In this randomized comparison of hepatitis A vaccine and immune globulin for prophylaxis after household or day-care exposure to hepatitis A, infection rates were low with either immune globulin (3.3%) or vaccine (4.4%), and the study's prespecified criterion for noninferiority was met. Hepatitis A vaccine provides long-term immunity and may be a reasonable choice for postexposure prophylaxis.

This trial of therapies for unresectable advanced head and neck cancer showed that induction chemotherapy (given before radiotherapy) with a combination of docetaxel plus the standard regimen of cisplatin and fluorouracil (TPF) was superior to the standard induction chemotherapy. Progression-free survival and overall survival were improved, and the toxicity of the triple-agent regimen was less than the toxicity of the standard regimen.

In this randomized trial, patients who had unresectable stage III or IV squamous-cell head and neck cancer with no distant metastases were assigned to receive induction treatment with docetaxel plus cisplatin and fluorouracil (TPF) or cisplatin and fluorouracil (PF) before receiving chemoradiotherapy. Patients who received TPF induction chemotherapy had significantly longer survival than did patients who received PF induction chemotherapy.

In an open-label trial, patients with type 2 diabetes with a suboptimal glycated hemoglobin level while receiving a maximally tolerated dose of metformin and sulfonylurea were randomly assigned to receive biphasic, prandial, or basal insulin. The addition of a single analogue-insulin formulation resulted in a glycated hemoglobin level of 6.5% or less in a minority of patients at 1 year. Regimens of biphasic or prandial insulin had greater efficacy than did the basal regimen but were associated with greater risks of hypoglycemia and weight gain.

Celiac disease is a unique autoimmune disorder in which the environmental precipitant, gluten, is known. Originally considered a rare malabsorption syndrome of childhood, celiac disease is now recognized as a common condition that may be diagnosed at any age and that affects many organ systems. This review discusses the pathogenesis, diagnosis, and management of the disease.

A 49-year-old HIV-positive man was seen in the hematology clinic because of rapidly progressive anemia. He had been HIV-positive for 20 years and had discontinued antiretroviral therapy 6 months earlier. The hemoglobin level was 6 g per deciliter, the hematocrit 16.9%, the reticulocyte count 0.2%, and the white-cell count 2600 per cubic millimeter, with a normal differential count. Diagnostic procedures were performed.

This interactive Journal feature presents the case of a 65-year-old man with hypertension, obesity, and diabetes. He comes to you for advice on the management of his recently diagnosed coronary artery disease. Three possible treatment options are presented, together with expert opinion on each. Which treatment option do you recommend? At www.nejm.org, you can vote for one and then, if you wish, submit a comment about your clinical decision. Voting results and a broad selection of comments will be posted on the Web site.

A recent study shows that fibroblasts that promote cardiac fibrosis are derived from the endothelium. Transforming growth factor β1 drives their derivation, whereas bone morphogenic protein 7 represses it.