This Week in JAMA FREE

Hallan and colleagues assessed possible effect modification by age of the association of chronic kidney disease (CKD)—defined by a low estimated glomerular filtration rate (eGFR) and high albuminuria—with mortality and end-stage renal disease in an individual-level meta-analysis that included data from 46 cohorts and more than 2 million participants representing the general population, individuals at high risk of vascular disease, and patients with chronic kidney disease. The authors found that both low eGFR and high albuminuria were independently associated with mortality and end-stage renal disease regardless of age. In an editorial, de Boer discusses implications for patient care.

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In an analysis of nationally representative survey data (1999-2002 and 2005-2008) from nearly 20 000 US adults, Ko and colleagues assessed the prevalence of nonrefractive visual impairment and its relationship with demographic and clinical risk factors. Among the authors' findings was that the prevalence of nonrefractive visual impairment increased from 1999-2002 to 2005-2008, which paralleled an increase in the prevalence of diabetes, an associated risk factor. In an editorial, Musch and Gardner discuss diabetes-associated visual impairment and implications for public health.

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Two articles in this issue address the safety and efficacy of bone marrow–derived cell therapy in patients with ischemic heart disease. In a randomized trial involving 30 patients with ischemic cardiomyopathy who received transendocardial injection of either allogeneic or autologous mesenchymal stem cells, Hare and colleagues found that both types of stem cells were associated with low rates of treatment-emergent serious adverse events. In a randomized trial that enrolled 120 patients with acute myocardial infarction, Traverse and colleagues found that compared with placebo, intracoronary infusion of bone marrow mononuclear cells—either 3 days or 7 days after successful percutaneous coronary intervention—had no effect on recovery of global or regional left ventricular function. In an editorial, Marbán and Malliaras discuss cell therapy for ischemic heart disease.

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Travel to higher elevations may exacerbate apnea in patients with obstructive sleep apnea (OSA). In a randomized crossover trial involving 51 patients with OSA who spent 3 days at moderately elevated altitude, Latshang and colleagues found that combination therapy with acetazolamide—used to treat acute mountain sickness—and computer-controlled, auto-adjusted continuous positive airway pressure (autoCPAP) therapy was associated with greater improvements in nocturnal oxygen saturation and the apnea/hypopnea index than autoCPAP alone.

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A man with a history of chronic sinusitis presented with unilateral periorbital swelling and subtle ptosis. Symptomatic improvement followed antibiotic treatment for presumed sinusitis, but within 1 month, increased periorbital swelling and persistent ptosis were noted. What would you do next?

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Annual physical examinations in asymptomatic persons appear to provide little benefit and may trigger unnecessary testing or treatments, report authors of a Cochrane Collaboration review.

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Biomedical research in an age of austerity

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Facing the NIH funding crisis

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Vasopressin receptor antagonists: the numbers game

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“Being uninsured is a potentially lethal condition.” From “Enough, Already.”

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Join Laura N. Gitlin, PhD, and coauthors December 19 from 2 to 3 PM eastern time to discuss nonpharmacologic management of behavioral symptoms in dementia. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr Bauchner summarizes and comments on this week's issue. Go to www.jama.com

For your patients: Information about sleep apnea and high altitudes.

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