Experimental data suggest that intravenous vitamin C may attenuate inflammation and vascular injury associated with sepsis and acute respiratory distress syndrome. Fowler and colleagues randomized 167 patients with sepsis and acute respiratory distress syndrome and found that a 96-hour infusion of vitamin C, compared with placebo, did not significantly improve organ dysfunction scores or alter markers of inflammation and vascular injury. In an Editorial, Brant and Angus suggest that a larger trial could address the dosing and timing of vitamin C for subtypes of patients with sepsis.
Visual Abstract
Procedures that influence metabolism by inducing weight loss and altering gastrointestinal physiology can improve cardiometabolic risk factors. Aminian and colleagues conducted a retrospective cohort study with 13鈥�722 participants who had type 2 diabetes and obesity and found that metabolic surgery, compared with nonsurgical management, was associated with a significantly lower risk of major adverse cardiovascular events. In an Editorial, Livingston suggests that bariatric surgery should be considered a preferred treatment option for some patients with diabetes and obesity who have not been able to lose weight by other means.
and CME
It is unclear whether anesthetic strategy affects functional outcome in patients undergoing mechanical thrombectomy for acute ischemic stroke. Sch枚nenberger and colleagues for the SAGA Collaborators reviewed data for 368 patients enrolled in 3 randomized trials and found that the use of protocol-based general anesthesia, compared with procedural sedation, was associated with less disability at 3 months.
CME
Clinical Review & Education
The most common causes of chronic kidney disease are diabetes and hypertension. Chen and colleagues review the clinical management of patients with chronic kidney disease, which includes cardiovascular risk reduction, treatment of albuminuria, avoidance of nephrotoxins, and adjustments to drug dosing.
CME
Using allele frequency to assess the likely pathogenicity of genetic variants is challenging because common variants are unlikely to cause diseases that decrease reproductive fitness and rare variants are typically benign. This JAMA Insights article by Whiffin and colleagues discusses the use of large, diverse reference data sets for the clinical interpretation of human genetic variation.
This JAMA Clinical Challenge by Buie and colleagues presents a 43-year-old man who had a firm, nontender breast mass with nipple retraction. What would you do next?