Answer questions and earn CME/CNE Fifteen percent of women with epithelial ovarian cancer have inherited mutations in the BRCA breast cancer susceptibility genes. Knowledge of her BRCA status has value both for the woman and for her family. A therapeutic benefit exists for the woman with cancer, because a new family of oral drugs, the poly ADP-ribose polymerase (PARP) inhibitors, has recently been

Despite somewhat prolonged progression-free survival, treatment with lomustine plus bevacizumab did not confer a survival advantage over treatment with lomustine alone in patients with progressive glioblastoma. (Funded by an unrestricted educational grant from F. Hoffmann–La Roche and by the EORTC Cancer Research Fund; EORTC 26101 ClinicalTrials.gov number, NCT01290939; Eudra-CT number, 2010-023218-30

Transgender individuals have a gender identity that does not align with their sex assignment at birth (gender incongruence). They account for about approximately 0.4% of the US population (1 million people).1 Some transgender people experience gender dysphoria, distress caused by the discrepancy between gender identity and birth-assigned sex, linked to lifetime suicide attempt rates of 40%.2 Some may

For 7 years, Republicans vowed to repeal and replace the Affordable Care Act. Less than 7 months into the Trump administration, that crusade has, at least for now, collapsed. Still, Obamacare’s fortunes remain uncertain.

The Trump administration may decide to permit states to partially expand their Medicaid programs to cover people with incomes up to 100% of the federal poverty level. Arkansas has requested a waiver to do so, and if it is granted, other states may follow suit.

Among patients with a PFO who had had a cryptogenic stroke, the risk of subsequent ischemic stroke was lower among those assigned to PFO closure combined with antiplatelet therapy than among those assigned to antiplatelet therapy alone; however, PFO closure was associated with higher rates of device complications and atrial fibrillation. (Funded by W.L. Gore and Associates; Gore REDUCE ClinicalTrials

Technological development has led to the more precise delivery of radiation to tumors. Advances in sensitizing tumors to and protecting normal tissues from the effects of radiation and in overcoming radiation resistance are improving the outcomes of radiotherapy.

A recent study in mice provides proof of concept that deep-brain tissue can be specifically targeted by the exterior application of two electromagnetic fields of slightly different frequencies.

To the Editor: Anderson et al. (June 22 issue)1 report that head positioning did not influence outcome in patients with acute stroke. The lying-flat position theoretically increases cerebral perfusion, which may alleviate acute ischemia through the recruitment of collaterals.2 However, in the Head Positioning in Acute Stroke Trial (HeadPoST), reported by Anderson et al., many patients had conditions

Obstructive lung diseases are common causes of disability and death worldwide. A hallmark feature is aberrant activation of Gq protein–dependent signaling cascades. Currently, drugs targeting single G protein (heterotrimeric guanine nucleotide–binding protein)–coupled receptors (GPCRs) are used to reduce airway tone. However, therapeutic efficacy is often limited, because various GPCRs contribute to

Treatment of type 2 diabetes mellitus continues to pose an important clinical challenge, with most existing therapies lacking demonstrable ability to improve cardiovascular outcomes. The atheroprotective peptide apelin (APLN) enhances glucose utilization and improves insulin sensitivity. However, the mechanism of these effects remains poorly defined. We demonstrate that the expression of APLNR (APJ/AGTRL1)

In melanoma, vascular endothelial growth factor–C (VEGF-C) expression and consequent lymphangiogenesis correlate with metastasis and poor prognosis. VEGF-C also promotes tumor immunosuppression, suggesting that lymphangiogenesis inhibitors may be clinically useful in combination with immunotherapy. We addressed this concept in mouse melanoma models with VEGF receptor–3 (VEGFR-3)–blocking antibodies

Reducing IgE with Omalizumab in children with asthma improves the plasmacytoid dendritic cell interferon response to virus in vitro.

A neuronal subpopulation in the central amygdala promotes food consumption.

Mast cell inhibition prevents heterotopic ossification in a model of fibrodysplasia ossificans progressiva.

A gain-of-function mutation in NLRP3 is associated with cochlear inflammation and hearing loss.

Increasing evidence supports the hypothesis that soluble misfolded protein assemblies contribute to the degeneration of postmitotic tissue in amyloid diseases. However, there is a dearth of reliable nonantibody-based probes for selectively detecting oligomeric aggregate structures circulating in plasma or deposited in tissues, making it difficult to scrutinize this hypothesis in patients. Hence, understanding

Creatine metabolism in adipose tissue is necessary to burn off extra dietary calories and helps prevent obesity.

Recognising and accurately coding reversal of type 2 diabetes is key to improving outcomes and reducing healthcare costs, argue Louise McCombie and colleagues Type 2 diabetes, generally perceived as progressive and incurable, now affects 5-10% of the population, about 3.2 million people in the UK.1 Until complications develop, most patients are managed entirely within primary care, with diabetes

Hurricanes and floods tell a story of planetary pain and distress. Many of us love our planet but don’t fully understand it. Our solutions are misdirected, ignoring what matters to the planet. Our interests come first. The same applies to patients. Many of us love our patients but struggle to understand their motivations. Our solutions are misdirected. Victoria Wright has a facial disfigurement. Born

An outdated concept that should be abandoned In a linked paper, Chan and colleagues (doi:10.1136/bmj.j3889) report the distribution of intraocular pressure (IOP) and the frequency of glaucoma in the EPIC-Norfolk cohort, a community based cross sectional study of a UK population.1 With knowledge of both the distribution of IOP and the frequency of glaucoma, the authors determined that the diagnostic

A 10 year old girl described intense headaches at the front of her head, which had been coming and going since she banged her head two months earlier. She also described feeling sick with the headaches, and had vomited on several occasions. On examination, she had papilloedema, otherwise neurological examination was normal. She had a computed tomography (CT) scan of the head (fig 1A⇓) followed by magnetic

A 21 year old woman from Singapore presented to the eye hospital with a two week history of painful red eyes, where the severity of the pain was continuing to worsen. She was short-sighted and wore rigid gas permeable contact lenses on most days and admitted to sometimes sleeping with them in situ. She had last worn contact lenses a week before presentation. She reported that she had been cleaning

When you are in mental and emotional distress, part of the agony is because the mind cannot make sense of what is happening inside or outside.1 In this situation I have wanted a diagnosis to help explain what I am going through and to give a semblance of choice and control. If what I am feeling is something others regard as real, maybe it becomes more amenable to being fixed. Diagnosis is a key that

How delightful to foresee 21 000 new posts in mental health.1 As a teacher, I would be delighted to help to build a revived, multidisciplinary workforce. As an academic, I would assume population mental health and developments across the lifecourse informed workforce planning.2 The first 19 pages of Health Education England’s plan, however, do not contain any population …

The Association of the British Pharmaceutical Industry’s report on cancer drugs12 uses data from the EUROCARE collaboration of cancer registries, which are not new. As might be expected, the association has added comparative information about the use of anticancer drugs. As well as slow uptake of …

A 46 year old man with Hodgkin’s lymphoma underwent 18F-FDG positron emission/computed tomography scanning to assess disease response after three cycles of chemotherapy. Diffuse …

UK health services do not have the resources to care for British pensioners currently living in other EU countries if they have to return because of stalled Brexit negotiations, peers have been told. Health experts have warned of the potential consequences if talks to ensure continuation of reciprocal healthcare arrangements stall. At the end of August the government said that both sides in Brexit

GPs in the UK earned £90 100 (€100 000; $120 000) on average in 2015-16, figures from NHS Digital show.1 This represents a 1.2% decrease on 2014-15, when GPs earned an average of £91 200. This figure is for the average taxable income for contractor and salaried GPs working in practices with …

The Dublin based drug maker Allergan is transferring the patents for its dry eye treatment Restasis (ciclosporin ophthalmic emulsion) to the Saint Regis Mohawk Tribe, hoping that the native people’s sovereign status under US law will enable them to fight off patent challenges from generic makers. The Mohawks, who live in upstate New York near the Canadian border, will immediately grant exclusive licenses

Sepsis, most succinctly defined as organ dysfunction due to infection, is estimated to account for more than 5 million deaths around the world each year and to cause or contribute to approximately half of all deaths occurring in hospitals in the United States.1,2 A 2016 report from the Healthcare Cost and Utilization Project estimated the cost of treating sepsis in US hospitals in 2013 at $24 billion

The new head of the US Centers for Disease Control and Prevention has received praise for obstetrics campaigns, writes Jeanne Lenzer , but criticism for supporting quackery and using Coca-Cola’s money to fund anti-obesity programmes When President Donald Trump named Brenda Fitzgerald as the new director of the US Centers for Disease Control and Prevention in June, several public health officials praised

Stain’s argument for bringing back 24 hour shifts is underpinned by flawed premises.1 Most worrisome is the suggestion that doctors should work such shifts because they’re eventually going to do it anyway. “Bad practice to gain experience in more bad practice” is not a valid education strategy. This “toughen ’em up” approach is exemplified by Stain …

The narrative on the Charlie Gard case has centred on the dilemma of parents disagreeing with doctors.1 But this case really turns on how parents respond when doctors disagree. Doctors disagree on a host of matters,2 and patients will invariably affiliate themselves to one side of a medical argument. Charlie’s parents’ stance was predicated on the offer from the American …

The head of NHS England has warned hospitals and GP surgeries to be prepared for a big increase in cases of flu this winter after a heavy season in the southern hemisphere. Speaking at the Health and Care Innovation Expo in Manchester on Tuesday 12 September, NHS England’s chief executive, Simon Stevens, said that the NHS should be on high alert and should ensure that all measures are taken to prepare

Women who go into preterm labour before 37 weeks of pregnancy should be offered antibiotics to prevent transmission of group B streptococcal (GBS) disease to their offspring, new guidelines from the Royal College of Obstetricians and Gynaecologists have recommended.1 “This guidance provides clear advice to doctors and midwives on which women should be offered antibiotics to avoid passing GBS infection

GPs and their staff are increasingly facing violence, harassment, and threatening behaviour in their surgeries, an investigation by The BMJ has found. Crime figures obtained from police forces across the UK show a 9% rise in the overall number of recorded crimes committed on the premises of GP surgeries and health centres over the past year (from 1974 in 2015-16 to 2147 in 2016-17). This is in line

Natasa Balogh This photograph, entitled Sorrow , has been awarded first prize in Flash Points, a competition organised to spark innovative ideas concerning public health. The winners of the competition―organised by the Royal Society for Public Health and …

The proportion of general practice patients in England given prescriptions of opioids and “Z drugs”—non-benzodiazepines such as zopiclone and zolpidem—doubled between 2000 and 2012, a new study has shown.1 Researchers from the Public Health Research Consortium, which is based at the London School of Hygiene and Tropical Medicine, analysed a random sample of 49 999 patients who between 2000 and 2015

Plans to reduce NHS costs in London are “not credible,” and more radical cuts to services may need to be considered to deliver savings, leading healthcare think tanks have warned. As part of work commissioned by the London mayor Sadiq Khan, the King’s Fund, and the Nuffield Trust analysed plans published by the five London based sustainability and transformation partnerships (STPs). The think tanks

Victoria Wright, 38, lives with an unusual facial appearance. She describes her experiences and the lessons she’d like to pass on The first time I realised that I looked different was when a boy called me “fat chin” at primary school. Thirty years later I still remember the burning shame and humiliation. I was born with cherubism, a rare genetic condition which is associated with variable degrees

Organisations such as the National Institute for Health and Care Excellence require the synthesis of evidence from existing studies to inform their decisions—for example, about the best available treatments with respect to multiple efficacy and safety outcomes. However, relevant studies may not provide direct evidence about all the treatments or outcomes of interest. Multivariate and network meta-analysis

A consultant maxillofacial surgeon who harmed patients by carrying out inappropriate surgery—including using an experimental material to rebuild bone—without obtaining informed consent has been struck off the UK medical register. Roger Bainton was accused of inappropriately treating 11 patients and failing to properly inform them of the risks and benefits of proposed procedures. In 2000 Bainton was

The results of 18 years of follow-up should provide reassurance that there is no long term increase in all cause mortality or mortality from specific causes, such as cardiovascular disease or cancer, among women who received hormone replacement therapy (HRT) for five to seven years.1 The results of the study, published in JAMA , show that it is appropriate to offer HRT to women experiencing menopausal

The JAMA Network is a consortium of peer-reviewed print and online medical publications that includes JAMA® and 11 other specialty Network journals. JAMA does not hold itself responsible for statements made by any contributor. All articles published, including opinion articles, represent the views of the authors and do not reflect the policy of JAMA, the American Medical Association, or the institution

The request of our secretary for a contribution to this meeting suggested to me an extension of my discussion1 on the psychobiologic level of medical facts (presented two years ago in San Francisco and published in The Journal of the American Medical Association, 1915), a consideration of my present plan of teaching psychopathology and psychiatry and of some principles characteristic of the plan. No