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  • 1
    In: JNCI Cancer Spectrum, Oxford University Press (OUP), Vol. 3, No. 3 ( 2019-09-01)
    Abstract: Although obesity is an established modifiable risk factor for multiple myeloma (MM), several nuanced aspects of its relation to MM remain unelucidated, limiting public health and prevention messages. Methods We analyzed prospective data from the Nurses’ Health Study and Health Professionals Follow-Up Study to examine MM risk associated with 20-year weight patterns in adulthood, body shape trajectory from ages 5 to 60 years, and body fat distribution. For each aforementioned risk factor, we report hazard ratios (HRs) and 95% confidence intervals (CIs) for incident MM from multivariable Cox proportional-hazards models. Results We documented 582 incident MM cases during 4 280 712 person-years of follow-up. Persons who exhibited extreme weight cycling, for example, those with net weight gain and one or more episodes of intentional loss of at least 20 pounds or whose cumulative intentional weight loss exceeded net weight loss with at least one episode of intentional loss of 20 pounds or more had an increased MM risk compared with individuals who maintained their weight (HR = 1.71, 95% CI = 1.05 to 2.80); the association was statistically nonsignificant after adjustment for body mass index. We identified four body shape trajectories: lean-stable, lean-increase, medium-stable, and medium-increase. MM risk was higher in the medium-increase group than in the lean-stable group (HR = 1.62, 95% CI = 1.22 to 2.14). Additionally, MM risk increased with increasing hip circumference (HR per 1-inch increase: 1.03, 95% CI = 1.01 to 1.06) but was not associated with other body fat distribution measures. Conclusions Maintaining a lean and stable weight throughout life may provide the strongest benefit in terms of MM prevention.
    Type of Medium: Online Resource
    ISSN: 2515-5091
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2975772-1
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  • 2
    Online Resource
    Online Resource
    American Association for Cancer Research (AACR) ; 2011
    In:  Cancer Prevention Research Vol. 4, No. 10_Supplement ( 2011-10-01), p. A79-A79
    In: Cancer Prevention Research, American Association for Cancer Research (AACR), Vol. 4, No. 10_Supplement ( 2011-10-01), p. A79-A79
    Abstract: Background: Multiple myeloma (MM) is a lethal malignancy with a poorly understood etiology. Adult body mass index (BMI) is a recently identified risk factor for MM, but the etiologic roles of body fatness at different ages and adult weight cycling have not been assessed. We prospectively examined body shape during childhood, adolescence, and adulthood, as well as weight cycling over a 20-year period, in relation to MM risk in the Nurses' Health Study (NHS) cohort. Methods: The NHS was formed in 1976 among 121,700 female registered nurses ages 30–55 years from the United States who returned the enrollment questionnaire on lifestyle and medical history. Biennial follow-up questionnaires have subsequently updated lifestyle and medical information. A validated somatogram-depicted body shape (current and at ages 5, 10, 20, 30, and 40 years) was queried in 1988. The 1992 questionnaire characterized weight change over the prior 20 years (when most NHS participants were middle-aged adults). The present analyses included women who completed the 1988 (somatogram) or 1992 (weight cycling) questionnaires and had no cancer history at that time. Women were followed through the earliest among a cancer diagnosis, death, or June 2008. We classified body shapes as relatively lean, medium, and heavier at the specified ages and for the average shape at ages 5 and 10 (“childhood”) and ages 10 and 20 years (“adolescent”). We classified women's 20-year weight cycling patterns as weight loser/maintainer, gainer (i.e., only weight gain), light cycler (i.e., net loss or gain of ≥5 lbs. with ≥1 episode of voluntary 5–9 lb. change), or heavy cycler (i.e., net loss or gain of ≥5 lbs. with ≥1 episode of voluntary ≥20 lb. change). We computed hazard ratios (HR) and 95% confidence intervals (CI) in Cox proportional hazard models to assess the association of body shape and weight cycling with MM risk. Models included only one body shape or weight cycling variable and controlled for potential confounding by age and baseline BMI. Results: We confirmed 126 incident diagnoses of MM over 1,049,600 person-years for the somatogram analyses and 96 incident diagnoses of MM over 749,578 person-years for the weight cycling analyses. We observed suggestive increases in MM risk among women who reported heavier average body shapes in childhood (v. those with a relatively lean childhood shape; HR=1.8; 95% CI=0. 8–4.2) and adolescence (HR=1.6; CI=0.6–4.1). Body shape at specific ages and at baseline did not appear to predict MM risk. In the 20-year weight cycling analysis, we observed a suggested modest increase in MM risk among women who were weight gainers (HR=1.2; 95% CI=0.5–3.0) or light (HR=1.2; 95% CI=0.5–2.8) or heavy cyclers (HR=1.4; 95% CI=0.6–3.2) compared to those who lost weight or maintained stable weight. Discussion: These first prospective studies of body shape at various ages and long-term adult weight cycling are consistent with existing evidence that obesity is positively associated with risk of MM. Obesity in adulthood has consistently predicted an increased risk of MM in published studies and is thus a potentially modifiable risk factor for MM. Obesity at younger ages or an inability to maintain stable adult weight may be predictors of adult obesity, or may indicate an etiologic role for earlier life exposures in MM. Confirmation of the present findings in men and in other large populations is warranted, as are studies to explore potential biologic correlates of these lifestyle factors. If confirmed, these data would suggest that maintenance of a healthy weight from an early age, in addition to conferring other health benefits, may help to diminish risk of MM. Citation Information: Cancer Prev Res 2011;4(10 Suppl):A79.
    Type of Medium: Online Resource
    ISSN: 1940-6207 , 1940-6215
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2011
    detail.hit.zdb_id: 2422346-3
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  • 3
    In: Journal of Pediatric Orthopaedics B, Ovid Technologies (Wolters Kluwer Health), Vol. 25, No. 4 ( 2016-07), p. 305-309
    Abstract: The purpose of this study was to examine institutional trends in the volume of clavicle fractures in children and adolescents. Medical records were retrospectively reviewed to identify patients aged 10–18 years treated for a clavicle fracture between 1999 and 2011 at a single tertiary-care pediatric hospital. There were significant increases in the number of clavicle fractures seen annually, of midshaft clavicle fractures, and of midshaft clavicle fractures treated operatively. The percentage of midshaft clavicle fractures treated with fixation also increased significantly. The volumes of clavicle fractures and midshaft clavicle fractures treated operatively appear to be increasing. Despite a lack of evidence-based support, the frequency of fixation of midshaft clavicle fractures appear to be increasing in the pediatric population.
    Type of Medium: Online Resource
    ISSN: 1060-152X
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2071269-8
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  • 4
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Journal of Pediatric Orthopaedics Vol. 36, No. 5 ( 2016-07), p. 541-547
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 5 ( 2016-07), p. 541-547
    Abstract: The purpose of this study was to review 2 separate cohorts of young patients treated for snapping scapula: those treated surgically and those managed nonoperatively. Methods: A retrospective IRB-approved review was conducted on 18 pediatric aged patients (19 shoulders): 12 patients (average age 13.3) were treated nonoperatively, 6 patients (average age 15.4) (7 shoulders) were treated operatively. Demographic and clinical data were collected from medical records and 2 questionnaires for level of activity, return to sport, subjective satisfaction from treatment, and preoperative/postoperative levels of pain. The American Shoulder and Elbow Society (ASES) score was measured for both groups. Results: Mean follow-up for nonoperative patients was 43.7 months (range, 20 to 116 mo). Pretreatment subjective pain levels were 5.2 (scale 1 to 10), posttreatment were 1.5. There was a 75% return to play rate, and an overall 75% satisfaction rate. Posttreatment ASES scores were 90.0. Mean follow-up for surgical patients was 129.5 months (range, 68 to 177 mo). Pretreatment subjective pain level was 8.6, posttreatment was 0.75. There was an 83% return to play rate, and an overall 100% satisfaction rate. There were no complications. Posttreatment ASES scores were 92.6. Conclusions: Outcomes for nonoperative treatment of snapping scapula are good for young patients. Surgical management of snapping scapula is a safe and viable treatment option for patients who fail nonoperative treatment. Level of Evidence: Level IV.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2049057-4
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  • 5
    In: BMC Emergency Medicine, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: Acute Heart Failure (AHF) is a potentially lethal pathology and is often encountered in the prehospital setting. Although an association between prehospital arterial hypercapnia in AHF patients and admission in high-dependency and intensive care units has been previously described, there is little data to support an association between prehospital arterial hypercapnia and mortality in this population. Methods This was a retrospective study based on electronically recorded prehospital medical files. All adult patients with AHF were included. Records lacking arterial blood gas data were excluded. Other exclusion criteria included the presence of a potentially confounding diagnosis, prehospital cardiac arrest, and inter-hospital transfers. Hypercapnia was defined as a PaCO 2 higher than 6.0 kPa. The primary outcome was in-hospital mortality, and secondary outcomes were 7-day mortality and emergency room length of stay (ER LOS). Univariable and multivariable logistic regression models were used. Results We included 225 patients in the analysis. Prehospital hypercapnia was found in 132 (58.7%) patients. In-hospital mortality was higher in patients with hypercapnia (17.4% [23/132] versus 6.5% [6/93] , p  = 0.016), with a crude odds-ratio of 3.06 (95%CI 1.19–7.85). After adjustment for pre-specified covariates, the adjusted OR was 3.18 (95%CI 1.22–8.26). The overall 7-day mortality was also higher in hypercapnic patients (13.6% versus 5.5%, p  = 0.044), and ER LOS was shorter in this population (5.6 h versus 7.1 h, p  = 0.018). Conclusion Prehospital hypercapnia is associated with an increase in in-hospital and 7-day mortality in patient with AHF.
    Type of Medium: Online Resource
    ISSN: 1471-227X
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2050431-7
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  • 6
    In: JMIR Formative Research, JMIR Publications Inc., Vol. 7 ( 2023-10-6), p. e48057-
    Abstract: Carbon monoxide (CO) poisoning is an important cause of morbidity and mortality worldwide. Symptoms are mostly aspecific, making it hard to identify, and its diagnosis is usually made through blood gas analysis. However, the bulkiness of gas analyzers prevents them from being used at the scene of the incident, thereby leading to the unnecessary transport and admission of many patients. While multiple-wavelength pulse oximeters have been developed to discriminate carboxyhemoglobin (COHb) from oxyhemoglobin, their reliability is debatable, particularly in the hostile prehospital environment. Objective The main objective of this pilot study was to assess whether the Avoximeter 4000, a transportable blood gas analyzer, could be considered for prehospital triage. Methods This was a monocentric, prospective, pilot evaluation study. Blood samples were analyzed sequentially with 2 devices: the Avoximeter 4000 (experimental), which performs direct measurements on blood samples of about 50 µL by analyzing light absorption at 5 different wavelengths; and the ABL827 FLEX (control), which measures COHb levels through an optical system composed of a 128-wavelength spectrophotometer. The blood samples belonged to 2 different cohorts: the first (clinical cohort) was obtained in an emergency department and consisted of 68 samples drawn from patients admitted for reasons other than CO poisoning. These samples were used to determine whether the Avoximeter 4000 could properly exclude the diagnosis. The second (forensic) cohort was derived from the regional forensic center, which provided 12 samples from documented CO poisoning. Results The mean COHb level in the clinical cohort was 1.7% (SD 1.8%; median 1.2%, IQR 0.7%-1.9%) with the ABL827 FLEX versus 3.5% (SD 2.3%; median 3.1%, IQR 2.2%-4.1%) with the Avoximeter 4000. Therefore, the Avoximeter 4000 overestimated COHb levels by a mean difference of 1.8% (95% CI 1.5%-2.1%). The consistency of COHb readings by the Avoximeter 4000 was excellent, with an intraclass correlation coefficient of 0.97 (95% CI 0.93-0.99) when the same blood sample was analyzed repeatedly. Using prespecified cutoffs (5% in nonsmokers and 10% in smokers), 3 patients (4%) had high COHb levels according to the Avoximeter 4000, while their values were within the normal range according to the ABL827 FLEX. Therefore, the specificity of the Avoximeter 4000 in this cohort was 95.6% (95% CI 87%-98.6%), and the overtriage rate would have been 4.4% (95% CI 1.4%-13%). Regarding the forensic samples, 10 of 12 (83%) samples were positive with both devices, while the 2 remaining samples were negative with both devices. Conclusions The limited difference in COHb level measurements between the Avoximeter 4000 and the control device, which erred on the side of safety, and the relatively low overtriage rate warrant further exploration of this device as a prehospital triage tool.
    Type of Medium: Online Resource
    ISSN: 2561-326X
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2023
    detail.hit.zdb_id: 2941716-8
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  • 7
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 3 ( 2013-04), p. 232-238
    Type of Medium: Online Resource
    ISSN: 0271-6798
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 2049057-4
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  • 8
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2012
    In:  Current Reviews in Musculoskeletal Medicine Vol. 5, No. 2 ( 2012-6), p. 120-125
    In: Current Reviews in Musculoskeletal Medicine, Springer Science and Business Media LLC, Vol. 5, No. 2 ( 2012-6), p. 120-125
    Type of Medium: Online Resource
    ISSN: 1935-973X , 1935-9748
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2012
    detail.hit.zdb_id: 2407827-X
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  • 9
    In: Cancer Epidemiology, Biomarkers & Prevention, American Association for Cancer Research (AACR), Vol. 21, No. 9 ( 2012-09-01), p. 1497-1509
    Abstract: Background: Whether the genomic rearrangement transmembrane protease, serine 2 (TMPRSS2):v-ets erythroblastosis virus E26 oncogene homolog (ERG) has prognostic value in prostate cancer is unclear. Methods: Among men with prostate cancer in the prospective Physicians' Health and Health Professionals Follow-Up Studies, we identified rearrangement status by immunohistochemical assessment of ERG protein expression. We used Cox models to examine associations of ERG overexpression with biochemical recurrence and lethal disease (distant metastases or cancer-specific mortality). In a meta-analysis including 47 additional studies, we used random-effects models to estimate associations between rearrangement status and outcomes. Results: The cohort consisted of 1,180 men treated with radical prostatectomy between 1983 and 2005. During a median follow-up of 12.6 years, 266 men experienced recurrence and 85 men developed lethal disease. We found no significant association between ERG overexpression and biochemical recurrence [hazard ratio (HR), 0.99; 95% confidence interval (CI), 0.78–1.26] or lethal disease (HR, 0.93; 95% CI, 0.61–1.43). The meta-analysis of prostatectomy series included 5,074 men followed for biochemical recurrence (1,623 events), and 2,049 men followed for lethal disease (131 events). TMPRSS2:ERG was associated with stage at diagnosis [risk ratio (RR)≥T3 vs. T2, 1.23; 95% CI, 1.16–1.30) but not with biochemical recurrence (RR, 1.00; 95% CI, 0.86–1.17) or lethal disease (RR, 0.99; 95% CI, 0.47–2.09). Conclusions: These results suggest that TMPRSS2:ERG, or ERG overexpression, is associated with tumor stage but does not strongly predict recurrence or mortality among men treated with radical prostatectomy. Impact: This is the largest prospective cohort study to examine associations of ERG overexpression and lethal prostate cancer among men treated with radical prostatectomy. Cancer Epidemiol Biomarkers Prev; 21(9); 1497–509. ©2012 AACR.
    Type of Medium: Online Resource
    ISSN: 1055-9965 , 1538-7755
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2012
    detail.hit.zdb_id: 2036781-8
    detail.hit.zdb_id: 1153420-5
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  • 10
    In: Cancer Prevention Research, American Association for Cancer Research (AACR), Vol. 4, No. 10_Supplement ( 2011-10-01), p. A29-A29
    Abstract: Background: The TMPRSS2:ERG gene fusion is a common genomic abnormality in prostate cancer that has been studied as a possible biomarker of prognosis. Methods: We undertook a prospective cohort study and meta-analysis to evaluate whether TMPRSS2:ERG is associated with more aggressive prostate cancers. The cohort consisted of 1,052 men with prostate cancer treated by radical prostatectomy between 1982 and 2005 nested within the Physicians' Health Study and Health Professionals Follow-Up Study. We identified presence of the fusion by immunohistochemical assessment of ERG protein expression. We used Cox proportional hazards models for associations of the fusion with biochemical recurrence and lethal prostate cancer. The meta-analysis included 6,448 subjects with prostate cancer from 43 studies (including our cohort) published since 2005. Studies characterized presence of the fusion by fluorescence in situ hybridization, polymerase chain reaction, or immunohistochemistry. Results: During a median follow-up of 12.5 years, 245 men in the cohort experienced biochemical recurrence, and 95 developed lethal disease (distant metastases or cancer-specific mortality). Men whose tumors harbored the fusion were more likely to be diagnosed at a higher stage (p=0.02). There was no association, however, between the fusion and Gleason score (Gleason 8–10 vs. 2–6; p=0.45), biochemical recurrence (HR: 0.93; 95% CI: 0.72–1.20), and lethal disease (HR: 0.81; 95% CI: 0.54–1.22). For men treated with radical prostatectomy, the meta-analysis yielded similar results. Fusion status was associated with higher stage at diagnosis (RR: 1.19; 95% CI: 1.11–1.28), but not with Gleason score (RR: 0.91; 95% CI: 0.76–1.10), biochemical recurrence (RR: 1.01; 95% CI: 0.84–1.22) or lethal disease (RR: 0.93; 95% CI: 0.44–1.99). Conclusions: The results suggest that TMPRSS2:ERG fusion status and ERG expression are associated with higher stage at diagnosis but are not strong predictors of Gleason score, biochemical recurrence or cancer-specific death among men with prostate cancer treated with radical prostatectomy. Citation Information: Cancer Prev Res 2011;4(10 Suppl):A29.
    Type of Medium: Online Resource
    ISSN: 1940-6207 , 1940-6215
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2011
    detail.hit.zdb_id: 2422346-3
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