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November 17, 2011  Vol. 365 No. 20

Audio Summary of this Issue

Perspective
1853-1856
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The 2012 presidential election campaign has created uncertainty about federal funding for human embryonic stem-cell research, with most Republican candidates suggesting that they would substantially reduce such funding. Where do U.S. voters stand on this issue? This Perspective summarizes polling results.

1856-1858

Somalia has been in the grips of disaster for two decades. Throughout this past summer, the human catastrophe dramatically worsened. Severe malnutrition and measles are rampant among Somali refugees in Kenya and Ethiopia and internally displaced people within Somalia.

1859-1861

The sustainable-growth-rate formula (SGR) used to calculate Medicare's physician fees remains a political football. MedPAC recommends replacing it with a “predictable 10-year path” of fee-schedule updates, offset by reduced payments to various providers and suppliers.

Original Articles
1863-1875
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Each year, about 225 million persons have malaria, with some 781,000 associated deaths. In a preliminary report of a phase 3 trial in African children, the RTS,S/AS01 malaria vaccine had about 50% efficacy against incident malaria and 34% efficacy against severe disease.

1876-1885

In four prospective cohort studies, obese adults who were overweight or obese in childhood had increased rates of cardiovascular risk factors. Those who were overweight or obese as children but not as adults had risks similar to the risks among those who were never obese.

1886-1895

In this double-blind, randomized trial, mycophenolate mofetil was superior to azathioprine for maintaining a renal response and preventing relapse in patients with lupus nephritis who had had a response to induction therapy.

1896-1904

This large study found no increased risk of cardiovascular events in children and young adults using attention deficit–hyperactivity disorder (ADHD) drugs. Although the data are compatible with nearly a doubling of risk, the study was underpowered and the absolute event rate was quite low.

Clinical Therapeutics
1905-1914

A 41-year-old woman presents with severe pneumonia, and the acute respiratory distress syndrome (ARDS) develops. Despite mechanical ventilation, her oxygenation deteriorates. The use of extracorporeal membrane oxygenation (ECMO) is recommended.

Images in Clinical Medicine
1915
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A 46-year-old male smoker presented to the ER with chest pain and shortness of breath. He was in mild distress, with an oxygen saturation of 97% while breathing ambient air. The physical examination revealed hyperresonance and decreased breath sounds on the left.

e40
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A 44-year-old man presented with severe right otalgia after an outbreak of a rash on the right side of his face. He had been treated for AML with cord-blood stem-cell transplantation 6 months earlier and had received immunosuppressive therapy with glucocorticoids.

Case Records of the Massachusetts General Hospital
1916-1924

A 33-year-old woman was admitted to the ICU 16.5 hours post partum because of leukocytosis and gram-positive rods in the blood. Diagnostic test results were received, and management decisions were made.

Editorials
1926-1927
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It's been a long time coming, and indeed we are still not there yet, but it is becoming increasingly clear that we really do have the first effective vaccine against a parasitic disease in humans. If there are no unforeseen disasters, the RTS,S/AS01 ...

1927-1929

Obesity is the most common nutritional problem among children in both developed and underdeveloped countries. Despite efforts over the past decade to prevent and control obesity, data from the 2003–2006 National Health and Nutrition Examination Surveys (...

1929-1930

Systemic lupus erythematosus is a prototypical autoimmune disease that can potentially involve every organ. Its clinical spectrum is therefore extremely heterogeneous and varies from relatively mild cases (e.g., involving only the skin or joints) to life-...

Clinical Implications of Basic Research
1931-1933

CDKAL1, a gene implicated in susceptibility to type 2 diabetes, has been found to mediate a fundamental event in protein translation that affects proinsulin processing.

Correspondence
1934-1935

To the Editor: To recommend antiretroviral therapy (ART) as a policy to prevent transmission of the human immunodeficiency virus type 1 (HIV-1), it is critical to understand the risk of transmission through sex without condom use when the plasma viral ...

1936-1937

To the Editor: Rahman and colleagues (Aug. 11 issue)1 found improved fluid drainage in patients with pleural infections and a reduced frequency of surgical referral and duration of hospital stay after combined therapy with intrapleural tissue plasminogen ...

1937-1939

To the Editor: Porter et al. (Aug. 25 issue)1 report that chimeric antigen receptor–modified T cells proliferated and survived after infusion in a patient with chronic lymphoid leukemia, and they exerted potent antitumor activity. However, the authors ...

1939-1940

To the Editor: Jena et al. (Aug. 18 issue)1 provide important insight into the medical malpractice quagmire. The data are presented and analyzed from the perspective of claims against individual physicians. In practice, an individual patient frequently ...

1940-1942

To the Editor: Mosaicism of an oncogenic AKT1 mutation causes Proteus syndrome, which is associated with epidermal nevi and an increased risk of cancer.1 The occurrence of oncogenic mutations in mosaicism may increase a person's risk for malignant ...

1942-1944

Hypobaric hypoxia occurs during ascent to higher altitude. In this observational study of healthy lowland dwellers, intracellular red-cell forms of nitric oxide, S-nitrosohemoglobin, and iron nitrosyl hemoglobin increased strikingly during ascent to 5050 m.

Corrections
1944

Medicare Drug Prices and the Deficit Perspective, N Engl J Med 2011;365:1657-1659. In the sixth paragraph (page 1658), beginning “Where competition is not robust,” the final sentence should have ended, “even though those receiving subsidies account for ...

1944

Case 39-2010: A 19-Year-Old Woman with Nausea, Jaundice, and Pruritus Case Records of the Massachusetts General Hospital, N Engl J Med 2010;363:2548-2557. In the fourth paragraph (page 2548), beginning “The next day,” the fifth sentence should have begun, ...

1944

Safety of Recombinant Activated Factor VII in Randomized Clinical Trials Original Article, N Engl J Med 2010;363:1791-1800. In the Results section of the Abstract (page 1791), the first sentence should have read, “Among 4468 subjects (4119 patients and ...