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April 15, 2004 Vol. 350 No. 16
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This study demonstrates that the genes expressed by peripheral-blood monocytes of adults with acute myeloid leukemia provide prognostic information over and above that provided by established indicators such as cytogenetic status. The authors analyzed the gene-expression profiles of samples obtained from 116 patients, who were subsequently assigned to receive various intensive treatments. They identified good- and poor-outcome classes of gene expression that were associated with differences in overall survival — even when the analysis was restricted to specimens with a normal karyotype.
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This investigation of 285 cases of acute myelogenous leukemia combined sophisticated analyses of gene-expression profiles with cytogenetic findings, mutational status, and morphologic characteristics to identify distinct groups of patients. These groupings were related to the outcome of treatment.
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In critically ill patients, elevated glucocorticoid secretion is marked by a rise in the serum total cortisol concentration. This study investigated the effect of decreased amounts of cortisol-binding protein on total and free serum cortisol concentrations during critical illness, when glucocorticoid secretion is maximally stimulated. Critically ill patients were found to have markedly elevated glucocorticoid secretion that was not detectable when only the serum total cortisol concentration was measured.
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An analysis of trends in the practice of assisted reproductive technology in the United States reveals that, since 1997, there have been consistent decreases in the number of embryos transferred per cycle and in the percentage of pregnancies involving three or more fetuses, along with a consistent increase in the percentage of live births per cycle.
This review summarizes current knowledge about the pathophysiology of ascites and explains the appropriate approach to clinical evaluation. The authors describe measures for the control of ascites as well as strategies for its management and for the prevention of major complications, including gastrointestinal bleeding, spontaneous bacterial peritonitis, and the hepatorenal syndrome.
This authoritative survey discusses how tumor cells cause bone metastases by producing both local and systemic factors that disrupt the balance between bone formation and bone resorption. Research on the molecular mechanisms of these processes has uncovered promising leads that may improve the treatment and prevention of bone metastases.
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A 38-year-old woman who had given birth to a healthy infant by cesarean section two weeks earlier experienced a sudden onset of pain in her throat, anterior chest, and back, maximal at onset, accompanied by shortness of breath, sweating, and nausea. Physical examination revealed symmetric pulses, normal blood pressure, and a diastolic heart murmur. Initial imaging studies showed widening of the aortic root, with inflammatory changes in the mediastinum, mild aortic regurgitation, and a pericardial effusion. The differential diagnosis of acute chest pain in a young woman is discussed.
The promise of gene therapy has been dimmed in the past few years by a number of setbacks, including the development of T-cell leukemia in infants treated for severe combined immunodeficiency. A recent study suggests that these cases do not augur ill for the field as a whole and that specific changes to gene-therapy protocols may reduce the chances that such therapy will inadvertently trigger cancer.
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