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February 14, 2008  Vol. 358 No. 7

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Perspective
661-663
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A popular component of the candidates' plans for controlling spiraling health care costs involves greater promotion of preventive health measures. Joshua Cohen, Peter Neumann, and Milton Weinstein write that sweeping statements about the cost-saving ...

664-665

The benefits of therapies targeting B cells in autoimmune diseases have led to increased interest in the role of B cells in diseases that have been thought to be largely mediated by T cells. Dr. Henry McFarland discusses the B-cell–mediated processes that ...

Original Articles
667-675

The causes of autism are largely unknown. This study establishes that aberrant dosage of a large genomic segment is associated with autism spectrum disorder. Deletion or duplication of the segment, which encompasses 25 known genes, was present in approximately 1% of case subjects and less than 0.1% of unscreened control subjects.

676-688

In this phase 2 trial involving 104 patients with relapsing–remitting multiple sclerosis, patients who received rituximab on days 1 and 15 had fewer gadolinium-enhancing lesions on magnetic resonance imaging and fewer relapses during 48 weeks of follow-up than patients who received placebo. Rituximab was associated with more adverse events within 24 hours after the first infusion. The study was too small and short to assess uncommon adverse events or long-term safety.

689-699

In a randomized trial, 154 patients with femoropopliteal-artery disease who were undergoing angioplasty were assigned to treatment with a paclitaxel-coated angioplasty balloon, an uncoated balloon with paclitaxel dissolved in the contrast medium, or an uncoated balloon without paclitaxel (control treatment). Late lumen loss, restenosis at 6 months, and target-lesion revascularization at 6, 12, and 24 months were significantly reduced with the paclitaxel-coated balloon but not with paclitaxel-containing contrast medium.

700-708

In this trial, preterm infants who needed ventilatory assistance were randomly assigned to receive initial treatment with nasal continuous positive pressure (CPAP) ventilation, followed by intubation if their condition deteriorated, or immediate intubation and mechanical support. Although there were more pneumothoraxes and fewer days of mechanical ventilation in the CPAP group, there was no difference in mortality or bronchopulmonary dysplasia between the two groups.

709-715

GPR54, a G protein–coupled receptor, and its ligand, kisspeptin, constitute an excitatory neuroregulator system for the secretion of gonadotropin-releasing hormone and appear to be important in the onset of puberty. This report describes an autosomal dominant GPR54 mutation, Arg386Pro, in an adopted girl with idiopathic central precocious puberty.

Review Article
716-727

Acute lower respiratory tract infections are a major cause of death and disability, yet the mechanisms that make such infections so virulent are not entirely understood. This review emphasizes the roles of inflammation and the response of the innate immune system and explains how these two processes interact to rid the lung of microbes but also how they can bring the elimination of infection in the lung to a perilous climax.

Images in Clinical Medicine
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A 63-year-old man who was a retired truck driver had undergone four-vessel coronary-artery bypass grafting and was well, with no recurrent symptoms. However, on follow-up stress echocardiography to assess left ventricular function 14 months later, mild ...

e7
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This 43-year-old woman presented with pain and stiffness in the hands and feet, having had the symptoms for 5 years. Rheumatoid arthritis had been diagnosed. Pulmonary sarcoidosis had also been diagnosed years earlier.

Case Records of the Massachusetts General Hospital
729-735

    An 18-month-old Chinese girl was seen for management of a life-threatening neck contracture due to burns to the face and torso at 12 months of age. The wounds had healed with contractures that resulted in fused nares, microstomia, and sleep apnea. Tracheal intubation was impossible because of the fused nares and microstomia, and scar tissue prevented tracheotomy.

    Editorial
    737-739

      Sixty-five years after Leo Kanner first described autism,1 we are beginning to move beyond description of this clinically heterogeneous neurobehavioral syndrome toward a deeper understanding of its biologic complexity. In areas such as genetics and ...

      Clinical Decisions
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      Large-scale genomic deletions, duplications, and inversions represent a major source of variation among persons; thus, new approaches to probing disease susceptibility are warranted.

      Clinical Implications of Basic Research
      740-741

      Large-scale genomic deletions, duplications, and inversions represent a major source of variation among persons; thus, new approaches to probing disease susceptibility are warranted.

      Correspondence
      742-743

      To the Editor: Fermé et al. (Nov. 8 issue)1 and Diehl in the accompanying editorial2 question the possibility that chemotherapy alone is curative in early-stage Hodgkin's disease. We wish to draw attention to the reported experience with mechlorethamine, ...

      743-746

      To the Editor: In their review article on chronic lung disease after premature birth, Baraldi and Filippone (Nov. 8 issue)1 comment on the absence of pathological findings in the lungs beyond infancy in survivors of bronchopulmonary dysplasia or ...

      746
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      To the Editor: Peters-Golden and Henderson (Nov. 1 issue)1 review the role of the 5-lipoxygenase pathway of arachidonate metabolism and of leukotrienes, a product of that pathway, in asthma, cardiovascular disease, and cancer. The authors conclude that ...

      747-749
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      To the Editor: In their review article on celiac disease, Green and Cellier (Oct. 25 issue)1 state that dietary nonadherence is the most common cause of unresponsive celiac disease. Several psychological disturbances — in particular, depression — are ...

      749-750
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      To the Editor: In the video on chest-tube insertion, Dev et al. (Oct. 11 issue)1 note that chest tubes are generally marked with numbers to indicate the distance into the chest wall. However, this is not the case with the chest tube shown in the video or ...

      750-752

      To the Editor: Cortisol-producing adrenocortical tumors have been associated with abnormalities of the cyclic AMP (cAMP)–signaling pathway. Examples are Cushing's syndrome in infants with the McCune–Albright syndrome due to adrenocortical adenomas that ...

      753-754

      To the Editor: Two independent, well-powered studies have recently identified the interleukin-7 receptor α (IL7RA) gene as a susceptibility gene for multiple sclerosis,1,2 thus extending and confirming earlier observations.3,4 A functional, nonsynonymous ...

      Book Reviews
      755-756

      We are used to thinking that a doctor's ability depends mainly on science and skill . . . these may be the easiest parts of care. Even doctors with great knowledge and technical skill can have mediocre results; more nebulous factors like aggressiveness ...

      756-757
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      No organ has a more immediate and vital connection to human life than the heart. Although we have learned to recognize the brain as the seat of our emotions, cultural symbols — from Valentine's Day cards to images of the Sacred Heart — persist in ...

      757-758

      The editors of the Textbook of Interventional Cardiovascular Pharmacology recruited more than 100 contributors from 17 countries to write 52 chapters. The authors of these chapters are internationally known authorities in the areas of their contributions, ...

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