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The New England jO ~.~.1 11 O Medicine EstsblLhed in 1812 as The NEW ENGLAND JO.-JB.NAL OF 3iEDICINE AND SIIB.G75EY VOLUME 323 JULY 5, 1990 NUMBF.IR t Original Articles Effects of Human Growth Hormone in Men cver 60 Years Old .................... D. RUDMAN, A.G. FELLER, H.S. NAGRAJ, G.A. CERGANS, P.Y. LALITHA, A.F. GOLDBERG, R.A. SCHLENKER, L. COHN, LW. RUDMAN, AND D.E. MAT-rsoN Screening for Carriers of Tay-Sachs Disease among Ashkenazi Jews - A Com- 1 Case Records of the Massachusetts General Ho A 63-Year-Old Woman with an Acute M cardial Infarct and a Falling Hemat P.T. O'GARA AND J.F. SOUTHERN Editorials Growth Hormone for the Elderly? .... spital yo- ocrit 42 .... 52 r arison of DNA-Based and E nzyme- M.L. VANCE p ............ Based Tests 6 ' .............. B.L. TRICCS-RAINE, A.S.J. FEIGENBAUU, Fewer Sperm in the Summer - It s No Heat It's . . . ................. t the .... 54 M. NATOWICZ, M: A. SKOxoROwslu, S.M. SCHusTER, J.T.R. CLARKE, D.J. MAHURAN, E.H. KOLODNY, AND R.A. GRAVEL , P.J. SNYDER New "Information for Authors" - and Readers ........................ .... 56 Differences in the Quality of Semen in Out- door Workers during Summer and Massachusetts Medical Society . ..... 57 Winter .............................. 12 Rj. LEVINE, R.M. MATHEW, C.B. CHENAULT, M.H. BROWN, M.E. HURZT, K.S. BENrLEY, K.L. MOHR, AND P.K. WORKING Correspondence High Blood Alcohol Levels in Women .... .... 58 Mut -tion Anal sis in C stic Fibrosis 62 Systemic Exposure to Mercaptopurine as a y y ..... z Hepatitis C in Institutionalized Children .. ..... .. 64 Prognostic Factor in Acute Lymphocytic Cisplatin Neurotoxicity ................ . .. ..... 64 Leukemia in Children ................ G. KOREN, G. FERRAZINI, H. SULH, A.M. LANGEVIN, 17 Vasovagal Syncope in a Heart-Transplant Recipient ........................ ..... 65 J. KAPELUSHNIK, J. KLEIN, E. GIESBRECHT, No Rationale for Finger-Stick Blood Sampli ng .. 66 S. SOLDIN, AND M. GREENBERG Salutations to a "Regulated Medical Wnste Genentor ., ...................... ..... 6 Abnormal Endothelium-Dependent Vascular Relaxation in Patients with Essential Book Reviews ..................... ..... 66 Hypertension ........................ 22 J.A. PANZ.o, A.A. Q.tmuw:, J.E. BRUSH, JR., AND S.E. EPSTEtN Notices ............................ ..... 69 Review Article Corrections Esophageal Tear Caused F• 1 Tortilla Chip ..... 70 Mechanisms of Disease: Regulatory Func- Interventional Radiology in the Chest and Abdomen ........................ ..... 70 tions o`_ the Vascular Endothelium..... 27 J.R. VANE, E.E. ANCCARD, AND R.M. BoTnxG Brief Report Mitochondrial Myopathy with a Defect of Special Report Statement from the National Institutes Health Workshop on Population Sc ing for the Cystic Fibrosis Gene .. of reen- ..... 70 Mitochondrial-Protein Transport ...... 37 IVORKSIIOP ON POPUI.AT/ON SCRk:ENING FOR TI IE t~S A.H.V. SCHAPIRA, J.I1'I. COOPER, CYSTIC FIBROSIS GENE Gx ~ J.A. MORCAN-HUCHES, D.N. LANDO., ~ AND J.B. CLARK Information for Authors .......... ..... 72 ~ >!R Ownec4, Published, and CCopyrighted, 1990, by the Massachusetts Medical Society lv -p CC THE NEw F.HCLAND JouaNAL OF h1EDcctNi: (ISSN 0028-4793) is publishcd wcckly from cditcnal officcs at 10 Shattuck Strcct, Buston, \SA 02l 15-G091. Sub•cription price: $79.00 per year. Second-class postage paid at Boston and at additional mailing o(Tices. POSTMASTER: Send address changes to P.O. Box R03, Waltham, AIA 0225}-0803. t-

56 THE NEW ENGLAND JOURNAL OF MEDICINE July 5, 1990 that cause changes in testicular fvrction in several animal species - or another far•or awaits further study. Tile data presented by Levine et al. illustrate once again how many factors influence human spermato- genesis and how it is possible to detect at least some of them in well-controlled studies that explore potential- ly confounding variables. Careful clinical studies such as this one, together with studies of the intratesticular mechanisms of spermatogenesis, will provide us with the information needed to increase fertility in men with impaired spermatogenesis and decrease fertility in men who desire contraception. University of Pennsylvania Philadelphia, PA 19104-6149 PETER J. SNYDER, M.D. REFERENCES 1. Levine RJ, Mathew RM. Chenault CB. et al. Differences in the quality of semen in outdoor workers during summer and winter. N Engl J Med 1990; 323:12-6. 2. Kandeel FR, Swerdloff RS. Role of tcmperaturc in regulation of spermato- genesis and the use of heating as a method for contraception. Fertil Steril 1988; 49:1-23. 3. MacLeod 1. Effect ofchickenpox and of pneumonia on semen quality. Fertil Steril 1951; 2:523-33. 4. Robinson D, Rock J, Menkin MF. Control of human spermatogenesis by induced changes of intrascrotal temperature. JAMA 1968; 204:290- 7. 5. Mieusset R, Grandjean H. Mansat A. Pontonnier F. Inhibiting effect of artificial ctyptorchidism on spemutogenesis. Fertil Sieril 1985; 43:589- 94. 6. Mengel W, Hienz HA, Sippe WG 11. Hecker WC. Studies on cryptorchi- dism: a comparison of histological findings in the germinative epitfte- lium before and after the second year of life. J Pediatr Surg 1974; 9:445- so. 7. Lipshultz LI, Caminos-Torres R. Greenspan CS. Snyder P1. Testicular function after orchiopexy for unilaterally undescended testis. N Engl J Med 1976; 295:15-8. 8. Mieusset R. Bujan L. Mondinat C. Maasat A, Pontonnier F, Grandjean H. Association of scraal hyperthermia with impaired spermatogenesis in infer- tile men. Fertil Steril 1987; 48:1006•11. 9. Baker HWG, Burger HG, deKretscr DM, Hudson B. Rennie GC, Straffon WGE. Tesiicular vein ligation and fertility in men with varicoceles. BMJ 1985; 291:1678-80. 10. Vemxulen A. Vandeweghe M. Improved fertility after varicoccle correc- tion: fact or fiction? Fertil Steril 1984: 42:249-56. 11. Saint Pol P. Beuscart R, Leroy-Martin B, Hennand E. Jablonski W. Circan- nual rhythms of sperm parameters of fertile men. Fertil Steril 1989; 51:1030- 3. 12. Politoff L, Birkhauser M, Almendral A. Zom A. New data confirming a circannual rhythm in spermatogenesis. Fertil Steril 1989; 52:486-9. NEW "INFORMATION FOR AUTHORS" - AND READERS IN this issue we publish a revised "Information for Authors" page, including three changes that should interest readers as well as authors. First, we are adopting a new, structured format for abstracts. fournal abstracts will henceforth consist of four paragraphs labeled Background, Methods, Re- sults, and Conclusions. Sometimes, when appropriate, two of the first three paragraphs will be combined in one. The object is to enable readers to grasp the es- sence of an article quickly by providing a framework that will present the work in a logical, complete, yet concise fashion. For many years we have been advis- ing authors to organize their abstracts with this quad- ripartite structure in mind. The new paragraph head- ings simply make the structure more explicit and, we hope, the abstract more inlbrmative. Second, we are asking that the letter of submission be signed by all authors, not just the corresponding author, and that it affirm not only that all authors have seen and approved the final manuscript but that they "have taken due care to ensure the integrity of the work." The latter requirement is meant to establish that all the authors are sufficiently familiar with the conduct of the research to warrant their public endorsement of it. We have taken this step because we believe that responsibility for the integrity of scientific research is a duty of all who wish to clailn credit for authorship. Furthermore, we be- lieve that greater awareness and acknowledgment of this responsibility will encourage coauthors to pay closer attention to the overall integrity of the work with which they are involved, thereby decreasing the likelihood of misconduct. When collaborating colleagues stay in close touch with each other there is much less chance that one of them can engage in mischief. Finally, our Information for Authors includes a new stipulation that authors of review articles and editori- als should have no financial association with a compa- ny whose product figures prominently in the article or with a company making a competitive product. Until now, our conflict-of-interest policy did not distinguish between research and review articles, and required only that authors disclose their financial ties. We be- lieve that this policy is adequate for research articles (although many institutions are beginning to pro- scribe certain kinds of financial arrangements involv- ing their research staffs), because these articles pro- vide data that readers can interpret for themselves. We have come to believe, however, that a stronger rule is necessary for review articles and editorials. In these articles authors use their own judgment in citing and interpreting the literature, and readers must thus rely on the objectivity of the author. When authors have a financial as well as a scientific interest in their sub- jects, questions inevitably arise that cast doubt on this presumption of objectivity. It is a problem that should and can be avoided by selecting authors who have no financial stake in the subjects they write about. We recognize that in some fields this policy will ex- clude many leading experts of unquestioned integrity. We regret that fact but regard the policy as necessary to support the reader's trust in these types of ar- ticles. As always, we welcome comments from our readers on the new editorial rules. ARNOLD S. RELMAN, M.D. UMI Article Clearinghouse has reproduced this material with permission of the copyright owner. Further reproduction is prohibited. i