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This Week in JAMA
November 14, 2012

This Week in JAMA

JAMA. 2012;308(18):1835. doi:10.1001/jama.2012.3318

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.

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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.

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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.

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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.

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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?

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Outdated treatment approaches are hampering the ability of the military health care system to treat patients who have substance abuse disorders.

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Preventing fatal opioid overdose

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Rethinking opioid prescribing

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Promises and limitations of genome-wide association studies

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“I am quite certain that I would seem like an ordinary patient to most physicians.” From “The Unasked Question.”

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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.

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