In a randomized, placebo-controlled multicenter trial that enrolled 823 patients with diabetic nephropathy who were receiving angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, Bakris and colleagues found that the addition of finerenone—a novel nonsteroidal mineralocorticoid receptor antagonist—improved the urinary albumin-creatinine ratio in a dose-dependent manner.
Autism spectrum disorder (ASD) represents a group of neurodevelopmental conditions that vary in clinical presentation and outcome. In a population-based sample of 258 unrelated children with ASD, Tammimies and colleagues assessed the molecular diagnostic yield of chromosomal microarray analysis and whole-exome sequencing. The authors report greater diagnostic yield from genome sequencing among children with a complex or dysmorphic ASD phenotype. In an Editorial, Miles discusses genetic evaluation of children with ASD.
Author Video Interview
Biffi and colleagues investigated the association between blood pressure after intracerebral hemorrhage and the risk of recurrence in a cohort of 1145 patients who had survived at least 90 days. The authors found that blood pressure measures suggesting inadequate control during a median 3-year follow-up were associated with higher risk of recurrence of intracerebral hemorrhage.
Continuing Medical Education
In a case series of 91 children and young adults with relapsed, refractory, or rare cancer, Mody and colleagues investigated the feasibility of incorporating genomic sequencing data from tumor and germline samples in clinical assessment and treatment. The authors report that clinical sequencing revealed potentially actionable findings in 46% of patients and was associated with changes in treatment and family genetic counseling in a small proportion of patients. In an Editorial, Schnepp and colleagues discuss opportunities and challenges in the application of genomics in pediatric oncology.
Chronic sinusitis is defined by symptomatic inflammation of the sinonasal cavities lasting longer than 3 months. Based on a review of 29 studies (12 meta-analyses, 13 systematic reviews, and 4 randomized trials), Rudmik and Soler report that evidence supports daily high-volume saline irrigation with topical corticosteroid therapy as first-line therapy for chronic sinusitis. Short-course systemic corticosteroids or doxycycline, with or without a leukotriene antagonist, may be considered for patients with nasal polyps, and a prolonged course of macrolide antibiotic may be considered for patients without polyps.
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Author Audio Interview and Continuing Medical Education
Missing data are common in clinical research and complicate the interpretation of study results. Unfortunately, many of the methods used to handle missing values during data analysis can yield biased results, reduce study power, or underestimate uncertainty. In this JAMA Guide to Statistics and Methods article, Newgard and Lewis discuss reasons for missing data and the underlying assumptions and limitations of commonly used analytic strategies to account for missing data in clinical studies. The authors conclude that multiple imputation is generally the best approach for modeling the effects of missing data in clinical studies.
A 64-year-old man with an 80 pack-year smoking history presented with a 2-week history of gait instability and diplopia. The patient denied a history of alcohol abuse. Neurologic examination revealed a right fourth cranial nerve palsy, left ptosis, bilateral restricted upward gaze, and ataxia. Elevated protein, lymphocyte predominant pleocytosis, and oligoclonal bands were found on cerebrospinal fluid analysis. Chest computed tomography revealed mediastinal lymphadenopathy. What would you do next?
Highlights. JAMA. 2015;314(9):853-855. doi:10.1001/jama.2014.11949