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This Week in JAMA
July 7, 2004

This Week in JAMA

JAMA. 2004;292(1):11. doi:10.1001/jama.292.1.11
JAMA-EXPRESS: Enoxaparin vs Heparin in Acute Coronary Syndrome

Clinical outcomes from 2 large randomized trials comparing enoxaparin, a low-molecular-weight heparin, with unfractionated heparin in the treatment of non–ST-segment elevation acute coronary syndrome (ACS) are reported in this issue of JAMA. In the first article,Articlefrom the Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa inhibitors (SYNERGY) trial investigators, enoxaparin was not superior to heparin for the end points of death or nonfatal myocardial infarction (MI) at 30 days in these high-risk patients. In addition, ischemic events during percutaneous revascularization or coronary artery bypass graft surgery were similar with both drugs. In a second article,ArticleBlazing and colleagues report results from phase A of the A to Z trial, in which patients with non–ST-segment elevation ACS who were receiving tirofiban and aspirin were randomized to receive either enoxaparin or unfractionated heparin. These authors found a similar risk of death, recurrent MI, or refractory ischemia 7 days after randomization in both patient groups. A third articleArticleby Petersen and colleagues reports results of their systematic review of data from approximately 22 000 patients enrolled in the 6 clinical trials comparing enoxaparin with unfractionated heparin in non–ST-segment elevation ACS. They conclude that enoxaparin is more effective than unfractionated heparin in preventing the combined end point of death or MI at 30 days and similar with respect to bleeding risk. In an editorial,ArticleDas and Moliterno discuss the implications of these results for clinical practice.

Effects of Isoflavones on Postmenopausal Health

Several studies have suggested that estrogenlike compounds in plant foods, such as isoflavones in soy, may prevent menopause-related changes in bone density, lipids, and cognition. To investigate this possibility, Kreijkamp-Kaspers and colleagues conducted a double-blind, placebo-controlled study of the effects of an isoflavone-containing soy protein supplement on bone mineral density, cognitive function, and plasma lipid levels in women aged 60 to 75 years. They found that women taking the soy supplement experienced no significant improvement in any of the assessed outcomes at the 12-month assessment.

Article
Pluripotentiality of Fetal Cells and Donor Bone Marrow

Two articles in this issue of JAMA report evidence on the pluripotent capacity of fetal hematopoietic and donor bone marrow cells. In the first study,ArticleKhosrotehrani and colleagues examined tissue specimens from women with male offspring to determine characteristics of fetal cells found within maternal organs. They found male cells in the sampled tissues that expressed leukocyte, hepatocyte, and epithelial cell markers, suggesting these fetal cells—likely of hematopoietic origin—have multilineage capacity. In the second study,ArticleTaylor determined HLA expression of endometrial biopsy specimens from women who had undergone HLA-mismatched bone marrow transplants. He found endometrial cells of the marrow donor's HLA type, suggesting that bone marrow stem cells can differentiate and regenerate endometrial tissue. In an editorial,ArticlePolan and Yao discuss the therapeutic potential of these findings.

A Piece of My Mind

"About ten days after being hospitalized, she shocked her husband by bringing up the prospect that she might die." From "Tomorrow."

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Medical News & Perspectives

Researchers are investigating the impact that long workdays and irregular working hours have on health, safety, stress, and overall quality of life.

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Authorship Contributions

Review of authors' contributions to research articles published in 3 major medical journals reveals differing editorial policies on authorship.

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CLINICIAN'S CORNER

Treatment of renal cell carcinoma.

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JAMA Patient Page

For your patients: Information about kidney cancer.

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