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August 28, 2008  Vol. 359 No. 9

Audio Summary of this Issue

Perspective
885-887

The presentations at the XVII International AIDS Conference and the meeting's theme, “universal action now,” reflected the fact that the pandemic continues to rage not only in developing countries, but also in developed countries where it is often ...

888-890
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An HIV vaccine has thus far been elusive. Drs. Margaret Johnston and Anthony Fauci remain cautiously optimistic that a substantial increase in our understanding of HIV infection and disease will lead to creative ideas about how to design an effective HIV ...

891-893

Dr. Philippe Froguel and Alexandra Blakemore write that pinning down which particular genes modulate the risk of obesity has proved difficult. Most successes come from the study of very severe early-onset disorders — the extreme forms of obesity caused by ...

Original Articles
895-905

In this multicenter, placebo-controlled, randomized trial of intravenous magnesium sulfate in women at imminent risk for delivery between 24 and 31 weeks of gestation, magnesium sulfate did not significantly reduce the primary composite outcome of moderate or severe cerebral palsy or death. However, it did result in a reduced rate of cerebral palsy among survivors (a prespecified secondary outcome), which may suggest the possibility of benefit.

906-917

Patients with newly diagnosed multiple myeloma who were ineligible for treatment with high-dose chemotherapy plus hematopoietic stem-cell transplantation were randomly assigned to receive either melphalan and prednisone alone or melphalan and prednisone plus bortezomib. The time to disease progression (the primary outcome) was longer in the bortezomib group. The combination of bortezomib, melphalan, and prednisone appears to be effective as initial treatment in patients with multiple myeloma who cannot withstand high-dose therapy.

918-927

This study examined genotype and body-mass index in patients with the Wilms' tumor, aniridia, genitourinary anomalies, and mental retardation (WAGR) syndrome. The related genes WT1 and PAX6 are on chromosome 11p13, centromeric to brain-derived neurotrophic factor (BDNF), an important gene in energy homeostasis. BDNF haploinsufficiency was linked to childhood-onset obesity and reduced levels of serum BDNF, suggesting a role of BDNF in energy homeostasis.

Review Articles
928-937
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The mortality associated with acute bleeding from a peptic ulcer remains high (5 to 10%), and the condition accounts for more than 400,000 hospital admissions per year in the United States. This review summarizes the approach to patient triage and risk stratification, the goals of early endoscopy, the options for medical therapy, and the role of surgery and interventional radiology.

938-949

This review is an account of recent advances in our understanding of the mechanisms of thrombus formation, with emphasis on two independent pathways: one involving primarily platelets and the other initiated by tissue factor.

Images in Clinical Medicine
950
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A 67-year-old woman with a history of cancer of the right breast, treated with a modified radical mastectomy, radiation, and chemotherapy in 1990, presented with a 6-month history of an enlarging plaque of coalescing purple papules and nodules within a ...

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This 84-year-old woman presented with this slowly growing asymptomatic lesion. It was completely excised surgically and proved to be an invasive squamous-cell carcinoma.

Case Records of the Massachusetts General Hospital
951-960

A 64-year-old man was admitted to the hospital because of abdominal pain, nausea, and an elevated serum creatinine level. He had a history of recurrent epigastric pain, which had been attributed to pancreatitis and gastroesophageal reflux disease. One week before admission, epigastric pain recurred, with nausea and vomiting; 3 days before admission, he stopped all oral intake, but symptoms worsened. On admission, the serum creatinine level was 3.5 mg per deciliter, and the urea nitrogen level was 28 mg per deciliter. Intravenous fluids were administered, without improvement. A diagnostic procedure was performed.

Editorials
962-964

Preterm infants are at increased risk for serious, lifelong neurologic abnormalities such as cerebral palsy.1,2 As the survival of preterm infants has improved with advances in perinatal care,2 the occurrence of cerebral palsy has increased further, since ...

964-966

In this issue of the Journal, San Miguel et al.1 describe the benefit of combining bortezomib with melphalan plus prednisone, as compared with melphalan plus prednisone alone, as initial therapy for patients with myeloma who are not candidates for ...

Clinical Implications of Basic Research
967-969

Topical application of inhibitors of growth factor receptors or their signaling pathways protects against choroidal neovascularization, vascular leakage, and retinal edema in mice.

Correspondence
970-971

To the Editor: In their study comparing three different regimens for initial treatment of human immunodeficiency virus type 1 (HIV-1) infection, Riddler et al. (May 15 issue)1 state that 19 patients died, but the authors report deaths according to study ...

971-974

To the Editor: In his editorial accompanying the article by Beckett et al.1 on the results of the Hypertension in the Very Elderly Trial (HYVET), Kostis (May 1 issue)2 describes why he thinks the data from the study are important. However, the vast ...

974

To the Editor: Tonna and Laing (May 15 issue)1 describe a patient with secondary syphilis. I question the authors' use of the term “keratoderma blennorrhagica,” which are the psoriasiform and vesicular pustular lesions of the palms and soles seen in ...

975-976

Sunitinib was approved in 2006 for the treatment of advanced renal-cell carcinoma and gastrointestinal stromal tumors. These authors report on patients who had dermatologic toxic effects in both the scrotal and inguinal areas.

977-979

To the Editor: We report on a patient with type 1 diabetes mellitus, diagnosed at 16 years of age, in whom widespread amyloid deposits developed many years later in transplanted human islets. The islets were administered through three intraportal ...

Book Reviews
980-981

In 1875, the newly graduated Cambridge polymath Joseph Jacobs wrote a review of George Eliot's last completed novel, Daniel Deronda, the story of a young English gentleman who discovers his Jewish identity. The experience was transformative for Jacobs; ...

981-982

This book is an autopsy of errors. Drawing on his 20 years as chief of epidemiology in the division for the prevention of the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) at the Centers for Disease Control and ...

982-983

The Oxford Textbook of Clinical Research Ethics is a resource suitable for a course in research ethics and would also be helpful for those starting a career in clinical research. It is an accessible synthesis and discussion of the many facets of research ...

Corrections
983

Bivalirudin versus Unfractionated Heparin during Percutaneous Coronary Intervention Original Article, N Engl J Med 2008:359;688-696.. In Methods, in the second paragraph under Study Protocol (page 689), the third sentence should read, “Sheaths were ...

983
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Photo filler (July 3, 2008;359:42). The title of the photograph printed on page 42 should have been Hyacinth Macaw rather than Blue Toucan. We regret the error.