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November 20, 2008  Vol. 359 No. 21

Audio Summary of this Issue

Perspective
2189-2191

Under a new law, physicians in South Dakota must tell any woman seeking an abortion that she is terminating the life of “a whole, separate, unique, living human being.” Zita Lazzarini argues that these provisions mark a substantial inroad into the ...

2192-2193
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Advances in genomics make it more likely that in the next presidential campaign, DNA will be collected and analyzed to assess genetic risk information that could be used against presidential candidates. Dr. Robert Green and George Annas argue that using ...

Original Articles
2195-2207

In this trial, 17,802 healthy men and women with low-density lipoprotein cholesterol levels of less than 130 mg per deciliter and high-sensitivity C-reactive protein levels of 2.0 mg per liter or more were randomly assigned to rosuvastatin or placebo. At a median of 1.9 years, the incidence of major cardiovascular events was significantly lower in the rosuvastatin group.

2208-2219

The authors of this study genotyped single-nucleotide polymorphisms (SNPs) at 18 diabetes-associated loci in participants of the Framingham Offspring Study. A genotype score based on these risk alleles predicted new cases of diabetes but resulted in only a slightly better prediction of risk than knowledge of common risk factors alone.

2220-2232

Sixteen SNPs were determined and clinical factors examined in two Scandinavian cohorts that were followed for a median of 23.5 years. Type 2 diabetes developed in 11.7% of the subjects. The inclusion of common genetic risk factors, many of which impair the capacity of beta cells to increase insulin secretion, in risk models modestly improved the prediction of future type 2 diabetes.

2233-2244

The timing of initiation of antiretroviral therapy in HIV-infected infants has been debated, in part because of the potential long-term toxicity of the medication, the risk of resistance, adherence challenges, and cost. In this randomized trial involving 377 HIV-infected infants in South Africa, early initiation of antiretroviral therapy reduced infant mortality by 76% and the rate of HIV progression by 75%.

Review Articles
2245-2253

Patients with a history of myocardial infarction and a reduced ejection fraction are at increased risk for life-threatening ventricular arrhythmias. Which of these patients are the most appropriate candidates for implantable cardioverter–defibrillator (ICD) therapy is unclear. Factors influencing the decision are discussed.

2254-2265

This review presents evidence for two overlapping yet distinctive clinical types of sickle cell disease. The basis of one is the vaso-occlusive crisis; the other is the consequence of intravascular hemolysis. The authors focus on the acute vaso-occlusive crisis, the acute chest syndrome, and pulmonary hypertension, all common complications of sickle cell disease.

Videos in Clinical Medicine
e26

    The ability to obtain peripheral intravenous access is an essential and potentially lifesaving skill for all physicians. This video demonstrates how to cannulate peripheral veins with the use of an intravenous catheter.

    Images in Clinical Medicine
    2266
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    A 34-year-old woman with a 3-year history of systemic lupus erythematosus was admitted to the hospital with sore throat and headache that had lasted for 3 weeks. She had been receiving cyclophosphamide for lupus nephritis for the previous 2 years. On the ...

    e27
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    An 84-year-old man was admitted to the hospital because of a decrease in mental status, profound hyponatremia, questionable lung infiltrates, and difficulty swallowing. A barium-swallow examination was performed.

    Case Records of the Massachusetts General Hospital
    2267-2278

      A 59-year-old man was admitted to this hospital with a 6-month history of chronic daily headache, fever, and myalgia. Dry mouth, polydipsia and polyuria, and pain in the jaws on chewing developed. Neuroimaging studies showed diffuse thickening and enhancement of the dura, extending to the pituitary stalk. Computed tomography revealed calcified nodules in the lungs and spleen. A diagnostic procedure was performed.

      Editorial
      2280-2282

      The aphorism “prevention is better than cure” makes perfect sense when applied to healthy habits such as following a sensible diet, maintaining an ideal body weight, exercising regularly, and not smoking. But increasingly, prevention of cardiovascular ...

      Clinical Implications of Basic Research
      2283-2285

      A proof-of-principle study shows that attenuation of a virus can be achieved by interfering with codon-pair bias. The modified virus encodes an amino acid sequence that is identical to that of wild-type virus but is probably translated less efficiently.

      Correspondence
      2286-2289

      To the Editor: In the article by Piot et al. (July 31 issue),1 cyclosporine, an inhibitor of the mitochondrial permeability transition, decreased infarct size after percutaneous coronary intervention (PCI) when administered just before the procedure. ...

      2289-2293

      To the Editor: Weintraub et al. (Aug. 14 issue)1 report the results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, which examined the effect of percutaneous coronary intervention (PCI), as compared ...

      2293-2294

      To the Editor: In his Clinical Practice article on malaria prevention in short-term travelers, Freedman (Aug. 7 issue)1 offers clinical advice for the family of three described in the vignette. For the 29-year-old wife, who is 15 weeks pregnant and has ...

      2294

      To the Editor: The American Heart Association enthusiastically supports the editorial by Curfman et al. (Sept. 4 issue)1 on a bill that would grant authority to the Food and Drug Administration to regulate tobacco products. We believe that this ...

      2294-2296

      To the Editor: The restless legs syndrome (RLS) is a common sensorimotor disorder of unknown cause affecting approximately 10% of the population.1 One uncontrolled study showed that spinal anesthesia caused postoperative RLS.2 We conducted a prospective ...

      Book Reviews
      2297-2298

      This book is about heads of state — presidents, shahs, prime ministers. Author David Owen seeks to examine the relationship between the health of leaders and the quality and integrity of their governance. Owen comes to the subject with appropriate ...

      2298-2299

      In the 1970s and 1980s, the first wave of disability theorists began to criticize medical professionals and bioethicists for using a medical model of disability. They argued that those who subscribed to the medical model were wrong to assume that, as ...

      2299-2300

      Supportive care for patients with cancer is not a new concept — the Multinational Association of Supportive Care in Cancer had its 21st international symposium earlier this year. However, both the nature of the problems encountered by patients with ...