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* This Week in the Journal
 October 23, 2008
 Audio Icon Audio Summary
*
Correspondence
* Antiretroviral Prophylaxis to Reduce Breast-Milk HIV-1 Transmission
* Electronic Health Records in Ambulatory Care
* Malignant Gliomas in Adults
* Case 20-2008: Abdominal Pain and Weakness after Gastric Bypass Surgery
* Antiemetic Properties of the Antiepileptic Drug Levetiracetam
*
Book Reviews
* The Sterilization Movement and Global Fertility in the Twentieth Century
* Prescription for Survival: A Doctor's Journey to End Nuclear Madness
* Evolution in Health and Disease
* DNA: Promise and Peril
*
Continuing Medical Examination
* Alemtuzumab vs. Interferon Beta-1a in Early Multiple Sclerosis
* Uric Acid and Cardiovascular Risk
* Case 33-2008: A 63-Year-Old Woman with Dyspnea on Exertion
Original Articles
K-ras Mutations and Cetuximab in Advanced Colorectal Cancer

This study examined the mutation status of the K-ras gene in colorectal tumors from patients who were enrolled in a trial of cetuximab, a monoclonal antibody against the epidermal growth factor receptor (EGFR). A survival benefit was found among patients with tumors bearing wild-type K-ras but not among patients with tumors bearing mutated K-ras. Wild-type K-ras is essential in transmitting signals initiated by EGFR.

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Original Articles
Donor TLR4 Polymorphisms and Aspergillosis in Stem-Cell Transplantation

Toll-like receptors (TLRs) are a central aspect of the innate immune response. Different TLRs are associated with the immune response to different infectious pathogens. In this retrospective analysis, an increased susceptibility to invasive aspergillosis was associated with certain polymorphisms in donor TLR4 in patients who received an allogeneic hematopoietic stem-cell transplant from an unrelated donor.

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Original Articles
Pulmonary-Vein Isolation for Atrial Fibrillation

In patients with symptomatic atrial fibrillation and heart failure, pulmonary-vein isolation was found to be superior to atrioventricular-node ablation with biventricular pacing. Isolation of the pulmonary veins by means of ablation is a viable option for patients with refractory atrial fibrillation and heart failure.


Original Articles
Alemtuzumab vs. Interferon Beta-1a in Early Multiple Sclerosis

In this randomized, phase 2 trial involving previously untreated patients with early, relapsing–remitting multiple sclerosis, alemtuzumab, a monoclonal antibody targeting CD52 on lymphocytes and monocytes, was more effective than interferon beta-1a in reducing the progression of disability and relapse. Alemtuzumab caused autoimmune complications, including immune thrombocytopenic purpura (resulting in one death) and thyroid disorders.

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Special Article
Cardiovascular Outcomes after a Change in Prescription Policy for Clopidogrel

A program requiring prior authorization for the use of clopidogrel was in place in Canada in 2000. After the prior-authorization requirement was removed in September 2003, the use of clopidogrel in patients receiving coronary stents after myocardial infarction increased substantially and clinical outcomes improved.


Review Article
Medical Progress: Uric Acid and Cardiovascular Risk

This review summarizes relevant studies concerning uric acid and possible links to hypertension, renal disease, and cardiovascular disease. Whether uric acid is an independent risk factor for such diseases is still a point of debate. Current evidence is presented.


Case Records of the Massachusetts General Hospital
A Woman with Dyspnea on Exertion

A 63-year-old woman was admitted to the hospital because of a 3-week history of dyspnea on exertion, associated left subscapular burning pain, and a mild dry cough. She had a history of ulcerative colitis, which was most recently treated with azathioprine and infliximab. On examination, there were inspiratory wheezes and rales, without expiratory wheezes. Chest imaging showed ground-glass opacities in both lower lobes. A diagnostic procedure was performed.


Clinical Implications of Basic Research
An Exercise in Endurance

Mice treated with an agonist of the AMP-activated protein kinase showed an increase in endurance as compared with exercise-trained controls.


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