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This Week in JAMA
April 21, 1999

This Week in JAMA

JAMA. 1999;281(15):1357. doi:10.1001/jama.281.15.1357
Determinants of Liver Transplantation Costs

Using data from 3 liver transplantation centers, Showstack and colleaguesArticle found that factors associated with higher hospital resource use from the day of transplantation through hospital discharge included more severe illness at the time of liver transplantation, donor age of 60 years or older, and alcoholic liver disease. Length of hospital stay and resource use varied significantly between the 3 centers. In an editorial, RussellArticle contrasts the clinical, ethical, and economic implications of a donor organ allocation policy based on clinical urgency criteria, as recently recommended by the United Network for Organ Sharing, and one that incorporates criteria of cost and resource use.

Egg Consumption Not Found to Increase CHD Risk

Limiting egg consumption has been recommended to lower blood cholesterol levels and reduce atherosclerosis, but there is little epidemiologic evidence on the relationship between egg consumption and the risk of coronary heart disease (CHD). Hu and colleagues report that the consumption of up to 1 egg per day was not associated with an increased incidence of nonfatal myocardial infarction, fatal CHD, or ischemic or hemorrhagic stroke among healthy individuals in 2 large prospective cohort studies, the Health Professionals Follow-up Study and the Nurses' Health Study. Egg consumption was found to be associated with a higher risk of CHD only in a subgroup analysis of subjects with diabetes mellitus.

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Morphologic Predictors of Prostate Cancer Progression

Marked variation in the natural history of prostate cancer complicates treatment decisions for this disease. In a study of morphologic characteristics of radical prostatectomy specimens from men with peripheral zone prostate cancers treated with surgical excision alone, Stamey and colleagues found that the proportion of each cancer scored as Gleason grade 4/5 (poorly differentiated) and cancer volume were strong independent predictors of prostate cancer progression as indicated by an increasing prostate-specific antigen level. Other independent predictors of prostate cancer progression included positive lymph node findings and intraprostatic vascular invasion.

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Cholinergic Activity Intact in Early Alzheimer Disease

The cholinergic hypothesis of Alzheimer disease states that cholinergic deficits occur early and their treatment should ameliorate symptoms of the disease. However, in a postmortem study of the brains of elderly patients, Davis and coworkersArticle found that subjects with mild functional and cognitive impairment during the 6 months prior to death had no evidence of either choline acetyltransferase or acetylcholinesterase deficiency. Only patients with severe dementia had a significant reduction in cholinergic markers compared with patients without dementia. In an editorial, DaviesArticle notes an alternative hypothesis of neuronal degeneration in the hippocampus to explain the early symptoms of Alzheimer disease and considers pharmacologic strategies to slow or prevent neuronal degeneration as alternatives to the acetylcholinesterase inhibitors currently available.

A Rational Recommendation for Vitamin C Intake

Vitamin C (L-ascorbic acid) is a specific cofactor for the optimal performance of enzymes in several metabolic pathways; it enhances the gastrointestinal absorption of iron and has demonstrated antioxidant activity. Levine and colleagues review recent biochemical, epidemiologic, and clinical evidence as the basis for updating recommendations for the dietary intake of vitamin C.

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Medical News & Perspectives

Sunscreens, in-office dispensing of nonprescription health products, and future directions for the specialty were explored at this year′s American Academy of Dermatology meeting.

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Clinical Cardiology

A review of clinical trials of platelet glycoprotein IIb/IIIa receptor antagonists for the treatment of patients undergoing percutaneous coronary interventions and patients with acute coronary syndromes.

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Health Law and Ethics

Mandatory disclosure of physician financial incentives in managed care plans: legal, policy, and ethical considerations.

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Thanks to Our Peer Reviewers

JAMA acknowledges with gratitudeArticle the contributions of the 3555 peer reviewersArticle who participated in manuscript reviews in 1998. More than 4000 manuscripts were received.

JAMA Patient Page

For your patients: Facts about vitamin C.

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