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October 19, 2006  Vol. 355 No. 16

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Perspective
1633-1637
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Human embryonic stem-cell research has become a political issue for many candidates for federal and state offices around the country. Dr. Susan Okie reports.

1634-1635
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Dr. Susan Okie discusses the controversy surrounding a recent report suggesting that new stem-cell lines may be generated while preserving embryos. On the contrary, all donated embryos used in the study were destroyed during the experiments.

1637-1640

Seriously ill Americans are receiving treatment at advanced private hospitals in low-income countries. Drs. Arnold Milstein and Mark Smith write that the trend is driven by the escalation of out-of-pocket spending for health care and insurance premiums ...

1640-1642

The development of guidelines for the treatment of sepsis was orchestrated as an extension of a pharmaceutical marketing campaign. Drs. Peter Eichacker, Charles Natanson, and Robert Danner write that the campaign appears to have usurped guideline ...

1643-1645

Thrombopoietic agents represent a promising new therapeutic strategy for ITP that is refractory to second- and third-line therapies. Dr. Michael Bromberg describes the pathogenesis of this chronic disease and the evolution of therapeutic options.

Original Articles
1647-1659

This 2-year controlled, randomized, double-blind study examined the effects of dehydroepiandrosterone (DHEA) in women and DHEA or testosterone in men, as compared with placebo. Neither DHEA nor low-dose testosterone replacement in the elderly subjects had physiologically relevant beneficial effects on body composition, physical performance, insulin sensitivity, or quality of life. The results of this study do not support the use of these agents as antiaging supplements.

1660-1671

In this randomized trial of patients with symptomatic carotid stenosis of 60% or more, patients who underwent endarterectomy had lower rates of death or stroke at 1 month and 6 months than patients who underwent stenting.

1672-1681

AMG 531 is a novel dipeptide linked to the Fc fragment of IgG. It is structurally unrelated to thrombopoietin but can stimulate the thrombopoietin receptor. In this phase 1–2 study of AMG 531 in patients with chronic immune thrombocytopenia, there were no major adverse events that could be attributed to the protein. AMG 531 elevated platelet counts in about half the patients, but platelet counts returned to previous low levels after discontinuation of the treatment.

1682-1689

This prospective cohort study of 802 infants showed significant associations between reduced lung function at birth, as determined by tidal breathing measures and passive respiratory mechanics, and the risk of asthma by 10 years of age. These findings indicate that alterations of airway function associated with subsequent asthma may be detectable shortly after birth.

Clinical Practice
1690-1698

A 38-year-old man reports pelvic pain, dysuria, and urinary urgency for the past 4 weeks. He has had several similar episodes over the past 2 years; urine cultures were not performed. He is sexually active and reports frequent discomfort after ejaculation. He is otherwise healthy and takes no medication. He has no fever, chills, or flank pain. How should he be evaluated and treated?

Review Article
1699-1713

A better understanding of the inflammatory, procoagulant, and immunosuppressive aspects of sepsis has contributed to rational therapeutic plans. This review considers optimal management of sepsis from the point of early, goal-directed therapy, lung-protective ventilation, antibiotics, and additional therapies, such as activated protein C, as well as the use of corticosteroids, vasopressin, and intensive insulin.

Images in Clinical Medicine
1714
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A previously healthy 102-year-old woman was admitted with abdominal pain and a 3-day history of vomiting. She lived with relatives, but cared for herself, and was able to garden. There was no history of abdominal surgery. On examination, her abdomen was ...

e17
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This 54-year-old man presented with hemoptysis and a remote history of tuberculosis. He then had an episode of massive hemoptysis.

Case Records of the Massachusetts General Hospital
1715-1722

A 3-year-old girl was admitted to the hospital with fever, rigors, lethargy, nausea, vomiting, and parasitemia 5 days after returning from a trip to Nigeria. She had not received antimalarial prophylaxis. On admission, the patient had anemia and thrombocytopenia. Twelve hours later, she had a generalized tonic–clonic seizure and hypotension and acidosis developed with an increasing level of parasitemia. A therapeutic procedure was performed.

Editorials
1724-1726

The search for eternal youth is vibrant in North America. In this search, it is all too easy to ascribe the aging process to endocrines. Although the secretion of growth hormone falls by about 12% per decade after middle age, perhaps the greatest ...

1726-1729

As compared with carotid endarterectomy, carotid-artery stenting has uncertain efficacy and safety in patients at risk for stroke from atherosclerotic stenosis of the internal carotid artery. The benefits of carotid endarterectomy for both symptomatic and ...

Health Policy Report
1730-1735
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The authors review existing regulations regarding cell and tissue products and discuss how they expect the Food and Drug Administration to apply these regulations to scientists' efforts to develop and test stem-cell–based therapies.

Correspondence
1736-1737

To the Editor: Two points in the report by Fiellin et al. (July 27 issue)1 on the use of counseling plus buprenorphine–naloxone maintenance therapy for opioid dependence warrant further discussion. First, the authors report that patients' adherence to ...

1737-1738

To the Editor: In the report by Fischer et al.1 and the accompanying Perspective article by Peters2 (May 25 issue) on two outbreaks of lymphocytic choriomeningitis virus (LCMV) infection in organ-transplant recipients, the authors focus long overdue ...

1738-1739
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To the Editor: The article by Jarcho (July 20 issue)1 summarizes the usefulness of biventricular pacing in the setting of chronic heart failure. Randomized clinical trials have shown a significant improvement in left ventricular function and remodeling ...

1740

To the Editor: In the Case Record describing a 77-year-old man with a rapidly progressive gait disorder (July 20 issue),1 paraneoplastic syndrome might have been discussed in more depth. The fluctuating clinical course of encephalopathy and motor neuron ...

1741-1742

To the Editor: The mapping of health data is now widespread in both academic research and public health practice.1 Although the notion that location influences the risk of disease dates back to the mapping of yellow fever and cholera in the 1800s, ...

Book Reviews
1743

“If there is a moral to my story — one that I could wish for the entire medical profession — it is transformation.” In Awakening Hippocrates, Edward O'Neil calls for internationalizing a medical profession that is provincial in experience, training, ...

1743-1745

The front cover of this book includes a reproduction of Pablo Picasso's The Absinthe Drinker — an appropriate beginning to a compelling work that spans the spectrum from molecules to the mind and behavior. In the painting, a middle-aged woman sits at a ...

1745-1746

In his largely autobiographical book, In Search of Memory, Nobel laureate Eric Kandel takes us, in a tour de force, on the two complementary voyages — one private, one professional — that have encompassed his life. Kandel elucidates the transformation of ...

Corrections
1746

Prevalence and Correlates of Accelerated Atherosclerosis in Systemic Lupus Erythematosus Original Article, N Engl J Med 2003:349;2399-2406.. On page 2403, in Table 2, the 12th entry should have read “Homocysteine (μmol/liter),” not “Homocysteine (mg/dl),” ...

1746

A Randomized Trial of Exemestane after Two to Three Years of Tamoxifen Therapy in Postmenopausal Women with Primary Breast Cancer Original Article, N Engl J Med 2004:350;1081-1092.. On page 1081, the list of authors should have included “Cornelius van de ...

1746

Erlotinib in Lung Cancer — Molecular and Clinical Predictors of Outcome Original Article, N Engl J Med 2005:353;133-144.. On page 139, the second line from the bottom of the right-hand column should have read “95 percent confidence interval, 0.40 to 1.50; ...