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This Week in JAMA
May 5, 2004

This Week in JAMA

JAMA. 2004;291(17):2049. doi:10.1001/jama.291.17.2049
Preimplantation HLA Testing

Parents of children with bone marrow diseases that can be treated with a stem cell transplant may try to conceive and give birth to a child whose cord blood might be used to treat the affected sibling. Verlinsky and colleaguesArticledescribe the process and outcomes of preimplantation HLA testing performed for 9 couples who had a child with acute leukemia or Diamond-Blackfan anemia and who desired another child. In 13 in vitro fertilization cycles, DNA was removed from 199 eight-cell embryos, for which HLA typing had been performed. Forty-five embryos had the same HLA type as the affected sibling, and 28 embryos were transferred, resulting in 5 clinical pregnancies and the birth of 5 healthy neonates. In an editorial,ArticleFost discusses benefits and concerns associated with this application of genetic and reproductive technology.

Long-term Efficacy of BCG Vaccine

The BCG tuberculosis (TB) vaccine has been in use for more than 80 years, but its long-term efficacy is not known. Aronson and colleaguesArticlereviewed medical records and death certificates of participants in a 1935-1938 placebo-controlled, single-dose BCG vaccine trial. Participants had been followed up through 1998 to determine the duration of vaccine protection. Results of their analyses suggest the vaccine has an efficacy of 52% over the 60 years of follow-up. In an editorial,ArticleDye reviews factors that can contribute to varying efficacy of the BCG vaccine and the challenges for new TB vaccine development.

Lipid-Lowering Therapy and In-Hospital Mortality

An estimated 2% to 3% of patients undergoing major noncardiac surgery will experience a perioperative myocardial infarction, with mortality rates that approach 25% to 40%. Through examination of patient data from 329 US hospitals, Lindenauer and colleagues sought to determine whether the use of lipid-lowering medication was associated with reduced mortality in these patients. They found that patients who received lipid-lowering agents in the first 2 days after surgery experienced significantly lower in-hospital mortality than patients who were not receiving these medications.

CIN Treatment and Risk of Preterm Delivery

Cervical intraepithelial neoplasia (CIN) is often diagnosed and treated during a woman's reproductive years, but whether treatment can increase the risk of preterm delivery in a subsequent pregnancy is not known. To address this question, Sadler and colleagues reviewed the delivery outcomes from a cohort of women with CIN. They found no effect of CIN treatment on the risk of spontaneous preterm delivery, but women who were treated with loop electrosurgical excision procedures or laser conization had a significantly increased risk of premature rupture of membranes.

Child and Adolescent Blood Pressure Trends

Recent studies in adults have documented concurrent increases in body mass index (BMI) and hypertension, and the increase in hypertension has been directly attributed to the rise in BMI. Whether similar increases in blood pressure levels have occurred in children and adolescents and whether such increases are related to overweight is not known. Muntner and colleagues compared data from 2 national health surveys conducted in 1988-1994 and 1999-2000. Among participants aged 8 to 17 years, significant increases in systolic and diastolic blood pressure levels were documented in the 1999-2000 survey. They conclude that these increases could be partially attributed to increases in BMI.

Medical News & Perspectives

Researchers say that bypassing a ban on federal funding for human embryonic stem cell research is all the more urgent in light of findings that adult stem cells might be less flexible than once thought.

(Photo Credit: Douglas A. Melton, PhD, Chad A. Cowan, PhD)
Prevalence of Marijuana Use Disorders

Increases in the prevalence of abuse and dependence disorders may reflect an increased potency of marijuana.


External fixation for unstable extremity fractures and reconstructive orthopedics.

(Photo Credit: Douglas A. Melton, PhD, Chad A. Cowan, PhD)

Evaluating historical and cultural trends in medical education.

JAMA Patient Page

For your patients: Information about bone fractures.