The Struggle for Reform — Challenges and Hopes for Comprehensive Health Care Legislation
Leading Democrats are relentlessly pursuing health care reform, as they hold hearings, engage key stakeholders, plot strategy, and draft legislation. The outlines of a proposal that could attract the support of a sizable majority of Democrats are emerging. John Iglehart reports.
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Published Online April 1, 2009 (DOI: 10.1056/NEJMp0902651)
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Common Genetic Variation and Human Traits
Researchers now know how to properly account for most of the multiple hypothesis testing involved in mining the genome for associations, and most reported associations reflect real biologic causation. But, David Goldstein asks, do they matter?
Published Online April 15, 2009 (DOI: 10.1056/NEJMp0806284)
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Genomewide Association Studies — Illuminating Biologic Pathways
Skeptics have questioned the value of genomewide association studies. Dr. Joel Hirschhorn writes that the main goal of these studies is not prediction of individual risk but rather discovery of biologic pathways underlying polygenic diseases and traits.
Published Online April 15, 2009 (DOI: 10.1056/NEJMp0808934)
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Genetic Risk Prediction — Are We There Yet?
Why not begin testing for common genetic variants whose associations with susceptibility to disease have been established? Peter Kraft and David Hunter write that the answer lies in the stability of the current risk estimates.
Published Online April 15, 2009 (DOI: 10.1056/NEJMp0810107)
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Minimally Invasive Total Knee Arthroplasty
Joint-replacement surgery is appropriate for patients with moderate-to-severe symptoms and functional limitation despite conservative therapy. The minimally invasive technique reduces postoperative pain and accelerates recovery but requires a surgeon with specific expertise and experience.
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Understanding Genetic Causes of Disease
Genomewide association studies have uncovered many genetic variants that confer susceptibility to disease. This article describes the genomewide association study and new approaches that may address some of its limitations.
Published Online April 15, 2009 (DOI: 10.1056/NEJMra0808700)
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Autophagy and Crohn’s Disease
Recent studies show that a gene implicated in susceptibility to Crohn’s disease critically affects autophagy in the Paneth cell and macrophage.
Published Online April 15, 2009 (DOI: 10.1056/NEJMcibr0810347)
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A Woman with Respiratory Failure and a Cavitary Lesion in the Lung
A 54-year-old woman was admitted to the hospital because of respiratory failure, hypotension, and a cavitary lesion in the lung. She had had cough and shortness of breath for a week, which abruptly worsened, and she collapsed at home.
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Coronary Bypass Surgery with or without Surgical Ventricular Reconstruction
Patients with coronary artery disease and an ejection fraction of 35% or less were randomly assigned to undergo either coronary-artery bypass grafting (CABG) or CABG plus surgical ventricular reconstruction. At a median of 48 months, there was no significant difference in the primary outcome of death or hospitalization for cardiac causes.
CME Exam
Published Online March 29, 2009 (DOI: 10.1056/NEJMoa0900559)
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Susceptibility Locus for Stroke
A genomewide association study indicates that a locus on chromosome 12 confers susceptibility (with a hazard ratio of approximately 1.3) to ischemic stroke. This locus is close to NINJ2, which encodes a cell adhesion molecule that shows increased expression on glia in response to nerve injury.
Published Online April 15, 2009 (DOI: 10.1056/NEJMoa0900094)
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HTRA1 Mutations and Familial Ischemic Cerebral Small-Vessel Disease
This study implicates HtrA serine peptidase 1 (HTRA1), a protease that represses signaling of TGF-β members in hereditary ischemic cerebral small-vessel disease.
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Changes in the Incidence and Duration of Periods without Insurance
The authors estimate that losing health insurance was more common in 2001–2004 than in 1983–1986, and people who lost insurance became more likely to transition to public insurance than to private insurance. This suggests that the availability of public insurance programs has become increasingly important.
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