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  • Correspondence

    To the Editor: Opioid-use disorder has reached epidemic proportions, with high attendant costs in terms of increases in overdoses and infectious diseases and in economic costs. Despite the demonstrated efficacy of maintaining abstinence by treating patients with opioid agonists, patients can remain…

    • December 22, 2016
    • N Engl J Med 2016; 375:2504-2505
    • Free Full Text

    In a randomized trial involving 50 opioid users on a waiting list for detoxification, 81% of users who received interim self-administered buprenorphine pills were abstinent over 12 weeks, as compared with 0% of those who did not receive buprenorphine.

  • Correspondence

    To the Editor: During the period from 2009 through 2013, only 21% of people with an opioid-use disorder in the United States received any type of treatment. In response to increasing rates of overdose deaths in the community, the Gloucester Police Department developed the Angel Program, a…

    • December 22, 2016
    • N Engl J Med 2016; 375:2502-2503
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    During the first year of a nonjudgmental referral program for drug detoxification and rehabilitation managed by the police department in Gloucester, Massachusetts, 376 persons presented for assistance; 85% had insurance, and the rate of direct placement was 94%.

  • Correspondence

    To the Editor: The incidence of cholangiocarcinoma in the general population is low; nevertheless, patients with primary sclerosing cholangitis face a lifetime risk of cholangiocarcinoma that is as high as 10%. Lazaridis and LaRusso (Sept. 22 issue) suggest the use of endoscopic retrograde…

    • December 22, 2016
    • N Engl J Med 2016; 375:2500-2502
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    To the Editor: The incidence of cholangiocarcinoma in the general population is low; nevertheless, patients with primary sclerosing cholangitis face a lifetime risk of cholangiocarcinoma that is as high as 10%.1 Lazaridis and LaRusso (Sept. 22 issue)2 ...

  • Correspondence

    To the Editor: Myeloma treatment with daratumumab shows an impressive efficacy and safety profile, as recently reported by Dimopoulos et al. in the POLLUX trial (Oct. 6 issue) and by others. However, we would appreciate a deeper discussion about the panreactivity on blood-compatibility testing that…

    • December 22, 2016
    • N Engl J Med 2016; 375:2497-2498
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    To the Editor: Myeloma treatment with daratumumab shows an impressive efficacy and safety profile, as recently reported by Dimopoulos et al. in the POLLUX trial (Oct. 6 issue)1 and by others.2 However, we would appreciate a deeper discussion about the ...

  • Correspondence

    To the Editor: In their interim report on the Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of FXA Inhibitors (ANNEXA-4) study, Connolly et al. (Sept. 22 issue) report on the potential utility of andexanet alfa in reversing three factor Xa inhibitors. We understand the difficulty…

    • December 22, 2016
    • N Engl J Med 2016; 375:2498-2500
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    To the Editor: In their interim report on the Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of FXA Inhibitors (ANNEXA-4) study, Connolly et al. (Sept. 22 issue)1 report on the potential utility of andexanet alfa in reversing three factor ...

  • Correspondence

    To the Editor: The investigation of outbreaks of Enterobacteriaceae that produce Klebsiella pneumoniae carbapenemases (KPCs) is hampered by the mobility of the blaKPC gene, which is spread by the Tn4401 transposon that carries the gene or by the plasmids that harbor the transposon, resulting in…

    • December 15, 2016
    • N Engl J Med 2016; 375:2408-2410
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    Determinants of antimicrobial resistance can be highly mobile. In this report, the diversity of carbapenem-resistant bacteria in a single patient over several years is investigated.

  • Correspondence

    To the Editor: Cogswell et al. (Aug. 11 issue) argue that the reported association between low sodium intake and increased cardiovascular risk does not fulfill the criteria for causality, and they therefore conclude that low sodium intake should be recommended. We wish to call attention to several…

    • December 15, 2016
    • N Engl J Med 2016; 375:2404-2408
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    To the Editor: Cogswell et al. (Aug. 11 issue)1 argue that the reported association between low sodium intake and increased cardiovascular risk does not fulfill the criteria for causality, and they therefore conclude that low sodium intake should be ...

  • Correspondence

    To the Editor: In the Acute Medically Ill VTE (Venous Thromboembolism) Prevention with Extended Duration Betrixaban (APEX) trial, Cohen et al. (Aug. 11 issue) analyzed whether the risk of venous thromboembolism was lower with extended-duration betrixaban than with the standard regimen of enoxaparin…

    • December 15, 2016
    • N Engl J Med 2016; 375:e50
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    To the Editor: In the Acute Medically Ill VTE (Venous Thromboembolism) Prevention with Extended Duration Betrixaban (APEX) trial, Cohen et al. (Aug. 11 issue)1 analyzed whether the risk of venous thromboembolism was lower with extended-duration betrixaban ...

  • Correspondence

    To the Editor: In the Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intracranial Pressure (RESCUEicp) trial reported by Hutchinson and others (Sept. 22 issue), mortality among patients with severe traumatic brain injury (TBI) and refractory intracranial…

    • December 15, 2016
    • N Engl J Med 2016; 375:2401-2404
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    To the Editor: In the Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intracranial Pressure (RESCUEicp) trial reported by Hutchinson and others (Sept. 22 issue),1 mortality among patients with severe traumatic brain ...

  • Correction

    Nitrates in Heart Failure with Preserved Ejection Fraction Correspondence, N Engl J Med 2016;374:1587-1589. In the letter from Mueller et al. (page 1588), one of the authors' surnames was misspelled: "Kohzuharov" should have been Kozhuharov. The same misspelling occurred in the authors' reply…

    • December 15, 2016
    • N Engl J Med 2016; 375:2410
    • Free Full Text

    Nitrates in Heart Failure with Preserved Ejection Fraction Correspondence, N Engl J Med 2016;374:1587-1589. In the letter from Mueller et al. (page 1588), one of the authors' surnames was misspelled: “Kohzuharov” should have been Kozhuharov. The same ...

  • Correction

    Smoking and Mortality — Beyond Established Causes Correspondence, N Engl J Med 2015;372:2168-2170. In the letter from Nabi et al. (page 2169), one of the authors' surnames was misspelled: "Estaqiuo" should have been Estaquio. The letter is correct at NEJM.org.

    • December 15, 2016
    • N Engl J Med 2016; 375:2410
    • Free Full Text

    Smoking and Mortality — Beyond Established Causes Correspondence, N Engl J Med 2015;372:2168-2170. In the letter from Nabi et al. (page 2169), one of the authors' surnames was misspelled: “Estaqiuo” should have been Estaquio. The letter is correct at ...

  • Correspondence

    To the Editor: We previously reported the results of a nonrandomized, controlled trial that compared survival among patients with Ebola virus (EBOV) disease who were treated with convalescent plasma with survival among historical controls. Although no safety concerns were identified, efficacy was…

    • December 8, 2016
    • N Engl J Med 2016; 375:2307-2309
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    In this follow-up report, the relationship between total anti–Ebola virus (EBOV) and EBOV neutralizing-antibody concentrations, in convalescent plasma used in the treatment of Ebola disease, was evaluated to determine the effect on efficacy.

  • Correspondence

    To the Editor: The results of the Sleep Apnea Cardiovascular Endpoints (SAVE) study reported by McEvoy et al. (Sept. 8 issue) provide the opportunity to reflect on the story of the glass that is half full. The study shows that if a person is not adherent to continuous positive airway pressure…

    • December 8, 2016
    • N Engl J Med 2016; 375:2301-2303
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    To the Editor: The results of the Sleep Apnea Cardiovascular Endpoints (SAVE) study reported by McEvoy et al. (Sept. 8 issue)1 provide the opportunity to reflect on the story of the glass that is half full. The study shows that if a person is not adherent ...

  • Correspondence

    To the Editor: Genomic studies of cardiovascular disease that are based on samples obtained from patients have identified variants associated with the risk of disease that do not always predict the onset of disease shown in prospective studies. Dewey et al. (March 24 issue) report lower levels of…

    • December 8, 2016
    • N Engl J Med 2016; 375:2303-2306
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    To the Editor: Genomic studies of cardiovascular disease that are based on samples obtained from patients have identified variants associated with the risk of disease that do not always predict the onset of disease shown in prospective studies.1,2 Dewey ...

  • Correspondence

    To the Editor: Qureshi et al. (Sept. 15 issue) report the results of the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) trial of blood-pressure lowering in patients with intracerebral hemorrhage. Though participants were assigned to a systolic blood-pressure target of 110 to…

    • December 8, 2016
    • N Engl J Med 2016; 375:e48
    • Free Full Text

    To the Editor: Qureshi et al. (Sept. 15 issue)1 report the results of the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) trial of blood-pressure lowering in patients with intracerebral hemorrhage. Though participants were assigned to ...

  • Correspondence

    To the Editor: In their review article on thyroid cancer, Fagin and Wells (Sept. 15 issue) state that 7% of unselected medullary thyroid carcinomas are attributable to germline RET mutations, but they do not provide a similar numerical estimate of genes that contribute to the development of…

    • December 8, 2016
    • N Engl J Med 2016; 375:2306-2307
    • Free Full Text

    To the Editor: In their review article on thyroid cancer, Fagin and Wells (Sept. 15 issue)1 state that 7% of unselected medullary thyroid carcinomas are attributable to germline RET mutations, but they do not provide a similar numerical estimate of genes ...

  • CorrespondenceOnline First

    To the Editor: We describe a case of Zika virus (ZIKV) infection during pregnancy in a Colombian woman. She was infected in December 2015 while she was visiting her home country. At 9 weeks’ gestation, she had a self-limited maculopapular, nonconfluent rash for 3 days that affected her trunk, arms,…

    • December 7, 2016
    • 10.1056/NEJMc1607580
    • Free Full Text

    To the Editor: We describe a case of Zika virus (ZIKV) infection during pregnancy in a Colombian woman. She was infected in December 2015 while she was visiting her home country. At 9 weeks’ gestation, she had a self-limited maculopapular, nonconfluent ...

  • Correspondence

    To the Editor: The genomic landscape of lower-grade gliomas has recently been investigated in "multi-omic" analyses that have revealed molecular subgroups with prognostic relevance. In particular, robust biomarkers, including 1p/19q codeletion (deletion of chromosome arms 1p and 19q), IDH mutation,…

    • December 1, 2016
    • N Engl J Med 2016; 375:2206-2208
    • Free Full Text

    Deletion of chromosome arms 1p and 19q and mutations in IDH and TERT define prognostic subgroups of low-grade gliomas. Gliomas without these lesions (triple-negative gliomas) are more common in China, often have TP53 mutations, and are associated with a worse prognosis.

  • Correspondence

    To the Editor: The results of the study by Cardoso et al. (Aug. 25 issue) suggest that chemotherapy can be safely withheld from patients who are clinically at high risk for recurrence but have a low-risk 70-gene signature (MammaPrint). However, the subgroup analysis does not show whether this…

    • December 1, 2016
    • N Engl J Med 2016; 375:2199-2201
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    To the Editor: The results of the study by Cardoso et al. (Aug. 25 issue)1 suggest that chemotherapy can be safely withheld from patients who are clinically at high risk for recurrence but have a low-risk 70-gene signature (MammaPrint). However, the ...

  • Correspondence

    To the Editor: Pocock and Stone (Sept. 8 issue) provide an excellent primer on evaluations of clinical trials and their applications to practice. However, early on in their article they make a common but erroneous statement regarding the nature of the P value: "A P value of 0.05 carries a 5% risk…

    • December 1, 2016
    • N Engl J Med 2016; 375:2205-2206
    • Free Full Text

    To the Editor: Pocock and Stone (Sept. 8 issue) provide an excellent primer on evaluations of clinical trials and their applications to practice.1 However, early on in their article they make a common but erroneous statement regarding the nature of the P ...

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