In the Physicians' Health Study II, 14 641 male US physicians aged 50 years or older were randomly assigned to receive a daily multivitamin or placebo. During a median follow-up of 11.2 years, Gaziano and colleagues found that compared with men taking placebo, those taking a daily multivitamin had a modest but significantly reduced risk of total cancer. In an editorial, Bach and Lewis discuss a number of uncertainties regarding the effect of multivitamin supplementation on cancer risk in men.
Management of low-grade gliomas is controversial. In a retrospective cohort study of 153 Norwegian patients with diffuse low-grade gliomas who received care at 2 university hospitals with different treatment strategies, Jakola and colleagues found that treatment at a center that favored early surgical resection was associated with better overall survival than treatment at a hospital that favored biopsy and watchful waiting. In an editorial, Markert discusses treatment of low-grade gliomas.
Migraine has been associated with a higher prevalence of magnetic resonance imaging (MRI)–detected lesions in the brain. Palm-Meinders and colleagues assessed progression of these lesions in a 9-year follow-up of 203 patients with migraine and 83 controls who participated in a population-based study of MRI-detected cerebral abnormalities in migraine. On MRI obtained during follow-up, the authors found that compared with controls, women with migraine had a higher prevalence and greater progression of deep white matter hyperintensities, but not progression of other brain lesions. In an editorial, Friedman and Dodick discuss implications for patients with migraine.
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In analyses of data from 4 independent prospective cohort studies—a discovery cohort involving 1514 participants and a replication meta-analysis across 3 cohorts involving 2727 participants—Levin and colleagues found that common variants of the vitamin D receptor gene modified the association of low serum vitamin D with a composite clinical outcome of hip fracture, myocardial infarction, cancer, and mortality.
Among patients with hepatitis B virus (HBV)–related hepatocellular carcinoma, higher HBV viral load is a risk factor for tumor recurrence following curative liver resection. In a cohort of 4569 newly diagnosed patients with HBV-related hepatocellular carcinoma who underwent curative liver resection, Wu and colleagues found that patients who received antiviral therapy—specifically nucleoside analogues—had a lower risk of tumor recurrence than patients who did not during 6 years' follow-up. In an editorial, Lok discusses the use of antiviral therapy in patients with HBV-related hepatocellular carcinoma.
A patient with a 30-year history of an enlarging, painless wrist mass has functional limitation and hand swelling. Ultrasound examination shows a cystic-appearing mass with no arterialized flow and angiography reveals delayed contrast enhancement. What would you do next?
Outdated treatment approaches are hampering the ability of the military health care system to treat patients who have substance abuse disorders.
Preventing fatal opioid overdose
Rethinking opioid prescribing
Promises and limitations of genome-wide association studies
“I am quite certain that I would seem like an ordinary patient to most physicians.” From “The Unasked Question.”
Dr Pasche summarizes and comments on this week's issue. Go to http://jama.jamanetwork.com/multimedia.aspx#Weekly
Join Nancy A. Rigotti, MD, Wednesday, November 14, from 2 to 3 PM eastern time to discuss strategies to help patients quit smoking. To register, go to http://www.ihi.org/Authorintheroom.
For your patients: Information about antibiotic resistance.
This Week in JAMA. JAMA. 2012;308(18):1835. doi:10.1001/jama.2012.3318