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January 19, 2017 Vol. 376 No. 3

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Perspective

197-199

Transparency and Trust — Online Patient Reviews of Physicians

V. Lee

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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.

200-202

Population Health — A Bipartisan Agenda for the Incoming Administration from State Leaders

C.F. Koller, T. Alexander, and S. Birch

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A bipartisan group of state-government health policy leaders has developed an agenda for the new U.S. administration entailing policies for improving population health that have bipartisan appeal, are supported by evidence, and are achievable without new legislation.

203-205

Cost-Effectiveness Analysis 2.0

P.J. Neumann and G.D. Sanders

As prominent groups in U.S. health care ramp up use of cost-effectiveness analysis to measure and communicate the value of new drugs and other interventions, an expert panel has released updated guidelines for such analysis.

205-207

Psychocatalytic Benefits of the Unexpected

M.W. Kahn

Few doctors would say they deliberately try to catch their patients off guard, but doing so under the right circumstances can have what might be called “psychocatalytic” effects, triggering or crystallizing a change in perspective.

Original Articles

209-220

Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis

X. Montalban and Others

CME
Comments

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.

221-234

Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis

S.L. Hauser and Others

In two trials involving patients with relapsing multiple sclerosis, the anti-CD20+ monoclonal antibody ocrelizumab was associated with lower annualized relapse rates, lower risk of disability progression, and better MRI features than interferon beta-1a.

235-242

“Zombie” Outbreak Caused by the Synthetic Cannabinoid AMB-FUBINACA in New York

A.J. Adams and Others

Quick Take

Eighteen patients in a street-drug–induced stupor were seen in EDs on a single day in a New York City neighborhood. With rapid cooperative efforts among physicians, police, public health authorities, and toxicologists, the cannabinoid AMB-FUBINACA was identified as the cause.

243-253

Transmission of Extensively Drug-Resistant Tuberculosis in South Africa

N.S. Shah and Others

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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.

Review Article

254-266

Mechanisms, Pathophysiology, and Management of Obesity

S.B. Heymsfield and T.A. Wadden

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.

Images in Clinical Medicine

267

Serrated Marine Nose

C. Schlapbach and P. Sendi

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A 37-year-old woman taking adalimumab for ankylosing spondylitis presented with ulcerations with a hemorrhagic crust over her nose. Two waterborne organisms grew in biopsy samples obtained from the ulcers.

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

J. Fernandez-Moure and V. Sherman

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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.

Case Records of the Massachusetts General Hospital

268-278

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

K.R. Olson, A.H. Davarpanah, E.A. Schaefer, N. Elias, and J. Misdraji

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.

Editorial

280-282

B-Cell Depletion — A Frontier in Monoclonal Antibodies for Multiple Sclerosis

P.A. Calabresi

Multiple sclerosis is a disabling autoimmune disease in which immune cells target central nervous system (CNS) antigens, leading to demyelination, glial activation, and subsequent loss of neurons and axons.¹ There are three main subtypes of multiple ...

Clinical Implications of Basic Research

283-285

Antibodies to Mycobacterium tuberculosis

A. Casadevall

Two studies shed light on and underscore the functional importance of the humoral immune response to infection by M. tuberculosis.

Correspondence

286-287

Long-Term Oxygen for COPD

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To the Editor: Members of the Long-Term Oxygen Treatment Trial (LOTT) Research Group (Oct. 27 issue)¹ report that the use of long-term supplemental oxygen had no significant effect on the time until a first hospitalization or death among patients with ...

288-289

Ribociclib for HR-Positive, Advanced Breast Cancer

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To the Editor: In their interim analysis of the Mammary Oncology Assessment of LEE011’s (Ribociclib’s) Efficacy and Safety (MONALEESA-2) trial, Hortobagyi et al. (Nov. 3 issue)¹ report that the addition of ribociclib to letrozole enhanced the efficacy and ...

289-290

Clinical Trials Involving Hypertension

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To the Editor: In their comprehensive review of trials examining the efficacy of antihypertensive medications since 1966, Pfeffer and McMurray (Nov. 3 issue)¹ state, “Since the risks and the potential benefits of using pharmacologic agents to reduce blood ...

290-292

Myocarditis with Immune Checkpoint Blockade

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To the Editor: In their report on cardiotoxicity associated with immune checkpoint blockade, Johnson et al. (Nov. 3 issue)¹ describe two patients with melanoma in whom fatal myocarditis developed after treatment with ipilimumab and nivolumab. In addition, ...

292-294

Variant Creutzfeldt–Jakob Disease in a Patient with Heterozygosity at PRNP Codon 129

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In this case study, variant Creutzfeldt–Jakob disease (CJD) is shown to occur in a young man with heterozygosity, rather than homozygosity, at codon 129 of the prion protein gene (PRNP).

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