Findings to advance understanding of the genetics and pathobiology of gliomas are reported in 2 articles in this issue. In the first article, Bredel and colleagues Article report results of multidimensional genomic and clinical profiling of 501 gliomas. The authors found a consistent pattern of nonrandom chromosomal alterations that involved multiple genes. In addition, the authors confirmed their hypothesis that these genetic alterations act synergistically to facilitate glioma development and progression and are associated with patient prognosis. In the second article, Yadav and colleagues Article examined the functional relationship between 2 of these interacting genes in glioblastomas—annexin A7 (ANXA7; a potential tumor suppressor gene) and epidermal growth factor receptor (EGRF). The authors found that heterozygous ANXA7 gene deletion is associated with an increase in EGRF expression, enhanced tumorigenicity, and poor survival of patients with glioblastomas. In an editorial, Pasche and Myers Article discuss potential clinical implications of these findings.
Performance of intraoperative transesophageal echocardiography during cardiothoracic surgery has made incidental discovery of patent foramen ovale common; however, the optimal management of patients with this finding is not clear. In a cohort of 13 092 patients who were undergoing cardiothoracic surgery, Krasuski and colleagues assessed the frequency of incidentally discovered patent foramen ovale and the associated perioperative and long-term effects. The authors report that intraoperative patent foramen ovale was diagnosed in 2277 patients (17%) and was not associated with increased perioperative morbidity or mortality. Surgical closure (performed in 639 patients) was unrelated to long-term survival but may increase postoperative stroke risk.
There is some evidence that women who take postmenopausal hormone therapy have an increased risk of ovarian cancer. Mørch and colleagues analyzed national data from Denmark to assess the risk of ovarian cancer in perimenopausal and postmenopausal women who were receiving different hormone therapies. The authors found that compared with women who have never taken hormone therapy, those who currently take it or who have taken it in the past are at increased risk of epithelial ovarian cancer. This risk did not differ significantly by duration of use, hormone formulation, regimen, estrogen dose, progestin type, or route of administration.
Long-term survival following allogeneic hematopoietic stem cell transplantation (HSCT) has improved, increasing the number of patients living with chronic graft-vs-host disease, a condition in which donor immune cells attack healthy host tissues. When lung tissue is affected, bronchiolitis obliterans syndrome ensues. Williams and colleagues discuss a patient who achieved a complete remission of acute myeloid leukemia and underwent HSCT from a sibling donor. Ten months after the transplant the patient developed shortness of breath and wheezing, and a lung biopsy was consistent with bronchiolitis obliterans. The authors discuss the diagnosis, epidemiology, pathogenesis, and treatment of this condition.
“I wasn't sure I would ever be able to speak in public again, let alone return to teaching and lecturing.” From “Rediscovering My Voice.”
An updated guideline from the Institute of Medicine for weight gain during pregnancy provides specific weight-gain targets for women who are obese and those who are carrying twins.
Health impact assessment
Integrating clinical care and community health
Community-partnered, participatory research
Vaccine against human hepatitis B
Call for Papers
Authors are invited to submit manuscripts for an upcoming JAMA theme issue.
For your patients: Information about hematopoietic stem cell transplantation.
This Week in JAMA . JAMA. 2009;302(3):227. doi:10.1001/jama.2009.1031