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June 16, 2009JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives of Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases. THIS WEEK'S CONTENTS
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT Tuesday, June 16, 2009)
JAMA REPORT (VIDEO SCRIPT)
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED. JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access. TV Note: This week's JAMA Report video is on the interaction between a gene marker, stressful life events, and the risk of depression. The report will be fed Tuesday, June 16, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 28 (C-Band), Transponder 19, downlink frequency: 4080 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA. Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), Tuesday, June 16, 2009
Study Compares Less Invasive CT-Scan Based Screening Method To Colonoscopy For Patients at Increased Risk of Colorectal Cancer
CHICAGO—Computed tomographic (CT) colonography may offer patients at increased risk of colorectal cancer an alternative to colonoscopy that is less-invasive, is better-tolerated and has good diagnostic accuracy, according to a study in the June 17 issue of JAMA. Colorectal cancer (CRC) accounts for approximately 210,000 deaths each year in Europe. CT colonography is a procedure in which a detailed picture of the colon is created by an x-ray machine linked to a computer. It has been shown to be sufficiently accurate in detecting colorectal neoplasia (abnormal growth of cells) and is now considered a valid alternative for CRC screening in the general population. Individuals at increased risk of CRC include those with a first-degree family history of advanced colorectal neoplasia and those with positive results from fecal occult blood tests (FOBTs). "However, adherence to follow-up colonoscopy in these individuals is suboptimal. Being less invasive and thus more tolerable, CT colonography may increase acceptability and adherence to screening, but little information is available on its performance," the authors write. Daniele Regge, M.D., of the Institute for Cancer Research and Treatment, Candiolo, Turin, Italy, and colleagues assessed the accuracy of CT colonography in detecting advanced colorectal neoplasia in asymptomatic individuals at increased risk of CRC using colonoscopy as the reference standard. The multicenter study included individuals at increased risk of CRC due to either family history of advanced neoplasia in first-degree relatives, personal history of colorectal adenomas (benign tumors), or positive results from FOBTs. Each participant underwent CT colonography followed by colonoscopy on the same day. Of 1,103 participants, 937 were included in the final analysis: 373 cases in the family-history group, 343 in the group with personal history of adenomas, and 221 in the FOBT-positive group. The prevalence of advanced neoplasia was 7.5 percent in the family-history group; 11.1 percent in the post-polypectomy group (had a polyp removed); and 50.2 percent in the FOBT-positive group. Overall, CT colonography identified 151 of 177 participants with advanced neoplasia 6 mm or larger (sensitivity, 85.3 percent) and correctly classified results as negative for 667 of 760 participants without such lesions (specificity, 87.8 percent). The positive and negative predictive values were 61.9 percent and 96.3, respectively. The negative predictive value ranged between 84.9 percent in the FOBT-positive group and 98.5 percent in the family-history group.
The authors write that these results "suggest a potentially effective use of CT colonography as an alternative to colonoscopy for screening individuals with family history of advanced colorectal neoplasia. Computed tomographic colonography has been shown to be better accepted than colonoscopy and has a negligible risk of serious adverse events; thus, it may help increase the low adherence reported for individuals who are candidates for screening, which is the main negative factor affecting its efficacy in reducing mortality from CRC."
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Editorial: Computed Tomographic Colonography for Patients at High Risk of Colorectal Cancer — Trading Accuracy for Access and Compliance
Emily Finlayson, M.D., M.S., of the University of Michigan, Ann Arbor, comments on these findings in an accompanying editorial.
"While the use of CT colonography as a screening and surveillance modality is still a matter of debate, the study by Regge et al suggests that CT colonography may be an acceptable alternative to colonoscopy in patients with a history of adenoma and those with a family history of colorectal neoplasm. The question remains whether clinicians are willing to accept a study with decreased sensitivity for the potential of increased adherence with recommended screening and surveillance guidelines. With the majority of individuals in the United States who meet criteria for colorectal cancer screening and surveillance not undergoing recommended procedures, an imperfect test that has a lower risk profile and greater acceptance among patients seems to be an appealing solution."
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), Tuesday, June 16, 2009
Therapy Helps Improve Outcomes for Patients With Severe Sepsis
CHICAGO—A preliminary study suggests that a therapy for severe sepsis or septic shock that included the use of an antibiotic-based "hemoperfusion" device to remove toxic products of bacteria from the blood in addition to conventional treatment resulted in a reduced risk of death and appeared to improve blood circulation and reduce organ dysfunction, according to a report appearing in the June 17 issue of JAMA. Severe sepsis and septic shock are common problems in the intensive care unit and carry a high risk of death. Endotoxin is one of the principal components of a form of bacteria, with high levels of endotoxin activity associated with worse clinical outcomes. Septic shock of intra-abdominal origin is often associated with high endotoxin levels. "Thus, it represents a condition in which endotoxin-targeted therapy may be of particular benefit," the authors write. Polymyxin B fiber column is a medical device designed to reduce blood endotoxin levels in sepsis. Reducing circulating endotoxin levels with polymyxin B (an antibiotic) hemoperfusion (the removal of toxins from the blood; blood filtering) could potentially improve patient clinical outcomes, according to background information in the article. Dinna N. Cruz, M.D., M.P.H., of St. Bortolo Hospital and the International Renal Research Institute Vicenza, Italy, and colleagues conducted a trial to determine whether polymyxin B hemoperfusion added to conventional medical therapy would improve clinical outcomes and survival compared with conventional therapy alone in patients with severe sepsis or septic shock who underwent emergency surgery for intra-abdominal infection. The randomized controlled trial (RCT) was conducted at 10 Italian intensive care units. Patients (n = 64) were randomized to either conventional therapy (n = 30) or conventional therapy plus two sessions of polymyxin B hemoperfusion (n = 34). "In this RCT of surgical patients with septic shock and severe sepsis induced by abdominal sepsis, polymyxin B hemoperfusion therapy was effective in improving 28-day [mortality was 32 percent (11/34) in the polymyxin B group vs. 53 percent (16/30) in the conventional therapy group] and hospital survival, blood pressure, vasopressor [an agent that increases blood pressure] requirement, and degree of organ failure ...when added to conventional medical treatment," the authors write.
"Larger multicenter studies are indicated to confirm these encouraging findings in other patient populations. Furthermore, we advocate further studies to explore the use of newer assays for endotoxin activity both for patient selection, as well as guiding the number of hemoperfusion sessions."
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Editorial: International Differences in the Treatment of Sepsis — Are They Justified
In an accompanying editorial, John A. Kellum, M.D., of the University of Pittsburgh, and Shigehiko Uchino, M.D., of the Jikei University School of Medicine, Tokyo, write that the therapy used in this study is common in Japan, but not in the U.S.
"This preliminary study is valuable as an example of 'New Yorkers' testing a Japanese intervention. This kind of cross-community validation is refreshing and necessary but unfortunately only too rare. The results, although preliminary, suggest a number of interesting hypotheses and should provoke further study. This is essential given the significant ongoing problem that sepsis represents."
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), Tuesday, June 16, 2009
Analysis Does Not Support Association Between Genetic Marker, Stress and Risk of Depression
CHICAGO—Contrary to a previous report, an analysis of 14 previous studies does not find an association between a serotonin transporter gene variation, stressful life events, and an increased risk of major depression, according to an article in the June 17 issue of JAMA. The authors did find that the number of stressful life events is associated with depression. Despite progress in risk gene identification for several complex diseases, few disorders have proven as resistant to gene identification as psychiatric illnesses. Although these disorders have long been assumed to result from some combination of genetic vulnerability and environmental exposure, direct evidence from a specific example has not been forthcoming. "Few if any of the genes identified in candidate gene association studies of psychiatric disorders have withstood the test of replication and to date, genome-wide association studies of psychiatric disorders have also had limited success," the authors write. One previous study (Caspi et al) concluded that, in interaction with stressful life events, genetic variation of the serotonin transporter gene (5-HTTLPR) plays a role in predisposition to major depression. Neil Risch, Ph.D., of the University of California at San Francisco and Kaiser Permanente Northern California Division of Research, Oakland, and colleagues conducted a meta-analysis of the interaction between the serotonin transporter gene and stressful life events on depression. The researchers identified 14 studies that met criteria for inclusion in the analysis. Of a total of 14,250 participants, 1,769 were classified as having depression; 12,481 as not having depression. The researchers found there was no association between 5-HTTLPR genotype and depression in any of the individual studies nor in the weighted average and no interaction effect between genotype and stressful life events on depression was observed. Comparable results were found in the sex-specific meta-analysis of individual-level data. The meta-analysis did show that the number of stressful life events was significantly associated with depression. The authors suggest that these results indicate why it is important that studies that find genetic associations be replicated.
"A more serious concern ...is that the findings of this [Caspi et al] and other nonreplicated genetic associations are now being translated to a range of clinical, legal, research, and social settings such as forensics, diagnostic testing, study participants, and the general public. It is critical that health practitioners and scientists in other disciplines recognize the importance of replication of such findings before they can serve as valid indicators of disease risk or have utility for translation into clinical and public health practice."
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
JAMA REPORTS
VIDEO: Windows Media | Quicktime
GENE VARIATION CONSIDERED A MARKER FOR DEPRESSION IS FOUND TO HAVE NO LINK TO AN ELEVATED RISK OF THE ILLNESS
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