One potential tool in the quest for global eradication of poliomyelitis is a newly developed monovalent type 1 oral poliovirus vaccine. In this study involving 421 infants in Egypt who were given either monovalent type 1 or trivalent vaccine at birth, significantly more infants given the monovalent vaccine underwent seroconversion to type 1 poliovirus (55%, vs. 32% of those given trivalent vaccine). In addition, the monovalent vaccine more effectively reduced shedding of type 1 poliovirus after challenge.

Control of poliovirus in Nigeria has been a considerable challenge, and incomplete control remains a threat to the goal of global eradication of poliomyelitis. The traditional approach to poliovirus control has relied largely on the use of the trivalent oral polio vaccine. Recently the monovalent oral vaccine for serotype 1 has been used to improve protective immunity to this specific serotype. In this case–control study of poliomyelitis in Nigeria, the estimated per-dose efficacies of monovalent and trivalent vaccine for serotype 1 were 67% and 16%, respectively. The estimated efficacy of trivalent vaccine for serotype 3 was 18%.

This large trial of methods used for the evaluation of screening mammograms compared the rate of detection of breast cancer achieved by the use of two readers for each mammogram with that of a single reader using computer-aided detection. The detection rates were virtually the same for both methods, but the recall rate was slightly but significantly higher for mammograms read by a single reader with computer-aided detection than for those read by two readers.

This study shows an association between a broad range of phenotypes and either deletion or duplication of a genomic segment at chromosome 1q21.1, suggesting a fundamental role of the deletion or duplication in early development and challenging the notion that a specific mutation disposes toward a specific disorder or syndrome.

A 53-year-old man, who is otherwise healthy and has a 20-year history of occasional heartburn, reports having had worsening heartburn for the past 12 months, with daily symptoms that disturb his sleep. He reports having had no dysphagia, gastrointestinal bleeding, or weight loss and in fact has recently gained 20 lb (9 kg). What would you advise regarding his evaluation and treatment?

Blunt aortic injury occurs after sudden deceleration, and it is second only to head injury as the leading cause of death after automobile crashes. Helical computed tomography of the thorax is more sensitive than angiography for detection. Although immediate operative repair was once the rule, endovascular repair is now an alternative for many patients, including those with multiple major injuries. The endovascular approach can improve survival as well as reduce the risk of paraplegia.

A 10.8-year-old girl was seen in the pediatric dermatology clinic because of recurrent oral ulcers and cutaneous bullae since 2 years of age. White lesions in the mouth and vesicles and bullae on the dorsal and plantar surfaces of the feet, the knees, and the hands that ulcerated and became painful occurred at intervals of 3 to 4 months, lasted 4 days to 2 weeks, and resolved without scarring. Biopsy of a lesion 2 years earlier was reported to show features of epidermolysis bullosa. A diagnostic procedure was performed.