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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.
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.
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.
"About ten days after being hospitalized, she shocked her husband by
bringing up the prospect that she might die." From "Tomorrow."
Researchers are investigating the impact that long workdays and irregular
working hours have on health, safety, stress, and overall quality of life.
Review of authors' contributions to research articles published in 3
major medical journals reveals differing editorial policies on authorship.
Treatment of renal cell carcinoma.
For your patients: Information about kidney cancer.
This Week in JAMA. JAMA. 2004;292(1):11. doi:10.1001/jama.292.1.11