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  • 10.1056/nejm_2017.376.issue-3

    Audio Summary

    Supplement to the New England Journal of Medicine, Vol. 376, No. 3.

  • 10.1056/NEJMdo005115

    QUICK TAKE

    Mass Intoxication with a Synthetic Cannabinoid

    Mass Intoxication with a Synthetic Cannabinoid

    In July 2016, emergency services in Brooklyn responded to a scene of mass intoxication of 33 persons who had been exposed to an “herbal incense” product. How was the cause of their zombielike behavior identified? New research findings are summarized in a short video.

    January 19, 2017

    Free

      In July 2016, emergency services in Brooklyn responded to a scene of mass intoxication of 33 persons who had been exposed to an “herbal incense” product. How was the cause of their zombielike behavior identified? New research findings are ...

    • Images in Clinical Medicine

      Swirl Sign — Intestinal Volvulus after Roux-en-Y Gastric Bypass

      A 56-year-old man presented after a day and a half of midabdominal pain, nausea, and bilious emesis. The patient had undergone Roux-en-Y gastric bypass 7 years earlier. During the physical examination, tachycardia and tachypnea were noted. The abdominal examination showed a distended, tympanic…

      • January 19, 2017
      • Fernandez-Moure J. and Sherman V.
      • N Engl J Med 2017; 376:e3
      • Free Full Text

      A 56-year-old man who had undergone gastric bypass 7 years earlier presented with midabdominal pain, nausea, and bilious emesis. Swirling of the bowel and mesenteric vessels, shown in a video, was noted on CT.

    • Perspective

      Transparency and Trust — Online Patient Reviews of Physicians

      Example of Patient Ratings and Comments from the University of Utah Health Care Website.

      • January 19, 2017
      • Lee V.
      • N Engl J Med 2017; 376:197-199
      • Free Full Text

      With Yelp forcing the issue of publicly available patient ratings of doctors, health care organizations need to consider the goals of transparency efforts, how they can best be achieved, whose responsibility it is, and the best venues for such data sharing.

    • Original Article

      Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis

      Primary and Key Secondary Clinical Outcomes (Intention-to-Treat Population).

      Panel A (primary end point) and Panel B (first secondary end point) show the cumulative probability of clinical disability progression (as defined by an increase in the score on the Expanded Disability Status Scale) that was confirmed after at least 12 weeks and at least 24 weeks, respectively, in…

      • January 19, 2017
      • Montalban X., Hauser S.L., Kappos L., et al.
      • N Engl J Med 2017; 376:209-220
      • CME

      Patients with primary progressive MS who received the anti-CD20+ humanized antibody ocrelizumab were less likely to have clinical deterioration that was sustained for 12 weeks than those who received placebo. The drug was associated with decreased lesion activity on MRI.

    • Original Article

      Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis

      MRI End Points (Intention-to-Treat Population).

      Panel A shows the percent change in the total volume of brain lesions on T2-weighted MRI from baseline to week 120 (third secondary end point). The P value was calculated with the use of a ranked analysis of covariance. Panel B shows the percent change on MRI scans in brain volume from week 24 to…

      • January 19, 2017
      • Montalban X., Hauser S.L., Kappos L., et al.
      • N Engl J Med 2017; 376:209-220
      • CME

      Patients with primary progressive MS who received the anti-CD20+ humanized antibody ocrelizumab were less likely to have clinical deterioration that was sustained for 12 weeks than those who received placebo. The drug was associated with decreased lesion activity on MRI.

    • Original Article

      Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis

      Baseline Demographic and Disease Characteristics (Intention-to-Treat Population).

      • January 19, 2017
      • Montalban X., Hauser S.L., Kappos L., et al.
      • N Engl J Med 2017; 376:209-220
      • CME

      Patients with primary progressive MS who received the anti-CD20+ humanized antibody ocrelizumab were less likely to have clinical deterioration that was sustained for 12 weeks than those who received placebo. The drug was associated with decreased lesion activity on MRI.

    • Original Article

      Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis

      Primary and Secondary End Points, According to Hierarchical Order in the Statistical Analysis (Intention-to-Treat Population).

      • January 19, 2017
      • Montalban X., Hauser S.L., Kappos L., et al.
      • N Engl J Med 2017; 376:209-220
      • CME

      Patients with primary progressive MS who received the anti-CD20+ humanized antibody ocrelizumab were less likely to have clinical deterioration that was sustained for 12 weeks than those who received placebo. The drug was associated with decreased lesion activity on MRI.

    • Original Article

      Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis

      Adverse Events (Safety Population).

      • January 19, 2017
      • Montalban X., Hauser S.L., Kappos L., et al.
      • N Engl J Med 2017; 376:209-220
      • CME

      Patients with primary progressive MS who received the anti-CD20+ humanized antibody ocrelizumab were less likely to have clinical deterioration that was sustained for 12 weeks than those who received placebo. The drug was associated with decreased lesion activity on MRI.

    • Original Article

      Transmission of Extensively Drug-Resistant Tuberculosis in South Africa

      Geospatial Coordinates of Participants with Extensively Drug-Resistant (XDR) Tuberculosis in KwaZulu-Natal Province, South Africa.

      Panel A shows the homes (red dots) of all 404 enrolled participants. Panel B shows the 53 hospitals (blue squares) where the participants were admitted before or after XDR tuberculosis was diagnosed.

      • January 19, 2017
      • Shah N.S., Auld S.C., Brust J.C.M., et al.
      • N Engl J Med 2017; 376:243-253
      • Free Full Text

      This study from South Africa showed that extensively drug-resistant tuberculosis, an emerging global public health threat, is largely associated with transmission of drug-resistant strains rather than new emergence of drug resistance.

    • Original Article

      Transmission of Extensively Drug-Resistant Tuberculosis in South Africa

      Single-Nucleotide Polymorphism (SNP)–Based Maximum Likelihood Phylogenetic Tree.

      Isolates are labeled according to study identification number and color coded according to restriction-fragment–length polymorphism (RFLP) group. Single-isolate RFLP groups are shown in black. The tree is rooted to the lineage 7 isolate Percy256. L2 denotes lineage 2, and L4 lineage 4. The other…

      • January 19, 2017
      • Shah N.S., Auld S.C., Brust J.C.M., et al.
      • N Engl J Med 2017; 376:243-253
      • Free Full Text

      This study from South Africa showed that extensively drug-resistant tuberculosis, an emerging global public health threat, is largely associated with transmission of drug-resistant strains rather than new emergence of drug resistance.

    • Original Article

      Transmission of Extensively Drug-Resistant Tuberculosis in South Africa

      Social Networks in Homes and Communities, Derived from Name-Based Person-to-Person Links.

      A social network of 59 participants with direct person-to-person links is shown. Large black circles indicate study participants. Small circles indicate 450 close contacts named by participants. Lines between two large circles indicate 2 study participants who named each other as a close contact.…

      • January 19, 2017
      • Shah N.S., Auld S.C., Brust J.C.M., et al.
      • N Engl J Med 2017; 376:243-253
      • Free Full Text

      This study from South Africa showed that extensively drug-resistant tuberculosis, an emerging global public health threat, is largely associated with transmission of drug-resistant strains rather than new emergence of drug resistance.

    • Original Article

      Transmission of Extensively Drug-Resistant Tuberculosis in South Africa

      Baseline Characteristics of the Participants with Extensively Drug-Resistant Tuberculosis in KwaZulu-Natal Province, South Africa, According to a Clinical Case Definition of Acquired or Transmitted Resistance.

      • January 19, 2017
      • Shah N.S., Auld S.C., Brust J.C.M., et al.
      • N Engl J Med 2017; 376:243-253
      • Free Full Text

      This study from South Africa showed that extensively drug-resistant tuberculosis, an emerging global public health threat, is largely associated with transmission of drug-resistant strains rather than new emergence of drug resistance.

    • Case Records of the Massachusetts General Hospital

      Case 2-2017 — An 18-Year-Old Woman with Acute Liver Failure

      Abdominal Ultrasound Images.

      Grayscale ultrasound images show mildly echogenic parenchyma of the liver (Panel A) and distention of the gallbladder, with layering sludge, wall edema, and a small amount of pericholecystic fluid (Panel B). A color Doppler ultrasound image shows that the common bile duct is normal in diameter…

      • January 19, 2017
      • Olson K.R.Davarpanah A.H.Schaefer E.A.Elias N.Misdraji J.
      • N Engl J Med 2017; 376:268-278
      • CME

      An 18-year-old woman presented with acute liver failure. The total bilirubin was 19.7 mg per deciliter. Three days earlier, she had received a diagnosis of bronchitis and was treated with azithromycin. A diagnosis was made.

    • Case Records of the Massachusetts General Hospital

      Case 2-2017 — An 18-Year-Old Woman with Acute Liver Failure

      Causes of Acute Liver Failure in Children and Adults.

      Data are adapted from Lee et al.1 and Squires and Alonso.3 The numbers shown are percentages. Among children older than 10 years of age, Wilson’s disease accounted for 90% of metabolic disease.

      • January 19, 2017
      • Olson K.R.Davarpanah A.H.Schaefer E.A.Elias N.Misdraji J.
      • N Engl J Med 2017; 376:268-278
      • CME

      An 18-year-old woman presented with acute liver failure. The total bilirubin was 19.7 mg per deciliter. Three days earlier, she had received a diagnosis of bronchitis and was treated with azithromycin. A diagnosis was made.

    • Case Records of the Massachusetts General Hospital

      Case 2-2017 — An 18-Year-Old Woman with Acute Liver Failure

      Explanted Liver.

      A photograph of the cut surface of the liver shows a mottled appearance, with several regenerative nodules that vary in color from tannish-brown to yellow (Panel A). Hematoxylin and eosin staining shows that the parenchyma has a nodular appearance and widespread inflammation (Panel B). At higher…

      • January 19, 2017
      • Olson K.R.Davarpanah A.H.Schaefer E.A.Elias N.Misdraji J.
      • N Engl J Med 2017; 376:268-278
      • CME

      An 18-year-old woman presented with acute liver failure. The total bilirubin was 19.7 mg per deciliter. Three days earlier, she had received a diagnosis of bronchitis and was treated with azithromycin. A diagnosis was made.

    • Case Records of the Massachusetts General Hospital

      Case 2-2017 — An 18-Year-Old Woman with Acute Liver Failure

      Laboratory Data.

      • January 19, 2017
      • Olson K.R.Davarpanah A.H.Schaefer E.A.Elias N.Misdraji J.
      • N Engl J Med 2017; 376:268-278
      • CME

      An 18-year-old woman presented with acute liver failure. The total bilirubin was 19.7 mg per deciliter. Three days earlier, she had received a diagnosis of bronchitis and was treated with azithromycin. A diagnosis was made.

    • Review Article

      Mechanisms, Pathophysiology, and Management of Obesity

      Some Pathways through Which Excess Adiposity Leads to Major Risk Factors and Common Chronic Diseases.

      Common chronic diseases are shown in red boxes. The dashed arrow denotes an indirect association.

      • January 19, 2017
      • Heymsfield S.B. and Wadden T.A.
      • N Engl J Med 2017; 376:254-266
      • CME

      Obesity is prevalent in the U.S. population and contributes significantly to morbidity and mortality. Treatments include behavioral therapy, pharmacotherapy, and bariatric surgery. Some sequelae of obesity are reversed with weight loss. Maintaining weight loss is a challenge.

    • Review Article

      Mechanisms, Pathophysiology, and Management of Obesity

      Weight Loss at 1 Year with High-Intensity Lifestyle Interventions or Pharmacotherapy Combined with Low-to-Moderate-Intensity Lifestyle Counseling.

      Shown are the percentages of participants in randomized, controlled trials who had weight loss of at least 5% or at least 10% of their initial weight at 1 year after a high-intensity lifestyle intervention or pharmacotherapy that typically was combined with low-to-moderate-intensity lifestyle…

      • January 19, 2017
      • Heymsfield S.B. and Wadden T.A.
      • N Engl J Med 2017; 376:254-266
      • CME

      Obesity is prevalent in the U.S. population and contributes significantly to morbidity and mortality. Treatments include behavioral therapy, pharmacotherapy, and bariatric surgery. Some sequelae of obesity are reversed with weight loss. Maintaining weight loss is a challenge.

    • Review Article

      Mechanisms, Pathophysiology, and Management of Obesity

      Weight Loss at 1 Year with Bariatric Surgery and Lifestyle Interventions as Compared with Lifestyle Interventions Alone.

      Shown are categorical weight losses at 1 year in persons with overweight or obesity and type 2 diabetes who participated in randomized, controlled trials evaluating laparoscopic adjustable gastric banding (LAGB) combined with medical therapy and a lifestyle intervention (MT/LI) as compared with…

      • January 19, 2017
      • Heymsfield S.B. and Wadden T.A.
      • N Engl J Med 2017; 376:254-266
      • CME

      Obesity is prevalent in the U.S. population and contributes significantly to morbidity and mortality. Treatments include behavioral therapy, pharmacotherapy, and bariatric surgery. Some sequelae of obesity are reversed with weight loss. Maintaining weight loss is a challenge.

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