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This Week in JAMA
April 25, 2007

This Week in JAMA

JAMA. 2007;297(16):1747. doi:10.1001/jama.297.16.1747

Ranolazine, a novel antianginal agent, is approved for patients with chronic angina, but whether it might benefit patients with acute coronary syndromes (ACS) is not clear. The efficacy and safety of ranolazine vs placebo in moderate- and high-risk patients with ACS who were receiving standard therapy were evaluated in the Metabolic Efficiency With Ranolazine for Less Ischemia in Non–ST-Elevation Acute Coronary Syndromes (MERLIN)-TIMI 36 randomized trial. Morrow and colleaguesArticle, writing for the trial investigators, report that compared with placebo, ranolazine was not associated with reductions in the primary efficacy outcome—a composite of cardiovascular death, myocardial infarction, or recurrent ischemia—or with the major safety end points of total mortality and symptomatic documented arrhythmia during a median follow-up of 348 days. In an editorial, Newby and PetersonArticle discuss the MERLIN trial outcomes in relation to other antiangina therapies.

Nonvaccine Serotypes of Pneumococcal Disease

Routine childhood immunization with the 7-valent pneumococcal vaccine (PCV7) has reduced the rates of vaccine-type invasive pneumococcal disease (IPD) in US children and adults. However, whether IPD caused by nonvaccine serotypes (“serotype replacement”) is increasing and has not been evaluated. Using statewide surveillance records, Singleton and colleaguesArticle assessed rates of IPD in Alaska Native children from 1995 through 2006. The authors found that among children younger than 2 years, overall IPD decreased 67% in the first 3 years (2001-2003) after introduction of routine vaccination with PCV7. However, between 2001-2003 and 2004-2006 the rate of IPD caused by nonvaccine serotypes increased 140%. In an editorial, Peters and PoehlingArticle discuss the consequences of pneumococcal serotype replacement for clinical practice and vaccine development.

Gene Variants and AMD Progression

Single-nucleotide polymorphisms in the genes CFH and are associated with age-related macular degeneration (AMD), but whether these polymorphisms are related to disease progression is not known. In an analysis of data from white participants in the Age-Related Eye Disease Study, Seddon and colleagues found that CFH Y402H and A69S polymorphisms were each independently related to progression of AMD. The presence of both risk genotypes, smoking, and high body mass index increased the risk of progression 19-fold.

Renal Replacement Therapy After Cardiac Surgery

Acute renal failure is a serious adverse outcome of cardiac surgery. To improve identification of patients at risk, Wijeysundera and colleagues analyzed clinical data in a retrospective cohort study of patients who had cardiac surgery at 2 hospitals in Ontario, Canada, to develop and validate a predictive index for renal replacement therapy (hemodialysis or continuous venovenous hemodiafiltration) after cardiac surgery. The authors identified 8 preoperative clinical variables that accurately predicted the likelihood of renal replacement therapy after cardiac surgery.


Dyspnea, tachycardia, elevated jugular venous pressure, pulsus paradoxus, or cardiomegaly on chest radiograph is present in the majority of patients with pericardial effusion and cardiac tamponade.

A Piece of My Mind

“For the first 7 years in practice, I handwrote my notes, trying to slow down like Sister Mary Myron admonished me to do when she gave me a D in penmanship in the third grade.” From “At a Loss for Words.”

Medical News & Perspectives

The American Academy of Neurology says that a review of the literature indicates that epidural steroid injections for back pain with sciatica may have little or no benefit beyond a 2- to 6-week window following treatment.

Obesity and the Brain

Cognitive processes in the right prefrontal cortex influence food intake, physical activity, and obesity.

Author in the Room Teleconference

Join Jan L. Brandes, MD, Wednesday May 16, 2007, from 2 to 3 PM eastern time to discuss sumatriptan-naproxen for acute treatment of migraine. To register, go to

Audio Commentary

Dr DeAngelis summarizes and comments on this week's issue. Go to

JAMA Patient Page

For your patients: Information about pericardial effusion.