This study from Delhi, India, assessed 1442 men and women 26 to 32 years of age who had been evaluated at birth and throughout childhood in a prospective, population-based study. Subjects who currently had impaired glucose tolerance or diabetes typically had a low body-mass index up to the age of two years, followed by an early, accelerated increase in body-mass index.

If these observations are confirmed, it may be possible to delay or prevent diabetes in early childhood by protecting infant growth and preventing children from crossing into higher categories of body-mass index.

Infliximab, a monoclonal antibody against tumor necrosis factor, reduces disease activity in patients with Crohn's disease. In this study of patients with fistulizing Crohn's disease who had a response to infliximab, continued infusions every 8 weeks were associated with a longer duration of response than were placebo infusions. After 54 weeks of treatment, 36 percent of patients in the infliximab group and 19 percent of those in the placebo group had no draining fistulas.

Maintenance treatment with infliximab reduced the likelihood of relapse in patients with fistulizing Crohn's disease.

This study showed that sickle cell disease is complicated by pulmonary hypertension in about one third of adult patients. Even more important, patients with pulmonary hypertension have a much higher mortality rate than those without pulmonary hypertension.

Pulmonary hypertension, which can be diagnosed noninvasively with Doppler echocardiography, is a finding that indicates a poor prognosis for patients with sickle cell disease. Trials of interventions aimed at mitigating pulmonary hypertension are urgently needed.

After the introduction of an intranasal influenza vaccine in Switzerland, there were several dozen reports of Bell's palsy in vaccine recipients. In this careful study, even with conservative assumptions, the risk of Bell's palsy appeared to be increased by a factor of 19 among those who received the intranasal vaccine. The risk of Bell's palsy was not increased after parenteral influenza vaccination.

This formulation of an inactivated intranasal influenza vaccine was available only in Switzerland and has since been withdrawn from the market. This report documents a low-frequency adverse effect that could not be detected in prelicensure trials.

An otherwise healthy 40-year-old man felt feverish and noted pain and redness over the dorsum of his foot. Tender edema and erythema extended up the pretibial area. Fissures were present between the toes. What diagnostic procedures and treatment are indicated?

Gene therapy, in which a retrovirus was used to carry the relevant gene (IL2Rc) into a patient's hematopoietic stem cells, was used to treat 10 boys with X-linked severe combined immunodeficiency (SCID). A syndrome resembling T-cell leukemia developed in two of the boys. In both boys — and a third in whom leukemia has not developed — the retrovirus integrated into the same genomic site, the locus of LMO2, which is involved in childhood lymphocytic leukemia. This article reviews the molecular biology of these events and discusses their implications for the future of gene therapy.

A 48-year-old woman with multiple pigmented skin lesions and a personal and family history of melanoma had been followed since the age of 32 in a clinic specializing in pigmented lesions. This Case Record reviews the classifications of familial mole and melanoma syndromes and discusses the role of genetic testing and the approach to management for this patient and her family.

This Health Policy Report reviews recent policy changes in Britain's National Health Service (NHS). The government plans to increase spending on health to 8 percent of the gross domestic product, which is the average level of spending across the European Union. The report discusses the implications of new initiatives to decentralize management of the NHS, improve the quality of health care, reduce patients' waiting times, and make the NHS more consumer-oriented.