bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insulin Resistance and Hyperinsulinemia Are Related to Plasma Aldosterone Levels in Hypertensive Patients
Authors: Colussi GianLuca , Catena Cristiana , Lapenna Roberta , Nadalini Elisa , Chiuch Alessandra , Sechi Leonardo A. 
Published: August 2007

OBJECTIVE—An association between aldosterone and insulin resistance has been demonstrated in obesity and primary aldosteronism and in blacks with the metabolic syndrome. The aim of this study was to evaluate the relationship of plasma aldosterone with insulin sensitivity in white subjects.
RESEARCH DESIGN AND METHODS—In 356 patients with essential hypertension and 102 normotensive control subjects of comparable age and BMI, we measured, after discontinuation of treatment, plasma active renin, aldosterone, cortisol, glucose, insulin, and C-peptide levels and calculated markers of insulin sensitivity. Direct assessment of insulin sensitivity was obtained in a subset of 64 hypertensive patients by a hyperinsulinemic clamp.
RESULTS—Hypertensive patients had significantly greater fasting plasma insulin and C-peptide concentrations and homeostasis model assessment (HOMA) indexes than normotensive control subjects. A positive association with increasing plasma aldosterone concentrations was demonstrated for plasma glucose, insulin, C-peptides, and HOMA. Assessment of insulin sensitivity by clamp showed a significant decrease of the metabolic clearance rate of glucose with increasing aldosterone levels. Significant correlations were found between plasma aldosterone, plasma insulin, and C-peptide levels, HOMA, and glucose metabolic clearance rate. Blood pressure and plasma potassium, plasma cortisol, and renin levels, but not BMI, were also directly correlated with plasma aldosterone. Multiple regression analysis showed that HOMA, together with plasma potassium, cortisol, and renin levels, was independently correlated with plasma aldosterone.
CONCLUSIONS—This study demonstrates a direct relationship between aldosterone, insulin resistance, and hyperinsulinemia in white subjects. In patients with hypertension, this relationship might contribute to maintenance of high blood pressure and increased cardiovascular risk.
Increased Incidence of Gestational Diabetes in Women Receiving Prophylactic 17α-Hydroxyprogesterone Caproate for Prevention of Recurrent Preterm Delivery
Authors: Rebarber Andrei , Istwan Niki B. , Russo-Stieglitz Karen , Cleary-Goldman Jane , Rhea Debbie J. , Stanziano Gary J. , Saltzman Daniel H. 
Published: August 2007

OBJECTIVE—Progesterone has a known diabetogenic effect. We sought to determine whether the incidence of gestational diabetes mellitus (GDM) is altered in women receiving weekly 17α-hydroxyprogesterone caproate (17P) prophylaxis for the prevention of recurrent preterm birth.
RESEARCH DESIGN AND METHODS—Singleton gestations in women having a history of preterm delivery were identified from a database containing prospectively collected information from women receiving outpatient nursing services related to a high-risk pregnancy. Included were patients enrolled for outpatient management at &lt;27 weeks' gestation with documented pregnancy outcome and delivery at &gt;28 weeks. Patients with preexisting diabetes were excluded. The incidence of GDM was compared between patients who received prophylactic intramuscular 17P (250-mg weekly injection initiated between 16.0 and 20.9 weeks' gestation) and those who did not.
RESULTS—Maternal BMI and age were similar. The incidence of GDM was 12.9% in the 17P group (n = 557) compared with 4.9% in control subjects (n = 1,524, P &lt; 0.001; odds ratio 2.9 [95% CI 2.1–4.1]).
CONCLUSIONS—The use of 17P for the prevention of recurrent preterm delivery is associated with an increased risk of developing GDM. Early GDM screening is appropriate for women receiving 17P prophylaxis.
Survey on Acute and Chronic Complications in Children and Adolescents With Type 1 Diabetes at Muhimbili National Hospital in Dar es Salaam, Tanzania
Authors: Majaliwa Edna S. , Munubhi Emanuel , Ramaiya Kaushik , Mpembeni Rose , Sanyiwa Anna , Mohn Angelika , Chiarelli Francesco 
Published: August 2007

OBJECTIVE—The purpose of this study was to assess glycemic control and complications of type 1 diabetes in children and adolescents in Tanzania.
RESEARCH DESIGN AND METHODS—This demographic and clinical survey included 99 children aged between 5 and 18 years attending Muhimbili National Hospital Clinic for Diabetes. A structured questionnaire was used for evaluating socioeconomic data and for estimation of the prevalence of acute complications occurring over the last 6 months. The prevalences of retinopathy and diabetic nephropathy were determined by fundus ophthalmoscopy and by microalbuminuria, respectively.
RESULTS—All of these children were treated with a conventional insulin regimen. The mean ± SD duration of diabetes was 4.76 ± 3.58 years. Only 1 child (1%) had good glycemic control (A1C &lt;7.5%), 60 children (60.6%) had moderate glycemic control (A1C 7.5–10%), 14 children (14.1%) had poor glycemic control (A1C &gt;10–12.5%), and 24 children (24.2%) had very poor glycemic control (A1C &gt;12.5%). At onset of diabetes, 75% of children presented with diabetic ketoacidosis (DKA); 89 children (89.80%) had at least one episode of DKA, and 55 children (55.67%) had symptomatic hypoglycemic episodes. Microalbuminuria was present in 29 (29.3%) and retinopathy in 22 (22.68%) children.
CONCLUSIONS—Although there are some methodological limitations, this survey highlights the difficulties of achieving good metabolic control and the high prevalence of acute and chronic complications in Tanzanian children with type 1 diabetes. These results clearly show that major efforts are needed to improve quality of care in children with type 1 diabetes in Tanzania.
IGF Binding Protein 1 Predicts Cardiovascular Morbidity and Mortality in Patients With Acute Myocardial Infarction and Type 2 Diabetes
Authors: Wallander Märit , Norhammar Anna , Malmberg Klas , Öhrvik John , Rydén Lars , Brismar Kerstin 
Published: August 2007

OBJECTIVE—There are indications that the IGF system is related to both type 2 diabetes and cardiovascular disease (CVD). We tested the hypothesis that low IGF-I and high IGF-binding protein (IGFBP)-1 predict future cardiovascular mortality and morbidity in patients with acute myocardial infarction (AMI) and type 2 diabetes.
RESEARCH DESIGN AND METHODS—The Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) 2 Trial recruited 1,253 patients with type 2 diabetes and AMI, of whom 575 were enrolled in a biochemical program with repeated blood sampling. Primary and secondary end points included adjudicated cardiovascular mortality and a composite of cardiovascular events (cardiovascular death, reinfarction, or stroke). Multiple Cox proportional hazard regression was used to study the relationship between the end points and the variables. Admission variables were used for the survival analysis and for blood glucose, and A1C updated mean values during follow-up were also available.
RESULTS—During a median follow-up period of 2.2 years, 131 (23%) patients died from all-cause mortality and 102 (18%) from CVD, whereas 175 patients (30%) suffered from at least one cardiovascular event. The independent predictors for cardiovascular death in the Cox regression model were (as hazard ratio [HR] [95% CI]): ln updated mean blood glucose (12.2 [5.8–25.7]), age (+5 years) (1.5 [1.4–1.7]), ln IGFBP-1 (1.4 [1.1–1.8]), and ln serum creatinine at admission (2.4 [1.3–4.2]). The model predicting cardiovascular events contained the same variables (ln IGFBP-1 at admission, 1.2 [1.0–1.4]).
CONCLUSIONS—High levels of IGFBP-1 at admission are associated with increased risk for cardiovascular mortality and morbidity in type 2 diabetes patients with AMI.
Childhood Obesity: Practical Considerations for Prevention and Management
Authors: Ponder Stephen W. , Anderson Meaghan A. 
Published: August 2007

In Brief
Treating obesity in the adult, and even more so in the pediatric,population can be a daunting and difficult task. Health care providers need to take a proactive role when treating children and focus on prevention of obesity rather than waiting until the condition exists. Obesity can lead to several complications and comorbidities; this article will address how to make an appropriate and thorough assessment of a child's lifestyle and behaviors and how to implement interventions that will result in improved health.
The Physiology of Body Weight Regulation: Are We Too Efficient for Our Own Good?
Authors: Dokken Betsy B. , Tsao Tsu-Shuen 
Published: August 2007

In BriefUnderstanding the physiology behind the regulation of body weight can help clinicians treat and educate obese patients. This article reviews the current knowledge of body weight regulation and the metabolic changes that occur in the body in response to weight loss. The physiological basis for the difficult nature of weight loss, and especially maintenance of lost weight, is discussed.
Machine Learning–Based Prediction of Hospitalization During Chemoradiotherapy With Daily Step Counts
Authors: Friesner Isabel D. , Feng Jean , Kalnicki Shalom , Garg Madhur , Ohri Nitin , Hong Julian C. 
Published: March 2024

ImportanceToxic effects of concurrent chemoradiotherapy (CRT) can cause treatment interruptions and hospitalizations, reducing treatment efficacy and increasing health care costs. Physical activity monitoring may enable early identification of patients at high risk for hospitalization who may benefit from proactive intervention.ObjectiveTo develop and validate machine learning (ML) approaches based on daily step counts collected by wearable devices on prospective trials to predict hospitalizations during CRT.Design, Setting, and ParticipantsThis study included patients with a variety of cancers enrolled from June 2015 to August 2018 on 3 prospective, single-institution trials of activity monitoring using wearable devices during CRT. Patients were followed up during and 1 month following CRT. Training and validation cohorts were generated temporally, stratifying for cancer diagnosis (70:30). Random forest, neural network, and elastic net–regularized logistic regression (EN) were trained to predict short-term hospitalization risk based on a combination of clinical characteristics and the preceding 2 weeks of activity data. To predict outcomes of activity data, models based only on activity-monitoring features and only on clinical features were trained and evaluated. Data analysis was completed from January 2022 to March 2023.Main Outcomes and MeasuresModel performance was evaluated in terms of the receiver operating characteristic area under curve (ROC AUC) in the stratified temporal validation cohort.ResultsStep counts from 214 patients (median [range] age, 61 [53-68] years; 113 [52.8%] male) were included. EN based on step counts and clinical features had high predictive ability (ROC AUC, 0.83; 95% CI, 0.66-0.92), outperforming random forest (ROC AUC, 0.76; 95% CI, 0.56-0.87; P = .02) and neural network (ROC AUC, 0.80; 95% CI, 0.71-0.88; P = .36). In an ablation study, the EN model based on only step counts demonstrated greater predictive ability than the EN model with step counts and clinical features (ROC AUC, 0.85; 95% CI, 0.70-0.93; P = .09). Both models outperformed the EN model trained on only clinical features (ROC AUC, 0.53; 95% CI, 0.31-0.66; P &amp;lt; .001).Conclusions and RelevanceThis study developed and validated a ML model based on activity-monitoring data collected during prospective clinical trials. Patient-generated health data have the potential to advance predictive ability of ML approaches. The resulting model from this study will be evaluated in an upcoming multi-institutional, cooperative group randomized trial.
Physical Activity Using a Wearable Device as an Alternative to Performance Status in Patients With Advanced Lung Cancer
Authors: Ito Kentaro , Suzuki Yuta , Sakaguchi Tadashi , Fujiwara Kentaro , Nishii Yoichi , Yasui Hiroki , Taguchi Osamu , Hataji Osamu 
Published: March 2024

ImportanceThe Eastern Cooperative Oncology Group Performance Status (ECOG PS) is extensively used to guide treatment decisions in patients with advanced lung cancer. However, its assessment is subjective, potentially leading to discordance among observers.ObjectiveTo investigate the association between measured physical activity and ECOG PS, as well as the potential prognostic value of physical activity measurements in patients with advanced lung cancer.Design, Setting, and ParticipantsThis single-institution, prospective observational study enrolled 119 patients with advanced lung cancer scheduled to receive systemic therapy as outpatients at Matsusaka Municipal Hospital in Mie, Japan. Participants wore the wearable device amuelink (Sony) for up to 14 days to measure physical activity, including metabolic equivalent tasks, distance walked, and number of steps taken. ECOG PS was assessed at enrollment, which took place from December 2021 to August 2022.Main Outcomes And MeasuresThe primary end point was estimating the area under the curve (AUC) for classification into ECOG PS of 2 or higher using physical activity measurements. An analysis of the association with survival was also conducted.ResultsAmong the 119 patients (median [range] age, 72 (32-88) years; 71 [59.7%] male), mean distance walked (MDW) had the highest diagnostic value for classifying an ECOG PS of 2 or greater, with an AUC of 0.818 (95% CI, 0.703-0.934). Moreover, MDW was also associated with 6-month survival, with an AUC of 0.806 (95% CI, 0.694-0.918). Survival curves significantly diverged based on the MDW threshold, indicating a potential association with survival outcome (hazard ratio, 0.17; 95% CI, 0.05-0.57).Conclusions and RelevanceThe cohort study suggests that MDW, as measured by a wearable device, was associated with ECOG PS and may serve as a predictor of health status alongside ECOG PS categories. It demonstrates the potential of objectively measured physical activity in complementing subjective ECOG PS assessments in patients with advanced lung cancer. Further research is needed to confirm the prognostic value of physical activity measurements.
Exogenous Estrogen in the Development of Head and Neck Cancer
Authors: Doll Christian , Hofmann Elena , Preissner Robert , Heiland Max , Seeland Ute , Konietschke Frank , Sehouli Jalid , Preissner Saskia 
Published: March 2024

ImportanceSex differences in head and neck cancer (HNC) incidence suggest a potential contribution of sex hormones.ObjectiveTo assess the role of exogenous estrogen exposure in the development of HNC in female patients.Design, Settings, and ParticipantsThis large multicenter cohort study using clinical records from the TriNetX real-world database included 20 years of data (through May 31, 2023) from 87 health care organizations. The TriNetX database was searched for medical records for female patients with and without exogenous estrogen exposure according to their chronological age. Cohort 1 included 731 366 female patients aged 18 to 45 years old with regular oral contraceptive (OC) intake and cohort 2 included 3 886 568 patients in the same age group who did not use OC. Cohort 3 comprised 135 875 female patients at least 50 years old receiving hormone replacement therapy (HRT), whereas cohort 4 included 5 875 270 patients at least 50 years old without HRT. Propensity score matching was performed for the confounders age, alcohol dependence, and nicotine dependence. Data analyses were performed in May 2023.Main Outcome and MeasuresDiagnosis of HNC (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision: C00-C14), and after propensity score matching (1:1 nearest-neighbor greedy matching), a risk analysis to investigate risk differences and risk ratios (RRs) with a 95% CI.ResultsAmong the 718 101 female patients in each of cohorts 1 and 2 (mean [SD] age at diagnosis, 25.9 [6.7] years), those with OC intake had a higher risk of an HNC diagnosis (RR, 1.47; 95% CI, 1.21-1.78) than those without OC use. Among the 131 835 female patients in each of cohorts 3 and 4 (mean [SD] age, 67.9 [12.0] years), those with postmenopausal HRT intake had a lower risk of an HNC diagnosis (RR, 0.77; 95% CI, 0.64-0.92) than those without HRT use.Conclusions and RelevanceThe findings of this cohort study illustrate a positive association between OC and a negative association between HRT and the development of HNC in female patients. Given the limitations of the TriNetX database, future research should include detailed information on the intake of OC and HRT and reproductive health information (eg, age at menarche/menopause, number of pregnancies) to more accurately define the strength and direction of the possible association between exogeneous estrogen exposure and the development of HNC in female patients.
Depressive Symptoms, Systemic Inflammation, and Survival Among Patients With Head and Neck Cancer
Authors: Cash Elizabeth , Albert Christy , Palmer Iona , Polzin Baylee , Kabithe Alyssa , Crawford Devaughn , Bumpous Jeffrey M. , Sephton Sandra E. 
Published: March 2024

ImportancePatients with head and neck cancer experience high rates of depression. Depression and systemic inflammation have been found to be associated in numerous cancer types, often independently from disease status. Depression-related inflammation may elevate the risks for poor tumor response to treatment and early mortality, and comprises a mechanism by which depression is associated with survival in head and neck cancer.ObjectiveTo assess mediation pathways incorporating pretreatment depressive symptoms, pretreatment inflammation, and tumor response posttreatment on overall survival among patients with head and neck cancer.Design, Setting, and ParticipantsThis was a prospective observational cohort study of patients with head and neck cancer treated in a single multidisciplinary head and neck cancer clinic from May 10, 2013, to December 30, 2019, and followed up for 2 years. Data analysis was performed from June 29, 2022, to June 23, 2023.ExposuresPatient-reported depressive symptoms using the Patient Health Questionnaire−9 item (PHQ−9) at treatment planning; pretreatment hematology workup for systemic inflammation index (SII) score; and clinical data review for tumor response (complete vs incomplete) and overall survival.Main OutcomesTwo-year overall survival.ResultsThe total study cohort included 394 patients (mean [SD] age, 62.5 [11.5] years; 277 [70.3%] males) with head and neck cancer. Among 285 patients (72.3%) who scored below the clinical cutoff for depression on the PHQ−9, depressive symptoms were significantly associated with inflammation (partial r, 0.168; 95% CI, 0.007-0.038). In addition, both depression and inflammation were associated with early mortality (PHQ−9: hazard ratio [HR], 1.04; 95% CI, 1.02-1.07; SII: HR, 1.36; 95% CI, 1.08-1.71). The depression-survival association was fully mediated by inflammation (HR, 1.28; 95% CI, 1.00-1.64). Depressive symptoms were also associated with poorer tumor response (odds ratio, 1.05; 95% CI, 1.01-1.08), and the depression-survival association was partially mediated by tumor response (HR, 9.44; 95% CI, 6.23-14.32). Systemic inflammation was not associated with tumor response.ConclusionsIn this cohort study, systemic inflammation emerged as a novel candidate mechanism of the association of depression with mortality. Tumor response partially mediated effects of depression on mortality, replicating prior work. Thus, depression stands out as a highly feasible target for renewed clinical attention. Even mild symptoms of depression during the treatment-planning phase may be associated with higher systemic inflammation in addition to poorer tumor response to treatment and survival outcomes; therefore, depression should be clinically addressed.
Neoadjuvant-Intent Immunotherapy in Advanced, Resectable Cutaneous Squamous Cell Carcinoma
Authors: Kim Emily Y. , Ruiz Emily S. , DeSimone Mia S. , Shalhout Sophia Z. , Hanna Glenn J. , Miller David M. , Schmults Chrysalyne , Rettig Eleni M. , Foreman Ruth K. , Sethi Rosh , Thakuria Manisha , Silk Ann W. 
Published: March 2024

ImportanceIn clinical trials, preoperative immune checkpoint inhibitors (ICIs) have shown clinical activity in advanced cutaneous squamous cell carcinoma (cSCC). However, these studies excluded patients with relevant comorbidities.ObjectiveTo evaluate radiologic and pathologic response rates to neoadjuvant-intent programed cell death protein 1 (PD-1) ICIs in a clinical population.Design, Setting, and ParticipantsThis cohort study of patients who were treated with neoadjuvant cemiplimab or pembrolizumab for advanced cSCC from January 2018 to January 2023 was conducted at 2 academic institutions in Boston, Massachusetts. Median follow-up was 9.5 months (range, 1.2-40.5).ExposuresCemiplimab or pembrolizumab.Main Outcomes and MeasuresPrimary outcomes were radiologic and pathologic response rates. Secondary outcomes were 1-year recurrence-free survival, progression-free survival, disease-specific survival, and overall survival.ResultsThis cohort study included 27 patients (including 9 patients [33.3%] with a history of lymphoma). Most patients were male (18 of 27 [66.7%]), with a median age of 72 years (range, 53-87 years). Most primary tumors were located on the head/neck (21 of 27 [77.8%]). There were no unexpected delays in surgery. The median number of doses before surgery was 3.5 (range, 1.0-10.0). Five patients (18.5%) ultimately declined to undergo planned surgery due to clinical responses or stability, and 1 (3.7%) did not undergo surgery due to progressive disease. The overall pathologic response rate (pathological complete response [pCR] or major pathological response) was 47.4% (9 of 19), and the overall radiologic response rate (radiologic complete response or partial response) was 50.0% (8 of 16). The pCR rate (7 of 19 [36.8%]) was higher than the radiologic complete response rate (2 of 16 [12.5%]). The pCR rate among patients with cSCC and concomitant lymphoma was 25.0%. The 1-year recurrence-free survival rate was 90.9% (95% CI, 50.8%-98.7%), progression-free survival was 83.3% (95% CI, 27.3%-97.5%), disease-specific survival was 91.7% (95% CI, 53.9%-98.8%), and overall survival was 84.6% (95% CI, 51.2%-95.9%).Conclusions and RelevanceThe results of this cohort study support the reproducibility of neoadjuvant-intent immunotherapy for cSCC in the clinical setting, including for patients with a history of lymphoma. Outside of clinical trials, it is not infrequent for patients to opt out of surgery for regressing tumors. The inclusion of higher-risk patients and preference for nonsurgical treatment are 2 factors that might explain the numerically lower pathologic response rate in this institutional experience.