Cerebral morbidity, including cognitive decline and stroke, has been
associated with coronary artery bypass graft (CABG) surgery using cardiopulmonary
bypass (on-pump surgery). In this randomized trial, Van Dijk and colleaguesArticle
found that 3 months after a first CABG surgery, the incidence of cognitive
decline was not significantly different between patients who received on-pump
CABG surgery and those who received CABG surgery using cardiac stabilizers
(off-pump surgery group), but overall improvement in cognitive outcomes was
greater in the off-pump group compared with the on-pump group. At 12 months,
however, differences in improvements in cognitive outcomes between the 2 groups
were not statistically significant. In an editorial, Mark and NewmanArticle discuss
the possible mechanisms of cognitive dysfunction after CABG surgery and emphasize
the importance of additional research on neuroprotective strategies.
To estimate the risk of non-Hodgkin lymphoma associated with celiac
disease, Catassi and colleagues evaluated patients with newly diagnosed non-Hodgkin
lymphoma (cases) and healthy adults (controls) for celiac disease using measurement
of IgA class serum antiendomysial antibody level as a screening test. Celiac
disease was associated with a significantly increased risk of non-Hodgkin
lymphoma, especially of the T-cell type and with a primary site in the gut,
although the magnitude of increased risk was lower than previous estimates.
Increased levels of asymmetric dimethylarginine (ADMA), an endogenous
inhibitor of nitric oxide synthase, are associated with endothelial dysfunction,
an abnormality that may be part of the link between insulin resistance, a
feature of the metabolic syndrome, and coronary heart disease risk. In this
cross-sectional study, Stühlinger and colleaguesArticle found that plasma ADMA
concentrations were positively correlated with insulin resistance, as measured
by steady-state plasma glucose concentrations, in both normotensive and hypertensive
nondiabetic volunteers. In a subset of insulin-resistant hypertensive volunteers,
insulin sensitivity improved and ADMA levels decreased after treatment for
12 weeks with rosiglitazone, an insulin-sensitizing agent. In an editorial,
NashArticle discusses the complex relationship among insulin resistance, ADMA levels,
and cardiovascular disease.
The diagnosis of pheochromocytoma depends on biochemical evidence of
excessive production of catecholamines by the tumor. Lenders and colleagues
evaluated the diagnostic performance of several biochemical tests in a cohort
of patients tested for pheochromocytoma. Plasma free metanephrines or urinary
fractionated metanephrines were more sensitive diagnostic tests than measurements
of plasma or urinary catecholamines or of urinary metanephrines or urinary
vanillylmandelic acid. Based on receiver operating characteristic curves,
measurement of plasma free metanephrines was the best test for confirming
or excluding pheochromocytoma.
The serendipitous discovery of harmless particles that exactly mimic
the Ebola virus promises to speed basic research on that virulent pathogen
and, possibly, the development of vaccines and drug therapies.
Part 1Article reviews clinical trials evaluating the efficacy of perioperative β-blocker
therapy for reduction of adverse cardiac events and mortality in patients
undergoing noncardiac surgery. Hypothetical cases in part 2Article illustrate clinical
decision-making for perioperative β-blocker use despite limitations of
the current evidence base.
An analysis of how the news media portrayed the rotavirus vaccine before
and after reports of intussusception in vaccine recipients.
For your patients: Information about celiac disease.
This Week in JAMA . JAMA. 2002;287(11):1359. doi:10.1001/jama.2012.345