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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2005;293(4):397. doi:10.1001/jama.293.4.397.
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Two articles in this issue of JAMA report results from 2 randomized clinical trials that investigated the efficacy of 2 interventions to improve outcomes following acute ST-segment elevation myocardial infarction (STEMI). In the first article, investigators from the Clinical Trial of Reviparin and Metabolic Modulation in Acute Myocardial Infarction Treatment Evaluation (CREATE)Article report the effect of reviparin, a low-molecular-weight heparin, initiated within 12 hours of symptom onset and added to usual therapy, on mortality, myocardial reinfarction, or stroke at 7 and 30 days. Compared with patients receiving placebo, patients receiving reviparin had less mortality and reinfarction and no significant increase in stroke risk. The second trial, CREATE–Estudos Cardiológicus Latinoamérica (CREATE-ECLA),Article tested the efficacy of a high-dose glucose-insulin-potassium infusion compared with placebo to reduce mortality, cardiac arrest, and cardiogenic shock in patients with acute STEMI. No benefit from the infusion was demonstrated. In an editorial, CaliffArticle discusses the implications of these results for clinical care and clinical trial design.

SODIUM CHANNEL DEFECT IN DILATED CARDIOMYOPATHY

Previous research has identified several gene defects associated with dilated cardiomyopathy. Olson and colleaguesArticle report their findings of heritable mutations in the gene encoding the cardiac sodium channel, SCN5A, present in patients with dilated cardiomyopathy and associated with susceptibility to early-onset dilated cardiomyopathy and atrial fibrillation. In an editorial, Adler and FusterArticle discuss sodium channel physiology and the pathophysiology of idiopathic cardiomyopathies and atrial fibrillation.

OBESITY, WEIGHT GAIN, AND RISK OF KIDNEY STONES

Some investigators have reported an association of large body size with an increased risk of kidney stones, but the specific contributions of weight, weight gain, and body mass index (BMI) have not been described. Taylor and colleagues assessed the relationship of body size—reflected in weight, weight change, BMI, and waist circumference—to incident symptomatic kidney stones in participants in 3 large prospective studies of health professionals. After adjusting for age, dietary factors, fluid intake, and thiazide use, they found that obesity, weight gain since early adulthood, and higher waist circumference were associated with an increased risk of incident kidney stones. In analyses by sex, they found the magnitude of risk may be greater in women than men.

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EXPOSURE TO INFANT SIBLINGS AND RISK OF MS

Living with siblings may increase the likelihood of early life infections, and there is some evidence that early life infections may protect against the development of multiple sclerosis (MS). Ponsonby and colleagues conducted a case-control study to assess whether exposure to infant siblings in the first 6 years of life is associated with the risk of MS. They found that increasing duration of contact with siblings younger than 2 years in the first 6 years of life was associated with a reduced risk of MS.

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MEDICAL NEWS & PERSPECTIVES

New insights into the factors that give rise to Parkinson disease are improving scientists’ understanding of the disorder and pointing to novel therapeutic approaches.

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SURFACTANT IN PEDIATRIC ACUTE LUNG INJURY

Endotracheal installation of exogenous surfactant improved oxygenation and decreased mortality in pediatric acute lung injury.

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CLINICIAN’S CORNER

Chest pain in women with normal or nonobstructive coronary angiograms is not as benign as commonly thought.

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CHRONIC DISEASE CARE

Casalino discusses the disease management model for chronic disease care and the Center for Medicare & Medicaid Services’ disease management initiative.

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JAMA PATIENT PAGE

For your patients: Information about multiple sclerosis.

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