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In This Issue of JAMA
November 8, 2016


Author Affiliations

Copyright 2016 American Medical Association. All Rights Reserved.

JAMA. 2016;316(18):1841-1843. doi:10.1001/jama.2015.14575

Proanthocyanidins present in cranberries inhibit adherence of Escherichia coli to uroepithelial cells, which has prompted the investigation of cranberry products as a potential nonantimicrobial strategy to prevent urinary tract infection. In a randomized placebo-controlled clinical trial involving 185 women residing in 21 nursing homes, Juthani-Mehta and colleagues found that compared with placebo capsules, daily administration of oral cranberry capsules (containing proanthocyanidins equivalent to 20 ounces of cranberry juice) for 1 year resulted in no significant difference in the presence of bacteriuria plus pyuria. In an Editorial, Nicolle discusses the lack of evidence to support cranberry products for prevention of urinary tract infection.



In a randomized open-label clinical trial that enrolled 2017 women with high-risk early-stage breast cancer, Foukakis and colleagues assessed whether individually tailored dose-dense adjuvant chemotherapy resulted in improved outcomes compared with conventional standard-dose adjuvant chemotherapy. The authors report that after a median follow-up of 5.3 years, use of tailored dose-dense chemotherapy did not result in a statistically significant improvement in breast cancer recurrence–free survival but was associated with more frequent nonhematologic toxic effects compared with conventional standard-dose adjuvant chemotherapy.


Feeding with mother’s milk is associated with improved neurodevelopment among very low-birth-weight (VLBW) infants. In a randomized trial involving 363 VLBW infants, O’Connor and colleagues assessed the effect of nutrient-fortified donor human milk compared with formula—both as a supplement to mother’s milk—on infant neurodevelopment. The authors report no difference in neurodevelopment score at 18 months’ corrected age among infants who received supplemental donor milk compared with those who received supplemental formula. In an Editorial, Colaizy discusses benefits of maternal milk for VLBW infants.



Pericarditis recurs in up to 30% of patients after a first pericarditis episode. Optimal treatment to prevent recurrences is not established. Brucato and colleagues evaluated the efficacy of anakinra—an interleukin 1β recombinant receptor antagonist—in a randomized clinical trial involving 21 consecutive patients with recurrent idiopathic colchicine-resistant and corticosteroid-dependent pericarditis. All patients received open-label treatment with anakinra for 60 days. Patients were then randomly assigned to receive anakinra or placebo for up to 6 months. The authors found that compared with placebo, use of anakinra reduced the risk of pericarditis recurrence over a median 14 months’ follow-up.

Clinical Review & Education

An article in JAMA Dermatology reported that indoor tanning is a likely factor for an observed steeper increase in melanoma rates among young women compared with young men in the United States. This From the JAMA Network article by Gershenwald and colleagues emphasizes the importance of limiting overexposure to the sun and limiting the use of indoor tanning devices—including restricting access to minors—to reduce the incidence of melanoma.

A 34-year-old woman presented for evaluation of a 20-year history of thick toenails not associated with pain or ambulation difficulties. The patient denied prior toenail trauma or hyperhidrosis of the feet and she had no history of dandruff, skin problems, or joint pains. She had used an over-the-counter antifungal cream to treat occasional pruritus of her feet. Physical examination revealed thickening, yellow discoloration, and subungual hyperkeratosis of all 10 toenails, with scale noted on the plantar skin and in the web spaces. What would you do next?