The lack of association between baseline plasma and CSF HIV RNA levels and incident dementia suggests highly active antiretroviral therapy may be affecting CNS viral dynamics, leading to lower HIV RNA levels, and therefore weakening the utility of baseline HIV RNA levels as predictors of HIV-associated dementia.

Background: Several markers of immune activation have been identified as potential prognostic markers for human immunodeficiency virus (HIV)-associated morbidity and mortality, but the results from studies are conflicting.Objective: To evaluate whether neurocognitive status and baseline levels of plasma and cerebrospinal fluid tumor necrosis factor ␣ (TNF-␣), macrophage chemoattractant protein 1 (MCP-1), matrix metalloproteinase 2 (MMP-2), or macrophage colony-stimulating factor (M-CSF) are associated with time to death in a cohort with advanced HIV infection.

At the start of the 20th century, Abraham Flexner proposed a number of reforms for medical education in his seminal 1910 report, Medical Education in the United States and Canada. His recommendations were wide ranging, including a strong scientific basis, use of pedagogical methods, and faculty whose principal role is that of educator. Of these, reforms in science education for medicine received the widest attention and revolutionized physicians' intellectual foundations for medical practice. But what of Flexner's other suggested reforms, those skills needed to develop "the educated man" who can meet the "greatly modified ethical responsibility" of modern medical practice? As the 21st century begins, Flexner's ideas on these other subjects he considered critical for physician training are reappearing in the medical education literature. If history is a guide, medical education could be on the cusp of another set of great advances by renewing interest in medical humanities, reevaluating the makeup of medical school teaching faculty, and seeking innovations in pedagogy to facilitate active and integrated learning. The time is ripe to embrace the rest of the Flexner Report.

Eduard Pernkopf created a classic anatomy atlas during World War II. He was also an ardent Nazi. Questions have been raised recently about the propriety of using an atlas created by a Nazi and illustrated by dissections of cadavers whose identities are unknown, but who could have been victims of Nazi political terror. To examine the ethical issues involved, the author first reviews recently published work regarding Pernkopf and his atlas, with the caution that facts are few in a debate where emotions run high and opinions abound. He then considers what has been written by bioethicists on the use of scientific data from the Nazi era and how those arguments might apply to Pernkopf and his atlas. Important questions remain, however. For example, are scientific data tainted by their associations with Nazism, or should such data (including the atlas) be assessed on their own merits, separate from the persons and ideologies involved in their creation? Finally, the author offers his own perspective as a young gross anatomist and physician. He argues that rejecting the hateful beliefs of Pernkopf and his fellow Nazis does not necessitate rejecting the elegant anatomic images they produced. The author further suggests that use of the atlas is itself the most fitting tribute to those who died for it, whether they were victims of Nazi repression or not. Those cadavers not only teach anatomy, they "can remind us of suffering not only in the past but in the present, that we may be more compassionate physicians, more compassionate citizens of the world."