tbuckley/cabot-search huggingface dataset:
Abstract P014: Cardiovascular Risk Factors Associated with Low Dehydroepiandrosterone Sulfate
Authors: Monik C Jimenez, JoAnn E Manson, Kathryn M Rexrode
Journal: Circulation (2012)

Introduction: Low dehydroepiandrosterone sulfate (DHEAS) levels recently have been related to elevated risk of ischemic stroke. However, the association between DHEAS and traditional cardiovascular risk factors remains unclear. Methods: Blood samples were collected in 1989-1990 among 32,826 participants of the Nurses’ Health Study. Samples were assayed for DHEAS, lipids, and other biomarkers as part of a nested case control study evaluating risk of ischemic stroke and 340 stroke-free controls with complete data were available. Lifestyle covariates were ascertained in 1988. Stepwise logistic regression models were used to evaluate the association of between CVD risk factors and low DHEAS (&lt;42 μ g/dL), while stepwise linear regression was used to evaluate the association with continuous DHEAS. Stepwise models utilized an entry threshold of α=0.20 and exit criterion of α=0.10. Results: The mean level of DHEAS was 78.38 μ g/dL (s.d. 50.02; median=67.03) in this population of women aged 43-69 years (median=62). Age was strongly associated with lower DHEAS. Women with history of heart disease and higher total/HDL cholesterol were more likely to have low DHEAS. In stepwise logistic regression analyses, age (OR=2.94; 95%CI: 1.73-5.00 for 10 yrs) and history of heart disease (OR=1.84; 95% CI: 0.91-3.70) were identified as risk factors for low DHEAS. In stepwise linear regression modeling, age, postmenopausal hormone use, history of heart disease and C-reactive protein (CRP) were associated with lower DHEAS levels while alcohol use was associated with higher DHEAS levels (Table 1). Body mass index, smoking, diabetes, glycosylated hemoglobin and lipids were not associated with low DHEAS. Conclusions: In this population of healthy women, lower levels of DHEAS were associated with older age, history of heart disease, postmenopausal hormone use, higher CRP and lower levels of alcohol consumption. Further research is needed to explore these associations. Table 1 Multivariable * adjusted estimates for DHEAS by cardiovascular disease risk factors DHEAS (continuous μ g/dL) β † 95%CI Age ‡ −28.40 −36.75, -20.05 History of Heart disease −18.76 −39.23, 1.71 Postmenopausal Hormone Therapy Use &amp; −12.01 −21.99, -2.04 CRP £ (mg/L) −0.66 −1.37, 0.04 Alcohol # (g/day) 2.95 0.46, 5.45 * All variables mutually adjusted for one another † Estimated from stepwise logistic regression model ‡ per 10 year increase in age &amp; Ref = No use of postmenopausal hormone therapy £ per 1 unit increase in C-reactive protein (CRP- mg/L) # per 5 unit increase in alcohol consumption (g/day)
Adjuvant chemoradiotherapy for T3, T4, or node positive gastric cancer: A phase II trial
Authors: V. B. Sharma, A. C. Koong, C. Cho, V. K. Mehta, M. C. Chen, J. A. Bastidas, W. Trueblood, G. A. Fisher, J. M. Ford
Journal: Journal of Clinical Oncology (2004)

4139 Background: Postoperative chemoradiotherapy using bolus 5FU has recently been established as the standard treatment of Stage II/III gastric cancer (Macdonald et. al., NEJM, 2001). Here we report the preliminary results of a modified “Macdonald” regimen, incorporating carboplatin and utilizing the less toxic infusional 5FU regimen, in the adjuvant treatment for resected T3/T4 or node positive gastric cancer. Methods: 19 patients underwent complete en bloc surgical resection and were treated with postoperative chemoradiotherapy for a total of 19 weeks. They received 5FU (200 mg/m2/day) via continuous IV infusion for weeks 1–6; leucovorin (20 mg/m2) on days 1, 8, 15, 22, 29, 36; and carboplatin (AUC 6) on days 1 and 22. This was followed by a one-week rest period. On week 8, patients were re-started on infusional 5FU (200mg/m2/day) with daily radiotherapy administered with standard AP/PA fields to a total dose of 4500 cGy. One to two weeks after completion of their radiation, patients then received an additional six weeks of chemotherapy identical to the first six weeks as tolerated. Results: The overall and disease free survival for combined postoperative chemoradiotherapy was 58% (95% CI 37%–79%). Survival by stage was 80% (95% CI 63%–97%) for stage II (4 out of 5 patients alive); 70% (95% CI 50%–90%) for stage IIIA/IIIB (7 out of 10 patients alive); and 0% for stage IV disease (T3N3M0; 0 out of 4 patients alive). 5 patients died from recurrent disease (26%), 2 died from other (non-malignant) causes (10%), and one was lost to follow-up. Median follow-up was 19 months (range 6 to 72 months) and median survival has not yet been reached. The most common toxicity was neutropenia (29% grade 3, 6% Grade 2); thrombocytopenia (12% grade 3, 18% grade 2); anemia (29% grade 2); and stomatitis (12% grade 2, 18% grade 1). Conclusion: In patients with advanced gastric cancer (T3/T4 or node positive disease) the addition of adjuvant chemoradiotherapy improves overall survival when compared to surgery alone. This regimen of continuous infusion 5FU/leucovorin/carboplatin and radiotherapy was relatively well tolerated with an overall survival of 58% and a median survival that has not been reached. No significant financial relationships to disclose.
Pharmacy Expenditures for Children With Serious Chronic Illness—Reply
Authors: Lisa J. Chamberlain, Sonja M. Swenson, Paul H. Wise
Journal: JAMA (2016)

In Reply We agree with Drs Ruble and Brixner that not all patients with hemophilia are the same. These patients represent a wide range of severity, and the cost skewing within the group reflects that. Hemophilia is not unique in this—most serious pediatric conditions demonstrate a range in severity.
&lt;TITLE&gt;Vehicle Safety and Children&lt;/TITLE&gt;
Authors: Lise M Stevens
Journal: JAMA (2002)

All children aged 12 and younger should be properly restrained in the backseat.Buy the appropriate seat for your child's age group and read all information on the seat before purchasing.Read your vehicle's manual and follow instructions for child seat installation.Using only seat belts instead of approved safety or booster seats for children can cause serious or fatal injuries
Attribution of Concussion-Like Symptoms and History of Collision Sports Exposure—Reply
Authors: Noah D. Silverberg, Rebekah Mannix, Grant L. Iverson
Journal: JAMA Pediatrics (2016)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Pediatrics journal
Symptom burden in cancer survivors: A report from the American Cancer Society's studies of cancer survivors
Authors: Q. Shi, T. Smith, T. Mendoza, C. Kaw, C. S. Cleeland
Journal: Journal of Clinical Oncology (2009)

9598 Background: Cancer survivors may have persistent symptoms as a result of the cancer or the late effects of cancer treatment, although few studies have assessed symptom burden after completion of cancer therapy. We described symptom burden and risk factors for high symptom burden in a population-based sample of cancer survivors. Methods: Cancer survivors were drawn from 11 state cancer registries and surveyed by telephone or mail approximately 1 year after diagnosis; 3697 respondents completed the Modified Rotterdam Symptom Checklist (RSCL-M) and Profile of Mood States-37 (POMS-37). Factor analyses were used to generate composite scores from RSCL-M and POMS-37.Two-step cluster analyses using these composite scores were performed to identify cancer survivors with high symptoms. Results: Six composite scores (pain, nausea/vomiting, fatigue, poor bowel and bladder control, weight loss, and unspecified symptoms) were generated for physical symptoms (RSCL-M). Five composite scores (anxious/depressed, miserable, energetic, exhausted, and annoyed) were generated for mental symptoms (POMS-37). Cluster analyses revealed that 20% of survivors reported both high physical and high mental symptoms. Multivariate logistic regression revealed risk factors associated with high physical and high mental symptoms: younger than 55, household income lower than $40,000, high school or lower education level, unemployed when diagnosed with cancer, lack of health insurance, distant cancer, one or more comorbid conditions, diagnosis of lung cancer, and previous chemotherapy. Conclusions: One of five cancer survivors in this survey belonged to a group with high physical and mental symptoms, which were associated with certain risk factors. These findings will help clinicians and researchers identify subgroups of survivors most likely to report high symptoms and therefore most in need of symptom management. The high symptoms reported by survivors without insurance may have policy implications. No significant financial relationships to disclose.
Quantitative gene expression by RT-PCR in the tubular, cribriform, mucinous, and papillary histologic subtypes of invasive breast cancer.
Authors: Vivian Tan, Carl N. Yoshizawa, Joseph Michael Anderson, Steven Shak, Frederick L. Baehner
Journal: Journal of Clinical Oncology (2013)

10 Background: ER+ special histologic breast cancer subtypes are prognostically significant. Here we report the special histologic subtypes of ER+ breast carcinoma and associated patterns of observed gene expression as measured by the 21 gene OncotypeDX assay. Methods: All tumors from 6/1/04-5/31/12 were included in analyses. Central path used WHO criteria. Ductal NOS (DC), tubular (TC), cribriform (CC), mucinous (MC) and papillary (PC) carcinomas were included. Quantitative expression of 16 cancer related genes was measured on a scale from 2 to 15 (relative to reference genes) where a 1 unit increment is associated with ~2-fold change in expression. Recurrence Score (RS) was calculated as published. Descriptive stats for the RS and individual genes [ER, PR, invasion gene group (IGG) and proliferation gene group (PGG)] were obtained. Comparisons of means were adjusted to control the overall error rate under any complete or partial null hypothesis. Results: DC accounted for 95.1%, TC 0.7% , CC 0.3%, MC 3.1% and PC 0.7% of 246,555 cases. For all types a wide continuous range of RS was noted. DC had the highest mean RS, followed in decreasing order by MC, TC, CC and PC. PC had the highest ER and PC and CC the highest PR. TC had the lowest ER. ER was not different between CC and MC but PR was. The proportion with ER+/PR- phenotype was different among the subtypes: TC (8.1%) and CC (7.1%) had the lowest incidence whereas MC (12.9%) and PC (10.3%) were more similar to DC (14.1%). TC had lowest PGG expression. MC and PC had lower IGG expression compared to other subtypes. Conclusions: The special subtypes had a wide continuous range of RS: DC had the highest mean RS, followed in decreasing order by MC, TC, CC and PC. PC had the highest ER and PC and CC the highest PR. TC had the lowest ER (may reflect submission bias). ER was not different between CC and MC but PR was. The proportion with ER+/PR- phenotype was different among the subtypes: TC and CC had the lowest incidence, MC and PC were more similar to DC. TC had the lowest PGG expression. MC and PC had lower IGG expression. [Table: see text]
Multi-institutional prognostic factor analysis of patients (pts) enrolled in phase I (Ph I) oncology trials: Can pts selection be improved?
Authors: D. Olmos
Journal: Journal of Clinical Oncology (2010)

2518 Background: The selection of suitable pts for Ph I oncology trials represents an important challenge as opportunities for new drug development increase. In our previous single-center studies (including 290 pts) we described a prognostic score comprising 3 variables (RMH score): number of metastatic (MTS) organs, albumin, and LDH; this identified pts with the shortest overall survival (OS) and highest 90 days (90d) mortality (JCO 2009; 27: 2692-6). Our aim here was to re-examine this issue in a larger multi-institutional population. Methods: Pts treated in Ph I trials from 14 leading European units between 2005 and 2007 were included. We collated baseline characteristics and outcomes. In addition we derived the clinical tumor growth rate (CTGR) (a log ratio of time from advanced disease to Ph I entry and number of treatment lines). Pts with PS ≤ 1, albumin, LDH and number of MTS organs were included with other factors to derive a predictive model using logistic regression in multiple training/test sets. Results: We identified a total of 2,232 pts. Median age was 58 years (range 13-86) and male/female ratio was 1.3. Median time on treatment was 51 days (range 1-1,342). The most common causes of Ph I discontinuation were progression in 75% and toxicity in 12%. The toxicity death rate was 0.4% (CI-95% 0.1-0.6). The estimated median OS was 8.8 months (CI-95% 8.3-9.4) with a 90d mortality of 16% (CI-95% 15-18). 10% discontinued Ph I during the first 30 days mainly due to progression. Initial analysis with 1,780 pts using predictive modeling identified 7 variables associated with early death: low albumin, lymphocytes, and CTGR; elevated WCC, LDH, and ALP; and higher number of MTS organs. Estimated sensitivity and specificity for this model were 48% and 78% respectively. Conclusions: Selection of pts using a 7 variables score was not superior to a 3 variables score (sensitivity 50%, specificity 80%); both would reduce the 90d mortality from 16% (unselected pts) to 10%. However either of these scores would reduce the number of eligible pts by 20% and may therefore impact on accrual; thus routine use needs careful consideration. Finally, this European collaboration provides a valuable tool for future analysis. No significant financial relationships to disclose.
The role of mitomycin C in the treatment of patients with advanced colorectal cancer resistant to 5-fluorouracil-folinic acid chemotherapy
Authors: S.A. Grumett, V.R. Archer, R. Midgley, P. Mulholland, S. Nicum, L. Blewitt, D.J. Kerr
Journal: Annals of Oncology (2001)
Abstract 12426: The Incremental Impact of Residual SYNTAX Score on Long-Term Clinical Outcomes in Patients With Multivessel Coronary Artery Disease Treated by Percutaneous Coronary Interventions
Authors: Guy Witberg, Ifat Lavi, Abid Assali, Hana Vaknin-Assa, Eli Lev, Ran Kornowski
Journal: Circulation (2014)

Background:  incomplete coronary revascularization (ICR) is associated with worse prognosis in patients with severe coronary artery disease (CAD), but there is no consensus as to it’s definition. There is a need to define ‘acceptable’ ICR in order to optimize the allocation of patients with severe CAD to CABG/PCI and improve long-term clinical outcomes.   Methods:  We studied 150 consecutive patients with triple vessel/left main (3VD/LM) CAD treated by percutaneous coronary interventions (PCI). Clinical outcomes at 3 years were collected, the SYNTAX score (SS) and residual SYNTAX score (rSS) were calculated. We used various definitions of ‘acceptable’ ICR :no post PCI total occlusion, single vs. mutivessel residual post PCI disease and the rSS at a cutoff determined according to an ROC curve fitted for 3 years major adverse cardiovascular and cerebrovascular adverse events(MACCE), in order to determine which definition is most strongly correlated with long term outcomes.   Results:  rSS   Conclusions:  ’acceptable’ ICR as determined by rSS, carries better long-term prognosis in terms of clinical outcomes vs. more extensive residual coronary disease in patients with 3VD/LMCAD treated by PCI. The rSS may improve the allocation of coronary patients to the optimal mode of revascularization.
Factors influencing risk reduction surgery among <i>BRCA</i> mutation carriers: A qualitative analysis.
Authors: Rachael Brandt, Cristina Polinsky, Jessica Katz, Minal Dhamankar, Rosemarie Tucci, Jennifer L. Sabol, Terri McHugh
Journal: Journal of Clinical Oncology (2012)

53 Background: Women known to carry deleterious mutations in BRCA1 and BRCA2 have a substantially increased lifetime risk to develop breast and ovarian cancer. Current risk management options include increased surveillance, chemoprevention and risk reducing surgery. Several studies have quantitatively evaluated the reasoning of high risk women for electing surgical intervention, noting mutation carrier status as a significant, but not sole rationale for this decision. The decision for surgery has also been associated with family cancer history, anxiety, demographics, healthcare setting and prior counseling. More insights regarding factors influencing women’s choice for risk reduction are needed. Methods: To further assess factors influencing the decision to have risk reduction surgery among women in a community hospital system, 129 BRCA mutation carriers in a community-based genetic counseling program were invited to participate in a qualitative study using questionnaires. A thematic analysis was performed by two independent reviewers on open dialogue responses. Results: Of the 59 respondents, 54 completed the question specifically addressing factors regarding the decision on surgery. Of them, 32 opted for mastectomy, salpingo-oophorectomy or both and 22 opted against surgical risk reduction. Themes emerging in support of surgery included: vicarious experience attributable to a strong family history of cancer; desire for control over risk through surgical intervention; high risk perception; co-morbidities; desire for living, regarding longevity and for loved ones; fear of cancer; and skepticism related to cancer detection methods. For women opting against surgery, themes included: co-morbidities; age (too old/young); incomplete childbearing; logistics (scheduling, finances); lack of disease; and skepticism in effectiveness of surgery. Conclusions: While various factors have been studied regarding the association with or probability of women’s decisions for risk reduction surgery, a deeper comprehension of women’s reasoning can be attained through qualitative analysis. This understanding may enhance health care providers’ ability to counsel women regarding this choice.
Abstract P370: Obesity and Incident Coronary Heart Disease in the Million Women Study: A Prospective, Population-based Cohort Study
Authors: Dexter Canoy, Benjamin J Cairns, Angela Balkwill, Jayne Green, Lucy Wright, Gillian K Reeves, Valerie Beral
Journal: Circulation (2012)

Background: Higher body-mass index (BMI) has been associated with increased risk for coronary heart disease (CHD) mortality but its association with incident CHD is less investigated, and data for women are limited. Methods: We examined the prospective relation between BMI and incident CHD (first CHD hospitalization or death) in 1.2 million women aged ≥50 years without prior CHD, who were recruited through a national breast screening programme in 1996 to 2001 and followed for an average of 9 years (48,842 events with 10.7 million person-years of follow-up). Absolute and relative risks (using Cox regression) associated with higher BMI were estimated. Results: After excluding the first 4 years of follow-up, there were 32,465 events (5.9 million person-years) including 3,345 CHD deaths. The adjusted relative risk per 5 kg/m 2 BMI difference was 1.24 [95% confidence interval (CI) 1.22 to 1.25]. CHD risk increased linearly across a wide range of BMI, with no apparent excess risk in the lower end of BMI distribution. The relation persisted after excluding current smokers or limiting cases to myocardial infarction only. For women in this cohort, the 20-year cumulative risk of CHD from age 55 to 74 years (95% CI) ranged from 9% (8 to10) to 18% (16 to 20) for women with BMI of 20 to 22.5 kg/m 2 and ≥35 kg/m 2 , respectively. Never smokers with BMI ≥35 kg/m 2 had comparable cumulative risk to current smokers with BMI of 20 to 22.5 kg/m 2 . Conclusion: In this large cohort of women, the impact of excess weight on CHD morbidity and mortality is substantial. Measures to prevent and control excess weight and other CHD risk factors are needed to help reduce CHD burden in women.
Letter by Garg et al Regarding Article, “Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup: An Updated Meta-Analysis of 23 Studies”
Authors: Scot Garg, Simon G. Anderson, Mark Woodward
Journal: Circulation (2016)

We read with interest the recent meta-analysis by Lee et al 1 of percutaneous coronary intervention (PCI) performed in centers with and without on-site surgical backup.We congratulate the authors on the quality and thoroughness of their analysis.Their results are of great importance, providing reassurance for interventional cardiologists practicing in PCI centers without on-site surgical backup, healthcare regulatory authorities who have commissioned this practice, and patients who continue to receive PCI procedures in these institutions without reservations.Lee et al report a population of >1 million patients; however, the actual number of patients treated in off-site surgical centers was only a fraction of this (n=79 463, 7.2%), a fact unlikely to be overlooked by sceptics of this practice or possibly future guideline committees.We recently published the outcomes of 384 013 patients treated by PCI delivered in centers with (n=264 917) and without (n=119 096, 31%) surgical backup over a 6-year period in the United Kingdom, a country that has embraced this mode of delivering PCI such that in 2013 more PCIs were performed in off-site (63%) compared with on-site (37%) surgical centers. 2 Moreover, unlike in the United States, in the United Kingdom, there are no regulations on what cases can or cannot be performed in PCI centers without surgical backup; hence, our reported population is truly unrestricted.It is mandatory to have appropriate protocols in place to allow emergency transfer to a cardiothoracic unit in the event of need; however, similar to the findings of Lee et al, rates of emergency surgery are reassuringly very low (0.04% in off-site centers versus 0.1% in on-site centers).Overall, our analysis found no differences in allcause 30-day, 1-year, or 5-year mortality among risk-adjusted, naïve, imputed, or propensity-matched populations treated in off-site versus on-site surgical PCI centers.Our consistent results add to the strength of the meta-analysis by Lee et al, which, with the inclusion of our data, increases the cohort treated in PCI centers without surgical backup to close to 200 000, with 158 460 patients treated for nonprimary PCI and 39 595 patients treated for primary PCI.Meta-analysis of this larger cohort results in odds ratios for mortality at long-term follow-up of 1.10 (95% confidence interval, 0.87-1.39;P=0.44;I 2 =90.4%) and 1.02 (95% confidence interval, 0.95-1.10;P=0.57;I 2 =17.8%) for nonprimary PCI and primary PCI, respectively.We would hope that these original and updated meta-analysis data provide an important stimulus for the reevaluation of the guideline recommendations for PCI in off-site surgical centers in the United States.