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This Week in JAMA
July 8, 2009

This Week in JAMA

JAMA. 2009;302(2):121. doi:10.1001/jama.2009.991

Minimally invasive, tubular diskectomy is thought to result in less postoperative pain and more rapid recovery than conventional microdiskectomy in the treatment of sciatica; however, data to support these assumptions are limited. To assess outcomes and time to recovery following tubular diskectomy vs conventional microdiskectomy, Arts and colleagues randomly assigned patients with sciatica caused by lumbar disk herniation to undergo either tubular diskectomy or microdiskectomy. The authors report that improvement in functional disability in the year after surgery did not differ significantly by procedure. At 1-year follow-up, patients who had tubular diskectomy reported less improvement in leg and back pain and lower rates of perceived recovery than patients who underwent conventional microdiskectomy.

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Routine infant vaccination with the 7-valent pneumococcal conjugate vaccine (PCV-7) has been associated with significant reductions in pneumococcal disease among vaccinees and nonimmunized individuals. The recommended 3 + 1-dose schedule involves 3 primary doses before age 6 months and a booster dose in the second year of life. To assess the effect of reduced-dose schedules with PCV-7 on nasopharyngeal pneumococcal carriage in young children, van Gils and colleagues randomly assigned healthy newborns to receive either 2 doses of PCV-7 at 2 and 4 months; 2 + 1 doses of PCV-7 at 2, 4, and 11 months; or no PCV-7 doses. The authors found that compared with receipt of no PCV-7, infants who received PCV-7 according to either reduced-dose schedule had significantly decreased rates of vaccine serotype pneumococcal carriage in the second year of life.

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Echocardiographic measures of left ventricular structure and function are heritable phenotypes of cardiovascular disease. Data from a few small studies have suggested associations between several gene polymorphisms and variability in left ventricular mass, but these findings have not been replicated. Vasan and colleagues conducted a meta-analysis of genome-wide association data derived from more than 12 000 participants in 5 population-based cohort studies and identified 16 common genetic variants associated with cardiac structure and function. In a replication study using data from 2 additional population-based cohorts, the authors found that 5 genetic loci were associated with variation in left ventricular diastolic dimension and aortic root diameter. However, these gene associations explained a very small proportion of the variance in cardiac structure observed on echocardiography.

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Some data suggest that adiponectin, a protein that is secreted by adipocytes with anti-inflammatory and insulin-sensitizing properties, may be useful to identify individuals at high risk of developing type 2 diabetes. In a systematic review and meta-analysis, Li and colleagues examined the association of plasma adiponectin levels with the risk of type 2 diabetes. They found that higher adiponectin levels were associated with a lower risk of type 2 diabetes across diverse populations.

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“I suffered the frustration of appreciating what the art of medicine should look like, but being completely incapable of painting it on my own.” From “Physician by Number.”

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A National Institutes of Health program aims to boost the production of new medications for rare and neglected diseases by ushering drug candidates through preclinical development.

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FDA performance goals for drug approvals

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Improved access to FDA reviews

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Comparative effectiveness research

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Exploring patients' information preferences

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Resolving unreported conflicts of interest

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Join Charles M. Morin, PhD, Wednesday, July 15, from 2 to 3 PM eastern time to discuss cognitive behavioral therapy to treat insomnia. Register at http://www.ihi.org/AuthorintheRoom. Send questions to replies@jama-archives.org.

For your patients: Information about sciatica.

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