Tag: nevin manimala

J Clin Oncol. 2025 Jul 9:JCO2402697. doi: 10.1200/JCO-24-02697. Online ahead of print.

ABSTRACT

PURPOSE: We investigated breastfeeding patterns, behaviors, and association with breast cancer (BC) outcomes in women with early hormone receptor-positive (HR+) BC who had a live birth in the POSITIVE trial.

PATIENTS AND METHODS: POSITIVE is a prospective trial that demonstrated no increased short-term risk of BC events in women with early HR+ BC who interrupted endocrine therapy (ET) to attempt pregnancy. We describe the frequency, duration, and laterality of breastfeeding and estimate the cumulative incidence of BC events by breastfeeding status.

RESULTS: At a median follow-up of 41 months, 317 patients had at least one live birth and 313 were eligible for this analysis. A total of 196 of 313 (62.6%) patients breastfed. A total of 130 of the 167 women (77.8%) who had breast-conserving surgery breastfed, and 90 of 130 (69.2%) breastfed from the unaffected breast only. Sixty-six of the 146 women (45.2%) who underwent unilateral mastectomy breastfed. The frequency of breastfeeding was higher in women older than 35 years (67.6% v 55.7%) and in those without previous children (66.4% v 48.5%). Over half (103 of 196, 52.6%) of women breastfed their first live birth for >4 months (median 4.4 months; 95% CI, 4.0 to 5.3). The cumulative incidence of a BC event at 24 months from first on-study live birth was 3.6% and 3.1% in the breastfeeding and nonbreastfeeding groups, respectively (0.5% difference; 95% CI, -4.3% to 5.2%).

CONCLUSION: In POSITIVE, two thirds of women who gave birth after BC diagnosis breastfed, mostly for 4 months or more. In early follow-up, we did not observe differences in BC-related events in women who breastfed compared with those who did not. These results are key for women who wish to pursue pregnancy and breastfeeding after BC.

PMID:40632989 | DOI:10.1200/JCO-24-02697

Neurology. 2025 Aug 12;105(3):e213829. doi: 10.1212/WNL.0000000000213829. Epub 2025 Jul 9.

ABSTRACT

BACKGROUND AND OBJECTIVES: Geographic disparities in stroke clinical trials may limit access to innovative treatments in high-burden regions. This study examines the distribution of completed stroke trials (2010-2020) relative to stroke mortality and hospitalization rates.

METHODS: Data on completed trials were obtained from ClinicalTrials.gov and stroke burden metrics from the Control and Prevention. We calculated relative study frequency (RSF) by dividing the number of stroke deaths, age-adjusted stroke death rates, and stroke hospitalizations per 100,000 Medicare beneficiaries by the number of available trials. RSF values were stratified by quartiles.

RESULTS: A total of 649 stroke-related clinical trials were completed across 40 states, with 10 states having no registered trials. RSF varied widely, with the lowest quartile, including Mississippi (RSF = 14.40) and Louisiana (RSF = 13.90), having high stroke hospitalizations with minimal research activity, while California (RSF = 0.09) and New York (RSF = 0.19) had greater clinical trial availability to address stroke burden.

DISCUSSION: Stroke trial availability is disproportionately low in high-burden regions, particularly in the Southeast and Midwest. States with high stroke mortality and hospitalization rates but low clinical trial availability may face barriers to trial access, potentially exacerbating disparities in stroke care.

PMID:40632981 | DOI:10.1212/WNL.0000000000213829

JCO Precis Oncol. 2025 Jul;9:e2500200. doi: 10.1200/PO-25-00200. Epub 2025 Jul 9.

ABSTRACT

PURPOSE: Although deep targeted DNA sequencing of liquid biopsies has shown prognostic utility in large B-cell lymphoma (LBCL), the routine clinical adoption of these assays remains limited because of their high costs.

MATERIALS AND METHODS: Here, leveraging a well-annotated cohort encompassing both frontline and relapsed/refractory (R/R) LBCL, we profiled patient plasma samples with two complementary modalities-ultra-low-pass whole-genome sequencing (ULP-WGS) and deep targeted DNA sequencing, the former being a cost-effective method to profile large scale chromosomal abnormalities and estimate tumor burden.

RESULTS: Our findings revealed a strong association of high cell-free tumor burden by both genomic profiling modalities with established measures of tumor burden and patient survival. Notably, the associations with survival remained statistically significant after accounting for international prognostic index scoring. Furthermore, we showed that del(17p) in circulating tumor DNA as detected by ULP-WGS was strongly associated with TP53 mutation status and predicted for significantly inferior outcome in frontline LBCL patients but not in patients with R/R LBCL.

CONCLUSION: Our study demonstrates that ULP-WGS can provide robust prognostic biomarkers for both frontline and R/R LBCL, highlighting its broad applicability for risk stratification.

PMID:40632977 | DOI:10.1200/PO-25-00200

J Am Acad Orthop Surg Glob Res Rev. 2025 Jul 9;9(7). doi: 10.5435/JAAOSGlobal-D-25-00194. eCollection 2025 Jul 1.

ABSTRACT

INTRODUCTION: Anterior cruciate ligament (ACL) injuries are relatively common in the pediatric population, and ACL reconstruction (ACLR) followed by postoperative physical therapy (PT) is frequently considered to decrease the risk of additional knee injury and improve functional outcomes. Disparities across insurance groups in ACL surgical rates and PT utilization have been previously reported, but there is limited analysis from national databases, and even less about disparity trends over time.

METHODS: The 2015 to 2020 M157 PearlDiver database was queried for patients younger than 18 years diagnosed with ACL injury with commercial or Medicaid insurance. Factors abstracted included year, insurance plan, ACLR or not, and PT utilization and number of visits. The incidence of ACLR and PT visits were compared across insurance groups by year.

RESULTS: In total, 61,333 ACL injuries were identified for which ACLR was done for 21,083 (34.4%). The incidence of reconstruction was higher for those with commercial than Medicaid (35.0% vs. 30.7%, P < 0.001). Over the years of the study, this gap decreased from 7.7% in 2015 (P < 0.001) to 0.7% in 2020 (P = 0.714). For postoperative patients, those with commercial insurance had more PT sessions (26.45 vs. 22.53, P < 0.001). This gap decreased from 6.48 sessions in 2015 (P < 0.001) to 4.07 sessions in 2020 (P = 0.002). For nonsurgical patients, those with commercial insurance were more likely to receive PT (43.3% vs. 39.8%, P < 0.001) and to receive more sessions (18.76 vs. 14.35, P < 0.001). The gap in PT incidence deceased from 9.7% in 2015 (P < 0.001) to 2.4% in 2020 (P = 0.200).

CONCLUSION: Medicaid pediatric patients with ACL injuries were markedly less likely to undergo reconstruction and received less PT than commercial insurance patients, but these differences decreased/disappeared over the years studied. It is reassuring to see these insurance-related disparities decreasing over time, and continued access efforts are needed.

PMID:40632971 | DOI:10.5435/JAAOSGlobal-D-25-00194

JCO Clin Cancer Inform. 2025 Jul;9:e2400234. doi: 10.1200/CCI-24-00234. Epub 2025 Jul 9.

ABSTRACT

PURPOSE: Previous studies have consistently reported disparities in electronic health record portal enrollment. Among patients enrolled in a portal, it is less clear whether there are disparities in usage. We investigated whether disparities existed in portal usage among enrolled oncology patients regarding both sending portal messages to and receiving messages from oncology providers.

METHODS: This retrospective cohort study included patients ≥18 years old with cancer who were seen at an urban academic cancer center between January 2011 and February 2025 and enrolled in the patient portal. We developed Cox proportional hazards models for the outcomes of patients sending portal messages to and receiving messages from oncology providers as the first message in a thread. Time measurement began with the first cancer center visit or portal enrollment, whichever was later. Models were adjusted for demographic, socioeconomic, disease, and administrative visit variables.

RESULTS: Among 101,678 patients, the median age was 62 years (IQR, 51-71), and 68,527 sent and 42,242 received messages. After adjustment, age ≥50 versus 18-29 years, Latinx and Pacific Islander versus White, single and widowed versus partnered, non-English preferred language, and Medicaid and Medicare versus private insurance were associated with reduced likelihood of sending and receiving messages. Black and American Indian/Alaska Native were associated with reduced likelihood of sending messages. Female provider was associated with increased likelihood of sending and receiving messages. Women were more likely to send messages.

CONCLUSION: Among oncology patients enrolled in the patient portal, disparities existed in sending and receiving portal messages. Given the association of messaging with better survival among oncology patients in previous studies, future studies should determine how best to minimize messaging disparities beyond just addressing disparities in portal enrollment.

PMID:40632947 | DOI:10.1200/CCI-24-00234

J Am Acad Orthop Surg Glob Res Rev. 2025 Jul 8;9(7). doi: 10.5435/JAAOSGlobal-D-25-00176. eCollection 2025 Jul 1.

ABSTRACT

INTRODUCTION: Orthopaedic surgery was the fifth most competitive specialty in the 2024 Match cycle as measured by the percentage of positions filled overall (915 of 916 [99.9%]). With the United States Medical Licensing Examination Step 1 examination now pass/fail, research experience and publications have become increasingly important for applicants. This study explores key aspects of orthopaedic surgery research fellowships for medical students including the average number of publications and presentations, additional learning opportunities, and total number of fellows who matched into an orthopaedic surgery residency after their research year.

METHODS: Research year fellowships were identified through an online search using publicly available information and the search terms “Orthopaedic Research Fellowship” and “Orthopaedic Research Gap Year” in May 2024. If available, information from individual program websites was used. Programs were contacted to provide the number of publications, presentations, and clinical opportunities offered by the program and the number of previous research fellows matched.

RESULTS: In total, 130 orthopaedic research year fellowship programs were identified. Information was collected for 80 programs through survey response or publicly available information. The average number of fellowship-related publications was 11.7 (range 2 to 30) and presentations was 11.86 (range 1 to 60). In addition, 68 programs offered additional opportunities including clinical and operating room exposure, educational experiences, and mentorship. The total number of research fellows from each program who matched into orthopaedic surgery ranged from 0 to 30.

CONCLUSION: This study found that orthopaedic research fellowships offer medical students an average of 11.7 publications and 11.86 presentations, along with notable clinical exposure. This study offers insights into key characteristics of research fellowships for students evaluating programs, while also highlighting the need for future research to determine which applicants benefit most and how the role of these fellowships is changing in light of the pass/fail United States Medical Licensing Examination Step 1 examination.

PMID:40632945 | DOI:10.5435/JAAOSGlobal-D-25-00176

Neurol Res. 2025 Jul 9:1-9. doi: 10.1080/01616412.2025.2528974. Online ahead of print.

ABSTRACT

BACKGROUND: The genetic contribution to the development of levodopa-induced motor complications in Parkinson’s disease (PD) remains poorly understood.

OBJECTIVES: We aimed to investigate the association between selected polymorphisms of the catechol-O-methyltransferase (COMT), dopamine receptor D2 (DRD2), ankyrin repeat and kinase domain containing 1 (ANKK1) and dopamine transporter (DAT) genes and the occurrence of motor complications in the group of PD patients.

METHODS: A total of 234 PD patients undergoing levodopa therapy for at least two years were genotyped for the following polymorphisms: rs4680 in COMT; rs6277, rs1076560, and rs2283265 in DRD2; rs1800497 and rs2734849 in ANKK1; and a VNTR (Variable Number of Tandem Repeats) polymorphism in the 3′-UTR (3′-untranslated region) of the DAT gene.

RESULTS: Levodopa-induced dyskinesia (LID) was significantly more frequent in carriers of the AA genotype of rs4680 in COMT compared to AG and GG carriers. Motor fluctuations occurred more frequently in carriers of the ANKK1/DRD2 haplotypes GGAAA and AGGAA than in non-carriers. Independent predictors of motor fluctuations included younger age at disease onset, longer disease duration, daily levodopa dose ≥ 500 mg, and greater disease severity. Independent predictors of LID included female gender, longer disease duration, levodopa equivalent daily dose (LEDD) ≥900 mg, greater disease severity, and the AA genotype of rs4680 in COMT, which conferred a 2.8-fold higher risk of dyskinesia.

CONCLUSION: These findings suggest that genetic variants, particularly in the COMT and ANKK1/DRD2 loci, may contribute to the development of levodopa-induced motor complications in PD. These preliminary results require confirmation in larger, longitudinal studies.

PMID:40632937 | DOI:10.1080/01616412.2025.2528974

JAMA Netw Open. 2025 Jul 1;8(7):e2525559. doi: 10.1001/jamanetworkopen.2025.25559.

NO ABSTRACT

PMID:40632541 | DOI:10.1001/jamanetworkopen.2025.25559

JAMA Netw Open. 2025 Jul 1;8(7):e2519426. doi: 10.1001/jamanetworkopen.2025.19426.

ABSTRACT

IMPORTANCE: Palliative care has been shown to improve important patient outcomes but is rarely available in small or rural hospitals.

OBJECTIVE: To assess whether culturally based palliative care video consultation could improve symptom distress compared with usual inpatient care without palliative care.

DESIGN, SETTING, AND PARTICIPANTS: Recruitment for this multisite, single-blind randomized clinical trial occurred from July 20, 2020, to December 20, 2023; data collection was completed on January 15, 2024. A community-aided approach was used to recruit inpatients from 3 rural hospitals lacking palliative care services in Alabama, Mississippi, and South Carolina. Self-identified non-Hispanic Black or African American and non-Hispanic White adults aged 55 years or older admitted with a serious chronic illness and a willing caregiver were invited to participate. Randomization was stratified by site and race.

INTERVENTIONS: Participants were randomized 1:1 to Community Tele-Pal, culturally based video consultation by a palliative care specialist followed by research coordinator (RC) contacts 3 and 6 days after video consultation (intervention arm), or to routine hospital care (control arm).

MAIN OUTCOMES AND MEASURES: The primary outcome was the between-group difference in the change in patient-reported symptom distress from baseline to day 7, assessed by the Edmonton Symptom Assessment Scale (ESAS; range, 0-90; lower scores indicate lower symptom distress). Secondary outcomes were quality of life (QOL; Patient-Reported Outcomes Measurement Information System global physical and mental health mean T scores), resource use (emergency department visits and hospital readmissions), and an exploratory outcome of feeling heard and understood.

RESULTS: A total of 209 patients were randomized (104 to usual care; 105 to the intervention); mean (SD) age was 73.3 (8.3) years, 120 (57.4%) were female, 58 (27.8%) were Black or African American, 157 (75.1%) were retired, and 75 (35.9%) had a Palliative Performance Scale score less than 70% (indicating need for functional assistance). On day 7, the mean (SE) ESAS score change from baseline was -11.4 (1.5) points in the intervention group and -7.3 (1.5) points in the control group; the between-group difference in change in ESAS scores was not statistically significant (Westfall d, -0.28; 95% CI, -0.56 to 0.01; P = .055). The mean (SE) day 7 between-group difference in ESAS score of -4.0 (1.8) points met the criteria for a minimal clinically important difference of 3 to 4 points. No between-group differences were observed for QOL, resource use, or feeling heard and understood.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, the intervention was not associated with reduced symptom distress at day 7 vs baseline or with improved QOL or reduced resource use compared with usual care. However, the between-group difference in the ESAS score met the criteria for a minimal clinically important difference of 3 to 4 points. Palliative video consultation to reduce health care inequities for hospitalized rural-dwelling individuals may warrant further investigation.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03767517.

PMID:40632537 | DOI:10.1001/jamanetworkopen.2025.19426

JAMA Netw Open. 2025 Jul 1;8(7):e2519622. doi: 10.1001/jamanetworkopen.2025.19622.

ABSTRACT

IMPORTANCE: The association between grandchild care and dementia remains unclear, with previous studies yielding mixed results and unclear mechanisms.

OBJECTIVE: To examine the association between grandchild care and dementia odds and to explore the mediating roles of mobile telephone ownership, broadband internet access, and reduced loneliness.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the China Health and Retirement Longitudinal Study from 2013 to 2018. Data analysis was conducted from March 10, 2024, to April 20, 2025. Multistage, stratified, cluster sampling was used to recruit participants from 28 provinces across China. Data were collected through biennial, computer-assisted personal interviews. The analytic sample comprised Chinese adults aged 50 to 79 years who were dementia free at baseline.

EXPOSURE: Grandchild caregiving was classified into 4 groups: noncaregivers (0 hours per week), nonintensive caregivers (1-39 hours per week), intensive caregivers (≥40 hours per week), and those without grandchildren.

MAIN OUTCOMES AND MEASURES: Dementia was assessed using both self-reports and proxy measures, with dementia defined by scores of 0 to 6 on the modified Telephone Interview for Cognitive Status or a score of 4 or higher on the Informant Questionnaire on Cognitive Decline in the Elderly.

RESULTS: From an initial cohort of 18 605 participants, 10 058 were included (5062 men [50.3%]; 4996 women [49.7%]; mean [SD] age, 60.9 [7.2] years). Nonintensive grandchild caregiving was associated with lower odds of dementia (odds ratio [OR], 0.76; 95% CI, 0.60-0.97) than no grandchild care. The mediation analysis revealed that the association of nonintensive grandchild care with dementia odds was partially mediated by mobile telephone ownership (17.68%; 95% CI, 2.05%-37.23%), broadband internet access (17.36%; 95% CI, 5.37%-30.05%), and reduced loneliness (16.83%; 95% CI, 4.52%-30.24%), with a combined mediating proportion of 36.99% (95% CI, 25.01%-51.41%). Neither intensive grandchild caregiving nor having no grandchildren was associated with dementia odds, and no significant indirect effects were observed through the mediators examined.

CONCLUSIONS AND RELEVANCE: In this cohort study of older Chinese adults, nonintensive grandchild caregiving was associated with lower odds of dementia, partly owing to increased digital technology access and reduced loneliness. Promoting digital inclusion and social engagement could be beneficial for cognitive health, particularly among older adults providing moderate levels of grandchild care.

PMID:40632534 | DOI:10.1001/jamanetworkopen.2025.19622