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This Week in JAMA
November 19, 2008

This Week in JAMA

JAMA. 2008;300(19):2213. doi:10.1001/jama.2008.685

The herb Ginkgo biloba is popularly claimed to have beneficial effects on memory and cognition, but evidence that it is effective for the primary prevention of dementia is lacking. In the Ginkgo Evaluation of Memory Study, 3069 older adults with normal cognition or mild cognitive impairment at baseline were randomly assigned to receive either G biloba or placebo and were assessed every 6 months for incident dementia. DeKosky and colleagues Article report that G biloba had no effect on the incidence of dementia or Alzheimer disease during a median follow-up of 6.1 years. In an editorial, Schneider Article discusses the lack of evidence that G biloba will prevent cognitive decline and dementia in elderly adults.

Human granulocytic anaplasmosis (HGA) is an emerging tick-borne infectious disease that has been recognized in the United States and Europe since the 1990s. Zhang and colleagues Article report the identification of HGA in China, which followed health care worker and family member exposure to a patient with a fulminant disease consistent with possible HGA. The authors compared exposure data from 9 secondary cases and 30 uninfected contacts to define the attack rate, relative risk of illness, and potential risks for disease transmission. In an editorial, Krause and Wormser Article discuss characteristics of the Chinese outbreak in relation to what is known about HGA in the United States and Europe.

Cryptorchidism is the most frequent congenital birth defect in male children. To determine the frequency of genetic alterations associated with cryptorchidism, Ferlin and colleagues analyzed blood samples from male infants with cryptorchidism and a control group of male children without cryptorchidism for karyotype and mutations in the INSL3, RXFP2, and AR genes. The authors found the frequency of genetic alterations in boys with cryptorchidism was 2.8% (95% confidence interval, 1.7%-4.5%). They report a significant association between bilateral and persistent cryptorchidism and several genetic alterations, including Klinefelter syndrome and INSL3 receptor gene mutations.

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Bevacizumab, a novel antiangiogenic agent widely used in cancer treatment, is associated with an increased risk of arterial thromboembolic events. Whether bevacizumab increases the risk of venous thromboembolism is not clear. To evaluate this question, Nalluri and colleagues reviewed the literature and performed a meta-analysis of data from clinical trials involving cancer patients who were randomly assigned to receive bevacizumab or placebo or best supportive care (control). The authors found that cancer patients who received bevacizumab had a significantly increased risk of venous thromboembolism compared with patients in the control group.

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In a systematic review of the literature on bariatric procedures among women of reproductive age, Maggard and colleagues found that women aged 18 to 45 years accounted for 49% of annual bariatric surgeries. The authors also found evidence that the rates of some adverse maternal and neonatal outcomes may be lower after bariatric surgery compared with the risks in obese women.

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“My path through child psychiatry fellowship and beyond is one strewn with both luck and hubris.” From “Raising Doctors.”

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Pediatricians and health officials are working to counter misconceptions about vaccine safety and to bolster public support for these lifesaving interventions.

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Importance of biodiversity to medicine

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Organizational improvements to enhance clinical epidemiology

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Methadone maintenance

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Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

Join Brett D. Thombs, PhD, and Roy Ziegelstein, MD, December 17 from 2 to 3 PM eastern time to discuss depression screening for patients with cardiovascular disease. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 24-year-old woman with intractable seizures since age 10 years? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is November 26.

For your patients: Information about dementia.

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