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  • Clinical Implications of Basic Research

    For the past couple of decades, clinicians have watched the stem-cell field with a mixture of anticipation and skepticism. No group of patients has been more expectant than those with spinal cord injuries. Therapies for spinal cord injury have been promised almost since the dawning of the stem-cell…

    • May 17, 2012
    • Snyder E.Y. and Teng Y.D.
    • N Engl J Med 2012; 366:1940-1942

      For the past couple of decades, clinicians have watched the stem-cell field with a mixture of anticipation and skepticism. No group of patients has been more expectant than those with spinal cord injuries. Therapies for spinal cord injury have been ...

    • Clinical Implications of Basic Research

      Generations of evolutionary pressure have honed a human immune system that is well poised to combat infectious challenges. However, the very same system can turn against us when it is activated by certain noxious stimuli, as is the case with cholesterol-laden meals triggering atherosclerosis.…

      • May 3, 2012
      • Gerszten R.E. and Tager A.M.
      • N Engl J Med 2012; 366:1734-1736

        The accrual of cholesterol-laden macrophages in the atherosclerotic plaque is a critical event that precedes plaque rupture. The guidance molecule netrin-1 mediates this accrual in a mouse model of atherosclerosis.

      • Clinical Implications of Basic Research

        Hippocrates observed that "walking is man's best medicine" and thus underscored the benefits of physical activity to health. More than two millennia later, the benefits of physical activity in lowering the risk of death from any cause and improving longevity have been well documented. Scientists…

        • April 19, 2012
        • Pedersen B.K.
        • N Engl J Med 2012; 366:1544-1545

          A recent study reveals a biochemical mechanism that underlies the effect of exercise on glucose metabolism and weight loss. The mechanism involves irisin, a molecule secreted by skeletal muscle in response to exercise.

        • Clinical Implications of Basic Research

          As the incidence of type 2 diabetes increases, new treatments are clearly needed. Many hormones and drugs that control metabolic pathways function as agonists or antagonists of nuclear receptors, which constitute a family of ligand-activated transcription factors. Included in this family, among…

          • April 5, 2012
          • Hollenberg A.N.
          • N Engl J Med 2012; 366:1345-1347

            Thiazolidinediones activate the nuclear receptor PPAR-γ, which brings about increased glucose tolerance and glucose sensitivity. Endogenous ligand can achieve the same effect under certain conditions, suggesting a different approach to activating the same pathway.

          • Clinical Implications of Basic Research

            Effective, curative chemotherapy has been a goal of modern cancer medicine for half a century. Many newly developed agents have led to modest improvements in survival. However, few new curative treatments of advanced cancers have been developed during the past quarter century — perhaps because of…

            • March 22, 2012
            • Weiner L.M. and Lotze M.T.
            • N Engl J Med 2012; 366:1156-1158

              Autophagy, a programmed cell-survival strategy that allows cells to sustain themselves by digesting their own contents, turns out to be a critical link between chemotherapy-induced cell death and the triggering of an antitumor immune response.

            • Clinical Implications of Basic Research

              Occasionally, two research disciplines converge at precisely the right moment and propel each other forward. Such is the case with a screen for growth regulators in acute myeloid leukemia and a small molecule synthesized to disrupt protein recognition of the histone code, recently reported by Zuber…

              • March 8, 2012
              • Godley L.A. and Le Beau M.M.
              • N Engl J Med 2012; 366:960-961

                The protein BRD4 binds acetylated histones (mediators of chromatin structure), which, when bound, can activate the MYC oncogene. A recent study implicated BRD4 in sustaining cells in AML. Treating these cells with a BRD4 inhibitor reduced MYC expression and elicited cell death.

              • Clinical Implications of Basic Research

                The defining feature of autosomal recessive spinal muscular atrophy is the dying back of motor neurons, which causes generalized paresis and, in the most severe and common form of this disorder (type 1), results in fatal respiratory failure. A direct corollary of this outcome is that correction of…

                • February 23, 2012
                • MacKenzie A.
                • N Engl J Med 2012; 366:761-763

                  A signal feature of spinal muscular atrophy (SMA) is the dying back of motor neurons. This is caused by a loss-of-function mutation in SMN1. Administration of an oligonucleotide that modifies the processing of SMN2, a homologous gene, extends the life span in a mouse model of SMA.

                • Clinical Implications of Basic Research

                  Stem cell–based therapies have the potential to repair and even correct the defects related to human diseases. Although tantalizing niche applications have moved forward in the clinical setting, progress seems to be slow, and ethical challenges have yet to be definitively addressed. The goal of…

                  • February 9, 2012
                  • Sandhaus R.A.
                  • N Engl J Med 2012; 366:567-569

                    The holy grail of gene therapy is the treatment of disease caused by genetic mutations. A recent study in mice provides proof of principle that alpha1-antitrypsin deficiency can be corrected, if not cured, by the infusion of autologous induced pluripotent stem cells.

                  • Clinical Implications of Basic Research

                    Genetic hemochromatosis is a prevalent iron-overload disease resulting from inadequate production of the iron-regulatory hormone hepcidin. Recently, Preza and colleagues developed an oral, biologically active hepcidin mimic that offers a new experimental approach to treating hemochromatosis and…

                    • January 26, 2012
                    • Andrews N.C.
                    • N Engl J Med 2012; 366:376-377

                      Ferroportin permits the uptake of dietary iron by cells of the intestinal epithelium into the circulation. Hepcidin targets ferroportin for lysosomal destruction. A recent study shows that an engineered minihepcidin reduces levels of iron in the serum and liver.

                    • Clinical Implications of Basic Research

                      "You are what you eat." A couple of recent studies underscore the relevance of this adage to the immune system. New studies by Kiss et al. and Li et al. show how certain dietary components derived from vegetables interact with intestinal immune receptors and thereby regulate the organogenesis of…

                      • January 12, 2012
                      • Tilg H.
                      • N Engl J Med 2012; 366:181-183

                        Cruciform vegetables may be critical to intestinal health and immunity. It turns out that these vegetables contain ligands of the aryl hydrogen receptor which, when bound, turn on genes that mediate intestinal immune defense.

                      • Clinical Implications of Basic Research

                        Hematopoietic stem-cell (HSC) transplantation remains the primary curative treatment for patients with a variety of hematologic cancers. Transplantation of either autologous or allogeneic stem cells requires the acquisition of sufficient numbers of HSCs to ensure rapid and consistent trilineage…

                        • December 29, 2011
                        • DiPersio J.F.
                        • N Engl J Med 2011; 365:2536-2538

                          Obtaining hematopoietic stem cells (HSCs) for transplantation depends on effective egress of HSCs from bone marrow into the peripheral circulation on induction. This process is impaired in a mouse model of diabetes and in patients undergoing autologous transplantation.

                        • Clinical Implications of Basic Research

                          A physical dimension of a cell is seldom its Achilles' heel. Yet for the neurons that are affected in most kinds of peripheral neuropathy, it is the length of their axons that best accounts for their selective vulnerability. As shown in Figure 1, the axon is contiguous with its cell soma. The soma…

                          • December 15, 2011
                          • Holzbaur E.L.F. and Scherer S.S.
                          • N Engl J Med 2011; 365:2330-2332

                            Understanding the function of proteins rendered mutant in disease provides insight into the mechanism of disease. Recent studies implicate the axonal cytoskeleton in neuropathies.

                          • Clinical Implications of Basic Research

                            Pneumonia is a major cause of death after acute cerebral ischemia. A recent study by Wong and colleagues provides some insight into susceptibility to infection after stroke. Specifically, they found that infections after stroke are promoted by noradrenergic-mediated dysfunction of a small subset of…

                            • December 1, 2011
                            • Meisel C. and Meisel A.
                            • N Engl J Med 2011; 365:2134-2136

                              There is growing evidence that acute injury of the central nervous system, including stroke, impairs the immune system. A recent study implicates the postischemic activation of a particular type of lymphocyte, by noradrenergic signaling, as a mediator of impairment.

                            • Clinical Implications of Basic Research

                              Type 2 diabetes mellitus is caused by a combination of genetic and environmental factors that result in decreased insulin function at sites of insulin action and a reduced ability of pancreatic beta cells to elevate insulin secretion in response to increased blood glucose levels. The variant genes…

                              • November 17, 2011
                              • Kaufman R.J.
                              • N Engl J Med 2011; 365:1931-1933

                                CDKAL1, a gene implicated in susceptibility to type 2 diabetes, has been found to mediate a fundamental event in protein translation that affects proinsulin processing.

                              • Clinical Implications of Basic Research

                                A key abnormality in heart failure is defective handling of calcium ions by cardiomyocytes. In the healthy heart, the action potential leads to an increase in the level of intracellular calcium (and subsequent systole) through two mechanisms. First, extracellular calcium enters the cell through L…

                                • November 3, 2011
                                • McMurray J.J.V. and Smith G.L.
                                • N Engl J Med 2011; 365:1738-1739

                                  Heart failure has been attributed to a deficiency in a calcium ATPase. A recent study shows that tweaking this enzyme may boost its levels and thus guard against heart failure.

                                • Clinical Implications of Basic Research

                                  The back-and-forth battle between influenza viruses and humans is defined by diversity. We fight previously unseen pathogens with a diverse repertoire of antibodies, and influenza viruses evade our immune system by presenting us with diverse surface-protein sequences. Corti and colleagues have…

                                  • October 20, 2011
                                  • Russell C.J.
                                  • N Engl J Med 2011; 365:1541-1542

                                    The genetic shifts and drifts of the influenza virus pose an obstacle to designing antiviral agents and vaccines that are effective over the long term. However, a recent study suggests that this goal is attainable.

                                  • Clinical Implications of Basic Research

                                    Many older adults believe that their memory is not as good as it was when they were younger. An epidemiologic study in Finland documented that 76% of persons over the age of 60 years reported problems with their memory. Age-associated memory decline has been well studied and refers to changes in…

                                    • October 6, 2011
                                    • D'Esposito M. and Gazzaley A.
                                    • N Engl J Med 2011; 365:1346-1347

                                      Many older adults believe that their memory is not as good as it was when they were younger. An epidemiologic study in Finland documented that 76% of persons over the age of 60 years reported problems with their memory.1 Age-associated memory decline has ...

                                    • Clinical Implications of Basic Research

                                      Sometimes simple things are hard to handle. This is true of infectious diarrhea, which remains one of the leading causes of death in children worldwide and a major factor in long-term morbidity. Some gut infections rapidly become systemic, with deadly effects even in adults, as evidenced by the…

                                      • September 22, 2011
                                      • Lencer W.I. and von Andrian U.H.
                                      • N Engl J Med 2011; 365:1151-1153

                                        Eliciting mucosal immunity through vaccination has been problematic. Two recent studies suggest a strategy to achieve this goal.

                                      • Clinical Implications of Basic Research

                                        Bone marrow transplantation has had a substantive therapeutic impact on survival, but its usefulness can be limited by the lack of matched donors, as well as by the risks of graft rejection and graft-versus-host disease (GVHD). Current strategies attempt to address these issues with conditioning…

                                        • September 8, 2011
                                        • Reya T.
                                        • N Engl J Med 2011; 365:956-957

                                          A recent study suggests that regulatory T cells are relevant in reducing the need for immunosuppressive drugs and in overcoming the limitations of a genetic mismatch between donor and recipient in allogeneic hematopoietic-cell transplantation.

                                        • Clinical Implications of Basic Research

                                          Most physicians can identify B lymphocytes and T lymphocytes, and perhaps dendritic cells, as the cells involved in the pathogenesis of systemic lupus erythematosus (SLE). This systemic autoimmune disease is characterized by the loss of tolerance to nuclear antigens, the deposition of immune…

                                          • August 25, 2011
                                          • Bosch X.
                                          • N Engl J Med 2011; 365:758-760

                                            Recent studies implicate a peculiar form of neutrophil death and its extracellular sequelae in mediating inflammation in patients with systemic lupus erythematosus.

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                                          Medical Meetings Pediatrics Conferences and Meetings

                                          2012 Certifying Examinations of the American Board of Pediatrics

                                          The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

                                          Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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