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January 18, 2007  Vol. 356 No. 3

Audio Summary of this Issue

Perspective
209-211

Gerard Anderson and Edward Chu argue that international health organizations need to greatly expand their efforts to prevent and treat noncommunicable chronic diseases.

212

The rapidly increasing global burdens of cardiovascular disease and diabetes call for interventions that have a population-wide effect. Dr. K. Srinath Reddy discusses the advocacy of a “polypill” — a single pill that would include a number of key drugs.

213-215
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Propelling an upsurge in cases of diabetes and hypertension is the growing prevalence of overweight and obesity. Drs. Parvez Hossain, Bisher Kawar, and Meguid El Nahas write that preventing obesity, diabetes, and hypertension will require fundamental ...

Original Articles
217-226

A small population of distinctive breast-cancer cells can recapitulate an entire breast cancer when injected into immunodeficient mice. These cells express a unique group of genes, which when expressed in patients with breast cancer portend a poor outcome. Surprisingly, this group of genes is also expressed in prostate and lung cancer and medulloblastoma. This gene group is associated with invasiveness in a range of neoplasms.

227-236

The light appearance of epithelium and stroma in a mammogram (mammographic density) can hide the presence of a cancer. A careful study of this problem found that extensive mammographic density is an important risk factor for breast cancer.

237-247

Of 300 persons selected for early-onset obesity, hyperphagia, and consanguineous parentage, 8 had mutations in the leptin-receptor gene (LEPR). Biochemical and clinical analyses of the affected subjects suggest that the assay of serum leptin levels is not an appropriate screening tool for LEPR mutations and that the LEPR protein product may not be the only leptin receptor in humans.

248-261

The authors report long-term follow-up of otherwise healthy young children with persistent middle-ear effusion who received either prompt insertion of tympanostomy tubes or delayed insertion if effusion persisted, as part of a randomized clinical trial or a separate observational cohort study. Prompt insertion of tympanostomy tubes did not improve developmental outcomes at 9 to 11 years of age — findings that were consistent with the results up to the age of 6 years. These findings provide additional support for a strategy of watchful waiting for children who have persistent middle-ear effusion.

Review Articles
262-270

    Thousands of international aeromedical evacuations are conducted every year. An increasing number of travelers are elderly or have chronic illnesses, and there is more travel to regions where road trauma and infectious diseases are endemic but dependable medical care is not available. This review explains the indications for aeromedical evacuation, as well as the logistics, safety considerations, and principles of in-flight care for sick or injured patients.

    271-283

    Preterm birth is associated with high rates of infant mortality and morbidity. This review emphasizes that the onset of labor entails a molecular collaboration between the mother and the fetus. Knowledge of these molecular mechanisms will be essential in understanding the causes and prevention of preterm birth.

    Images in Clinical Medicine
    284
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    A previously healthy 56-year-old woman had spontaneous eruption of a lacy, net-like erythema of her entire skin, which was especially pronounced on her arms and legs (Panel A). The erythema of her lower arms disappeared within 2 minutes after immersion ...

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    In this 85-year-old woman with lung cancer, bluish discoloration of the left great toe was noted, followed by progressive swelling and cyanosis of the leg.

    Case Records of the Massachusetts General Hospital
    285-292
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    A 49-year-old woman was seen in consultation for management of cutaneous melanoma. A pigmented lesion on her upper arm had been excised at another facility, and a superficial spreading malignant melanoma, 0.91 mm thick, with a vertical growth phase was diagnosed. Sentinel lymph-node biopsy disclosed a nest of tumor cells in one of two lymph nodes. A decision on management was made.

    Editorials
    294-297

    The advent of technology for the analysis of human tissue samples for the activity of the entire genome initiated a quest for the molecular profiling of tumors. The aim of this quest was a better system for classifying cancers, a clarification of the ...

    297-300

    That mammographic density is an important risk factor for breast cancer was first recognized by Wolfe in the 1970s. His pioneering observation has since been confirmed in more than 42 studies, the vast majority of which have shown an association between ...

    300-302

    Retrospective studies carried out in the 1950s, 1960s, and 1970s suggested an association between otitis media early in life and subsequent developmental impairments in children. Although these studies were not designed to establish a cause-and-effect ...

    Clinical Implications of Basic Research
    303-304

      Molecules that mediate cell migration in response to a chemical gradient also mediate migration in response to a gradient of electric potential in the context of wound healing.

      Correspondence
      305-307

      To the Editor: Mas et al. (Oct. 19 issue)1 report the results of the randomized Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial, which suggest the superiority of carotid endarterectomy over carotid-...

      307-308

      To the Editor: Bussel et al. (Oct. 19 issue)1 justify the rationale for using the thrombopoiesis-stimulating drug AMG 531 in chronic immune thrombocytopenic purpura (ITP) by citing previous reports on abnormalities of megakaryocytic survival and ...

      308-311

      To the Editor: In the Clinical Therapeutics article by Pisansky (Oct. 12 issue),1 intensity-modulated radiotherapy with photons and proton therapy2 are mentioned, but intensity-modulated proton therapy3 and tomotherapy are not.4 With proton therapy, ...

      311
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      To the Editor: In the Clinical Problem-Solving article, “Lost in Transcription” (Oct. 5 issue),1 Kalus and colleagues quickly home in on a medication error involving methotrexate overdosing as the likely cause of the patient's fever and presumed ...

      311-312

      To the Editor: Dr. Melton (July 6 issue)1 misrepresents my study on the reversal of type 1 diabetes in mice and its implications for new treatment strategies in humans.2 As in a previous study,3 my colleagues and I discovered that an immune therapy ...

      312-313

      To the Editor: Strains of influenza A (H3N2) virus with a specific mutation (Ser31Asn) have recently shown a dramatic increase in resistance to amantadine in communities in Asia and North America. This resistance in 70 to 90% of strains has occurred ...

      Book Reviews
      314-315

      Toward the end of Goethe's Faust (Part 1), Mephistopheles rejects Faust's demand that the devil rescue Gretchen, saying, “Who was it that plunged her into ruin? I or you?” In a provocative and penetrating satire, Medicare Meets Mephistopheles, David Hyman ...

      315-316

      Most of us know someone like Paul (a pseudonym). He has a master's degree in computer science and works as a contract employee for a large software company. He has a good job and earns a decent salary. But like many other college-educated, full-time ...

      316-317

      Virtually all of us are frustrated by the high costs and underperformance of the U.S. health care system. We spend about twice as much per capita on health care as our European counterparts, yet our results on key metrics such as infant mortality rates ...

      317-318

      Disparities in health resulting from social class, race or ethnic group, and sex have long been viewed as the elephant in the room of public health practice and discourse. But in fact, so often has the fundamental determining role of these social ...

      Correction
      318

      Paclitaxel–Carboplatin Alone or with Bevacizumab for Non–Small-Cell Lung Cancer Original Article, N Engl J Med 2006:355;2542-2550.. In the fifth paragraph of the Discussion section (page 2548), the third sentence should have read “The median overall ...

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