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April 9, 2009  Vol. 360 No. 15

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Perspective
1477-1479

Perhaps the most profound effect on doctors and patients of the recently enacted stimulus bill will result from its unprecedented $19 billion program to promote the adoption and use of health information technology and electronic health records. Dr. David ...

1479-1481

In February, under the American Recovery and Reinvestment Act, the NIH received $10.4 billion in new funding. Dr. Robert Steinbrook discusses NIH funding under the recovery act.

1482-1483

Today, with the funding for biomedical research dwindling, the current structure of the enterprise is unsustainable. Eric Campbell argues that the fiscal and operational models must be restructured if the stability of academic institutions is to be ...

1484-1485

A new rule from the Department of Health and Human Services aims to raise awareness of and ensure compliance with federal health care conscience protection statutes. Dr. Julie Cantor writes that, taken to its logical extreme, the rule could cause health ...

Original Articles
1487-1499
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Acid reflux is commonly thought to be a preventable cause of wheezing. In this randomized, placebo-controlled trial, the investigators found that proton-pump inhibitors do not reduce asthma exacerbations.

1500-1508
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The authors of this study measured putative brown-adipose-tissue activity in relation to body composition and energy metabolism, using a standard protocol and integrated positron-emission tomography and computed tomography. Twenty-three of 24 healthy men had detectable levels of activity after cold exposure but not under thermoneutral conditions. Brown-adipose-tissue activity was positively related to resting metabolic rate and was significantly lower in overweight or obese subjects than in lean subjects.

1509-1517

This study used 18F-fluorodeoxyglucose positron-emission tomographic and computed tomographic scans to identify substantial depots of brown adipose tissue in a region extending from the anterior neck to the thorax. Such depots were found in 7.5% of the women (76 of 1013) and 3.1% of the men (30 of 959). The amount of brown adipose tissue was inversely correlated with body-mass index, especially in older people, suggesting a potential role of brown adipose tissue in adult human metabolism.

1518-1525

Brown adipose tissue helps maintain normal body temperature in newborn humans but was thought to be absent in healthy adults. This report shows the presence of substantial amounts of metabolically active brown adipose tissue, as documented by biochemical, molecular, and morphologic criteria, and by a cold-induced glucose uptake in paracervical and supraclavicular adipose tissue that was increased by a factor of 15.

Review Article
1526-1538

The prognosis and treatment of myocarditis vary according to the cause, and clinical and hemodynamic data usually offer guidance on when to refer a patient to a specialist for endomyocardial biopsy. The aim of this review is to provide a practical and current approach to the evaluation and treatment of suspected myocarditis.

Images in Clinical Medicine
1539
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A 59-year-old woman with hypertension and diabetic nephropathy presented with a sudden onset of dyspnea after discontinuing her medications. Physical examination revealed hypertension (blood pressure, 225/122 mm Hg), tachycardia (heart rate, 112 bpm), ...

e21

A 16-year-old girl with juvenile dermatomyositis reported having had bleeding gums that had not responded to traditional dental treatment. Close examination of the mouth revealed markedly dilated capillaries in the attached gingiva, with bushy loop ...

Case Records of the Massachusetts General Hospital
1540-1548

A 47-year-old man was admitted to the hospital because of fever, headache, rash, and vomiting. The patient had been well until 8 days earlier, when pleuritic chest pain developed, along with a maculopapular rash that spared the palms and soles. Examination of the cerebrospinal fluid disclosed an elevated white-cell count (70% lymphocytes), elevated protein levels, and a normal glucose level. Vancomycin, ceftriaxone, and acyclovir were administered. Additional diagnostic tests were performed.

Editorials
1550-1551
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Patient safety is a national concern. Major stakeholders throughout our health care system agree that every step must be taken to ensure that medical interventions, used with the intention of improving patients' health, are as safe as possible. But every ...

1551-1553

There are some patients with asthma who have a good response to standard therapy, but there are always some whose symptoms are not well controlled despite treatment with standard asthma medications. Guidelines for the treatment of asthma recommend that ...

1553-1556

Obesity has reached epidemic proportions, and complications related to obesity contribute substantially to health care costs and mortality. Since the accumulation of fat is the net result of a prolonged state of imbalance between energy intake and energy ...

Health Law, Ethics, and Human Rights
1557-1566

In January, the Food and Drug Administration (FDA) issued guidance permitting pharmaceutical and device manufacturers to distribute reprints of articles from medical journals that discuss the off-label use of products. The authors review the history of FDA regulation of off-label promotion and discuss the pertinent legal and policy issues.

Clinical Implications of Basic Research
1567-1569

A protein implicated in the preservation of cardiomyocytes during infarction may also promote fibrosis.

Correspondence
1570-1571

To the Editor: Tita et al. (Jan. 8 issue) suggest that delaying elective repeat cesarean delivery until 39 weeks of gestation will decrease the incidence of neonatal morbidity.1 However, delaying repeat cesarean delivery may have maternal and fetal ...

1571-1572

To the Editor: Cecil and colleagues (Dec. 11 issue)1 report that the A allele of the fat mass and obesity–associated (FTO) gene variant rs9939609, which has been associated with obesity, is also associated with increased levels of physical activity in ...

1572-1574

To the Editor: In the Case Record of a patient with hypocalcemic seizures due to vitamin D deficiency, discussed by Holick et al. (Jan. 22 issue),1 it is surprising to note that in spite of these seizures, he was treated with fosphenytoin twice. ...

1574

To the Editor: In their Image in Clinical Medicine, Zalts and Hayek (Dec. 18 issue)1 describe a woman with postpartum venous thromboembolism. The patient was found to be heterozygous for a mutation in the gene encoding for 5,10-methylenetetrahydrofolate ...

1574-1575

To the Editor: Graves' disease is treated with antithyroid drugs, radioactive iodine, or surgery.1,2 Propylthiouracil and methimazole are widely used in children as first-line therapy.1,2 Over the past 60 years of propylthiouracil and methimazole use, ...

Book Reviews
1576-1577

Placebo Effects is a comprehensive monograph on placebo that appears at an auspicious time, after we have had a chance to digest recent research using brain imaging to determine possible placebo effects. Its author, Fabrizio Benedetti, and his group at ...

1577

Clinical research in developing countries has generated considerable discussion. Especially controversial are the use of a placebo instead of the best proven treatment as a control, and the availability of a test intervention after the trial. That such ...

1578-1579

Sustainable health, which mirrors the concept of sustainable development, is about good health for the current generation that does not come at the expense of good health for future generations. This theme is central to Sustaining Life, which illustrates ...

Correction
1579

EGFR Antagonists in Cancer Treatment Review Article, N Engl J Med 2008:358;1160-1174.. In Table 2 (page 1163), the information for gefitinib under Approved Uses should give the FDA approval date as May 2003. In the Clinical Efficacy of EGFR Antagonists in ...

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