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This Week in JAMA
September 16, 2009

This Week in JAMA

JAMA. 2009;302(11):1141. doi:10.1001/jama.2009.1357

Celiac disease has been associated with an increased risk of mortality. In a retrospective cohort study, Ludvigsson and colleagues Article assessed whether the increased risk exists across the spectrum of celiac disease–related small intestinal histopathology. The authors found an increased risk of death among children and adults with celiac disease–related villous atrophy, inflammation, and latent celiac disease (positive celiac disease serology and normal intestinal mucosa). In an editorial, Green Article discusses the epidemiology and diagnosis of celiac disease and mortality risks.

In a population-based cohort study, Wald and colleagues Article evaluated the risk of chronic dialysis and death among patients who experienced acute kidney injury requiring in-hospital dialysis and who survived free of dialysis for at least 30 days after hospital discharge. The authors found that compared with patients without acute kidney injury, patients whose hospitalization was complicated by acute kidney injury had an increased risk of chronic dialysis but not all-cause mortality during a median follow-up of 3 years. In an editorial, Waikar and Winkelmayer Article discuss the long-term implications of severe acute kidney injury.

Because diabetes is in part an inflammatory condition, Pradhan and colleagues hypothesized that treatment with insulin, metformin, or both might reduce inflammatory biomarkers such as C-reactive protein among patients with recent-onset type 2 diabetes. In a randomized 2 × 2 factorial trial of open-label insulin and placebo-controlled metformin, the investigators found that compared with placebo metformin, treatment with insulin alone or combined with metformin was not associated with reductions in inflammatory biomarkers, despite improvements in glycemic control.

In an analysis of data from a national registry of cardiopulmonary resuscitation, Chan and colleagues examined racial differences in survival among patients experiencing in-hospital cardiac arrest. The authors report that rates of survival to discharge were significantly lower for black patients than for white patients, with black patients having significantly lower rates of successful resuscitation and postresuscitation survival.

In a population-based cohort study involving older men (median age, 78 years) who were diagnosed with localized (T1 or T2) prostate cancer between 1992 and 2002 and managed conservatively—without surgery or radiation within 6 months of diagnosis and deferral of treatment until necessitated by disease signs or symptoms thereafter—Lu-Yao and colleagues found significantly better overall survival and prostate cancer–specific survival following conservative management than in previous eras.

Charakida and colleagues examined potential mechanisms underlying the accelerated atherosclerosis seen in some patients with the antiphospholipid syndrome. In analyses that matched for age and cardiovascular risk factors, they found that women with antiphospholipid antibodies had greater carotid intima-media thickness and pulse wave velocity and had lower flow-mediated dilatation and paraoxonase activity—a high-density lipoprotein–related antioxidant enzyme—than those without it.

“Sometimes when passing [the roadside crosses], I wonder about the fragility of life, why bad things happen, and the limits of my medical skills, even after 34 years of practice.” From “Driving Thoughts.”

Pregnant women, health care workers, children, adolescents, and young adults are among the priority groups who should receive H1N1 influenza vaccine this fall, according to advisors to the US Centers for Disease Control and Prevention.

International response to climate change

Pandemic influenza preparedness: lessons from Mexico

Bending the cost curve with health care reform

How would you manage a 52-year-old woman with disabling diabetic neuropathy? Go to www.jama.com to read the case and submit a response by October 4 for possible online publication.

Join Barbara A. Slade, MD, MS, Wednesday, October 21, from 2 to 3 PM eastern time to discuss postlicensure safety surveillance for HPV vaccine. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

For your patients: Information about celiac disease.

Theme Issue on Medical Education