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In This Issue of JAMA
September 12, 2017


JAMA. 2017;318(10):883-885. doi:10.1001/jama.2016.13300


Sentinel lymph node dissection (SLND) is noninferior to axillary lymph node dissection (ALND) in patients with invasive breast cancer followed up for a median of 6.3 years, but there is concern about late recurrence. In a randomized clinical trial, Giuliano and colleagues studied 891 women who had surgery for breast cancer and found that the noninferiority of SLND for the outcome of overall survival persisted for up to 10 years. In an Editorial, Livingston and Li suggest that less than perfect clinical trials may yield evidence to improve patients’ quality of life without increasing their risk of mortality.


Author Audio Interview

Randomized trials of hormone therapy have demonstrated adverse health outcomes in women treated for 5 to 7 years. In a long-term study of 27 347 postmenopausal women, Manson and colleagues found that hormone therapy was not associated with increased risks of all-cause, cardiovascular, or cancer mortality after a cumulative follow-up of 18 years. In an Editorial, McNeil supports the use of hormone therapy for women with troubling vasomotor symptoms, premature menopause, or early-onset osteoporosis.


Author Video Interview and CME

Laparoscopic fundoplication creates a mechanical barrier to prevent the reflux of gastric contents into the esophagus. Maret-Ouda and colleagues conducted a population-based study of 2655 patients with laparoscopic antireflux surgery and identified risk factors for reflux recurrence. In an Editorial, Spechler suggests that laparoscopic antireflux surgery may be an appealing option for young and otherwise healthy men.



Cholesteryl ester transfer protein (CETP) inhibitors, which reduce levels of low-density lipoprotein cholesterol (LDL-C), have not been shown to reduce the risk of cardiovascular events. To better understand this counterintuitive finding, Ference and colleagues conducted a genetic variability analysis of 102 837 participants and found that the clinical benefit of lowering LDL-C levels can be attributed to a reduction in the number of lipoprotein particles containing apolipoprotein B (apoB). In an Editorial, Sniderman and Peterson suggest that the lipid hypothesis should be reframed as the lipoprotein particle hypothesis, given that apoB, a measure of the total number of circulating atherogenic particles, appears to be a better marker of cardiovascular disease risk than LDL-C.



Clinical Review & Education

Oral rehydration is recommended for all patients with acute diarrhea, but indications for antibiotic use are less clear. In this JAMA Clinical Guidelines Synopsis, Acree and Davis discuss a 2016 guideline of the American College of Gastroenterology that is based on the presence of dysentery or fever, severity of illness, and a history of foreign travel.

This JAMA Diagnostic Test Interpretation article by Gupta and colleagues presents the case of a 39-year-old man with a swollen leg, shortness of breath, and a history of ischemic stroke. He had elevated titers of anticardiolipin and anti–β2 glycoprotein I antibodies with negative screening assays for lupus anticoagulant. How would you interpret these test results?