Patients with cystic fibrosis have inspissated mucus that is thought to contribute to the pulmonary exacerbations characteristic of the disease. As compared with treatment with normal saline, twice-daily treatment with inhaled hypertonic saline after the inhalation of a bronchodilator did not affect the linear rate of change in the forced expiratory volume in one second (FEV₁) but was associated with improved FEV₁ values and with fewer and shorter pulmonary exacerbations.

Inhalation of hypertonic saline has a modest beneficial effect on lung function and the frequency of exacerbations in patients with cystic fibrosis. In this article, the investigators provide in vivo and in vitro data suggesting that this therapeutic effect derives from sustained acceleration of mucus clearance.

This randomized, open-label trial compared two regimens for the initial treatment of human immunodeficiency virus (HIV) infection: tenofovir disoproxil fumarate and emtricitabine plus efavirenz or a fixed dose of zidovudine and lamivudine plus efavirenz. Through week 48, the first regimen was superior in terms of viral suppression, CD4-cell response, and adverse events leading to discontinuation of the medication. As this trial continues, it will be important to assess any differences in long-term toxic effects, especially with regard to lipoatrophy and hyperlipidemia.

Women with the Lynch syndrome (hereditary nonpolyposis colorectal cancer) are at high risk for endometrial cancer and at increased risk for ovarian cancer. In this retrospective cohort study, there were no cases of either cancer among women who underwent prophylactic hysterectomy with bilateral salpingo-oophorectomy, as compared with women who did not undergo prophylactic surgery. The risk reduction was significant for endometrial cancer, although not for ovarian cancer. These results support the consideration of prophylactic hysterectomy with bilateral salpingo-oophorectomy to reduce the risk of cancer in women with the Lynch syndrome.

Estrogen exposure is a major determinant of the risk of breast cancer. This article reviews how genotoxic, mutagenic metabolites of estrogen and stimulation of tissue growth by the hormone participate in the pathogenesis of breast cancer.

A 31-year-old HIV-positive man was seen in the clinic because of four days of rectal pain on defecation, with a mucopurulent rectal discharge. He was homosexual and had regular anal-receptive sex with multiple partners.

Effective treatment of a mouse model of cholera demonstrates a new strategy for developing antibiotics: targeting the expression of virulence proteins.