The effect of red blood cell (RBC) storage duration on tissue oxygenation by transfused RBCs is uncertain. In a randomized, noninferiority trial involving 290 Ugandan children with lactic acidosis due to severe anemia, Dhabangi and colleagues found that transfusion of RBC units stored for 25 to 35 days compared with those stored for 1 to 10 days did not result in inferior reduction of elevated blood lactate levels—a surrogate of tissue oxygenation—assessed 8 hours after transfusion. In an Editorial, Spinella and Acker discuss the need for quality metrics to ensure the efficacy and safety of transfused RBCs.
Limited data suggest that autologous hematopoietic stem cell transplantation (HSCT) may benefit some patients with Crohn disease. In a parallel-group randomized trial involving 45 adult patients who had refractory Crohn disease not amenable to surgery and impaired quality of life despite treatment with 3 or more immunosuppressive biologic agents and corticosteroids, Hawkey and colleagues found that HCST was no different from conventional therapy in achieving sustained disease remission at 1 year and was associated with significant toxicity.
Continuing Medical Education
In a multicenter randomized trial involving 695 patients who had completed chemoradiotherapy for glioblastoma, Stupp and colleagues evaluated the safety and efficacy of tumor-treating fields (TTF)—transcutaneous delivery of low-intensity, intermediate-frequency alternating electric fields—used in combination with temozolomide maintenance treatment compared with temozolomide alone. In an interim analysis of 315 patients (median follow-up, 38 months), the authors found that adding TTF to maintenance temozolomide chemotherapy significantly prolonged progression-free and overall survival. In an Editorial, Sampson discusses alternating electric field therapy for the treatment of glioblastoma.
Author Video Interview
Graves disease, an autoimmune thyroid disease caused by stimulating antibodies to the thyrotropin receptor on thyroid follicular cells, is the most common cause of persistent hyperthyroidism in adults. Based on a review and synthesis of data from 13 clinical trials, 5 systematic reviews, and 52 observational studies, Burch and Cooper provide an evidence-based update of the treatment of Graves disease. Optimal management depends on patient preference, geography, and clinical features. Treatment can include antithyroid drugs, destruction of the thyroid using radioiodine therapy, or thyroidectomy.
Author Audio Interview and Continuing Medical Education
A 50-year-old man was evaluated for a 5-month history of blurry vision. He was not under regular medical care but reported that he had been diagnosed with the metabolic syndrome many years previously. He was not taking any medications. His body mass index was 30.6. His blood pressure was 160/102 mm Hg. A dilated retinal examination was performed. How would you interpret the findings?
This JAMA Diagnostic Test Interpretation article by Sam and Ehrmann presents the case of a 19-year-old woman seen for evaluation of oligomenorrhea—present since menarche. The patient expressed concern about acne and excessive facial hair, apparent thinning of her scalp hair, and a recent weight gain of 20 pounds. Physical examination revealed coarse dark hair on her chin and abdomen and acne on her face and back. Thyroid-stimulating hormone, prolactin, follicle-stimulating hormone, luteinizing hormone, and testosterone levels were obtained. How would you interpret these results?
Highlights. JAMA. 2015;314(23):2469-2471. doi:10.1001/jama.2014.12145