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  • 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.

    • Review Article

      The impact of certain skin diseases on the lives of those affected tends to be underestimated or even dismissed as simply a "cosmetic problem." Alopecia areata exemplifies such a condition, owing to its substantial disease burden and its often devastating effects on the patient's quality of life…

      • April 19, 2012
      • Gilhar A., Etzioni A., Paus R.
      • N Engl J Med 2012; 366:1515-1525
      • CME

      This review article synthesizes relevant information about hair-follicle biology and pathobiology and summarizes the clinical presentation and management of this common condition.

    • 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.

      • Original Article

        The abscopal effect refers to a rare phenomenon of tumor regression at a site distant from the primary site of radiotherapy. Localized radiotherapy has been shown to induce abscopal effects in several types of cancer, including melanoma, lymphoma, and renal-cell carcinoma.– The biologic…

        • March 8, 2012
        • Postow M.A., Callahan M.K., Barker C.A., et al.
        • N Engl J Med 2012; 366:925-931

          A patient with metastatic melanoma with slowly progressive disease while receiving ipilimumab underwent radiotherapy for a pleural-based metastasis. Tumor lesions in nonirradiated sites began to disappear, and titers of antibody against a tumor-associated antigen increased.

        • Review Article

          IgG4-related disease is a newly recognized fibroinflammatory condition characterized by tumefactive lesions, a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and, often but not always, elevated serum IgG4 concentrations. The disease was not recognized as…

          • February 9, 2012
          • Stone J.H., Zen Y., Deshpande V.
          • N Engl J Med 2012; 366:539-551

            A number of autoimmune diseases that affect diverse organ systems have recently been noted to be related to IgG4 autoantibodies. The authors review the spectrum of IgG4-related disease and the current status of diagnostic and management approaches.

          • Original Article

            The genetic dissection of unique inflammatory phenotypes can identify and elucidate immunologic pathways and mechanisms. Such investigations have ultimately led to findings whose significance extends beyond the monogenic diseases harboring the mutations. Examples include the recognition that FOXP3…

            • January 26, 2012
            • Ombrello M.J., Remmers E.F., Sun G., et al.
            • N Engl J Med 2012; 366:330-338

              Analyses of families affected by cold urticaria, immunodeficiency, and autoimmunity implicate mutations that activate phospholipase Cγ2 (PLCγ2), an enzyme pivotal to the translation of binding events at the cell surface to the intracellular milieu, as a cause of the disease.

            • 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.

              • Review Article

                Rheumatoid arthritis is a common autoimmune disease that is associated with progressive disability, systemic complications, early death, and socioeconomic costs. The cause of rheumatoid arthritis is unknown, and the prognosis is guarded. However, advances in understanding the pathogenesis of the…

                • December 8, 2011
                • McInnes I.B. and Schett G.
                • N Engl J Med 2011; 365:2205-2219

                  The increased understanding of the immune mechanisms of rheumatoid arthritis has led to the development of a considerable number of new therapeutic agents that alter the natural history of the disease and reduce mortality.

                • Original Article

                  Interleukin-2 has been identified for its capacity to stimulate T cells in vitro and has been used to boost effector immune responses in patients with cancers and infectious diseases. It is a registered indication when used as an adjunct for the treatment of renal-cell carcinoma, but there is a…

                  • December 1, 2011
                  • Saadoun D., Rosenzwajg M., Joly F., et al.
                  • N Engl J Med 2011; 365:2067-2077

                    This phase 1–phase 2a study of the use of low-dose interleukin-2 to treat vasculitis associated with HCV infection suggests the presence of a therapeutic effect that is mediated by an increase in regulatory T cells.

                  • 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.

                    • Editorial

                      In this issue of the Journal, the findings of two case series suggest that in vivo treatment with interleukin-2 can suppress immune-mediated diseases. In one study, Koreth et al. found that low-dose interleukin-2 was associated with reversal of glucocorticoid-refractory chronic graft-versus-host…

                      • December 1, 2011
                      • Bluestone J.A.
                      • N Engl J Med 2011; 365:2129-2131

                        In this issue of the Journal, the findings of two case series suggest that in vivo treatment with interleukin-2 can suppress immune-mediated diseases. In one study, Koreth et al.1 found that low-dose interleukin-2 was associated with reversal of ...

                      • Original Article

                        Allogeneic hematopoietic stem-cell transplantation (HSCT) invokes donor-derived immune responses that can result in therapeutic graft-versus-tumor activity and toxic graft-versus-host disease (GVHD). Chronic GVHD, a systemic inflammatory disorder with pleomorphic autoimmune manifestations that is…

                        • December 1, 2011
                        • Koreth J., Matsuoka K.-i., Kim H.T., et al.
                        • N Engl J Med 2011; 365:2055-2066

                          A low daily dose of subcutaneous interleukin-2 increases the number and function of regulatory T cells and results in substantial improvement in about half of patients with chronic graft-versus-host disease.

                        • 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 ...

                          • 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
                            • Free Full Text

                            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.

                          • Review Article

                            The major autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, type 1 diabetes mellitus, psoriasis, and inflammatory bowel disease, share epidemiologic, clinical, and therapeutic features. In each of these diseases, chronic and often intermittent…

                            • October 27, 2011
                            • Cho J.H. and Gregersen P.K.
                            • N Engl J Med 2011; 365:1612-1623
                            • Free Full Text

                            This article reviews the many new insights into autoimmune disease brought about through genomic investigations.

                          • Original Article

                            Inflammatory disorders of the skin and gut, including eczema, psoriasis, and celiac disease, have been linked to changes in barrier function and immune responses, by means of genetic and functional studies. Large case–control studies combined with genomewide association studies have identified…

                            • October 20, 2011
                            • Blaydon D.C., Biancheri P., Di W.-L., et al.
                            • N Engl J Med 2011; 365:1502-1508
                            • Free Full Text

                            A mutation that abrogates the function of ADAM17, an enzyme that cleaves cell-surface proteins such as tumor necrosis factor α, was found to be associated with inflammatory skin and bowel disease in a pair of siblings.

                          • Correspondence

                            To the Editor: Borderline tuberculoid leprosy with type 1 reaction can have an acute presentation in persons infected with HIV. This reaction may develop as part of the immune reconstitution inflammatory syndrome after the initiation of effective antiretroviral therapy.– Despite advances in…

                            • October 20, 2011
                            • N Engl J Med 2011; 365:1549-1551
                            • Free Full Text

                            A case of probable zoonotic leprosy acquired in the United States is described in a patient infected with HIV. The immune reconstitution inflammatory syndrome developed when antiretroviral therapy was initiated.

                          • 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

                              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.

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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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