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JAMA. 2001;285(14):1807. doi:10.1001/jama.285.14.1807.
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GENETIC RISK FACTOR FOR LUMBAR DISK DISEASE

Collagen IX is a structural component of intervertebral disks and also of the hyaline cartilage structures of the vertebral bodies adjacent to the disks. It consists of 3 distinct chains, α1, α2, and α3, encoded by the COL9A1, COL9A2, and COL9A3 genes. A Gln326→Trp substitution in the α2 chain associated with dominantly inherited lumbar disk disease was recently reported. In this mutation analysis of all 3 collagen IX genes among patients with lumbar disk disease and controls without lumbar disk disease, Paassilta and colleaguesArticle identified an Arg103→Trp substitution in the α3 chain. The frequency of alleles carrying this substitution was 12.2% in cases and 4.7% in controls, a statistically significant difference. In an editorial, MariniArticle explains how these molecular changes in type IX collagen might weaken the matrix of intervertebral disks and decrease resistance to compressive forces.

STATIN THERAPY AND FRACTURE RISK

Evidence that statin therapy protects against osteoporotic fractures has been inconsistent. In this case-control study using data from patients aged 50 years or older from all 683 general practices in the UK General Practice Research Database, van Staa and colleaguesArticle found that use of statins was not associated with a reduced risk of fractures. In an editorial, Hennessy and StromArticle discuss possible explanations for differences in results of studies on the association between statin use and osteoporotic fractures.

COGNITIVE BEHAVIORAL THERAPY FOR PRIMARY INSOMNIA

Pharmacotherapy is the most common treatment for chronic primary insomnia, but some studies suggest that nonpharmacological behavioral therapy may have more enduring benefit. In this trial, Edinger and colleagues compared the efficacy of cognitive behavioral therapy (sleep education, stimulus control, and time-in-bed restrictions) with that of a first-generation behavioral therapy (progressive muscle relaxation training) and a placebo therapy for the treatment of primary sleep-maintenance insomnia. Improvements in most of the objective (polysomnography) and subjective (sleep logs; symptom measures) outcomes were greater in the cognitive behavioral therapy group compared with the other 2 groups at the end of the 6-week treatment program and at follow-up 6 months later.

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PREDICTORS OF CARDIAC EVENTS AFTER VASCULAR SURGERY

Patients with severe peripheral vascular disease often have coronary artery disease and are at increased risk of cardiac complications when undergoing major vascular surgery. Boersma and colleagues examined the relationship between clinical characteristics, dobutamine stress echocardiography (DSE) results, β-blocker therapy, and adverse cardiac events after major vascular surgery. Forty-five of 1351 patients had cardiac death or nonfatal myocardial infarction (MI) within 30 days after major vascular surgery. Clinical determinants of perioperative cardiac events included age 70 years or older, current or prior angina pectoris, prior MI, heart failure, and cerebrovascular accident. Among patients with fewer than 3 clinical risk factors, patients receiving β-blocker therapy had a low risk of complications regardless of DSE results. Among patients with 3 or more risk factors, those without stress-induced ischemia receiving β-blocker therapy also had a low risk of events, but patients with extensive stress-induced ischemia were at considerable cardiac risk despite β-blocker therapy.

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NEWBORN HBV VACCINE POLICIES AFTER GUIDELINE REVISIONS

In July 1999, the American Academy of Pediatrics and the Public Health Service recommended that the first dose of hepatitis B virus (HBV) vaccine be routinely administered at 2 to 6 months of age instead of at birth because of the potential neurotoxicity of the vaccine preservative thimerosal. A thimerosal-free preparation became available in September 1999, and the recommendation for universal HBV immunization at birth was reinstated. Oram and colleagues report, however, that although 74% of 46 surveyed hospitals with obstetric services and newborn nurseries offered routine HBV immunization to all newborns before July 1999, only 39% had this policy in August 2000.

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CONTEMPO UPDATES

A review of findings from recent studies on treatment of primary cutaneous melanoma.

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MEDICAL NEWS & PERSPECTIVES

Susceptibility to cancer is influenced by subtle genetic changes. New research has identified a genetic change associated with the development of benign prostatic hypertrophy and prostate cancer.

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GRAND ROUNDS

A case discussion of a 47-year-old man found to have non-Hodgkin lymphoma, secondary deep venous thrombosis, and HIV infection illustrates a multidisciplinary strategy to treat AIDS-associated malignancy, concurrent morbidity, and HIV infection.

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JAMA PATIENT PAGE

For your patients: Information about lymphoma.

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