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  • Correspondence

    To the Editor: Levels of glucose in the cerebrospinal fluid (CSF) are used to discriminate bacterial meningitis from viral meningitis. Children with bacterial meningitis typically have low levels of CSF glucose because of glycolysis by both white cells and the pathogen and impaired CSF glucose…

    • February 9, 2012
    • N Engl J Med 2012; 366:576 - 578
    • Free Full Text

    The relationship between levels of serum and cerebrospinal fluid glucose in children is carefully examined in this study, which included more than 19,000 children.

  • Correspondence

    To the Editor: In 1934, a 10-year-old girl was hospitalized at the Children's Hospital of Boston for 1 1/2 years for Staphylococcus aureus osteomyelitis of the left femur. This was the preantibiotic era, so she did not receive any antibiotic therapy at that time but, instead, underwent multiple…

    • February 2, 2012
    • N Engl J Med 2012; 366:481 - 482
    • Free Full Text

    In this case report, Staphylococcus aureus was found to persist in an 85-year-old woman 75 years after the successful treatment of osteomyelitis during her childhood.

  • Perspective

    Recently, the mother of a young child confessed to me that she didn't know any parents who were following the recommended immunization schedule for their children. She said that when she told her pediatrician she'd like to follow an alternative schedule, the physician had simply acquiesced, leading…

    • February 2, 2012
    • Diekema D.S.
    • N Engl J Med 2012; 366:391 - 393
    • Free Full Text

    U.S. parents who decline or delay selected vaccinations or refuse to vaccinate their children are a diverse group. Vaccine coverage can be increased by focusing on parents who encounter barriers to obtaining vaccines or hesitate because of fears about safety.

  • Original Article

    The clinical onset of type 1 diabetes is manifested by the effects of inadequate insulin secretion due to the immunologic destruction of pancreatic-islet beta cells. Despite replacement therapy with exogenous insulin, type 1 diabetes is associated with substantial morbidity and mortality. Even…

    • February 2, 2012
    • Ludvigsson J., Krisky D., Casas R., et al.
    • N Engl J Med 2012; 366:433 - 442

      This trial assessed alum-formulated glutamic acid decarboxylase, the 65-kD isoform (GAD65), a major autoantigen in type 1 diabetes. In patients with recent-onset disease; the compound did not significantly alter the loss of C peptide or improve clinical outcomes.

    • Review Article

      Focal segmental glomerulosclerosis accounts for approximately 20% of cases of the nephrotic syndrome in children and 40% of such cases in adults, with an estimated incidence of 7 per 1 million. It is the most common primary glomerular disorder causing end-stage renal disease in the United States,…

      • December 22, 2011
      • D'Agati V.D., Kaskel F.J., Falk R.J.
      • N Engl J Med 2011; 365:2398 - 2411
      • CME

      Focal segmental glomerulosclerosis, which is characterized by progressive glomerular scarring, accounts for about 20% of cases of the nephrotic syndrome in children and 40% in adults. This review considers current approaches to diagnosis and management of the disease.

    • Correspondence

      To the Editor: Vemurafenib is an inhibitor of the BRAF V600E mutation and has recently been approved by the Food and Drug Administration (FDA) for treatment of metastatic melanoma in adults in the absence of brain metastases.– Trials are currently under way involving the use of vemurafenib for…

      • December 22, 2011
      • N Engl J Med 2011; 365:2439 - 2441
      • Free Full Text

      A 16-year-old girl had melanoma with the BRAF V600E mutation that metastasized to the brain. The response to vemurafenib was dramatic, and the patient continues to improve 6 months after starting therapy.

    • 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.

      • Images in Clinical Medicine

        Figure 1.

        • December 15, 2011
        • Harris K.C. and Campbell A.I.M.
        • N Engl J Med 2011; 365:e45
        • Free Full Text
        • Video

        An 8-year-old girl with a history of congenital mitral stenosis and mitral-valve replacement presented with dyspnea on exertion, fatigue, and orthopnea. On examination, she had tachypnea, a heart rate of 130 bpm, and oxygen saturation of 85 to 87% while breathing ambient air.

      • Case Records of the Massachusetts General Hospital

        Presentation of Case. Dr. Sze Man Tse (Pediatrics): A male infant was admitted to this hospital at the age of 5.5 months, because of tachypnea and respiratory distress. The patient had been well until 2 days earlier, when cough and somnolence developed. The night before admission, the temperature…

        • December 8, 2011
        • Kinane T.B., Shailam R., Mark E.J.
        • N Engl J Med 2011; 365:2221 - 2228

          A 9-month-old boy had had recurrent episodes of tachypnea and respiratory distress since he was 5.5 months of age, with expiratory wheezing and fine crackles on auscultation, hyperinflation on chest radiography, and bilateral ground-glass opacities on CT.

        • Original Article

          Recurrent wheezing episodes in preschool-age children are usually triggered by respiratory tract infections,, which often progress to severe exacerbations requiring systemic glucocorticoids and frequent use of health care services. In children under the age of 5 years who had at least four wheezing…

          • November 24, 2011
          • Zeiger R.S., Mauger D., Bacharier L.B., et al.
          • N Engl J Med 2011; 365:1990 - 2001

            Guidelines suggest daily inhaled glucocorticoids in young children at high risk for asthma exacerbation. These investigators found that such treatment was not superior to the intermittent use of budesonide initiated when signs and symptoms indicated an impending asthma exacerbation.

          • Editorial

            It's been a long time coming, and indeed we are still not there yet, but it is becoming increasingly clear that we really do have the first effective vaccine against a parasitic disease in humans. If there are no unforeseen disasters, the RTS,S/AS01 Plasmodium falciparum malaria vaccine should…

            • November 17, 2011
            • White N.J.
            • N Engl J Med 2011; 365:1926 - 1927
            • Free Full Text

            It's been a long time coming, and indeed we are still not there yet, but it is becoming increasingly clear that we really do have the first effective vaccine against a parasitic disease in humans. If there are no unforeseen disasters, the RTS,S/AS01 ...

          • Original Article

            Each year, malaria occurs in approximately 225 million persons worldwide, and 781,000 persons, mostly African children, die from the disease. During the past decade, the scale-up of malaria-control interventions has resulted in considerable reductions in morbidity and mortality associated with…

            • November 17, 2011
            • The RTS,S Clinical Trials Partnership
            • N Engl J Med 2011; 365:1863 - 1875
            • Free Full Text

            Each year, about 225 million persons have malaria, with some 781,000 associated deaths. In a preliminary report of a phase 3 trial in African children, the RTS,S/AS01 malaria vaccine had about 50% efficacy against incident malaria and 34% efficacy against severe disease.

          • Perspective

            Many physicians take great pride in the practice of evidence-based medicine. Modern medical education emphasizes the value of the randomized, controlled trial, and we learn early on not to rely on anecdotal evidence. But the application of such superior evidence, however admirable the ambition, can…

            • November 10, 2011
            • Frankovich J., Longhurst C.A., Sutherland S.M.
            • N Engl J Med 2011; 365:1758 - 1759

              Pediatricians facing critical clinical decisions often lack data on which to draw. The authors recently put their institution's electronic medical record to unusual use to inform a decision about anticoagulation in a patient with systemic lupus erythematosus.

            • Review Article

              Epilepsy is characterized by both recurrent seizures and clinical uncertainty. Paroxysmal symptoms unpredictably punctuate life. Although most people with epilepsy live full and productive lives, doctors may too readily assure patients that seizures "never hurt the brain" and "are never fatal."…

              • November 10, 2011
              • Devinsky O.
              • N Engl J Med 2011; 365:1801 - 1811
              • CME

              The magnitude of the problem of sudden unexplained death in epilepsy is unrecognized in both the medical and lay communities. This review presents information on frequency, risk factors, and theories about mechanisms and recommends strategies for prevention and for patient education.

            • Original Article

              Although cellular therapies may be effective in cancer treatment, their potential for expansion, damage of normal organs,– and malignant transformation is a source of concern. In contrast, the toxic effects of small molecules usually diminish once the drugs are withdrawn. One approach to…

              • November 3, 2011
              • Di Stasi A., Tey S.-K., Dotti G., et al.
              • N Engl J Med 2011; 365:1673 - 1683

                The introduction of a transgene into human donor T cells that can kill the cells when dimerization is induced by a pharmacologic agent has improved prospects for the exploitation of T-cell graft-versus-tumor effects while controlling graft-versus-host disease.

              • Original Article

                Cystic fibrosis, the most common lethal genetic disease in whites, affects approximately 70,000 people worldwide.– There is no cure for this disease, and the progressive lung disease associated with it is the leading cause of death. Current treatments for cystic fibrosis target the secondary…

                • November 3, 2011
                • Ramsey B.W., Davies J., McElvaney N.G., et al.
                • N Engl J Med 2011; 365:1663 - 1672

                  Ivacaftor, a potentiator of CFTR, was studied in patients with cystic fibrosis (CF) who had mutations that reduced the function of the CFTR protein. Ivacaftor significantly improved FEV1 and reduced pulmonary exacerbations; it holds promise in the treatment of selected patients with CF.

                • Original Article

                  After exposure to factor VIII, alloantibodies (inhibitors) that neutralize factor VIII clotting function develop in approximately 30% of patients with severe hemophilia A. The development of high-titer factor VIII inhibitors (>5 Bethesda units [BU]) complicates treatment because bleeding no longer…

                  • November 3, 2011
                  • Leissinger C., Gringeri A., Antmen B., et al.
                  • N Engl J Med 2011; 365:1684 - 1692
                  • CME

                  In patients with hemophilia A in whom inhibitors of factor VIII develop, the prophylactic use of a factor VIII bypassing agent (anti-inhibitor coagulant complex) three times a week significantly reduced the risk of bleeding.

                • Editorial

                  The therapeutic use of cells from healthy donors or patients is increasing. Decades ago, transfusion medicine and bone marrow transplantation provided the first successful cell therapeutics and established the foundations for cell delivery. Clinical investigation soon uncovered the double-edged…

                  • November 3, 2011
                  • Sadelain M.
                  • N Engl J Med 2011; 365:1735 - 1737

                    The therapeutic use of cells from healthy donors or patients is increasing. Decades ago, transfusion medicine and bone marrow transplantation provided the first successful cell therapeutics and established the foundations for cell delivery. Clinical ...

                  • Editorial

                    Over the past four decades, implementation of therapies directed entirely at symptoms have improved the quality of life in patients with cystic fibrosis and have increased the median survival age from 11 years to 37 years. Now, in this issue of the Journal, Ramsey et al. provide the first proof…

                    • November 3, 2011
                    • Davis P.B.
                    • N Engl J Med 2011; 365:1734 - 1735

                      Over the past four decades, implementation of therapies directed entirely at symptoms have improved the quality of life in patients with cystic fibrosis and have increased the median survival age from 11 years to 37 years. Now, in this issue of the ...

                    • Clinical Practice

                      Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 26-year-old…

                      • October 13, 2011
                      • Diller L.
                      • N Engl J Med 2011; 365:1417 - 1424
                      • CME
                      • Full Text Audio

                      This article provides guidance for care of adult survivors of childhood acute lymphoblastic leukemia, the most common childhood cancer. Treatments are associated with increased late risks of several other conditions; surveillance and patient education strategies are reviewed.

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                    Medical Meetings Conferences and Meetings

                    American Association for the Study of Liver Diseases

                    The following courses will be offered in Atlanta, unless otherwise indicated: "Hepatitis Single Topic Conference: HCV Direct Antiviral Agents (DAA): Concepts, Development and Optimal Use" (March 16 and 17); "The Henry M. and Lillian Stratton Basic Research Single Topic Conference: Mitochondria and Hepatotoxicity" (June 8 and 9); "Clinical Research Single Topic Conference: Acetaminophen Poisoning" (June 9 and 10); and "63rd Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2012" (Boston, Nov. 9-13).

                    Contact AASLD, 1001 North Fairfax St., Suite 400, Alexandria, VA 22314; or call (703) 299-9766; or see http://www.aasld.org .

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