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Better noninvasive methods to distinguish patients with chest pain who have clinically important coronary artery disease (CAD) from those who do not would be useful. This study found a modest improvement in estimation of CAD risk by an algorithm that included a gene score compared with the Diamond–Forrester clinical score but found less improvement compared with an expanded set of clinical measures. Further study is warranted to evaluate the contribution of gene test scores in the accurate estimation of CAD risk.
Decreased sleep time has been suggested to contribute to obesity. This study assigned 10 healthy adults to sleep either 5.5 hours or 8.5 hours each night in conjunction with moderate caloric restriction and measured changes in weight and metabolism. After 5.5 hours of sleep, participants lost less body fat and more fat-free body mass, had less favorable changes in metabolic hormones and in substrate and energy utilization, and were hungrier than after 8.5 hours of sleep. Sleep restriction may attenuate the effects of caloric restriction.
Because survivors of childhood cancer are at high risk for second malignant neoplasms during adulthood, the Children's Oncology Group developed guidelines for screening childhood cancer survivors whose treatments increase their risk for breast, colorectal, and skin cancer. This survey of more than 8000 childhood cancer survivors found that most patients who were eligible for breast, colorectal, and skin cancer screening did not report receipt within the recommended interval. Survivors of childhood cancer and their physicians must be better educated about the potential benefits of enhanced cancer screening.
Studies suggest that persons with HIV infection develop non–AIDS-related cancer at earlier ages than the general population and that this may be due to HIV-induced accelerated aging. These data from the U.S. HIV/AIDS Cancer Match Study show that after adjustment for differences in the age composition of the populations at risk, age at cancer diagnosis in HIV-infected persons and in the general population did not differ for most types of cancer. These results do not support the hypothesis that HIV accelerates carcinogenesis and suggest that clinicians can apply cancer screening guidelines for the general population to HIV-infected persons for most types of cancer.
In this issue, Rosenberg and colleagues report how they prospectively validated a gene expression–based algorithm for predicting prevalent CAD status in nondiabetic patients with suspected CAD in whom coronary angiography is clinically indicated. This editorial describes how there is too little information about the derivation of the algorithm for readers to determine whether the screening tool provides internally valid results and discusses why caution should be used in interpreting the report.
In this issue, Nedeltcheva and colleagues provide insight into why sleep deprivation interferes with the achievement and maintenance of healthy weight. This editorial discusses the findings and the important questions that remain regarding the link between sleep and metabolism.
In this issue, Shiels and colleagues illustrate that it is insufficient to observe the distribution of age of onset of cancer in HIV-infected patients compared with HIV-uninfected persons. This editorial describes the hypothesis of premature aging in HIV infection and the article's findings.
At his funeral, we laughed that Jim would kill us if he knew we closed the office for a day. Did we bury more than a doctor that day? Was the funeral for a whole way of doing things?
The author describes how attending rounds have changed over the past 45 years.