Systemic sclerosis is an autoimmune connective tissue disease associated with vasculopathy and skin and internal organ fibrosis. In a multicenter randomized trial that involved 156 patients with early diffuse cutaneous systemic sclerosis, van Laar and colleagues found that compared with monthly intravenous pulsed cyclophosphamide, autologous hematopoietic stem cell transplant (HSCT) was associated with increased treatment-related mortality in the first year after treatment but higher rates of long-term event-free survival. In an Editorial, Khanna and colleagues discuss HSCT in the treatment of severe systemic sclerosis.
Single-center studies have found that adding tomosynthesis鈥攁 3-dimensional breast imaging technique鈥攖o mammography increases breast cancer detection with fewer false-positive results. Friedewald and colleagues analyzed screening performance metrics from 13 academic and nonacademic breast centers鈥� representing 281鈥�187 digital mammography examinations and 173鈥�663 examinations that combined digital mammography with tomosynthesis鈥攁nd found the addition of tomosynthesis to digital mammography was associated with a decrease in recall rate and an increase in cancer detection rate. In an Editorial, Pisano and Yaffe discuss continuing controversies over breast cancer screening and screening modalities.
Practice guidelines have called for greater use of regional anesthesia for hip fracture surgery. In a matched retrospective cohort analysis involving 56鈥�729 patients who underwent hip fracture surgery with either regional or general anesthesia, Neuman and colleagues found that compared with general anesthesia, use of regional anesthesia was not associated with lower 30-day mortality, but was associated with a modestly shorter (0.6-day) length of stay.
An established chronic kidney disease progression end point鈥攄oubling of serum creatinine concentration (corresponding to a 57% or greater decline in estimated glomerular filtration [GFR])鈥攊s a late event in the progression to end-stage renal disease (ESRD). In a meta-analysis of data from 1.7 million patients, Coresh and colleagues found that smaller declines in estimated GFR occur commonly and are strongly and consistently associated with ESRD and mortality.
Clinical Review & Education
Authors of an article in JAMAInternal Medicine reported that between 2001 and 2009, the annual prescription rate of levothyroxine increased and a trend toward treatment of more marginal degrees of hypothyroidism was found. In this From the 糖心vlog article, Cappola discusses possible reasons for the increase in thyroid hormone prescriptions.
In this JAMA Clinical Evidence Synopsis article, O鈥橫eara and colleagues summarize a Cochrane review of 45 clinical trials (4486 patients) of topical or systemic antimicrobial therapy vs usual care (dressings and bandages with no antimicrobials) for venous leg ulcers. The authors report that the available evidence neither supports nor refutes an association of systemic antibiotic therapy with improved ulcer healing. Among topical antimicrobials, cadexomer iodine may be associated with better healing.
This JAMA Diagnostic Test Interpretation article by Konerman and Lok presents the case of a presumably healthy woman who underwent hepatitis C virus (HCV) testing because she is a member of the 1945-1965 birth cohort recommended for HCV screening. The HCV antibody result was positive, and an HCV RNA level was elevated. Liver function test results were unremarkable. How would you interpret the findings?