Cystatin C is a cysteine protease inhibitor that is freely filtered by the glomerulus and is therefore a measure of renal function. In this study of elderly persons, the serum cystatin C level was a better predictor of the risk of death and cardiovascular disease than was the serum creatinine level. Cystatin C is a useful alternative measure of renal function, as well as an effective prognostic tool.

A prior study of colon-cancer screening in men demonstrated that 30 percent of advanced colonic neoplasias found on colonoscopy would have been missed by flexible sigmoidoscopy. In this parallel study of women, the yield of flexible sigmoidoscopy was even lower: 65 percent of advanced lesions found on colonoscopy would have been missed by flexible sigmoidoscopy.

These data suggest that in women, flexible sigmoidoscopy is a much less effective screening test for colon cancer than colonoscopy.

Asymptomatic newborns in whom infantile Krabbe's disease was diagnosed at or before birth and who underwent transplantation of umbilical-cord blood had progressive myelination and substantial gains in several developmental skills, although they continued to have substantial delays in gross motor function and language.

These data suggest that transplantation of umbilical-cord blood favorably alters the natural history of infantile Krabbe's disease if performed before the onset of symptoms.

This case–control study in Tennessee assessed 635 persons 2 to 49 years of age with invasive pneumococcal disease and 6350 matched controls. Among those with asthma, the risk of invasive pneumococcal disease was about twice that among the controls; among those with high-risk asthma, the risk was more than three times as great. Asthma appears to be an independent risk factor for invasive pneumococcal disease. These data suggest that asthma should be an additional indication for pneumococcal vaccination.

This cluster-randomized trial in rural Pakistan compared perinatal and maternal outcomes in control districts with the outcomes in districts in which traditional birth attendants were trained and were issued disposable delivery kits and in which obstetrical teams provided outreach clinics for antenatal care. Perinatal mortality was reduced significantly in the intervention districts.

An intervention involving training traditional birth attendants and integrating them into an improved health care system was achievable and effective in reducing perinatal mortality in rural Pakistan.

A seven-year-old girl is 130 cm tall (the 90th percentile for girls of the same age) and weighs 34.6 kg (above the 95th percentile), with a body-mass index of 20.5 (above the 95th percentile). Physical examination reveals no abnormalities aside from her excess weight. She eats fast food and drinks soft drinks regularly, has limited exercise, and watches television or uses the computer for hours each day. What should you advise?

George Annas reviews international and U.S. laws and U.S. Supreme Court decisions relevant to torture in wartime. He also discusses the controversy over physicians' roles in the torture of prisoners in the prisons at Abu Ghraib and Guantanamo Bay and argues that physicians have a special responsibility to prevent and report torture.

An 80-year-old man was admitted to the hospital because of shortness of breath. He had pleural effusions, edema of the legs, and a history of atrial fibrillation, several episodes of congestive heart failure, and increasing proteinuria. Laboratory studies revealed nephrotic-range proteinuria and an IgG paraprotein. A diagnostic procedure was performed.