NEJM Audio Summary - Sep 22, 2011

TIME TABLE

00:53 | Efficacy of a Tyrosine Kinase Inhibitor in Idiopathic Pulmonary Fibrosis
02:41 | Resolving the Scar of Pulmonary Fibrosis
03:16 | Lebrikizumab Treatment in Adults with Asthma
04:37 | Asthma Phenotypes and Interleukin-13 — Moving Closer to Personalized Medicine
05:18 | Long Interdialytic Interval and Mortality among Patients Receiving Hemodialysis
06:47 | Rotavirus Vaccine and Health Care Utilization for Diarrhea in U.S. Children
08:28 | Current Concepts: Hepatocellular Carcinoma
10:13 | Case 29-2011 — A 66-Year-Old Woman with Cardiac and Renal Failure
11:26 | Reforming the Regulations Governing Research with Human Subjects
12:55 | Eliciting Mucosal Immunity
14:32 | Confronting Alzheimer's Disease
16:15 | The Threat of Artemisinin-Resistant Malaria
18:02 | Health Care Policy in an Age of Austerity
19:18 | Porphyria Cutanea Tarda
20:18 | Renal Tuberculosis

NEJM BLOGGERS

• 内科開業医のお勉強日記「特発性肺線維症：チロシンキナーゼ阻害薬 BIBF 1120の有効性」
• 呼吸器内科医「特発性肺線維症に対するBIBF 1120 の有用性」
• 内科開業医のお勉強日記「抗ＩＬ１３治療：Lebrikizumabによるコントロール不良喘息治療 periostin値による層別化有効」
• 呼吸器内科医「ステロイド抵抗性喘息にlebrikizumabは有用」

EXCERPTED SCRIPT

"The Threat of Artemisinin-Resistant Malaria", a PERSPECTIVE article by Arjen Dondorp, from Mahidol University, Bangkok, Thailand
Since the 1970's when Chinese researchers demonstrated the artemisinins antimalarial potency, artesiminin based combination therapy has become key to malaria control. But reduced susceptibility of Plasmodium falciparum to artemisinin derivatives has been documented in the Cambodia–Thailand border region.  Although most P. falciparum infections still eventually clear after treatment with artemisinin-based combination therapies, resistant parasites take 3 or 4 days to do so, as compared with less than 2 days for artemisinin-sensitive parasites. This delayed clearance could be a step toward high-level resistance and frank treatment failure. Since the artemisinins have very short half-lives, this loss of potency also renders the more slowly eliminated drugs that are part of combination therapies vulnerable to development of resistance. The gravity of this threat has been recognized, and an ambitious program to contain artemisinin resistance has been launched under the guidance of the World Health Organization. Still, several critically important questions about artemisinin resistance and containment merit urgent attention. The artemisinins have been crucial to recent successes in reducing the malaria burden, and artemisinin-based combination therapies are essential to all plans for malaria elimination. Losing artemisinins to resistance will not only jeopardize the goal of malaria eradication, but will also result in large increases in African childhood mortality.

今年はLasker-DeBakey臨床医学研究賞を上記中国研究者の筆頭である屠呦呦(Tu Youyou)女史が受賞されたのですね。

NEJM Audio Summary - Sep 15, 2011

TIME TABLE

00:43 | Apixaban versus Warfarin in Patients with Atrial Fibrillation
02:26 | A New Era for Anticoagulation in Atrial Fibrillation
03:24 | Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis
05:20 | The Challenges of Intracranial Revascularization for Stroke Prevention
06:25 | A Field Trial to Assess a Blood-Stage Malaria Vaccine
07:50 | Response-Guided Telaprevir Combination Treatment for Hepatitis C Virus Infection
09:42 | Breast-Cancer Screening
11:35 | Genomic Medicine: Genomics, Health Care, and Society
13:24 | Case 28-2011 — A 74-Year-Old Man with Pemphigus Vulgaris and Lung Nodules
15:03 | Moving beyond Parity — Mental Health and Addiction Care under the ACA
16:53 | Medical Devices — Balancing Regulation and Innovation
18:48 | Medical Devices and Health — Creating a New Regulatory Framework for Moderate-Risk Devices
20:35 | Splenic Calcification
21:14 | Gout Nodulosis

NEJM BLOGGERS

呼吸器内科医「AMA1組換え蛋白マラリアワクチンの有用性について」

ABRIDGED SCRIPT

"Breast-cancer screening",
a Clinical Practice article by Ellen Warner from University of Toronto, Canada.
Mortality from breast cancer in industrialized countries has been decreasing at the rate of approximately 2.2% per year. In the United States, this decline has been attributed both to advances in adjuvant therapy and to increasing use of screening mammography. Nevertheless, the 2009 recommendations of the U.S. Preventive Services Task Force support a reduction in the use of screening mammography. This revision resulted in considerable confusion and controversy. The two most disputed changes were the reclassification of screening for women between the ages of 40 and 49 years from a B recommendation (based on moderately strong evidence) to a C recommendation (“the decision should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms”), and the recommendation that the frequency of screening be reduced from every 1 to 2 years to every 2 years. This article focuses on the updated evidence and recommendations for screening women who are at average risk for breast cancer. The most important benefits of screening are a reduction in the risk of death and the number of life-years gained. Costs include the financial costs and other costs of the screening regimen itself (radiation risk, pain, inconvenience, and anxiety), the ensuing diagnostic workup in the case of false positive results, and overdiagnosis. The ratio of benefit to cost varies significantly with the patient's age. An audio version of this article is available at NEJM.org.

COMMONLY MISPRONOUNCED WORDS

gout [ɡaʊt]
malaria[məˈleriə]

NEJM Audio Summary - Sep 1, 2011

TIME TABLE

00:51 | Early versus Later Rhythm Analysis in Patients with Out-of-Hospital Cardiac Arrest
02:30 | A Trial of an Impedance Threshold Device in Out-of-Hospital Cardiac Arrest
03:48 | Cardiac Arrest and the Limitations of Clinical Trials
04:54 | A Functional Element Necessary for Fetal Hemoglobin Silencing
05:55 | Progress in Understanding the Hemoglobin Switch
06:22 | Cord Colitis Syndrome in Cord-Blood Stem-Cell Transplantation
08:00 | Electronic Health Records and Quality of Diabetes Care
09:27 | Finding the Meaning in Meaningful Use
10:35 | Care of the Adult Patient after Sexual Assault
12:15 | A Problem in Gestation
14:00 | Opportunities and Challenges for Episode-Based Payment
15:41 | Global Health: Health Technologies and Innovation in the Global Health Arena
17:24 | The Art of Doing Nothing
19:21 | Scleroderma
20:13 | Lung Herniation after Minimally Invasive Cardiothoracic Surgery

"The Art of Doing Nothing"

A perspective article by Lisa Rosenbaum, a cardiology fellow at New York–Presbyterian/Weill Cornell Medical Center, New York.
Near the end of medical school, Dr Rosenbaum injured her knee running a marathon.  What began as classic “runner's knee” during training worsened when she ran the race anyway. A month later, she still couldn't run comfortably.Then one day, she felt an odd, round mass protruding from the most tender area. Was it a tear? An infection? A tumor? The only logical solution seemed to be an MRI and a referral to an orthopedist. Her primary care physician, Dr. B eyed her lump.  “It's just a simple tendon cyst, a ganglion,” he told her. “You don't need an MRI; you just need to rest.” When she faced Dr. B. again, she informed him of the expert opinion of her distant cousin, an orthopedist. “He says I need an MRI,” she said “I might have a torn meniscus or something.”
Three weeks later, she got an MRI. Dr. B. called with the results. “You have something called `lateral compression syndrome'.” She pushed her knee to the point where, on imaging, it looked like someone had repeatedly whacked her with a club. Dr. B. said he suspected the orthopedist would recommend surgery.“But Dr. B.,” Dr Rosenbaum said, “don't you think I just need to rest?” Of course, in the end Dr. B. had been right all along; proper rest was all she ever needed.
Dr Rosenbaum writes: What a culture values may be constantly in flux, but it is still up to us to determine. We may choose to value an MRI more than the wisdom and experience of our physicians, but this does not mean that an MRI is inherently more beneficial to our health.

Podcastでは触れられてませんが、この記事の執筆者Lisa Rosenbaum先生は、日本でも公開されたウィリアム・ハート主演の映画「ドクター」のネタ本の著者のお孫さんだそうです。本誌の記事では、お爺ちゃんの思い出とともに綴られています。