, 4, and 6 months...
February 14, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28177852/anesthesia-and-developing-brains-implications-of-the-fda-warning
#4
Dean B Andropoulos, Michael F Greene
For more than 15 years, the potential for lasting neurotoxic effects of agents used to induce general anesthesia and sedation when administered to young children — and indirectly through pregnant women to fetuses with developing brains — has been a subject of concern and considerable research..
February 8, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28146648/trump-s-executive-order-on-immigration-detrimental-effects-on-medical-training-and-health-care
#5
Ahmad Masri, Mourad H Senussi
On January 27, 2017, U.S. President Donald Trump signed an executive order banning nationals of seven countries — Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen — from entering the United States for at least 90 days, with the possibility of a wider "Muslim ban" in the works. Setting the..
February 1, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28146644/per-capita-caps-in-medicaid-lessons-from-the-past
#6
Andrew J Goodman-Bacon, Sayeh S Nikpay
In the summer of 2016, Representative Paul Ryan (R-WI) released "A Better Way," a wide-ranging proposal that included a plan for reforming Medicaid. Its fate depended heavily on the presidential election, and now that Republicans hold majorities in both the Senate and the House of Representatives..
February 1, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28146640/denying-visas-to-doctors-in-the-united-states
#7
Muhammad H Majeed, Fahad Saeed
To the Editor: In an embarrassed tone, an 87-year-old patient with end-stage chronic renal disease who is now receiving palliative care asked one of us, "Will you be able to stay in the United States for a few more months? I don’t want to change my physician during the last few months of my life."..
February 1, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28146413/international-exchange-and-american-medicine
#8
Katrina Armstrong, Mark E Anderson, John M Carethers, Joseph Loscalzo, Michael S Parmacek, Robert M Wachter, Mark L Zeidel
On January 27, 2017, President Donald Trump issued an executive order suspending "entry into the United States, as immigrants and nonimmigrants" of aliens from Iraq, Iran, Libya, Somalia, Sudan, Syria, and Yemen for 90 days, suspending the U.S. Refugee Admissions Program for 120 days, and..
February 1, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28146412/success-and-failure-in-the-insurance-exchanges
#9
Craig Garthwaite, John A Graves
The results of the 2016 election portend a vigorous 2017 debate about the future of the Affordable Care Act (ACA). Both President Donald Trump and large fractions of the Republican majority party in the House and Senate campaigned on an explicit pledge to repeal and replace the ACA. At least part..
February 1, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28121514/genetic-drivers-of-kidney-defects-in-the-digeorge-syndrome
#10
Esther Lopez-Rivera, Yangfan P Liu, Miguel Verbitsky, Blair R Anderson, Valentina P Capone, Edgar A Otto, Zhonghai Yan, Adele Mitrotti, Jeremiah Martino, Nicholas J Steers, David A Fasel, Katarina Vukojevic, Rong Deng, Silvia E Racedo, Qingxue Liu, Max Werth, Rik Westland, Asaf Vivante, Gabriel S Makar, Monica Bodria, Matthew G Sampson, Christopher E Gillies, Virginia Vega-Warner, Mariarosa Maiorana, Donald S Petrey, Barry Honig, Vladimir J Lozanovski, Rémi Salomon, Laurence Heidet, Wassila Carpentier, Dominique Gaillard, Alba Carrea, Loreto Gesualdo, Daniele Cusi, Claudia Izzi, Francesco Scolari, Joanna A E van Wijk, Adela Arapovic, Mirna Saraga-Babic, Marijan Saraga, Nenad Kunac, Ali Samii, Donna M McDonald-McGinn, Terrence B Crowley, Elaine H Zackai, Dorota Drozdz, Monika Miklaszewska, Marcin Tkaczyk, Przemyslaw Sikora, Maria Szczepanska, Malgorzata Mizerska-Wasiak, Grazyna Krzemien, Agnieszka Szmigielska, Marcin Zaniew, John M Darlow, Prem Puri, David Barton, Emilio Casolari, Susan L Furth, Bradley A Warady, Zoran Gucev, Hakon Hakonarson, Hana Flogelova, Velibor Tasic, Anna Latos-Bielenska, Anna Materna-Kiryluk, Landino Allegri, Craig S Wong, Iain A Drummond, Vivette D'Agati, Akira Imamoto, Jonathan M Barasch, Friedhelm Hildebrandt, Krzysztof Kiryluk, Richard P Lifton, Bernice E Morrow, Cecile Jeanpierre, Virginia E Papaioannou, Gian Marco Ghiggeri, Ali G Gharavi, Nicholas Katsanis, Simone Sanna-Cherchi
Background The DiGeorge syndrome, the most common of the microdeletion syndromes, affects multiple organs, including the heart, the nervous system, and the kidney. It is caused by deletions on chromosome 22q11.2; the genetic driver of the kidney defects is unknown. Methods We conducted a genomewide search for structural variants in two cohorts: 2080 patients with congenital kidney and urinary tract anomalies and 22,094 controls. We performed exome and targeted resequencing in samples obtained from 586 additional patients with congenital kidney anomalies...
25, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28118549/tight-glycemic-control-in-critically-ill-children
#11
Michael S D Agus, David Wypij, Eliotte L Hirshberg, Vijay Srinivasan, E Vincent Faustino, Peter M Luckett, Jamin L Alexander, Lisa A Asaro, Martha A Q Curley, Garry M Steil, Vinay M Nadkarni
Background In multicenter studies, tight glycemic control targeting a normal blood glucose level has not been shown to improve outcomes in critically ill adults or children after cardiac surgery. Studies involving critically ill children who have not undergone cardiac surgery are lacking. Methods In a 35-center trial, we randomly assigned critically ill children with confirmed hyperglycemia (excluding patients who had undergone cardiac surgery) to one of two ranges of glycemic control: 80 to 110 mg per deciliter (4...
24, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28099063/improve-quality-control-spending-maintain-access-can-the-merit-based-incentive-payment-system-deliver
#12
Eric C Schneider, Cornelia J Hall
Medicare is poised to overhaul the way it pays for ambulatory care services. The Centers for Medicare and Medicaid Services (CMS) has published a final rule codifying the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which directed CMS to gradually replace fee-for-service..
18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/27959704/clarifying-stem-cell-therapy-s-benefits-and-risks
#13
Peter W Marks, Celia M Witten, Robert M Califf
The current excitement over the potential for stem-cell therapy to improve patient outcomes or even cure diseases is understandable. We at the Food and Drug Administration (FDA) share this excitement. However, to ensure that this emerging field fulfills its promise to patients, we must first..
November 30, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/28199808/addressing-the-fentanyl-threat-to-public-health
#14
Richard G Frank, Harold A Pollack
Fentanyl, a powerful synthetic opioid, poses an increasing public health threat. Low production costs encourage suppliers to "cut" heroin with the drug, particularly white powder heroin sold in the eastern United States. Fentanyl also appears as a prevalent active ingredient in counterfeit..
February 16, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28199806/eosinophilic-otitis-media
#15
Hugo Lara-Sánchez, Luis A Vallejo
A 50-year-old man presented with a 6-month history of pain, intermittent otorrhea, and progressive hearing loss in both ears. He had a history of asthma, recurrent sinus disease with nasal polyps, and aspirin sensitivity. Otoendoscopy revealed polypoid masses in the external canals of both ears...
February 16, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28199804/gas-in-the-left-atrium-and-ventricle
#16
Mary Thomson, Fredy El Sakr
A 60-year-old man with coronary artery disease, ischemic cardiomyopathy with biventricular implantable cardioverter–defibrillator placement, and atrial fibrillation presented with chest pain and numbness in both arms. During his initial presentation, he suddenly collapsed and became unresponsive...
February 16, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28199802/adjusting-risk-adjustment-accounting-for-variation-in-diagnostic-intensity
#17
Amy Finkelstein, Matthew Gentzkow, Peter Hull, Heidi Williams
In the U.S. health care system, payments and performance measures are often adjusted to account for differences in patients’ baseline health and demographic characteristics. The idea behind such risk adjustments is to create a level playing field, so that providers aren’t penalized for serving..
February 16, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28103146/the-common-rule-updated
#18
Jerry Menikoff, Julie Kaneshiro, Ivor Pritchard
For the first time since it was issued in 1991, the Common Rule — the set of federal regulations for ethical conduct of human-subjects research — has been updated. Most of the new requirements, many of which increase flexibility, will go into effect in 2018, which gives institutions a year to work..
February 16, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28099066/new-vaccines-against-epidemic-infectious-diseases
#19
John-Arne Røttingen, Dimitrios Gouglas, Mark Feinberg, Stanley Plotkin, Krishnaswamy V Raghavan, Andrew Witty, Ruxandra Draghia-Akli, Paul Stoffels, Peter Piot
The vaccine-development response to the 2014 Ebola epidemic in West Africa, though a valiant effort, was too little, too late. Three vaccine candidates were tested successfully under challenging conditions. Governments and foundations mobilized funds quickly. Companies and research-and-development..
February 16, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/27959700/osimertinib-or-platinum-pemetrexed-in-egfr-t790m-positive-lung-cancer
#20
Tony S Mok, Yi-Long Wu, Myung-Ju Ahn, Marina C Garassino, Hye R Kim, Suresh S Ramalingam, Frances A Shepherd, Yong He, Hiroaki Akamatsu, Willemijn S M E Theelen, Chee K Lee, Martin Sebastian, Alison Templeton, Helen Mann, Marcelo Marotti, Serban Ghiorghiu, Vassiliki A Papadimitrakopoulou
Background Osimertinib is an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) that is selective for both EGFR-TKI sensitizing and T790M resistance mutations in patients with non-small-cell lung cancer. The efficacy of osimertinib as compared with platinum-based therapy plus pemetrexed in such patients is unknown. Methods In this randomized, international, open-label, phase 3 trial, we assigned 419 patients with T790M-positive advanced non-small-cell lung cancer, who had disease progression after first-line EGFR-TKI therapy, in a 2:1 ratio to receive either oral osimertinib (at a dose of 80 mg once daily) or intravenous pemetrexed (500 mg per square meter of body-surface area) plus either carboplatin (target area under the curve, 5 [AUC5]) or cisplatin (75 mg per square meter) every 3 weeks for up to six cycles; maintenance pemetrexed was allowed...
February 16, 2017: New England Journal of Medicine
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