{"id":75,"date":"2006-12-28T12:50:37","date_gmt":"2006-12-28T11:50:37","guid":{"rendered":"http:\/\/resource.bmj.com\/bmj\/2006\/12\/28\/nejm-21-dec-2006\/"},"modified":"2006-12-28T12:50:37","modified_gmt":"2006-12-28T11:50:37","slug":"nejm-21-dec-2006","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2006\/12\/28\/nejm-21-dec-2006\/","title":{"rendered":"NEJM 21 Dec 2006"},"content":{"rendered":"<p>Now children, who can remember from last week\u2019s lesson what is the best <a href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/355\/25\/2631\">biomarker for death or cardiovascular events<\/a>? Don\u2019t tell me you\u2019ve forgotten already. Well, never mind, in the general population you can tell just as much by working out the (expanded) <a href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/355\/25\/2631\">Framingham score<\/a>, according to this <a href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/355\/25\/2631\">paper <\/a>from the Framingham Offspring Study. <!--more-->They looked at the added value of various biomarkers such as CRP, homocysteine, aldosterone, fibrinogen, D-dimer and, oh yes, <a href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/355\/25\/2631\">B-type natriuretic peptide<\/a>. Remember now? The best biomarker? All together now, children \u2013 <a href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/355\/25\/2631\">BNP<\/a>! Lovely. But even BNP has little predictive value over and above basic things like smoking, BP and diabetes in the general population.<\/p>\n<p>Which <a href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/355\/25\/2640\">antibiotic <\/a>should colorectal surgeons use when <a href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/355\/25\/2640\">opening the bowel electively<\/a>? I don\u2019t suppose many readers really need to know, but for the record, ertapenem, a long-acting carbapenem, looks like a good choice, judging from this paper which compared it with another parenteral antibiotic you\u2019ve never heard of, cefotetan. The down side of all these antibiotics is that the more effective they are at eliminating the normal gut flora, the more they encourage <em>Clostridium difficile.<\/em><\/p>\n<p><a href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/355\/25\/2652\">Positrons <\/a>are positively charged particles of antimatter which are rapidly eliminated by collision with electrons, producing gamma radiation. The Universe was 10<sup>-43 <\/sup>of a second old when positrons first appeared, and minute asymmetries between them and their paired electrons gave rise (after a further 13 billion years) to the entire visible Universe. <a href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/355\/25\/2652\">Positron emission tomography<\/a> depends on the proximity of a Big-Bang machine to the patient, producing positron-emitting isotopes of short half-life (e.g.<sup>18<\/sup>F, approx 110 minutes). The <a href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/355\/25\/2652\">study <\/a>here shows that PET can distinguish between <a href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/355\/25\/2652\">mild cognitive impairment<\/a>, <a href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/355\/25\/2652\">Alzheimer\u2019s disease<\/a>, and normal cognitive function; but sadly I cannot see myself making use of these findings, since the primary care trust has turned down our request for a new cyclotron.<\/p>\n<p>\u201c<a href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/355\/25\/2664\">Teaching surgical skills \u2013 changes in the wind<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Now children, who can remember from last week\u2019s lesson what is the best biomarker for death or cardiovascular events? Don\u2019t tell me you\u2019ve forgotten already. Well, never mind, in the [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2006\/12\/28\/nejm-21-dec-2006\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38363,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[111],"tags":[],"class_list":["post-75","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-lehmans-weekly-review-of-medical-journals"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>NEJM 21 Dec 2006 - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2006\/12\/28\/nejm-21-dec-2006\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"NEJM 21 Dec 2006 - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Now children, who can remember from last week\u2019s lesson what is the best biomarker for death or cardiovascular events? 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