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  • Original Article

    Pseudomonas aeruginosa is a gram-negative opportunistic pathogen associated with cystic fibrosis, a multisystem genetic disease characterized by defects in the cystic fibrosis transmembrane conductance regulator (CFTR) protein, which results in recurrent infective exacerbations. Median overall…

    • May 24, 2012
    • Chotirmall S.H., Smith S.G., Gunaratnam C., et al.
    • N Engl J Med 2012; 366:1978-1986

      Pseudomonas aeruginosa is an important pathogen in patients with cystic fibrosis. In this report, data suggest that estrogen may play a role in the modulation of virulence factors in P. aeruginosa and thus affect clinical exacerbations in women with cystic fibrosis.

    • Images in Clinical Medicine

      Figure 1.

      • May 24, 2012
      • Lin L.-Y. and Wong J.-U.
      • N Engl J Med 2012; 366:2017
      • Free Full Text

      A 19-year-old woman with type 1 diabetes mellitus and suspected cystic fibrosis presented with a 1-day history of acute abdominal pain. Plain radiography revealed a typical mechanical obstruction.

    • Images in Clinical Medicine

      Figure 1.

      • May 24, 2012
      • Weibel L. and Spinas R.
      • N Engl J Med 2012; 366:e32
      • Free Full Text

      A 17-year-old girl presented with a 10-year history of transient excessive wrinkling of her palms after brief exposure to water and sweating. She reported some uncomfortable tightness of the skin during these epi¬sodes.

    • Original Article

      Chronic diarrhea is a health problem that poses challenges with respect to both diagnosis and treatment. The irritable bowel syndrome affects 15 to 20% of adults and is a common cause of diarrhea. Other causes include inflammatory bowel disease, infections, paraneoplastic hormones, celiac disease,…

      • April 26, 2012
      • Fiskerstrand T., Arshad N., Haukanes B.I., et al.
      • N Engl J Med 2012; 366:1586-1595

        Heat-stable enterotoxin induces diarrhea by activating guanylate cyclase (GC-C) on enterocytes, resulting in the secretion of water into the intestinal lumen. This study shows that an activating mutation affecting GC-C also produces this effect.

      • Correspondence

        To the Editor: Telomeres protect the ends of chromosomes from erosion; telomerase ensures their integrity. We report a case of familial idiopathic pulmonary fibrosis and bone marrow failure associated with a mutation in telomerase reverse transcriptase (TERT). The patient was a 56-year-old lifelong…

        • April 19, 2012
        • N Engl J Med 2012; 366:1551-1553
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        The authors report on a family with a new mutation in telomerase associated with pulmonary fibrosis and bone marrow failure. What fraction of patients with idiopathic pulmonary fibrosis have telomerase defects has not been defined, but the association should be kept in mind.

      • Original Article

        Epithelial–mesenchymal interactions are important in the development and tissue homeostasis of many multicompartment organs, such as the kidneys, lungs, and skin. Adhesion of epithelial cells to basement membranes provides the structural and functional integrity of the organs. Cues from the…

        • April 19, 2012
        • Has C., Spartà G., Kiritsi D., et al.
        • N Engl J Med 2012; 366:1508-1514

          Three patients with homozygous mutations in the integrin α3 gene, a transmembrane integrin receptor subunit, were found to have disrupted basement-membrane structures causing congenital nephrotic syndrome, interstitial lung disease, and epidermolysis bullosa.

        • Original Article

          Podoconiosis (endemic nonfilarial elephantiasis) is a noninfectious geochemical disease that results in bilateral swelling of the lower legs (Figure 1). It is found among subsistence farmers whose feet are exposed over many years to red-clay soil derived from volcanic rock. Podoconiosis is an…

          • March 29, 2012
          • Tekola Ayele F., Adeyemo A., Finan C., et al.
          • N Engl J Med 2012; 366:1200-1208

            Podoconiosis is a tropical form of noninfectious lymphedema associated with exposure to red-clay soil. It affects over 4 million people and is associated with substantial morbidity. In this genomewide association study in Ethiopia, associations were identified in two HLA class II loci.

          • Original Article

            In 2003, Abifadel and colleagues described two families with autosomal dominant hypercholesterolemia that was associated with gain-of-function mutations in proprotein convertase subtilisin/kexin 9 (PCSK9), one of the serine proteases. These patients had high plasma levels of low-density lipoprotein…

            • March 22, 2012
            • Stein E.A., Mellis S., Yancopoulos G.D., et al.
            • N Engl J Med 2012; 366:1108-1118

              A monoclonal antibody to PCSK9 was studied in two single-dose trials in healthy volunteers and one multiple-dose trial in patients with familial or nonfamilial hypercholesterolemia. In all three groups, the antibody reduced levels of LDL cholesterol.

            • Correspondence

              To the Editor: Dense-deposit disease (also known as membranoproliferative glomerulonephritis type II) is a rare glomerulopathy characterized by electron-dense deposits in the glomerular basement membrane as well as the glomerular deposition of complement. Within 10 years, the disease progresses to…

              • March 22, 2012
              • N Engl J Med 2012; 366:1163-1165
              • Free Full Text

              Dysregulation of the alternative complement pathway plays a pathogenic role in dense-deposit disease (also known as membranoproliferative glomerulonephritis type II). This letter reports the use of eculizumab in a patient with this disease.

            • Review Article

              To function normally, human cells require energy in the form of ATP. In many cell types, ATP is primarily generated by mitochondria, which are also key players in other important cellular processes, such as adaptive thermogenesis, ion homeostasis, innate immune responses, production of reactive…

              • March 22, 2012
              • Koopman W.J.H., Willems P.H.G.M., Smeitink J.A.M.
              • N Engl J Med 2012; 366:1132-1141

                Rare monogenic disorders of mitochondria have shed light on mitochondrial function, and the development of therapeutic agents for these disorders may be applicable to more common sporadic diseases characterized by mitochondrial dysfunction.

              • Correspondence

                To the Editor: Membranoproliferative glomerulonephritis (MPGN) mainly affects children, often progresses to end-stage kidney disease, and can recur after transplantation. Primary MPGN is one of several glomerulopathies that have recently been linked to dysregulation of the complement alternative…

                • March 22, 2012
                • N Engl J Med 2012; 366:1165-1166
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                This letter to the editor discusses the use of eculizumab in refractory membranoproliferative glomerulonephritis. The response appears to be dramatic.

              • Images in Clinical Medicine

                Figure 1.

                • March 22, 2012
                • Schrag A. and Schott J.M.
                • N Engl J Med 2012; 366:e18
                • Free Full Text

                An 18-year-old woman presented with color and temperature changes in her hands, as well as intermittent tremor of the hands for 3 years. She also reported involuntary right arm movements and difficulties with concentration.

              • Correspondence

                To the Editor: In 1999, an 11-year-old girl with the nephrotic syndrome received a biopsy-confirmed diagnosis of membranoproliferative glomerulonephritis. The level of plasma complement C3 was 7 mg per deciliter (normal range, 90 to 180). Glucocorticoids, administered for 5 years, were ineffective.…

                • March 22, 2012
                • N Engl J Med 2012; 366:1161-1163
                • Free Full Text

                This letter indicates that in a patient with long-standing dense-deposit disease, a variant of membranoproliferative glomerulonephritis, eculizumab can be useful in the resolution of the nephrotic syndrome.

              • Editorial

                Thirty-one years ago, Mabuchi and colleagues reported in the Journal that a statin called compactin reduced plasma low-density lipoprotein (LDL) cholesterol levels by 29% in patients with heterozygous familial hypercholesterolemia. This drug inhibits an early step in cholesterol synthesis catalyzed…

                • March 22, 2012
                • Young S.G. and Fong L.G.
                • N Engl J Med 2012; 366:1154-1155

                  Thirty-one years ago, Mabuchi and colleagues1 reported in the Journal that a statin called compactin reduced plasma low-density lipoprotein (LDL) cholesterol levels by 29% in patients with heterozygous familial hypercholesterolemia. This drug inhibits an ...

                • Original Article

                  Gene mutation is an important cause of cardiomyopathy. Mutations in eight sarcomere-protein genes cause hypertrophic cardiomyopathy, detected in 40 to 70% of patients. Variations in more than 40 genes, most of which encode components of the sarcomere, the cytoskeleton, or the nuclear lamina, have…

                  • February 16, 2012
                  • Herman D.S., Lam L., Taylor M.R.G., et al.
                  • N Engl J Med 2012; 366:619-628

                    Titin, an important protein in the sarcomere, is the largest human protein. This study identified mutations in the titin gene that result in a truncated protein as important causes of dilated cardiomyopathy.

                  • Perspective

                    Ms. H. is a 35-year-old woman from Japan who has had a cough for 3 weeks. Her physician sends her for an x-ray and CT scan that reveal an advanced lesion, which a biopsy confirms to be non–small-cell lung cancer. She has never smoked. Can anything be done for her? Had Ms. H.'s cancer been…

                    • February 9, 2012
                    • Mirnezami R., Nicholson J., Darzi A.
                    • N Engl J Med 2012; 366:489-491
                    • Free Full Text

                    Precision medicine uses clinicopathological indexes and molecular profiling to create diagnostic, prognostic, and therapeutic strategies tailored to the patient. Its success depends on establishing frameworks for regulating, compiling, and interpreting key information.

                  • Review Article

                    Iron-overload disorders are typically insidious, causing progressive and sometimes irreversible end-organ injury before clinical symptoms develop. With a high index of suspicion, however, the consequences of iron toxicity can be attenuated or prevented. Some iron-overload disorders are quite common…

                    • January 26, 2012
                    • Fleming R.E. and Ponka P.
                    • N Engl J Med 2012; 366:348-359
                    • CME

                    Iron is both essential and toxic. The authors review how the body absorbs, uses, and loses iron and explore both common and unusual causes of iron overload and treatment of the resulting disorders.

                  • Editorial

                    Hemophilia B (also known as Christmas disease) is due to deficiency of coagulation factor IX (FIX). In this issue of the Journal, Nathwani et al. report the first unequivocal evidence of successful gene therapy for hemophilia B — a major advance in this field. This success for hemophilia may…

                    • December 22, 2011
                    • Ponder K.P.
                    • N Engl J Med 2011; 365:2424-2425

                      Hemophilia B (also known as Christmas disease) is due to deficiency of coagulation factor IX (FIX). In this issue of the Journal, Nathwani et al. report the first unequivocal evidence of successful gene therapy for hemophilia B — a major advance in this ...

                    • Original Article

                      Hemophilia B is an X-linked bleeding disorder that results from a defect in the gene encoding coagulation factor IX (FIX), a serine protease that is critical for blood clotting. Persons with severe hemophilia B have functional FIX levels that are less than 1% of normal values and have frequent…

                      • December 22, 2011
                      • Nathwani A.C., Tuddenham E.G.D., Rangarajan S., et al.
                      • N Engl J Med 2011; 365:2357-2365

                        Using techniques to target the liver, enhance gene expression, and avoid eliciting an immune response, the authors administered an adenovirus-associated virus containing the gene for factor IX (FIX) in six patients with hemophilia B. The result was either reduction or elimination of the need for FIX prophylaxis.

                      • Correspondence

                        To the Editor: Membranoproliferative glomerulonephritis (MPGN) type II (MPGN II), also called dense-deposit disease, is a rare glomerular disease that often progresses to end-stage renal disease. MPGN II is associated with complement because of systemic C3 activation and deposition of C3 cleavage…

                        • December 15, 2011
                        • N Engl J Med 2011; 365:2340-2342
                        • Free Full Text

                        This letter describes two unrelated patients with membranoproliferative glomerulonephritis type 2 and autoantibodies to the two individual components of C3 convertase, factor B and C3. These autoantibodies enhance C3 convertase activity, probably leading to nephritis.

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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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