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Evidence is emerging that the outcome for patients with subarachnoid haemorrhage may be poorer if they carry the APOE4 allele. In a meta-analysis of eight observational studies involving almost 700 patients, E4 carriers were more likely to have a negative outcome (death, dependency, or severe cognitive impairment) and delayed ischaemia. The apoE protein has neurotrophic and antioxidant functions (Neurology 2007;69:766-75 doi: 10.1212/01.wnl.0000267640.03300.6b).
A systematic review of human papillomavirus (HPV) infection and disease in women reports that for women aged 15-25 who were not previously infected with vaccine-type HPV strains, prophylactic vaccination seems to be highly effective in preventing HPV infection and precancerous cervical disease. The proof will be in the pudding, however, when data on a reduction—or otherwise—in the incidence of cervical cancer finally filter through (CMAJ 2007;177:469-79 doi: 10.1503/cmaj.070948).
Could your hospital accommodate the four huge “Acts of Mercy” paintings that belong to the former Middlesex Hospital in London (BMJ 2007;334:820 doi: 10.1136/bmj.39184.573241.DB)? Their sale has been deferred for six months so that an appropriate location can be found for them—preferably in a hospital. If you've got a space of 3 metres by 4.80 metres for each of them, please contact Johanna Kociejowski (gro.dnuftra@ikswojeicokj).
Cancer cells overexpress certain sugar molecules on their cell surface, and antibodies to these sugars can eliminate circulating tumour cells and micro-metastases in cancer patients. A study in mice has now identified a single chemical structure that incorporates adjuvants into a vaccine that produces a more powerful immune response than previously. This new structure enables the body to produce enough antibodies to recognise cancer cells. The next step is to test the vaccine for its ability to kill cancer cells (Nature Chemical Biology 2007 Aug 26, doi: 10.1038/nchembio.2007.25).
Patients, clinical staff, and the public are being put at risk needlessly, says the Health Services Journal, because investigations into “what went wrong” when mental health patients have killed are taking years to complete, as is changing flawed systems (23 August 2007, http://tinyurl.com/yr2nl4). NHS reorganisations, police inquiries, and deliberate foot dragging are blamed. The journal says there are currently 27 outstanding cases in England, and seven of the 10 strategic health authorities are yet to implement changes arising from incidents that happened three or more years ago.
Whether speed cameras in urban Spain reduce the number of road traffic injuries has been assessed (American Journal of Public Health 2007;97:1632-7 doi: 10.2105/AJPH.2006.093195). The relative risk of a road crash occurring after speed cameras were installed was 0.73 (95% confidence interval 0.63 to 0.85), compared with before installation. The protective effect was greater at weekends. In the two years of the study, an estimated 364 collisions were prevented by speed cameras, 507 fewer people were injured, and 789 fewer vehicles were involved in collisions.
If women are obese before they become pregnant, are they more likely to produce babies with structural defects? The answer, according to a multicentre case-control study, is “possibly.” Maternal obesity has a weak to moderate positive association with seven of 16 categories of birth defects, but a strong inverse association with gastroschisis. Undiagnosed diabetes may be the culprit (Archives of Pediatric and Adolescent Medicine 2007;161:745-50).
The latest in a long line of tests devised to establish the existence of a superior labral tear of the shoulder joint has passed with distinction. The “passive compressive test” (American Journal of Sports Medicine 2007;35:1489-94 doi: 10.1177/0363546507301884) achieved success (confirmed by arthroscopy) in 27 of 31 patients with a positive result. Of the 30 patients with a negative result, six turned out to have a superior labral tear. The authors estimate a sensitivity of 81.8% and a specificity of 85.7%.
What's the optimal antibiotic regimen for treating acute exacerbations of chronic bronchitis? A meta-analysis of 12 randomised controlled trials concludes that first line antibiotics (amoxicillin, trimethoprim, and doxycycline, among others) were associated with lower treatment success (but not less safety) than second line antibiotics (macrolides and second and third generation cephalosporins, among others). The authors caution readers to look at the fine print, however. The data didn't allow for further analyses that might be relevant, such as age, impaired lung function, and the frequency of exacerbations (Chest 2007;132:447-55 doi: 10.1378/chest.07-0149).