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Coinfection with GB Virus C and Survival in HIV-Infected Patients
The GB virus C (GBV-C), also known as the hepatitis G virus, is related to hepatitis C virus but does not appear to cause liver disease. Previous studies have suggested that the progression of human immunodeficiency virus (HIV) disease is delayed in persons who are coinfected with GBV-C. This study examined the effect of coinfection with GBV-C on the survival of patients with HIV infection. It found that GBV-C infection is common in people with HIV infection and is associated with significantly improved survival.
This study also found evidence that HIV replication in cell cultures was inhibited by GBV-C coinfection. The findings should prompt evaluation of the potential implications of GBV-C infection for the treatment of HIV infection.
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GB Virus C and Survival in HIV-Infected Patients
This study investigated the relation between infection with GB virus C (GBV-C) and long-term outcomes in 197 patients infected with the human immunodeficiency virus (HIV). The 33 patients who tested positive for GBV-C RNA had significantly longer survival and a slower progression to AIDS than the 164 patients without evidence of the presence of this virus. The GBV-C viral load correlated inversely with the HIV viral load.
GBV-C is not known to cause human disease, but this study suggests that coinfection with GBV-C is associated with improved survival in HIV-infected patients. It is possible that coinfection leads to an inhibition of HIV replication, but it is also possible that infection with GBV-C is a marker for another favorable factor. Additional research will be needed to resolve these issues.
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Adjuvant Chemoradiotherapy for Gastric Cancer
In this large, randomized study, patients with resectable gastric cancer were assigned to surgery only or surgery followed by chemotherapy plus radiotherapy. After a median follow-up of five years, the group treated with adjuvant chemoradiotherapy had significantly longer overall and relapse-free survival than the surgery-only group.
The incidence of gastric cancer has been declining steadily during the past 20 years, yet it remains the eighth most common cause of death from cancer and accounts for about 13,000 deaths annually in the United States. Surgery is curative in less than half the cases. This large, carefully monitored, multi-institutional trial shows that postoperative chemoradiotherapy can substantially increase survival after gastric resection.
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Sympathetic Reinnervation of Transplanted Hearts
Early after cardiac transplantation, the donor heart has no sympathetic innervation from the recipient. This study shows, on the basis of myocardial positron-emission tomography (PET), that sympathetic reinnervation occurs late after cardiac transplantation and that reinnervation results in improved responses of the heart rate and contractility to exercise.
With the use of myocardial PET scanning and [11C]hydroxyephedrine as a marker, the investigators show that sympathetic reinnervation of the heart can occur after transplantation. We now also know that this reinnervation favorably affects cardiac performance.
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Clinical Practice: Chronic Mitral Regurgitation
A 56-year-old man with no history of cardiac disease and no cardiac symptoms has a holosystolic murmur at the apex that radiates to the axilla. Echocardiography shows moderate mitral regurgitation with mild left ventricular dilatation. How should this patient's care be managed?
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Advances in Immunology: Effects of Immune Globulin in Autoimmune and Inflammatory Diseases
Intravenous immune globulin is used not only as replacement therapy for antibody-deficiency disorders but also in the treatment of a wide range of autoimmune and inflammatory conditions. This article, part of the Immunology series, reviews how intravenous immune globulin affects the immune system and the likely mechanisms of its therapeutic effects in a variety of autoimmune diseases.
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Clinical Problem-Solving: The Effusion That Would Not Go Away
A 36-year-old man with end-stage renal disease who was receiving long-term hemodialysis presents with increasing exertional dyspnea. A chest film reveals a massive, left-sided pleural effusion.
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