Bacteria were first detected in human tumors more than 100 years ago, but the characterization of the tumor microbiome has remained challenging because of its low biomass. We undertook a comprehensive analysis of the tumor microbiome, studying 1526 tumors and their adjacent normal tissues across seven cancer types, including breast, lung, ovary, pancreas, melanoma, bone, and brain tumors. We found that each tumor type has a distinct microbiome composition and that breast cancer has a particularly rich and diverse microbiome. The intratumor bacteria are mostly intracellular and are present in both cancer and immune cells. We also noted correlations between intratumor bacteria or their predicted functions with tumor types and subtypes, patients’ smoking status, and the response to immunotherapy.

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We found that vitamin D insufficiency is associated with increased fat infiltration in muscle in healthy young women.

Objective: Disability or death occurs more frequently in patients with hemorrhagic transformation (HT) after ischemic stroke. In rat models of stroke, sulfonylurea (SU) drugs such as glibenclamide (adopted US name, glyburide) confer protection against swelling and HT through actions on the novel SUR1‐regulated NCCa‐ATP channel. Here, we sought to determine whether the use of SU drugs in patients with diabetes mellitus (DM) presenting with acute ischemic stroke might influence the incidence of HT. Methods: We retrospectively analyzed data on 220 patients with DM who presented with acute ischemic stroke, 43 of whom were managed with and continued to receive SU drugs, and 177 of whom were managed without (controls). Results: During a median length of stay in hospital of 11 days, 20 control patients (11%) experienced symptomatic HT (sHT), whereas no patient in the SU group experienced sHT (p = 0.016). No patient in the SU group died, compared to 18 (10%) in the control group (p = 0.027). Similarly favorable outcomes were observed after matching for baseline imbalances and excluding outliers. In support of the proposed mechanism, we present a case of sHT in which an analysis of brain tissues obtained intraoperatively showed prominent upregulation of SUR1, the target of SU drugs, in microvessels and neurons. Interpretation: We conclude that, in diabetic patients with acute ischemic stroke, prior and continued use of SU drugs is associated with reduced sHT compared to those whose treatment regimen does not include SU drugs. ANN NEUROL 2012;72:799–806

Despite intensive investigation, an underlying cause of miscarriage has not been found in a high proportion of women with a history of recurrent miscarriage. No effective intervention has been identified that improves rates of live birth. Some investigators have suggested that treatment of women with unexplained recurrent miscarriage with aspirin and low-molecular-weight heparin may increase the proportion of live births; the limited data available from randomized controlled trials have been inconsistent.This multicenter, randomized, placebo-controlled trial investigated whether a combination of aspirin with lowmolecular-weight heparin or aspirin alone, compared with placebo, would improve the live-birth rate in women with a history of unexplained recurrent miscarriage. The study subjects were 364 women aged 18 to 42 years with a history of unexplained recurrent miscarriage who were trying to conceive or were pregnant less than 6 weeks. Women were randomly assigned to receive combined therapy (n ϭ 123) consisting of daily doses of aspirin 80 mg plus open-label subcutaneous low-molecular-weight heparin (nadroparin) at a dose of 2850 IU, or 80 mg of aspirin alone (n ϭ 120), or placebo (n ϭ 121) either before conception or at a gestational age of less than 6 weeks. The main study outcome measure was the rate of live birth. Secondary outcome measures included rates of miscarriage, obstetrical complications, and maternal and neonatal adverse events.No significant difference between the 3 study groups was found in the proportion of live births (combined therapy, 54.5%; aspirin only, 50.8%; and placebo, 57%); the absolute difference in live-birth rate for combined therapy versus placebo was Ϫ2.6 percentage points, with a 95% confidence interval of Ϫ15.0 to 9.9; and for the aspirin only versus placebo was Ϫ6.2, with a 95% confidence interval of Ϫ18.8 to 6.4 (P ϭ 0.63). There was also no significant difference in the live-birth rates among the 299 women in these 3 groups who became pregnant; the rates were 69.1% in the combined therapy group, 61.6% in the aspirin-only group, and 67.0% in the placebo group (P ϭ 0.52). Compared to the other 2 groups, the combined therapy group had a significantly increased tendency for bruising and swelling or itching at the injection site (P Ͻ 0.001).These findings demonstrate that neither aspirin combined with nadroparin nor aspirin alone increase the likelihood of a live birth in comparison with placebo among women with unexplained recurrent miscarriage. EDITORIAL COMMENT(I have mentioned on several occasions that if you want to make a splash in medicine, choose a well-accepted dictum and disprove it. Al-though the treatment of recurrent miscarriage is not exactly in that category, the methods of treatment with aspirin plus heparin or aspirin GYNECOLOGY Volume 65, Number 10 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTCirculating levels of anti-Müllerian hormone (AMH) have significantly increased in adolescent girls with polycystic ovary syndrome (PCOS) compared with that of normal girls...