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Articles 
Leena Sharma, Dorothy D. Dunlop, September Cahue, Jing Song, and Karen W. Hayes Greater quadriceps strength at baseline was associated with increased likelihood of tibiofemoral osteoarthritis progression in malaligned knees and lax knees. This surprising observation will require us to reconsider our approach to developing muscle strength that protects the osteoarthritic knee.
Frank J. Palella, Jr., Maria Deloria-Knoll, Joan S. Chmiel, Anne C. Moorman, Kathleen C. Wood, Alan E. Greenberg, Scott D. Holmberg the HIV Outpatient Study (HOPS) Investigators* Among HIV-infected persons with CD4+ cell counts of 0.201 to 0.350 x 109 cells/L, initiating antiretroviral therapy is associated with lower mortality than if therapy is delayed until the CD4+ cell count decreases further. Initiation of antiretroviral therapy at CD4+ cell counts of 0.351 to 0.500 x 109 cells/L may help improve survival.
Elizabeth D. Morrison, David J. Brandhagen, Pradyumna D. Phatak, James C. Barton, Edward L. Krawitt, Hashem B. El-Serag, Stuart C. Gordon, Mark V. Galan, Bruce Y. Tung, George N. Ioannou, and Kris V. Kowdley Patients with hemochromatosis and serum ferritin levels less than 1000 µg/L are unlikely to have cirrhosis. Liver biopsy to screen for cirrhosis may be unnecessary in such patients, regardless of age or serum liver enzyme levels.
Eduardo B. Saad, Nassir F. Marrouche, Cynthia P. Saad, Edward Ha, Dianna Bash, Richard D. White, John Rhodes, Lourdes Prieto, David O. Martin, Walid I. Saliba, Robert A. Schweikert, and Andrea Natale Severe pulmonary vein stenosis after catheter ablation of atrial fibrillation is associated with respiratory symptoms that often mimic more common diseases.
Brief Communications
Ezekiel J. Emanuel, Yinong Young-Xu, Norman G. Levinsky, Gail Gazelle, Olga Saynina, and Arlene S. Ash Among patients who died of cancer, chemotherapy was used frequently in the last 3 months of life. Patients with cancer who are dying often receive chemotherapy for types of cancer that seldom respond to chemotherapy.
Academia and Clinic
Mitchell H. Katz This paper reviews the basics of multivariable analysis, including what multivariable models are, why they are used, what assumptions underlie them, how to interpret them, and how to evaluate them.
Updates
Andrew Siderowf and Matthew Stern This Update reports new research on genetic and environmental factors in the etiology of Parkinson disease and emerging data on treatment. This research has moved the field closer to understanding the mechanisms of cell death in Parkinson disease well enough to design rational therapies.
Reviews
Daniel J. Brat and Timothy B. Mapstone Malignant gliomas have invasive properties that make them nearly impossible to cure surgically. Most physicians agree that the best hope for long-term control lies with adjunctive therapies. One emerging field of research attempts to limit tumor growth by interfering with vascular proliferation that occurs as a physiologic response to hypoxia within the tumor.
Perspectives
Donna T. Chen, Franklin G. Miller, and Donald L. Rosenstein The authors discuss several ethical and practical challenges facing physicians who wish to help their patients decide about volunteering for clinical trials. They assert that medical education should prepare physicians to inform patients about participation in clinical research.
History of Medicine
Robert A. Wilcox and Emma M. Whitham This paper describes the ancient origin of the Asklepian (the single serpent–entwined staff of Asklepios, the ancient Greco-Roman god of medicine) and how a misunderstanding of ancient mythology and iconography led to popular acceptance of the modern caduceus as a medical symbol.
Editorials
Kenneth D. Brandt Sharma and colleagues' interesting results in this issue are hypothesis generating rather than conclusive evidence that standard quadriceps-strengthening exercise programs harm patients with osteoarthritis who have greater quadriceps strength. It is too early to begin tailoring strength-maintenance programs to particular subsets of patients.
H. Clifford Lane and James D. Neaton The fundamental unanswered questions about the treatment of patients with HIV infection include when to start therapy, what therapy to start, and when to change therapy. The study by Palella and colleagues in this issue supports earlier rather than later intervention. Although their data are unlikely to change current recommendations about when to initiate therapy, they generate new uncertainty that may lead to clinical trials that will contribute to this important debate.
Harold C. Sox, Dennis Ausiello, Dale Benos, and Paul Epstein With the review by Brat and Mapstone in this issue, Annals begins a series of articles intended to help clinicians understand the scientific basis of new developments in diagnosis and treatment of disease. We will publish these articles under a distinguished name: Physiology in Medicine.
On Being a Doctor
Eric J. Warm All was quiet. There was a dead man on the floor in Room 465, and I wasn't moving. On the first day of residency I would have been in his room, grabbing his shoulder, yelling, "Sir, are you okay?" On the first day of residency I would have pounded on his chest and asked questions later. On the first day of residency I would have broken ribs. But not this night.
Letters Hepatotoxicity Associated with a Dietary Supplement
Effects of Three Therapies for Neck Pain
Subgroup Variation in Diagnostic Test Evaluation
Postmenopausal Hormone Replacement Therapy
Screening for Postmenopausal Osteoporosis
Breast Cancer Screening
Physicians and Patient Spirituality
Hepatitis B Virus Reactivation after a Single Session of Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma
Correction: Reversal of Warfarin–Induced Excessive Anticoagulation
Jennifer Fisher Wilson
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