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October 20, 2005  Vol. 353 No. 16

Perspective
1645-1649

Researchers in the United States and other countries are being offered a chance to work with human embryonic stem-cell lines without having to make them themselves. But will U.S. scientists, ethicists, and research institutions embrace the proposal? Dr. ...

1646-1647

A recent study found that human embryonic stem cells can reprogram adult somatic-cell chromosomes after cell fusion. Elizabeth Phimister writes that there is some risk that people who are seeking to place restrictions on research into the biology of human ...

1650-1651
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Recently, Susan Wood resigned from her post of assistant commissioner for women's health and director of the Office of Women's Health at the FDA after the agency leadership had chosen to delay indefinitely a decision about switching emergency ...

1652-1654

The history of HER2 and trastuzumab treatment is a triumphal narrative of translational research. Dr. Harold Burstein writes that like all good stories, this one has a profound lesson: not all breast cancers are the same.

1655-1657

Learning to talk is one of the most important milestones in human development. Simon Fisher explains that we are just starting to unravel the genetic causes of developmental communication disorders and explore how they relate to language problems in other ...

Original Articles
1659-1672

After surgical excision of early HER2-positive breast cancer and adjuvant chemotherapy, the administration of trastuzumab, a monoclonal antibody against HER2, was associated with longer disease-free survival than was observation.

1673-1684

A combined analysis of two large studies found that the addition of trastuzumab to chemotherapy with doxorubicin and cyclophosphamide plus paclitaxel improved the outcome among women with operable HER2-positive breast cancer.

1685-1693
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Acute lung injury is a syndrome of hypoxemic respiratory failure and bilateral pulmonary infiltrates. In this prospective, population-based study, the incidence of acute lung injury was 79 cases per 100,000 person-years. The authors estimate that each year there are 190,000 cases of acute lung injury in the United States, resulting in 75,000 deaths, which suggests a much larger public health impact than previously reported.

1694-1701

A patient carrying an exact duplication of the chromosomal region that is typically deleted in persons with the Williams–Beuren syndrome has severe developmental apraxia of speech. This finding suggests that one or more genes that lie in the duplicated region influence human language.

Clinical Practice
1702-1710

A 25-year-old previously healthy woman is found to have a positive test for human immunodeficiency virus type 1 (HIV-1) antibody as part of a routine examination for insurance coverage. Heterosexual contact is her only risk factor for HIV acquisition. She is asymptomatic and has a normal physical examination. The results of routine hematologic and laboratory tests are normal. Her CD4 cell count is 325 per cubic millimeter and her plasma HIV-1 RNA level is 60,000 copies per milliliter. How should her case be managed?

Review Article
1711-1723

Glucocorticoids are among the most common therapeutic agents used in medical practice, yet their mechanisms of action are only partly understood. This review summarizes our understanding of how glucocorticoids inhibit inflammation and give rise to side effects.

Images in Clinical Medicine
1724
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A 52-year-old woman received a diagnosis of stage II hormone-receptor–negative, HER2-positive breast carcinoma (2 of 13 nodes positive). She underwent a left segmental mastectomy, axillary dissection, adjuvant chemotherapy (doxorubicin and ...

e14

This man reported acute left retro-orbital pain of one week's duration. Three days later, double vision developed.

Case Records of the Massachusetts General Hospital
1725-1732

A 34-year-old woman who had had asymptomatic human immunodeficiency virus (HIV) infection for nine years desired to become pregnant. She had stable CD4 T-cell counts without antiretroviral therapy. She had a history of human papillomavirus infection and cervical dysplasia. An obstetrician and a specialist in infectious diseases discuss the management of HIV infection and pregnancy.

Editorials
1734-1736

Two articles in this issue of the Journal report on the considerable therapeutic benefit of trastuzumab, a monoclonal antibody, in primary breast cancer, as measured by reductions in the rates of both recurrence and death.1,2 These reports, which complete ...

1736-1738

    Acute lung injury is the clinical syndrome of rapid-onset bilateral pulmonary infiltrates and hypoxemia of noncardiac origin. When the hypoxemia is severe, the condition is termed the acute respiratory distress syndrome (ARDS).1 As archetypal examples of ...

    Correspondence
    1739-1741

    To the Editor: Shepherd and colleagues (July 14 issue)1 report that erlotinib prolongs survival in non–small-cell lung cancer, as compared with placebo, after the failure of first-line or second-line chemotherapy. One disturbing aspect of this trial is ...

    1742-1744

    To the Editor: The report by Toff and colleagues on the United Kingdom Pacing and Cardiovascular Events (UKPACE) trial (July 14 issue),1 evaluating cardiovascular end points in elderly patients with atrioventricular block, showed that the use of dual-...

    1744-1746

    To the Editor: According to the established definition of multiple sclerosis,1 the condition in the patient described by Kleinschmidt-DeMasters and Tyler (July 28 issue)2 should not have been diagnosed as multiple sclerosis. Apart from the unusual ...

    1746-1747

    To the Editor: The case of human herpesvirus 8 (HHV-8) reported by Dagna et al. (July 14 issue)1 is considered to be distinct from HHV-8–associated multicentric Castleman's disease owing to the absence of typical histologic findings and elevated plasma ...

    1747
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    To the Editor: Cukierman et al., in their Clinical Problem-Solving article (Aug. 4 issue),1 affirm that “the clinical picture suggests primary Sjögren's syndrome because of the lack of clinical features associated with rheumatoid arthritis or other ...

    1748-1749

    To the Editor: Celiac disease is caused by aberrant T-cell responses to wheat gluten and the gluten-like proteins in barley and rye.1 The only cure for the disease is a lifelong gluten-free diet. Although consumption of oats is generally considered safe ...

    Book Reviews
    1750

    Each year, more than 40,000 children are adopted around the world, with more than 20,000 in the United States alone. Most children who are available for adoption live in crowded institutional settings with a limited number of caregivers, poor nutrition, ...

    1751-1752

    How do nature and nurture interact to produce a persistent awareness of one's identity as male or as female — that is, one's “gender identity,” as this term is now used in the official diagnostic manual of the American Psychiatric Association? How does ...

    1752-1753

    This volume in the Endocrine Development series is a collection of state-of-the-art reviews, plus two chapters presenting original data. All chapters but one originate from European centers, and all authors are well respected in their fields.

    There is a ...

    1753

    The timing of this textbook's arrival is perfect. The field of pediatric cardiology has evolved from a focus on early survival toward an emphasis on the long-term health of children with heart disease. The editors, who are respected leaders in this field, ...