This digest presents the most recent research from leading scientific journals -- Science, Nature, Cell, JAMA, and the New England Journal of Medicine -- as excerpted on The Scientific Lawyer. You are invited to download this digest's RSS feed:
August 27, 8:55 PM / New England Journal of Medicine / CME: Management of Acute Bleeding from a Peptic Ulcer(No abstract is available for this citation)
August 27, 8:55 PM / New England Journal of Medicine / EDITORIAL: Antenatal Magnesium Sulfate for Neuroprotection before Preterm Birth?Preterm infants are at increased risk for serious, lifelong neurologic abnormalities such as cerebral palsy.1,2 As the survival of preterm infants has improved with advances in perinatal care,2 the occurrence ...
August 27, 8:55 PM / New England Journal of Medicine / CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2008 -- A 64-Year-Old Man with Abdominal Pain, Nausea, and an Elevated Level of Serum CreatinineA 64-year-old man was admitted to the hospital because of abdominal pain, nausea, and an elevated serum creatinine level. He had a history of recurrent epigastric pain, which had been attributed to pancreatitis and gastroesophageal reflux disease. One week before admission, epigastric pain recurred, with nausea and vomiting; 3 days before admission, he stopped all oral intake, but symptoms worsened. On admission, the serum creatinine level was 3.5 mg per deciliter, and the urea nitrogen level was 28 mg per deciliter. Intravenous fluids were administered, without improvement. A diagnostic procedure was performed.
August 27, 8:55 PM / New England Journal of Medicine / IMAGES IN CLINICAL MEDICINE: Squamous-Cell Carcinoma Manifesting as a Cutaneous HornA healthy 84-year-old woman presented with a 6-month history of a slowly growing asymptomatic lesion on the dorsum of her right hand. Physical examination revealed a keratotic cutaneous horn -- ...
August 27, 8:55 PM / New England Journal of Medicine / IMAGES IN CLINICAL MEDICINE: The Stewart-Treves SyndromeA 67-year-old woman with a history of cancer of the right breast, treated with a modified radical mastectomy, radiation, and chemotherapy in 1990, presented with a 6-month history of an ...
August 27, 8:55 PM / New England Journal of Medicine / REVIEW ARTICLE: Mechanisms of Disease: Mechanisms of Thrombus FormationThis review is an account of recent advances in our understanding of the mechanisms of thrombus formation, with emphasis on two independent pathways: one involving primarily platelets, and the other initiated by tissue factor. The review includes information from new studies of microparticles in the circulation that display tissue derived from injured cells, cancer cells, and inflammatory cells. It ends with a discussion of the clinical implications for prevention and management of thrombosis. A showing thrombus formation in vivo is available at www.nejm.org.
August 27, 8:55 PM / New England Journal of Medicine / REVIEW ARTICLE: Current Concepts: Management of Acute Bleeding from a Peptic UlcerThe mortality associated with acute bleeding from a peptic ulcer remains high (5 to 10%), and the condition accounts for more than 400,000 hospital admissions per year in the United States. This review summarizes the approach to patient triage and risk stratification, the goals of early endoscopy, the options for medical therapy, and the role of surgery and interventional radiology.
August 27, 8:55 PM / New England Journal of Medicine / ORIGINAL ARTICLE: Brain-Derived Neurotrophic Factor and Obesity in the WAGR SyndromeThis study examined genotype and body-mass index in patients with the Wilms' tumor, aniridia, genitourinary anomalies, and mental retardation (WAGR) syndrome. The related genes WT1 and PAX6 are on chromosome 11p13, centromeric to brain-derived neurotrophic factor (BDNF), an important gene in energy homeostasis. BDNF haploinsufficiency was linked to childhood-onset obesity and reduced levels of serum BDNF, suggesting a role of BDNF in energy homeostasis.
August 27, 8:55 PM / New England Journal of Medicine / ORIGINAL ARTICLE: Bortezomib plus Melphalan and Prednisone for Initial Treatment of Multiple MyelomaPatients with newly diagnosed multiple myeloma who were ineligible for treatment with high-dose chemotherapy plus hematopoietic stem-cell transplantation were randomly assigned to receive either melphalan and prednisone alone or melphalan and prednisone plus bortezomib. The time to disease progression (the primary outcome) was longer in the bortezomib group. The combination of bortezomib, melphalan, and prednisone appears to be effective as initial treatment in patients with multiple myeloma who cannot withstand high-dose therapy.
August 27, 8:55 PM / New England Journal of Medicine / ORIGINAL ARTICLE: A Randomized, Controlled Trial of Magnesium Sulfate for the Prevention of Cerebral PalsyIn this multicenter, placebo-controlled, randomized trial of intravenous magnesium sulfate in women at imminent risk for delivery between 24 and 31 weeks of gestation, magnesium sulfate did not significantly reduce the primary composite outcome of moderate or severe cerebral palsy or death. However, it did result in a reduced rate of cerebral palsy among survivors (a prespecified secondary outcome), which may suggest the possibility of benefit.
August 27, 8:55 PM / New England Journal of Medicine / PERSPECTIVE: An HIV Vaccine -- Challenges and ProspectsNow well into the third decade of the pandemic of human immunodeficiency virus (HIV) and AIDS, we have seen dramatic successes in the treatment of HIV-infected persons in the United ...
August 27, 8:55 PM / New England Journal of Medicine / PERSPECTIVE: The AIDS Epidemic -- A Progress Report from Mexico CityA quarter-century after the discovery of the human immunodeficiency virus (HIV), the world is finally gaining ground against AIDS. Yet the millions of new infections and deaths each year are ...
August 27, 8:55 PM / New England Journal of Medicine / CLINICAL IMPLICATIONS OF BASIC RESEARCH: Targeting Intraocular Neovascularization and Edema -- One Drop at a TimeTopical application of inhibitors of growth factor receptors or their signaling pathways protects against choroidal neovascularization, vascular leakage, and retinal edema in mice.
August 27, 8:55 PM / New England Journal of Medicine / EDITORIAL: Treatment of Myeloma -- Are We Making Progress?In this issue of the Journal, San Miguel et al.1 describe the benefit of combining bortezomib with melphalan plus prednisone, as compared with melphalan plus prednisone alone, as initial therapy ...
August 27, 8:55 PM / New England Journal of Medicine / CORRESPONDENCE: Initial Treatment of HIV-1 InfectionTo the Editor: In their study comparing three different regimens for initial treatment of human immunodeficiency virus type 1 (HIV-1) ...
August 27, 8:55 PM / New England Journal of Medicine / CME: Case 27-2008: A 64-Year-Old Man with Abdominal Pain, Nausea, and an Elevated Level of Serum Creatinine(No abstract is available for this citation)
August 27, 8:55 PM / New England Journal of Medicine / CME: Bortezomib plus Melphalan and Prednisone for Initial Treatment of Multiple Myeloma(No abstract is available for this citation)
August 27, 8:55 PM / New England Journal of Medicine / CORRECTIONS: Photo FillerPhoto filler (July 3, 2008;359:42). The title of the photograph printed on page 42 should have been Hyacinth Macaw rather than Blue Toucan. We regret the error.
August 27, 8:55 PM / New England Journal of Medicine / CORRECTIONS: Bivalirudin versus Unfractionated Heparin during Percutaneous Coronary InterventionBivalirudin versus Unfractionated Heparin during Percutaneous Coronary Intervention . In Methods, in the second paragraph under Study Protocol (page 689), the third sentence should read, "Sheaths were removed and manual ...
August 27, 8:55 PM / New England Journal of Medicine / BOOK REVIEW: The Oxford Textbook of Clinical Research EthicsThe Oxford Textbook of Clinical Research Ethics is a resource suitable for a course in research ethics and would also be helpful for those starting a career in clinical research. ...
August 27, 8:55 PM / New England Journal of Medicine / BOOK REVIEW: Scientific Errors and Controversies in the U.S. HIV/AIDS Epidemic: How They Slowed Advances and Were ResolvedThis book is an autopsy of errors. Drawing on his 20 years as chief of epidemiology in the division for the prevention of the human immunodeficiency virus (HIV) and the ...
August 27, 8:55 PM / New England Journal of Medicine / BOOK REVIEW: Jacob's Legacy: A Genetic View of Jewish HistoryIn 1875, the newly graduated Cambridge polymath Joseph Jacobs wrote a review of George Eliot's last completed novel, Daniel Deronda, the story of a young English gentleman who discovers his ...
August 27, 8:55 PM / New England Journal of Medicine / PERSPECTIVE: Focus on Research: The Power of the Extreme in Elucidating ObesityDespite the worrisome statistics that 16% of children in the United States are obese and that the number of adults with a body-mass index (the weight in kilograms divided by ...
August 27, 8:55 PM / New England Journal of Medicine / CORRESPONDENCE: Treatment of Hypertension in the ElderlyTo the Editor: In his editorial accompanying the article by Beckett et al.1 on the results of the Hypertension in ...
August 27, 8:55 PM / New England Journal of Medicine / CORRESPONDENCE: Correction: Keratoderma Blennorrhagicum-like RashTo the Editor: Tonna and Laing (May 15 issue)1 describe a patient with secondary syphilis. I question the authors' use ...
August 27, 8:55 PM / New England Journal of Medicine / CORRESPONDENCE: Scrotal Cutaneous Side Effects of SunitinibTo the Editor: Sunitinib is an oral, multitargeted kinase that blocks the receptors for vascular endothelial growth factor (VEGF), platelet-derived ...
August 27, 8:55 PM / New England Journal of Medicine / CORRESPONDENCE: Widespread Amyloid Deposition in Transplanted Human Pancreatic IsletsTo the Editor: We report on a patient with type 1 diabetes mellitus, diagnosed at 16 years of age, in ...
August 27, 6:23 PM / Nature / Puzzles, promises and a cure for ageingRecent discoveries in the science of ageing indicate that lifespan in model organisms such as yeast, nematodes, flies and mice is plastic and can be manipulated by genetic, nutritional or pharmacological intervention. A better understanding of the targets of such interventions, as well as the proximate causes of ageing-related degeneration and disease, is essential before we can evaluate if abrogation of human senescence is a realistic prospect.
August 27, 6:23 PM / Nature / How Cooper pairs vanish approaching the Mott insulator in Bi2Sr2CaCu2O8+δThe antiferromagnetic ground state of copper oxide Mott insulators is achieved by localizing an electron at each copper atom in real space (r-space). Removing a small fraction of these electrons (hole doping) transforms this system into a superconducting fluid of delocalized Cooper pairs
August 27, 6:23 PM / Nature / Egalitarianism in young childrenHuman social interaction is strongly shaped by other-regarding preferences, that is, a concern for the welfare of others. These preferences are important for a unique aspect of human sociality—large scale cooperation with genetic strangers—but little is known about their developmental roots. Here we show that
August 27, 6:23 PM / Nature / Major viral impact on the functioning of benthic deep-sea ecosystemsViruses are the most abundant biological organisms of the world's oceans. Viral infections are a substantial source of mortality in a range of organisms—including autotrophic and heterotrophic plankton—but their impact on the deep ocean and benthic biosphere is completely unknown. Here we report that viral
August 27, 6:23 PM / Nature / Misfolded proteins partition between two distinct quality control compartmentsThe accumulation of misfolded proteins in intracellular amyloid inclusions, typical of many neurodegenerative disorders including Huntington's and prion disease, is thought to occur after failure of the cellular protein quality control mechanisms. Here we examine the formation of misfolded protein inclusions in the eukaryotic cytosol
August 27, 6:23 PM / Nature / A common mass scale for satellite galaxies of the Milky WayThe Milky Way has at least twenty-three known satellite galaxies that shine with luminosities ranging from about a thousand to a billion times that of the Sun. Half of these galaxies were discovered in the past few years in the Sloan Digital Sky Survey, and they are among the least luminous galaxies in the known Universe. A determination of the mass of these galaxies provides a test of galaxy formation at the smallest scales and probes the nature of the dark matter that dominates the mass density of the Universe. Here we use new measurements of the velocities of the stars in these galaxies to show that they are consistent with them having a common mass of about 107nature07222-m1jpg6333019 within their central 300 parsecs. This result demonstrates that the faintest of the Milky Way satellites are the most dark-matter-dominated galaxies known, and could be a hint of a new scale in galaxy formation or a characteristic scale for the clustering of dark matter.
August 27, 6:23 PM / Nature / Experimental demonstration of a BDCZ quantum repeater nodeQuantum communication is a method that offers efficient and secure ways for the exchange of information in a network. Large-scale quantum communication (of the order of 100 km) has been achieved; however, serious problems occur beyond this distance scale, mainly due to inevitable photon loss in the transmission channel. Quantum communication eventually fails when the probability of a dark count in the photon detectors becomes comparable to the probability that a photon is correctly detected. To overcome this problem, Briegel, Dür, Cirac and Zoller (BDCZ) introduced the concept of quantum repeaters, combining entanglement swapping and quantum memory to efficiently extend the achievable distances. Although entanglement swapping has been experimentally demonstrated, the implementation of BDCZ quantum repeaters has proved challenging owing to the difficulty of integrating a quantum memory. Here we realize entanglement swapping with storage and retrieval of light, a building block of the BDCZ quantum repeater. We follow a scheme that incorporates the strategy of BDCZ with atomic quantum memories. Two atomic ensembles, each originally entangled with a single emitted photon, are projected into an entangled state by performing a joint Bell state measurement on the two single photons after they have passed through a 300-m fibre-based communication channel. The entanglement is stored in the atomic ensembles and later verified by converting the atomic excitations into photons. Our method is intrinsically phase insensitive and establishes the essential element needed to realize quantum repeaters with stationary atomic qubits as quantum memories and flying photonic qubits as quantum messengers.
August 27, 6:23 PM / Nature / Late Pliocene Greenland glaciation controlled by a decline in atmospheric CO2 levelsIt is thought that the Northern Hemisphere experienced only ephemeral glaciations from the Late Eocene to the Early Pliocene epochs (about 38 to 4 million years ago), and that the onset of extensive glaciations did not occur until about 3 million years ago. Several hypotheses have been proposed to explain this increase in Northern Hemisphere glaciation during the Late Pliocene. Here we use a fully coupled atmosphere–ocean general circulation model and an ice-sheet model to assess the impact of the proposed driving mechanisms for glaciation and the influence of orbital variations on the development of the Greenland ice sheet in particular. We find that Greenland glaciation is mainly controlled by a decrease in atmospheric carbon dioxide during the Late Pliocene. By contrast, our model results suggest that climatic shifts associated with the tectonically driven closure of the Panama seaway, with the termination of a permanent El Niño state or with tectonic uplift are not large enough to contribute significantly to the growth of the Greenland ice sheet; moreover, we find that none of these processes acted as a priming mechanism for glacial inception triggered by variations in the Earth's orbit.
August 27, 6:23 PM / Nature / Formation of current coils in geodynamo simulationsComputer simulations have been playing an important role in the development of our understanding of the geodynamo, but direct numerical simulation of the geodynamo with a realistic parameter regime is still beyond the power of today's supercomputers. Difficulties in simulating the geodynamo arise from the extreme conditions of the core, which are characterized by very large or very small values of the non-dimensional parameters of the system. Among them, the Ekman number, E, has been adopted as a barometer of the distance of simulations from real core conditions, in which E is of the order of 10-15. Following the initial computer simulations of the geodynamo, the Ekman number achieved has been steadily decreasing, with recent geodynamo simulations performed with E of the order of 10-6. Here we present a geodynamo simulation with an Ekman number of the order of 10-7—the highest-resolution simulation yet achieved, making use of 4,096 processors of the Earth Simulator. We have found that both the convection flow and magnetic field structures are qualitatively different from those found in larger-Ekman-number dynamos. The convection takes the form of sheet plumes or radial sheet jets, rather than the columnar cell structures that are usually found. We have found that this sheet plume convection is an effective dynamo and the generated current is organized as a set of coils in the shape of helical springs or at times as a torus.
August 27, 0:00 AM / Nature / Atheism could be science's contribution to religionSirWe were perplexed by your Editorial on the work of the Templeton Foundation ('Templeton's legacy' Nature454, 253–254; 10.1038/454253b2008). Surely science is about finding material explanations of the world — explanations that can inspire those spooky feelings of
August 27, 0:00 AM / Nature / Changes in the rules now governing Italy's drug industrySirI was surprised and dismayed that your Editorial 'Clean hands, please' (Nature454, 667; 10.1038/454667b2008) should be so careless with the evidence in addressing the question of relations between the government and the pharmaceutical industry in Italy.In Italy,
August 27, 0:00 AM / Nature / Olympics may have a negative impact on China's researchSirYour Editorial 'China's challenges' (Nature454, 367–368; 2008) and News Feature 'Visions of China' (Nature454, 384–387; 2008) proclaim China's increasing strength in science and technology. But this summer's Olympics Games in Beijing may cast
August 27, 0:00 AM / Nature / Postdoc glut means academic pathway needs an overhaulSirIn his Correspondence 'Fewer academics are not the answer to funding woes' (Nature454, 397; 10.1038/454397d2008), Philip Strange suggests that we need to increase the number of trained scientists to help deal with current and future crises such as
August 27, 0:00 AM / Nature / Journal clubAn ecologist notes that important details are missing from climate-change models.Unmitigated climate change will gravely reduce Earth's biodiversity. How much this will happen is calculated by combining data on how the species richness of different habitats varies with their area and projections of how
August 27, 0:00 AM / Nature / Zoology: Under pressureCurr. Biol.18, R695–R696 (2008)Wind turbines are bafflingly bad for bats, the bodies of which are often found beneath their blades. Erin Baerwald and her colleagues at the University of Calgary in Canada think they know why: the pressure differential near the blades
August 27, 0:00 AM / Nature / Geosciences: Soil sink surpriseNature Geosci. doi:10.1038/ngeo284 (2008)It is vital to know how much carbon is stored in Earth's Arctic soils, because much of it could be released as greenhouse gases as the planet warms.Chien-Lu Ping at the University of Alaska Fairbanks
August 27, 0:00 AM / Nature / Materials science: Finding focusAppl. Phys. Lett.93, 05311 (2008)Physicists would like to make lenses from metamaterials — structures that can have a negative refractive index. Such lenses would tightly focus light over short distances with little or no distortion. So far, researchers have only been able
August 27, 0:00 AM / Nature / Palaeobiology: MegabiteJ. Zool. doi:10.1111/j.1469-7998.2008.00494.x (2008)How hard can a great white bite? The shark (Carcharodon carcharias) can chomp with about 18,000 Newtons of downward force — the strongest known bite of any living species — and its habit of
August 27, 0:00 AM / Nature / The blossoming of Japanese mathematicsA new compilation of the illustrated geometry problems that decorated shrines in seventeenth-century Japan provides puzzles that are still intriguing today, finds Peter J. Lu.
August 27, 0:00 AM / Nature / More cacophony than harmonySix songs seems a small repertoire to address so grandiose a theme. Yet Daniel Levitin contentiously argues for six classes of song in his quickly published follow-on from This Is Your Brain On Music. He purports to explain neuroscientific concepts by framing them around
August 27, 0:00 AM / Nature / Culture dishArt of noiseAn early collaboration between engineers at Bell Laboratories in New Jersey and ten artists, among them Robert Rauschenberg, Robert Whitman and John Cage, is highlighted in an exhibition at New York's Museum of Modern Art. The group built and featured novel technical
August 27, 0:00 AM / Nature / Condensed-matter physics: Dual realities in superconductorsIn some copper oxides, superconductivity emerges when fixed electrons become mobile. A microscopy technique reveals that this process is associated with the transfer of electrons between real and abstract spaces.
August 27, 0:00 AM / Nature / The future ain't what it used to beRather than teleporting, or even arriving on a hoverboard, I rode to work this morning on the distinctly nineteenth-century technology of a bicycle on tarmac. Much to the relief of my colleagues, I don't sit at my desk in a silver jumpsuit, and my lunch
August 27, 0:00 AM / Nature / 50 & 100 Years Ago50 Years AgoBradenham Manor, the property of the National Trust, has been leased to the British Tabulating Machine Co., Ltd., for use as a Hollerith Computer Training Centre ... [T]he Centre was opened by Lord Halsbury ... who said that the old idea that
August 27, 0:00 AM / Nature / Systems biology: Reverse engineering the cellBorrowing ideas that were originally developed to study electronic circuits, two reports decipher how yeast reacts to changes in its environment by analysing the organism's responses to oscillating input signals.
August 27, 0:00 AM / Nature / Earth science: A sheet-metal geodynamoA decade of modelling Earth's core on computers has led to the belief that we understand what produces Earth's magnetic field. More realistic simulations are now shaking that complacency.
August 27, 0:00 AM / Nature / Human behaviour: Share and share alikeThe happy tendency to share resources equitably — at least with members of one's own social group — is a central and unique feature of human social life. It emerges, it seems, in middle childhood.
August 27, 0:00 AM / Nature / Battle of the sexes may set the brainA tug-of-war between the mother's and father's genes in the developing brain could explain a spectrum of mental disorders from autism to schizophrenia, suggest Christopher Badcock and Bernard Crespi.
August 27, 0:00 AM / Nature / Spartan sport laid bareEdgar Degas's painting of female athletes challenging male competitors in classical Sparta raises subtle questions about gender, politics and sport, explains Martin Kemp.
August 27, 0:00 AM / Nature / Innovations of an ancient nationThis ancient Chinese 'environmentally friendly' oil lamp (pictured) has a built-in system to eliminate smoke and dates from the Western Han dynasty of 206 bc to ad 25. It is one of 169 artefacts on display in the exhibition Chinese Memory, showing
August 27, 0:00 AM / Nature / Evolution: Serotonin for mothersNature Neurosci. doi:10.1038/nn.2176 (2008)The neurotransmitter serotonin is known to be important in mood and behaviour; now researchers have shown that its function is also essential to the survival of baby mice.Evan Deneris at Case Western Reserve University in
August 27, 0:00 AM / Nature / Particle physics: Antimatter bounces backPhys. Rev. A78, 022506 (2008)In the early 1990s, physicists at CERN in Switzerland watched as antiprotons and helium annihilated in flashes of energy. But their experiment also yielded an unexplained secondary string of annihilations in the facility's experimental chamber.Andrea Bianconi of
August 27, 0:00 AM / Nature / Developmental genetics: A sex-specific switchThose who are intimate with the fruitfly Drosophila melanogaster will recognize this fine specimen as a male. Most notably, the last two of its abdominal segments are pigmented. The equivalent segments in the posterior abdomen of females lack pigment, and sexual dimorphism of this
August 27, 0:00 AM / Nature / After MusharrafPakistan's elected governments should break the habit of a lifetime and give due priority to science.
August 27, 0:00 AM / Nature / Future transportThe hike in the price of oil means that new ways of fuelling transport are no longer fantasy.
August 27, 0:00 AM / Nature / From the blogosphereCalling all science tourists! Inspired by the exotic research locales of two News Features last week, a Nature Network forum asks, “What did you do with your summer holiday?”One feature treks to coastal Chile to record the return of jumbo squid, prized by neuroscientists
August 27, 0:00 AM / Nature / AbstractionsFirst authorOne often-cited concern about global warming is that it could cause Greenland's ice sheet to melt. To better understand what controls the ice sheet's volume, researchers want to know how it first grew to cover much of Greenland around 3 million years ago.
August 27, 0:00 AM / Nature / Making the paper: Ernst FehrChildren's sense of fairness makes them egalitarian but not generous.
August 27, 0:00 AM / Nature / Biophysics: Water bombJ. Am. Chem. Soc. doi:10.1021/ja802248m (2008)Water trapped inside barrel-shaped enzymes called chaperonins could be crucial to the way they help proteins fold. Without such attendance, complicated proteins would fail to form their proper arrangement, and consequently would not work.
August 27, 0:00 AM / Nature / Doubly endangeredThe landmark Endangered Species Act in the United States needs more flexibility and fresh thinking — but not of the kind being advocated by the Bush administration.
August 27, 0:00 AM / Nature / Microbiology: Suffocating tuberculosisProc. Natl Acad. Sci. USA105, 11945–11950 (2008)A compound that inhibits the production of ATP, the primary energy carrier in cells, could make treating tuberculosis a little easier, report Kevin Pethe at the Novartis Institute for Tropical Diseases in Chromos, Singapore, and his
August 27, 0:00 AM / Nature / Evolutionary biology: Commonality and cuckoosBehav. Ecol. Sociobiol. doi:10.1007/s00265-008-0618-0 (2008)Natural selection is driving birds that are parasitized by common cuckoos (Cuculus canorus) to lay clutches of more uniformly patterned eggs, researchers have found.Working around the village of Apaj near Kiskunság National
August 27, 0:00 AM / Nature / Electronics: Silicon enhancementScience321, 1069–1071 (2008)The formation of compounds containing silicon usually involves the silicon atoms changing their oxidation states. But Gregory Robinson, Paul von Schleyer and their colleagues at the University of Georgia in Athens have produced a stable silicon compound in which the
August 26, 0:00 AM / JAMA current issue / LETTERS: Guest Authorship, Mortality Reporting, and Integrity in Rofecoxib Studies
August 26, 0:00 AM / JAMA current issue / LETTERS: Guest Authorship, Mortality Reporting, and Integrity in Rofecoxib Studies
August 26, 0:00 AM / JAMA current issue / LETTERS: Guest Authorship, Mortality Reporting, and Integrity in Rofecoxib Studies
August 26, 0:00 AM / JAMA current issue / LETTERS: Guest Authorship, Mortality Reporting, and Integrity in Rofecoxib Studies
August 26, 0:00 AM / JAMA current issue / LETTERS: Guest Authorship, Mortality Reporting, and Integrity in Rofecoxib Studies
August 26, 0:00 AM / JAMA current issue / LETTERS: Guest Authorship, Mortality Reporting, and Integrity in Rofecoxib Studies
August 26, 0:00 AM / JAMA current issue / LETTERS: Guest Authorship, Mortality Reporting, and Integrity in Rofecoxib Studies
August 26, 0:00 AM / JAMA current issue / LETTERS: Guest Authorship, Mortality Reporting, and Integrity in Rofecoxib Studies
August 26, 0:00 AM / JAMA current issue / LETTERS: Guest Authorship, Mortality Reporting, and Integrity in Rofecoxib Studies
August 26, 0:00 AM / JAMA current issue / PRELIMINARY COMMUNICATION: Effect of Allopurinol on Blood Pressure of Adolescents With Newly Diagnosed Essential Hypertension: A Randomized TrialContext Hyperuricemia is a predictor for the development of hypertension and is commonly present in new-onset essential hypertension. Experimentally increasing uric acid levels using a uricase inhibitor causes systemic hypertension in animal models. Objective To determine whether lowering uric acid lowers blood pressure (BP) in hyperuricemic adolescents with newly diagnosed hypertension. Design, Setting, and Patients Randomized, double-blind, placebo-controlled, crossover trial (September 2004-March 2007) involving 30 adolescents (aged 11-17 years) who had newly diagnosed, never-treated stage 1 essential hypertension and serum uric acid levels ≥6 mg/dL. Participants were treated at the Pediatric Hypertension Clinic at Texas Children's Hospital in Houston. Patients were excluded if they had stage 2 hypertension or known renal, cardiovascular, gastrointestinal tract, hepatic, or endocrine disease. Intervention Allopurinol, 200 mg twice daily for 4 weeks, and placebo, twice daily for 4 weeks, with a 2-week washout period between treatments. The order of the treatments was randomized. Main Outcome Measures Change in casual and ambulatory blood pressure. Results For casual BP, the mean change in systolic BP for allopurinol was –6.9 mm Hg (95% confidence interval [CI], –4.5 to –9.3 mm Hg) vs –2.0 mm Hg (95% CI, 0.3 to –4.3 mm Hg; P = .009) for placebo, and the mean change in diastolic BP for allopurinol was –5.1 mm Hg (95% CI, –2.5 to –7.8 mm Hg) vs –2.4 (95% CI, 0.2 to –4.1; P = .05) for placebo. Mean change in mean 24-hour ambulatory systolic BP for allopurinol was –6.3 mm Hg (95% CI, –3.8 to –8.9 mm Hg) vs 0.8 mm Hg (95% CI, 3.4 to –2.9 mm Hg; P = .001) for placebo and mean 24-hour ambulatory diastolic BP for allopurinol was –4.6 mm Hg (–2.4 to –6.8 mm Hg) vs –0.3 mm Hg (95% CI, 2.3 to –2.1 mm Hg; P = .004) for placebo. Twenty of the 30 participants achieved normal BP by casual and ambulatory criteria while taking allopurinol vs 1 participant while taking placebo ( P Conclusions In this short-term, crossover study of adolescents with newly diagnosed hypertension, treatment with allopurinol resulted in reduction of BP. The results represent a new potential therapeutic approach, although not a fully developed therapeutic strategy due to potential adverse effects. These preliminary findings require confirmation in larger clinical trials. Trial Registration clinicaltrials.gov Identifier: NCT00288184
August 26, 0:00 AM / JAMA current issue / EDITORIAL: Tight Glycemic Control in Critically Ill Adults
August 26, 0:00 AM / JAMA current issue / JAMA CLASSICS: Yellow Fever: 100 Years of Discovery
August 26, 0:00 AM / JAMA current issue / COMMENTARY: Food Safety for the 21st Century
August 26, 0:00 AM / JAMA current issue / COMMENTARY: Single-Patient Rooms for Safe Patient-Centered Hospitals
August 26, 0:00 AM / JAMA current issue / COMMENTARY: Opportunities for Enhancing the FDA Guidance on Pharmacovigilance
August 26, 0:00 AM / JAMA current issue / LETTERS: Guest Authorship, Mortality Reporting, and Integrity in Rofecoxib Studies
August 26, 0:00 AM / JAMA current issue / SPECIAL COMMUNICATION: Opt-Out Testing for Human Immunodeficiency Virus in the United States: Progress and ChallengesThe Centers for Disease Control and Prevention (CDC) has recommended human immunodeficiency virus (HIV) testing for all persons aged 13 to 64 years in all health care settings. Signed consent would not be required and counseling with referral would be managed as it is for other serious conditions. The goal of the recommendations is to promote earlier entry into care to reduce unnecessary mortality and facilitate prevention by behavioral changes that accompany knowledge of serostatus. Concerns about the change include laws in some states that mandate signed consent and counseling, a perception that counseling is an effective prevention strategy, variability in payment coverage for the test, concerns about the stigma and discrimination that may accompany the HIV diagnosis, and the possibility that other testing policies would be more effective. Eleven of 16 states have changed legislation to reduce barriers to testing, 35 of 74 national professional societies have endorsed the new recommendations, and multiple demonstration projects have shown feasibility. Metrics to evaluate the health outcomes of the CDC's recommendations for HIV testing have been defined, but the data necessary to determine the effects on early entry into care, the actual reduction in disease incidence, and the unanticipated consequences are not yet available.
August 26, 0:00 AM / JAMA current issue / CARING FOR THE CRITICALLY ILL PATIENT: Benefits and Risks of Tight Glucose Control in Critically Ill Adults: A Meta-analysisContext The American Diabetes Association and Surviving Sepsis Campaign recommend tight glucose control in critically ill patients based largely on 1 trial that shows decreased mortality in a surgical intensive care unit. Because similar studies report conflicting results and tight glucose control can cause dangerous hypoglycemia, the data underlying this recommendation should be critically evaluated. Objective To evaluate benefits and risks of tight glucose control vs usual care in critically ill adult patients. Data Sources MEDLINE (1950-2008), the Cochrane Library, clinical trial registries, reference lists, and abstracts from conferences from both the American Thoracic Society (2001-2008) and the Society of Critical Care Medicine (2004-2008). Study Selection We searched for studies in any language in which adult intensive care patients were randomly assigned to tight vs usual glucose control. Of 1358 identified studies, 34 randomized trials (23 full publications, 9 abstracts, 2 unpublished studies) met inclusion criteria. Data Extraction and Analysis Two reviewers independently extracted information using a prespecified protocol and evaluated methodological quality with a standardized scale. Study investigators were contacted for missing details. We used both random- and fixed-effects models to estimate relative risks (RRs). Results Twenty-nine randomized controlled trials totaling 8432 patients contributed data for this meta-analysis. Hospital mortality did not differ between tight glucose control and usual care overall (21.6% vs 23.3%; RR, 0.93; 95% confidence interval [CI], 0.85-1.03). There was also no significant difference in mortality when stratified by glucose goal ([1] very tight: ≤110 mg/dL; 23% vs 25.2%; RR, 0.90; 95% CI, 0.77-1.04; or [2] moderately tight: Conclusion In critically ill adult patients, tight glucose control is not associated with significantly reduced hospital mortality but is associated with an increased risk of hypoglycemia.
August 26, 0:00 AM / JAMA current issue / ORIGINAL CONTRIBUTION: Lead, Mercury, and Arsenic in US- and Indian-Manufactured Ayurvedic Medicines Sold via the InternetContext Lead, mercury, and arsenic have been detected in a substantial proportion of Indian-manufactured traditional Ayurvedic medicines. Metals may be present due to the practice of rasa shastra (combining herbs with metals, minerals, and gems). Whether toxic metals are present in both US- and Indian-manufactured Ayurvedic medicines is unknown. Objectives To determine the prevalence of Ayurvedic medicines available via the Internet containing detectable lead, mercury, or arsenic and to compare the prevalence of toxic metals in US- vs Indian-manufactured medicines and between rasa shastra and non–rasa shastra medicines. Design A search using 5 Internet search engines and the search terms Ayurveda and Ayurvedic medicine identified 25 Web sites offering traditional Ayurvedic herbs, formulas, or ingredients commonly used in Ayurveda, indicated for oral use, and available for sale. From 673 identified products, 230 Ayurvedic medicines were randomly selected for purchase in August-October 2005. Country of manufacturer/Web site supplier, rasa shastra status, and claims of Good Manufacturing Practices were recorded. Metal concentrations were measured using x-ray fluorescence spectroscopy. Main Outcome Measures Prevalence of medicines with detectable toxic metals in the entire sample and stratified by country of manufacture and rasa shastra status. Results One hundred ninety-three of the 230 requested medicines were received and analyzed. The prevalence of metal-containing products was 20.7% (95% confidence interval [CI], 15.2%-27.1%). The prevalence of metals in US-manufactured products was 21.7% (95% CI, 14.6%-30.4%) compared with 19.5% (95% CI, 11.3%-30.1%) in Indian products ( P = .86). Rasa shastra compared with non–rasa shastra medicines had a greater prevalence of metals (40.6% vs 17.1%; P = .007) and higher median concentrations of lead (11.5 µg/g vs 7.0 µg/g; P = .03) and mercury (20 800 µg/g vs 34.5 µg/g; P = .04). Among the metal-containing products, 95% were sold by US Web sites and 75% claimed Good Manufacturing Practices. All metal-containing products exceeded 1 or more standards for acceptable daily intake of toxic metals. Conclusion One-fifth of both US-manufactured and Indian-manufactured Ayurvedic medicines purchased via the Internet contain detectable lead, mercury, or arsenic.
August 26, 0:00 AM / JAMA current issue / ORIGINAL CONTRIBUTION: Nut, Corn, and Popcorn Consumption and the Incidence of Diverticular DiseaseContext Patients with diverticular disease are frequently advised to avoid eating nuts, corn, popcorn, and seeds to reduce the risk of complications. However, there is little evidence to support this recommendation. Objective To determine whether nut, corn, or popcorn consumption is associated with diverticulitis and diverticular bleeding. Design and Setting The Health Professionals Follow-up Study is a cohort of US men followed up prospectively from 1986 to 2004 via self-administered questionnaires about medical (biennial) and dietary (every 4 years) information. Men reporting newly diagnosed diverticulosis or diverticulitis were mailed supplemental questionnaires. Participants The study included 47 228 men aged 40 to 75 years who at baseline were free of diverticulosis or its complications, cancer, and inflammatory bowel disease and returned a food-frequency questionnaire. Main Outcome Measures Incident diverticulitis and diverticular bleeding. Results During 18 years of follow-up, there were 801 incident cases of diverticulitis and 383 incident cases of diverticular bleeding. We found inverse associations between nut and popcorn consumption and the risk of diverticulitis. The multivariate hazard ratios for men with the highest intake of each food (at least twice per week) compared with men with the lowest intake (less than once per month) were 0.80 (95% confidence interval, 0.63-1.01; P for trend = .04) for nuts and 0.72 (95% confidence interval, 0.56-0.92; P for trend = .007) for popcorn. No associations were seen between corn consumption and diverticulitis or between nut, corn, or popcorn consumption and diverticular bleeding or uncomplicated diverticulosis. Conclusions In this large, prospective study of men without known diverticular disease, nut, corn, and popcorn consumption did not increase the risk of diverticulosis or diverticular complications. The recommendation to avoid these foods to prevent diverticular complications should be reconsidered.
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