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Regulatory approval of currently available drug-eluting coronary stents was granted on the basis of results from relatively small clinical trials that enrolled highly selected patients. To assess outcomes in patients who are representative of “real world” clinical practice, investigators from the 5-center Danish Organization on Randomized Trials with Clinical Outcome (SORT OUT II) study randomly assigned 2098 patients undergoing primary coronary intervention to receive either sirolimus-eluting or paclitaxel-eluting stents to treat target lesions. Galløe and colleagues Article report that there were no significant differences in the composite clinical end point of either cardiac death, acute myocardial infarction (AMI),
target lesion revascularization, or target vessel revascularization,
or the secondary end points of total and cardiac mortality, AMI, or stent thrombosis among patients receiving either the sirolimus-eluting or paclitaxel-eluting stent. In an editorial, Mukherjee and Moliterno Article discuss the contributions and limitations of the SORT OUT II trial results for determining safe and effective revascularization practices.
Gene-environment interactions are a possible explanation for the variations in disease expression in single-gene disorders, such as cystic fibrosis. The US Cystic Fibrosis Twin and Sibling Study assessed the relationship of 2 environmental factors—secondhand smoke exposure and household socioeconomic status—on lung function in patients with cystic fibrosis. Collaco and colleagues report that participants who were exposed to any secondhand smoke in the home had significantly worse cross-sectional and longitudinal lung function compared with study participants who were never exposed, and this association was not confounded by socioeconomic status. The authors also report that several cystic fibrosis gene variants amplify the association of secondhand smoke exposure with reduced lung function.
MicroRNAs—noncoding RNA molecules that regulate the translation of genes—may function as diagnostic biomarkers and therapeutic targets in cancer. Schetter and colleagues examined microRNA expression patterns in colon tumors and paired nontumorous tissue from 2 independent cohorts of patients with sporadic colon adenocarcinoma. The authors identified expression patterns that were associated with colon tumor formation, response to chemotherapy, and cancer-specific survival.
In particular, tumors with a high expression of microRNA miR-21 were associated with a poor response to adjuvant chemotherapy and poor patient survival.
Mr R, a 49-year-old man from Guyana, has had asymptomatic eosinophilia for at least 1 year, and multiple stool evaluations were negative for ova and parasites. Page and Zenilman discuss the evaluation of patients with eosinophilia, including aspects of the patient history and physical examination, and diagnostic studies that may reveal the cause. The authors highlight the diagnosis and treatment of strongyloidiasis.
Researchers report advances in diagnosing and treating red blood cell diseases, although many patients are not receiving a treatment that can significantly reduce morbidity and mortality.
Patient safety and systems of care
Health of contingent workers
Genetics in pediatric primary care
How would you manage a 32-year-old woman with a 1-year history of chronic abdominal pain? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is January 30.
Join Mark J. Pletcher, MD, February 20, 2008, from 2 to 3 PM eastern time to discuss opioid prescribing by race/ethnicity.
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 myocardial infarction.
This Week in JAMA . JAMA. 2008;299(4):385. doi:10.1001/jama.299.4.385