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June 17, 2010  Vol. 362 No. 24

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Perspective
2241-2243
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The global H1N1 influenza pandemic disproportionately affected pregnant women, drawing attention to the fact that they have always been a marginalized study population. Dr. Sara Goldkind and colleagues argue that it is imperative that pregnant women be ...

2244-2246
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Christopher Jennings and Katherine Hayes write that our ability to achieve a workable federal–state balance will be seriously tested as the Obama administration and the states define and apply their roles in implementing the myriad new policies for ...

2246-2249

George Annas writes that, although it's not a thought that has leapt to the minds of commentators, U.S. Supreme Court Justice John Paul Stevens will be missed by physicians and patients.

Original Articles
2251-2259

The treatment of chronic myeloid leukemia (CML) achieved a great leap forward with the development of imatinib, a BCR-ABL kinase inhibitor. Alterations in the chemical structure of the inhibitor have produced agents that are more potent in vitro. In these studies, two new second-generation BCR-ABL kinase inhibitors, nilotinib and dasatinib, are compared with imatinib; these new drugs produce more complete responses and do so faster than imatinib. Both also appear to reduce the rate of progression to accelerated-phase and blast-phase disease.

2260-2270

The treatment of chronic myeloid leukemia (CML) achieved a great leap forward with the development of imatinib, a BCR-ABL kinase inhibitor. Alterations in the chemical structure of the inhibitor have produced agents that are more potent in vitro. In these studies, two new second-generation BCR-ABL kinase inhibitors, nilotinib and dasatinib, are compared with imatinib; these new drugs produce more complete responses and do so faster than imatinib. Both also appear to reduce the rate of progression to accelerated-phase and blast-phase disease.

2271-2281

Approximately 200,000 infants worldwide become infected with human immunodeficiency virus type 1 (HIV-1) annually through breast-feeding. In this randomized trial involving 2369 mother–infant pairs in Malawi, the use of either maternal antiretroviral therapy or infant nevirapine through the age of 6 months was found to significantly decrease the rate of maternal transmission of HIV-1 during breast-feeding.

2282-2294

This double-blind, randomized trial in Botswana compared two highly active antiretroviral regimens in HIV-1−infected pregnant women (CD4+ count, ≥200) from pregnancy through 6 months post partum (when breast-feeding ceased). Both regimens were highly effective in suppressing the maternal HIV-1 viral load as well as mother-to-child transmission, with an overall transmission rate of 1.1%.

Review Article
2295-2303

This review gives an account of the cigarette as a highly efficient nicotine delivery system. It explains how nicotine induces pleasure, reduces stress and anxiety, and causes addiction to tobacco smoking. The basis of nicotine addiction rests on its effects on the brain, but addiction is also influenced by learned or conditioned factors, genetics, and social and environmental conditions.

Images in Clinical Medicine
2304
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A 25-year-old man presented with a 4-month history of pain and restricted movement of his right shoulder. Initially, he had experienced severe, sharp pain in the region of the right shoulder and between the shoulder blades; subsequently, progressive ...

e68
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This 52-year-old man had a history of total esophagogastrectomy with jejunal anastomosis after necrotic injury from ingestion of lye 20 years earlier. Isoperistaltic movements were visible.

Interactive Medical Case
e69
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  • CME

A 40-year-old woman presented with diarrhea. It had begun 2 years ago with four to five loose bowel movements a day and progressed in recent months to 15 large-volume, watery stools daily. The patient's diarrhea persisted with fasting and also occurred at ...

Case Records of the Massachusetts General Hospital
2305-2312

A 7-year-old boy was seen for treatment of infection with HIV-1. When he was 3 years of age, pulmonary tuberculosis was diagnosed, and at 5 years of age, a diagnosis of HIV-1 infection was made. Despite 19 months of therapy, viremia persisted. A diagnostic test was performed, and a management decision was made.

Editorials
2314-2315

The clinical success of imatinib in patients with chronic myeloid leukemia (CML), which was first reported 9 years ago,1 catalyzed a systemwide shift in the development of cancer drugs to include molecularly targeted therapies. According to one recent ...

2316-2318

More than 90% of the 430,000 human immunodeficiency virus type 1 (HIV-1) infections in children each year occur in sub-Saharan Africa, where HIV-1 acquisition through breast milk accounts for more than 40% of infections. However, in Africa, breast-feeding ...

Health Law, Ethics, and Human Rights
2319-2325
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  • CME

The Department of Housing and Urban Development has issued a memorandum encouraging Public Housing Authorities to restrict smoking in public-housing units. The current law relevant to smoking regulations is reviewed and discussed.

Clinical Implications of Basic Research
2326-2327

    Wnt signaling is critical to leukemogenesis in two mouse models of acute myeloid leukemia.

    Correspondence
    2328-2331

    To the Editor: The Sepsis Occurrence in Acutely Ill Patients (SOAP) II study, reported by De Backer and colleagues (March 4 issue),1 is a major multicenter effort to find the elusive answer to the question of whether one vasopressor is superior to ...

    2331-2334

    To the Editor: The comprehensive review of management of variceal bleeding by Garcia-Tsao and Bosch (March 4 issue)1 highlights the special difficulties in managing bleeding gastric varices, particularly with the limited availability of vasoactive agents ...

    2334-2335
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    To the Editor: As Gill and colleagues note in their Clinical Practice article (Feb. 18 issue),1 the topic of a small renal mass was recently addressed by a Guidelines Panel commissioned by the American Urological Association.2,3 However, we disagree with ...

    2335-2336

    To the Editor: In his Clinical Practice article, Zimmerli (March 18 issue)1 states that regimens that include rifampin appear to be superior to those without rifampin for the treatment of infections related to orthopedic implants. However, to my ...

    2336-2337

    Investigators in South Africa undertook four renal transplantations involving HIV-positive donors and HIV-positive recipients with end-stage renal disease. At 12 months after transplantation, all recipients had good renal function and had not needed ...