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This Week in JAMA
JAMA. 2007;297:1519.
Nonvalidation of Genetic Risks for ACS
A genetic basis for atherosclerotic heart disease and acute coronary syndromes (ACS) has been implicated in a number of small studies, but there has been little consistency in the associated gene variants across studies. Morgan and colleagues performed a systematic literature review and identified 85 variants in 70 genes that have been previously reported as associated with ACS. The authors sought to replicate these findings in a cohort study of 811 patients with ACS and 650 age- and sex-matched controls. The authors report that they could not unequivocally validate any of the 85 genetic variants previously implicated as susceptibility factors for ACS.
(SEE ARTICLE)
Corticosteroids and Prevention of Atrial Fibrillation
Atrial fibrillation (AF) is common after cardiac surgery, and it has been hypothesized that AF after cardiac surgery may be a consequence of an exaggerated inflammatory response. In a placebo-controlled, randomized trial of patients having cardiac surgery who had no prior history of AF, Halonen and colleagues investigated whether intravenous corticosteroids administered after cardiac surgery would prevent postoperative AF. The authors found that patients who received postoperative corticosteroids had a significantly lower risk of AF during the first 84 hours after surgery and had no increased risk of superficial or deep wound infections compared with patients who received a placebo infusion.
(SEE ARTICLE)
Early Stem Cell Transplantation in Type 1 Diabetes
Some autoimmune diseases have been successfully treated with high-dose immunosuppression followed by autologous hematopoietic stem cell transplantation. Voltarelli and colleagues (SEE ARTICLE) assessed the safety and effectiveness of this strategy in 15 patients diagnosed with type 1 diabetes mellitus within the previous 6 weeks. The authors report that during a follow-up of 7 to 36 months (mean 18.8 months), 14 of the 15 patients experienced between 1 and 35 months of insulin independence and that treatment-related toxicity was low. In an editorial, Skyler (SEE ARTICLE) discusses the study results and implications for future investigations of interventions to prevent or reverse type 1 diabetes mellitus.
Baculovirus Hemagglutinin Influenza Vaccine
Development of influenza vaccines that do not use embryonated eggs in production is a high priority. In a randomized, placebo-controlled clinical trial, Treanor and colleagues investigated the dose-related safety, immunogenicity, and protective efficacy of an experimental trivalent influenzavirus hemagglutinin (rHA0) vaccine produced in insect cells using recombinant baculoviruses. The authors report that the experimental vaccine was safe, induced 4-fold or greater increases in serum hemagglutinin inhibition antibodies to the 3 vaccine strains in comparisons of prevaccination and postvaccination samples, and was associated with reduced rates of culture-documented influenza illness.
(SEE ARTICLE)
CLINICIAN'S CORNER
Ventilator-Associated Pneumonia
The Rational Clinical Examination
The combination of a new radiographic infiltrate plus at least 2 of fever, leukocytosis, or purulent sputum increases the likelihood of ventilator-associated pneumonia.
(SEE ARTICLE)
A Piece of My Mind
"Steven was my best friend, and I didn't realize, until just before he died, that I was confusing his suffering with my own." From "Steven's Violin."
(SEE ARTICLE)
Medical News & Perspectives
Two investigational agents with novel mechanisms of action show promise for treating patients infected with strains of multidrug-resistant HIV, according to findings from large efficacy trials reported at the 14th Conference on Retroviruses and Opportunistic Infections.
(SEE ARTICLE)
Back Pain in the Workplace
Psychosocial factors in the workplace are more likely to be confounders of coping with backache than the physical demands of the job.
(SEE ARTICLE)
Crash Risk in General Aviation
Crash rates, risk factors, and fatalities in noncommercial aviation.
(SEE ARTICLE)
Author in the Room Teleconference
Join Jan Lewis Brandes, MD, April 16, 2007, from 2 to 3 PM eastern time to discuss the treatment of migraine in primary care. To register, go to http://www.ihi.org/AuthorintheRoom.
Audio Commentary
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
JAMA Patient Page
For your patients: Information about ventilator-associated pneumonia.
(SEE ARTICLE)
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