Citations

PURPOSE The nodal burden of patients with residual isolated tumor cells (ITCs) in the sentinel lymph nodes (SLNs) after neoadjuvant chemotherapy (NAC) (ypN0i+) is unknown, and axillary management is not standardized. We investigated rates of additional positive lymph nodes (LNs) at axillary lymph node dissection (ALND) and oncologic outcomes in patients with ypN0i+ treated with and without ALND. METHODS The Oncoplastic Breast Consortium-05/ICARO cohort study (ClinicalTrials.gov identifier: NCT06464341 ) retrospectively analyzed data from patients with stage I to III breast cancer with ITCs in SLNs after NAC from 62 centers in 18 countries. The primary end point was the 3-year rate of any axillary recurrence. The rate of any invasive recurrence was the secondary end point. RESULTS In total, 583 patients were included, of whom 182 (31%) had completion ALND and 401 (69%) did not. The median age was 48 years. Most patients (74%) were clinically node-positive at diagnosis and 41% had hormone receptor–positive/human epidermal growth factor receptor 2–negative tumors. The mean number of SLNs with ITCs was 1.2. Patients treated with ALND were more likely to present with cN2/3 disease (17% v 7%, P < .001), have ITCs detected on frozen section (62% v 8%, P < .001), have lymphovascular invasion (38% v 24%, P < .001), and receive adjuvant chest wall (89% v 78%, P = .024) and nodal radiation (82% v 75%, P = .038). Additional positive nodes were found at ALND in 30% of patients, but only 5% had macrometastases. The 3-year rates of any axillary and any invasive recurrence were 2% (95% CI, 0.95 to 3.6) and 11% (95% CI, 8 to 14), respectively, with no statistical difference by type of axillary surgery. CONCLUSION The nodal burden in patients with ypN0(i+) was low, and axillary recurrence after ALND omission was rare in patients selected for this approach. These results do not support routine ALND in all patients with ypN0(i+).

Abstract Background: Chronic dry eye disease (CDED) is a condition of the ocular surface that causes discomfort, visual disturbance, conjunctival injection, and photophobia. A debilitating form of CDED in patients undergoing allogeneic bone marrow transplant results from ocular graft versus host disease (oGVHD). Autologous serum eye drops (ASED) have beneficial effects on the ocular surface. The aim of this study is to compare improvements in symptoms and function in a cohort of CDED patients with ocular GVHD treated with ASED and a cohort of CDED without GVHD (non-GVHD). We additionally report on some of the biologic characteristics of one specific ASED formulation. Materials and Methods: A total of 71 patients seen in a multi-specialty ophthalmology practice in a university hospital setting receiving ASEDs underwent ocular surface disease index (OSDI) and visual function questionnaire measurements at baseline, 3 months, and 6 months. Twenty-four ASED samples were studied for biomarkers. Results: Compared to baseline, OSDI scores significantly decreased after 3 and 6 months of ASED treatment in both oGVHD and non-GVHD CDED groups. Additionally, visual function questionnaire-25 (VFQ-25) subscales (ocular pain, distance activity, driving, role difficulties, dependency, and mental health) were significantly improved at 3 months and 6 months, and social functioning was improved at 6 months. The majority of patients in both groups had severe disease. Improvements in patient-reported outcomes were greater in the oGHD CDED group than in the non-GVHD CDED group There were no reported complications. Conclusion: ASED is safe and effective in patients with CDED due to oGVHD and non-GVHD. Those with oGVHD had greater improvements. These findings potentiate the wider adoption of this therapy in CDED patients and warrant additional studies into the biochemical makeup of ASED.

The purpose of the study was to examine differences in body fat percentage (BF%) across groups stratified by resting metabolic rate (RMR) when normalized to body weight. National Collegiate Athletic Association Division III athletes (n = 190; Age: 19.8 ± 1.4 year; Body Mass: 79.3 ± 20.2 kg; Height: 175.0 ± 9.3 cm, Body Mass Index: 25.6 ± 4.9 kg/m2) participated in this cross-sectional mixed cohort study. Body composition was assessed using air displacement plethysmography. RMR was assessed using indirect calorimetry. For each sex, tertiles were determined and used to create low, moderate, and high relative RMR groups as follows: low (M: <26 kcal/kg; F: <24 kcal/kg), moderate (M: 26.1–29.0 kcal/kg; F: 24.1–27.0 kcal/kg), and high (M: >29.1 kcal/kg; F: >27.1 kcal/kg). The mean ± standard deviation RMR for male and female athletes was 27.9 ± 3.2 and 25.9 ± 2.8 kcals/kg when expressed relative to body weight. When stratified by sex, males in the low RMR group had significantly higher BF% values than those in the moderate (mean difference, [95% confidence intervals]) (7.2, [2.4, 12.0] kcal/kg; p < 0.01) and high RMR groups (7.7, [2.9, 12.5] kcal/kg; p < 0.001). Female athletes in the moderate RMR group had higher body fat percentages than those in the high RMR group (mean difference, [95% confidence intervals]) (5.8, [2.4, 9.2] kcal/kg; p < 0.01). Female athletes in the moderate relative RMR group had higher BF% values than those in the higher relative RMR group (3.3, [−0.1, 6.7] kcal/kg; p = 0.049). Both male and female athletes with a low relative RMR had a higher BF%.

ABSTRACT Women experience a higher rate of anterior cruciate ligament (ACL) injuries than men. Muscle imbalance, in particular hamstring-to-quadriceps (H:Q) strength ratio, is considered a risk factor for ACL injury. The purpose of this systematic review was to identify isokinetic H:Q strength ratios in women team sport athletes and determine whether cutoff values, determined from research with predominantly males, of >0.6 for conventional ratio (Hamstring concentric :Quadriceps concentric [CR]) and >1.0 for functional ratio (Hamstring eccentric :Quadriceps concentric [FR]) were met. The CR (0.6) was not met for team ([mean ± SD: 0.56 ± 0.08]), field (0.57 ± 0.08), and court (0.56 ± 0.08) sports. Handball presented the highest (0.58 ± 0.07), and softball presented the lowest CRs (0.47 ± 0.06). The FR (1.0) was not met for team (0.69 ± 0.14), field (0.85 ± 0.14), and court (0.65 ± 0.14) sports. Soccer presented the highest (0.85 ± 0.14) and handball the lowest (0.66 ± 0.13) FRs. When assessing hamstring and quadriceps strength balance, women team sport athletes did not meet CR or FR values, which may contribute to increased ACL injury risk. H:Q ratios below cutoff values may indicate compromised hamstring strength. It is recommended practitioners implement strength exercises aimed to improve H:Q ratios.

Background Older adults with non–ST‐segment–elevation acute coronary syndrome are less likely to undergo an invasive strategy compared with younger patients. Randomized controlled trials traditionally exclude older adults because of their high burden of geriatric conditions. Methods and Results We searched for randomized controlled trials comparing invasive versus medical management or a selective invasive (conservative) strategy for older patients (age≥75 years) with non–ST‐segment–elevation acute coronary syndrome. Fixed effects meta‐analysis was conducted to estimate the odds ratio (OR) with 95% CI for the composite of death or myocardial infarction (MI) and individual secondary end points of all‐cause death, cardiovascular death, MI, revascularization, stroke, and major bleeding. Nine studies with 2429 patients (invasive: 1228 versus control: 1201) with a mean follow‐up of 21 months were included. An invasive strategy was associated with a significantly decreased risk of a composite of death and MI (OR, 0.67 [95% CI, 0.54–0.83], P <0.001), MI (OR, 0.56 [95% CI, 0.45–0.70], P <0.001) and subsequent revascularization (OR, 0.27 [95% CI, 0.16–0.48], P <0.001). There was no difference in all‐cause death (OR, 0.84 [95% CI, 0.65–1.10], P =0.21), cardiovascular death (OR, 0.85 [95% CI, 0.63–1.15], P =0.30), stroke (OR, 0.74 [95% CI, 0.38–1.47], P =0.39), or major bleeding (OR, 1.24 [95% CI, 0.42–3.66], P =0.70). Conclusions In older patients ≥75 years old with non–ST‐segment–elevation acute coronary syndrome, an invasive strategy reduced the risk of a composite of death and MI, MI, and subsequent revascularization compared with a conservative strategy alone. Older adults with higher burden of geriatric conditions should be included in future trials to improve generalizability to this growing population.

Background Despite advances in cancer care and detection, >65% of patients with squamous cell cancer of the head and neck (HNSCC) will develop recurrent and/or metastatic disease. The prognosis for these patients is poor with a 5-year overall survival of 39%. Recent treatment advances in immunotherapy, including immune checkpoint inhibitors like pembrolizumab and nivolumab, have resulted in clinical benefit in a subset of patients. There is a critical clinical need to identify patients who benefit from these antiprogrammed cell death protein 1 (anti-PD-1) immune checkpoint inhibitors. Methods Here, we report findings from a multicenter observational study, PREDicting immunotherapy efficacy from Analysis of Pre-treatment Tumor biopsies (PREDAPT), conducted across 17 US healthcare systems. PREDAPT aimed to validate OncoPrism-HNSCC, a clinical biomarker assay predictive of disease control in patients with recurrent or metastatic HNSCC treated with anti-PD-1 immune checkpoint inhibitors as a single agent (monotherapy) and in combination with chemotherapy (chemo-immunotherapy). The test used RNA-sequencing data and machine learning models to score each patient and place them into groups of low, medium, or high. Results The OncoPrism-HNSCC prediction significantly correlated with disease control in both the monotherapy cohort (n=62, p=0.004) and the chemo-immunotherapy cohort (n=50, p=0.01). OncoPrism-HNSCC also significantly predicted progression-free survival in both cohorts (p=0.015 and p=0.037, respectively). OncoPrism-HNSCC had more than threefold higher specificity than programmed death-ligand 1 combined positive score and nearly fourfold higher sensitivity than tumor mutational burden for predicting disease control. Conclusions Here, we demonstrate the clinical validity of the OncoPrism-HNSCC assay in identifying patients with disease control in response to anti-PD-1 immune checkpoint inhibitors. Trial registration number NCT04510129.