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October 6, 2005  Vol. 353 No. 14

Perspective
1433-1436
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Extreme weather events reflect massive and ongoing changes in our climate to which biologic systems on all continents are reacting. Dr. Paul Epstein writes about some of the health effects that may lie ahead if the increase in very extreme weather events ...

1437-1439

The intelligent design movement has attracted much support. Acquiescing to this anti-science movement, writes Dr. Robert Schwartz, would have far-reaching consequences for the development of future generations of physicians, for the likelihood of ...

1439-1441

Medicaid is the nation's health safety net, but as Diane Rowland explains, its growing role and increasing costs in the face of state budgetary pressures and the federal deficit have made it a target for reform that could fundamentally reshape the ...

Original Articles
1443-1453
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It is well known that among patients with cystic fibrosis who have the ΔF508 deletion mutation, there is substantial variation in the severity of clinical disease. These investigators identified, and then replicated in a second population, variants in the DNA encoding of the TGFβ1 gene that were associated with more severe disease.

1454-1462

Do higher fasting plasma glucose levels within the normal range independently predict the risk of type 2 diabetes? This study revealed a progressively increased risk of incident diabetes with fasting plasma glucose levels at the high end of the normal range. Fasting glucose levels, when considered together with body-mass index and triglyceride levels, may help to identify apparently healthy young men at increased risk for diabetes.

1463-1470

An outbreak of gastroenteritis on a cruise ship led to the identification of 62 people with diarrhea due to V. parahaemolyticus after consumption of raw Alaskan oysters. The source of the oysters was 1000 km farther north than the source for any previous outbreak. Rising ocean temperatures seem to have contributed to this outbreak.

Special Article
1471-1480
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Eight clinical trials have evaluated the benefit of the implantable cardioverter–defibrillator (ICD) in patients with left ventricular dysfunction but no previous life-threatening ventricular arrhythmia. The cost-effectiveness of the ICD in this setting was investigated with the use of a Markov model that incorporated data from these trials. Prophylactic implantation of an ICD was estimated to have a cost-effectiveness ratio below $100,000 per quality-adjusted life-year gained.

Clinical Practice
1481-1488

    A 17-year-old girl is taken to her physician by worried parents. Never overweight, in the past six months she became determined to reduce from her baseline weight of 59.1 kg. Her height is 1.7 m; body-mass index, 21. Through dieting and exercise, she lost 13.6 kg and stopped menstruating four months ago; her current body-mass index is 16. She denies having any problems and is annoyed that her parents, friends, and teachers are concerned. How should she be evaluated and treated?

    Review Article
    1489-1501

    This review discusses the structure and function of molecular chaperones, with emphasis on their role in rescuing misfolded proteins. It also includes a discussion of the diseases in which abnormalities of these caretaker molecules or their molecular partners have been found.

    Images in Clinical Medicine
    1502
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    A 10-year-old boy has a brown right eye and a blue left eye, as well as mild ptosis and miosis of his left eye. What is the condition he had at the age of 10 months?

    Clinical Problem-Solving
    1503-1507

      A 50-year-old man presented to the clinic with fever, chills, and generalized weakness that he had had for three weeks. He also noticed pain and swelling in his right hand and left elbow, a weight loss of about 4.5 kg, and occasional upper abdominal pressure. He had no nausea, vomiting, diarrhea, dyspnea, or dysuria.

      Editorials
      1509-1511

      Susceptibility genes and modifier genes are two biologic phenomena that few clinicians should ignore in the genome era. Susceptibility genes, which are genes with functional variants that affect the causes of disease, are routinely being identified for ...

      1511-1513

      We live in an era in which the public interest in medical matters is high. When so much information and misinformation are available on the Internet, many patients devote a fair share of time to matching their most recent laboratory results with the “...

      1513-1515

      The remarkable reduction of 50 percent or more in the age-adjusted mortality rate from coronary heart disease over the past four decades in the United States1 has been driven by three parallel phenomena: an understanding of the risk factors that influence ...

      Sounding Board
      1516-1522

        In this article, the authors discuss the obstacles to the use of cost-effectiveness analysis in Medicare decisions about coverage. They argue that policymakers could avert the impending financial crisis facing Medicare by incorporating cost-effectiveness analysis into a comprehensive strategy to allocate health care resources more rationally.

        Correspondence
        1523-1524

        To the Editor: In the randomized trial of adjuvant chemotherapy for patients with stage IB or stage II non–small-cell lung cancer reported by Winton et al. (June 23 issue),1 a statistically significant survival advantage was found overall, but no ...

        1524
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        To the Editor: In his Clinical Practice article (June 16 issue),1 Abrams suggests that a 24-hour interval is warranted between the use of the phosphodiesterase inhibitors sildenafil, vardenafil, and tadalafil and the use of nitrates to prevent serious ...

        1525-1527

        To the Editor: In his Perspective article, Topol (July 14 issue)1 discusses current clinical practice with respect to nesiritide. According to the Food, Drug, and Cosmetic Act, drug approval can be withdrawn when “new evidence of clinical experience, not ...

        1527-1529

        To the Editor: Avorn's proposal in his Perspective article (June 23 issue)1 that the combination of torcetrapib and atorvastatin is market-driven, undermining its usefulness, is baseless. The program does not extend the patent on atorvastatin. Its basic ...

        1529-1530

        To the Editor: The case described by Medoff et al. (June 9 issue)1 and a similar one published in the Journal eight years ago2 illustrate how rapidly the acute respiratory distress syndrome (ARDS) related to sickle cell anemia can become irreversible. In ...

        1530-1531

        To the Editor: Post-marketing surveillance has revealed a higher incidence of reactivation of granulomatous infections — most notably, tuberculosis1 and histoplasmosis2 — in patients receiving the tumor necrosis factor α (TNF-α) inhibitor infliximab (...

        1532

        To the Editor: Recently, a patient presented to our emergency department with severe poisoning after ingesting an aconite-containing tea with therapeutic intent. Her course highlights the potentially great danger of ingesting such a preparation. The ...

        Book Reviews
        1533

        “When I first became aware of commercialism as a possibility in organ transplantation, I, like most everybody here . . . was very opposed to it and thought it a terrible thing. More recently, I am not so sure. I think the issue is much more complex than ...

        1534-1535

        Rigorous control of hyperglycemia has been shown to slow the progression of complications in patients with diabetes or prevent them altogether. Nonetheless, the management of blood glucose by the administration of insulin has failed to achieve true ...

        1535

        The rapid progress in our understanding of the fundamental mechanisms of neoplasia and the pace of discovery in diagnostics and therapeutics in malignant hematology present great challenges for publishers and editors of hematology textbooks. Chapters that ...

        1535-1536

        Hemophilia is an unusual sex-linked inherited hemorrhagic disorder, but it has contributed to the advancement of biomedical knowledge and medical practice at a level that far exceeds its relatively low incidence. Transfusion medicine, cell biology, and ...

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