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In This Issue of JAMA |

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JAMA. 2014;311(23):2355-2357. doi:10.1001/jama.2013.279556.
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In a randomized trial that enrolled 1635 sedentary adults aged 70 to 89 years who had physical limitations but were able to walk 400 meters, Pahor and colleagues found that compared with a health education program, a long-term structured physical activity program that involved aerobic, resistance, and flexibility training reduced the occurrence of incident major mobility disability over 2.6 years.

Uveal melanoma is characterized by gene mutations that activate the mitogen-activated protein kinase (MAPK) pathway. In a randomized trial that enrolled 101 patients with metastatic uveal melanoma, Carvajal and colleagues found that compared with chemotherapy, selumetinib—a selective inhibitor of the MAPK pathway—resulted in a modest improvement in progression-free but not overall survival.

Tumor necrosis factor α (TNF-α) antagonists are effective in the treatment of inflammatory bowel disease (IBD); however, there is concern that treatment-induced immunosuppression may increase the risk of cancer. In a nationwide study from Denmark that included 56 146 patients with IBD (4553 with TNF-α antagonist exposure), Andersen and colleagues found no increased risk of cancer associated with TNF-α antagonist exposure during a median follow-up of 3.7 years.

To assess mortality and bleeding risks associated with thrombolytic therapy vs anticoagulation in acute pulmonary embolism, Chatterjee and colleagues performed a meta-analysis of data from 16 randomized trials (2115 patients)—including 8 trials (n=1775) of patients who were hemodynamically stable with right ventricular dysfunction (intermediate-risk pulmonary embolism). Among the authors’ findings was that thrombolytic therapy was associated with lower rates of all-cause mortality and increased risks of major bleeding and intracranial hemorrhage. In an Editorial, Beckman discusses thrombolysis in patients with pulmonary embolism.

CLINICAL REVIEW & EDUCATION

Thoracentesis is performed to identify the cause of a pleural effusion. In a systematic review of data from 48 studies that examined diagnostic tests for differentiating pleural exudates from transudates, Wilcox and colleagues found that pleural fluid cholesterol and lactate dehydrogenase levels, the pleural fluid cholesterol to serum cholesterol ratio, and Light’s criteria were the most accurate diagnostic indicators for pleural exudates.

Exercise is sometimes considered an adjunct or substitute for pharmacological or psychological treatment of depression. In this JAMA Clinical Evidence Synopsis, Cooney and colleagues summarize a Cochrane review of 39 randomized trials of exercise as a treatment for depression. The authors found that compared with no treatment, placebo, or an active control intervention such as relaxation or meditation, exercise was associated with a greater reduction in depressive symptoms. However, analysis of 6 high-quality studies (464 participants) suggested the benefit of exercise is small.

A 16-year-old girl presents with acute left shoulder pain, left-sided chest pain, and shortness of breath. Similar pain symptoms had been present intermittently for 4 months. Examination reveals tenderness over the left fifth rib and reduced left chest expansion without a chest wall deformity. A chest x-ray shows left lower lobe opacification. What would you do next?

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