Intensive glucose lowering targeting glycated hemoglobin levels of less than 6.0% was unexpectedly associated with an increase in overall mortality in high-risk patients with type 2 diabetes in the ACCORD trial. The findings identify a previously unrecognized risk of intensive glucose lowering in such patients.

As compared with standard glucose control in patients with type 2 diabetes, intensive glucose control in the ADVANCE trial reduced the risk of nephropathy but not the risk of macrovascular events. There was no significant difference between the two groups in overall mortality. These findings, along with those of the ACCORD trial, raise complex questions about the role of intensive glucose control in type 2 diabetes.

There is a need for a vaccine against avian influenza (H5N1). In this initial study, the administration of two doses of a whole-virus H5N1 vaccine derived from Vero cell culture was shown to induce neutralizing-antibody responses to clades 1, 2, and 3 of H5N1 virus strains.

Somatic characteristics of neuroblastoma tumors — such as MYCN amplification — are associated with more aggressive disease. This report shows that persons who inherit variants on chromosome 6p22 are more susceptible to the development of the disease than those who do not inherit these variants.

A 23-year-old woman has palpitations. Over the past 6 months, she has had a 10-lb (4.5-kg) weight loss. Her pulse is 119 beats per minute, and blood pressure is 137/80 mm Hg. Her thyroid gland is diffusely enlarged. She has eyelid lag but no proptosis. The level of thyrotropin is 0.02 µU per ml (normal range, 0.35 to 4.50), and free thyroxine is 4.10 ng per deciliter (normal range, 0.89 to 1.76). How should she be further evaluated and treated?

Age-related macular degeneration is the leading cause of irreversible blindness in people 50 years of age or older in the developed world. This article reviews the clinical and histopathological features of age-related macular degeneration and its genetics and epidemiology and discusses current management options and research advances.

A 68-year-old man was admitted to the hospital because of headache and loss of vision in the right eye, 3 1/2 months after orthotopic liver transplantation. Four weeks after transplantation, headaches and jaw claudication developed, followed by blurred vision in the right eye. Two weeks before admission, an ophthalmologist began therapy with prednisone; symptoms improved and then worsened 2 days before admission. On admission, additional diagnostic studies were performed.