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Patients with end-stage renal disease can be treated with either hemodialysis
or peritoneal dialysis, but whether one modality offers a survival advantage
over the other is unknown. If survival is relatively equivalent, patient preference
can weigh more heavily in treatment choice. Rubin and colleaguesArticle
assessed satisfaction with dialysis care among new dialysis patients who had
undergone an average of 7 weeks' treatment. Compared with patients who received
hemodialysis at the same centers, those receiving peritoneal dialysis rated
their overall care as excellent and expressed more satisfaction on all 23
care-related items investigated. In an editorial, HeafArticle
highlights advantages of peritoneal dialysis and offers recommendations for
increasing its use.
Similarities in several risk factors for both cardiovascular disease
and age-related macular degeneration (AMD) have led some researchers to suggest
the existence of common biological precursors, including inflammation. Elevated
levels of C-reactive protein (CRP), a marker of systemic inflammation, are
seen in patients with cardiovascular disease, and it has been hypothesized
that similar elevations might be observed in patients with AMD. To test this
hypothesis, Seddon and colleagues examined the relationship between CRP levels
and AMD in a subset of participants enrolled in the Age-Related Eye Disease
Study. While controlling for established risk factors for AMD, they found
significantly elevated CRP levels in patients with intermediate and advanced
AMD vs those in patients with no AMD, suggesting inflammation may have a role
in AMD development.
Patients with hemochromatosis may develop type 2 diabetes, but whether
moderate elevations in body iron are associated with diabetes risk in healthy
individuals is an open question. In a nested case-control study within the
Nurses' Health Study, Jiang and colleagues examined the association of baseline
plasma ferritin concentration and the ratio of transferrin receptors to ferritin
with development of type 2 diabetes. Controlling for body mass index, C-reactive
protein level, and other risk factors for diabetes; alcohol consumption; and
menopausal status, they found that women who developed diabetes in a 10-year
follow-up had significantly higher baseline serum ferritin levels and a significantly
lower ratio of transferrin receptors to ferritin than women who did not.
Gene mutations linked to increased cancer risk are typically identified
in relatively small, homogeneous populations. When a common mutation is found
in diverse populations, counseling and clinical surveillance of individuals
at risk are facilitated. Lynch and colleagues determined the prevalence of
a founder mutation associated with hereditary nonpolyposis colorectal cancer
(HNPCC) in members of 9 presumably unrelated families in the United States.
Detailed genealogic studies of the 9 families revealed that 3 of the families
share common ancestry traced to a couple who migrated from Germany to Pennsylvania
in the early 1700s; an additional 5 families had common time and geographic
connections to the progenitor couple. The authors suggest this mutation may
account for a significant number of cases of HNPCC in the white US population.
Recent resumption of a smallpox immunization program in the United States
brought renewed concerns about inadvertent inoculation and transmission to
household contacts. Garde and colleagues report the first case of inadvertent
contact vaccinia transmission to a breastfeeding infant whose mother developed
areolar vaccinia lesions several weeks after primary vaccination of her spouse.
"The tears start again. How does he do this every day? How can he stand
this?" From "The Chronicity of Chronic Disease."
New research is providing insights into how mitochondria influence brain
health and disease.
Members of the UCLA Medical Center Ethics Committee and Renal Transplant
ProgramArticle discuss a case of surrogate consent for living
related organ donation prior to withdrawal of life support from a permanently
comatose patient. Wendler and EmanuelArticle review ethical
and practical considerations relative to surrogate consent for living organ
donation in patients presumed to be near death.
Advances in interventions for acute myocardial infarction.
Words of appreciation for JAMA's peer reviewers.
For your patients: Information about percutaneous coronary intervention.
This Week in JAMA. JAMA. 2004;291(6):663. doi:10.1001/jama.291.6.663
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