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In This Issue of JAMA
November 5, 2014


JAMA. 2014;312(17):1715-1717. doi:10.1001/jama.2013.279809

In a phase 2 randomized clinical trial that enrolled 245 patients with metastatic melanoma, Hodi and colleagues assessed overall survival of patients treated with ipilimumab—a monoclonal antibody that blocks cytotoxic T-lymphocyte–associated antigen 4 and has proven survival benefit—or the combination of ipilimumab with sargramostim—a granulocyte-macrophage colony-stimulating factor–secreting tumor vaccine. The authors report that combination treatment with ipilimumab plus sargramostim, compared with ipilimumab alone, resulted in longer overall survival and lower toxicity but no difference in progression-free survival.

Little is known about the risk of adverse outcomes among patients with nonobstructive coronary artery disease (CAD). In a retrospective cohort study involving 37 674 patients undergoing elective coronary artery angiography, Maddox and colleagues found that compared with patients with no apparent CAD, patients with nonobstructive CAD had a significantly greater 1-year risk of myocardial infarction and all-cause mortality.

Author Video Interview

To assess whether genetic contributions to elevations in low-density lipoprotein cholesterol (LDL-C) and other lipids are associated with early subclinical aortic valve disease and incident aortic stenosis, Smith and colleagues analyzed genetic and clinical data from 4 longitudinal cohort studies (35 403 participants total). The authors report that genetic predisposition to elevated LDL-C was associated with the presence of aortic valve calcium and incidence of aortic stenosis—evidence supportive of a causal association between LDL-C and aortic valve disease.

In a preliminary study that involved 20 patients with relapsing or refractory Clostridium difficile infection, Youngster and colleagues assessed adverse events and rate of diarrhea resolution following oral (capsulized) frozen fecal microbiota transplantation from healthy unrelated donors. The authors report no serious adverse events and a resolution of diarrhea in a majority of patients.

Author Audio Interview

Clinical Review & Education

Wadden and colleagues report results of a systematic review of the evidence supporting behavioral treatment of obesity among patients encountered in primary care settings. The authors identified 12 trials (3893 total participants) of good quality; however, none involved primary care physicians working alone or with trained interventionists to provide a recommended 14 face-to-face sessions in 6 months. Intensive behavioral counseling—delivered by a range of trained interventionists, including dietitians, psychologists, and health educators—was found to induce clinically meaningful weight loss.

Continuing Medical Education

A recent article in JAMA Surgery summarized findings from a 2013 National Institutes of Health workshop on the current status of bariatric surgery and future research priorities. In this From the JAMA Network article, Wolfe and Belle highlight the need for information on long-term outcomes of bariatric surgery and strategies to meet this goal.

A 57-year-old woman presents with a 7-year history of painful, recurrent gingival “peeling” and white patches on the oral mucosa. Intraoral examination shows generalized erythema, gingival sloughing, and diffuse white striae and patches on the gingiva and mucosa. What would you do next?

Probiotics are live, nonpathogenic microorganisms marketed as dietary supplements. This Medical Letter on Drugs and Therapeutics article summarizes new data on probiotics—including possible benefit in the treatment of some gastrointestinal disorders and adverse effects in immunocompromised individuals.