WILLIAM E. CAYLEY, JR., M.D.

Distinguishing between benign and serious causes of chest pain is imperative, although overlapping clinical manifestations make diagnosis a challenge. Clinical rules that combine key groups of symptoms have been validated, and key symptoms and clinical findings can help rule in or rule out diagnoses.

DONNA I. MELTZER, M.D.

Piercing the tongue, ear, nose, navel, nipple, or genitals may result in minor and systemic infections and cosmetic problems. Physicians should be familiar with the potential complications associated with each piercing site and be prepared to offer informed advice about health risks.

Patient information: "Body Piercing: What You Should Know," p. 2035

CLAY ROSCOE, M.D., and TED EPPERLY, M.D.

Soft-bodied ticks can pass the Borrelia spirochete to humans, generating variable symptoms that include abdominal pain, vomiting, and altered sensorium.

Patient information: "Tick-Borne Relapsing Fever: What You Should Know," p. 2046

SANFORD R. KIMMEL, M.D.

The meningococcal conjugate vaccine, containing serogroups A, C, Y, and W-135, induces bactericidal antibody production and promotes immunologic memory that should result in a longer duration of immunity.

Editorial: "Time of Hope for the Eventual Elimination of Meningococcal Strains A, C, Y, and W-135 in the United States," p. 1978

LEONARD J. HAAS, PH.D., JENNIFER P. LEISER, M.D., MICHAEL K. MAGILL, M.D., and OSMAN N. SANYER, M.D.

Patients may be perceived as difficult because of behavioral or emotional aspects that impede their care. The origin of difficulties should be traced to patient, physician, or health care system factors, then rationally and effectively addressed.