Summary Background We compared standard adjuvant anthracycline chemotherapy with anthracycline–taxane combination chemotherapy in women with operable node-positive breast cancer. Here we report the ...final, 10-year follow-up analysis of disease-free survival, overall survival, and long-term safety. Methods BCIRG 001 was an open label, phase 3, multicentre trial in which 1491 patients aged 18–70 years with node-positive, early breast cancer and a Karnofsky score of 80% or more were randomly assigned to adjuvant treatment with docetaxel, doxorubicin, and cyclophosphamide (TAC) or fluorouracil, doxorubicin, and cyclophosphamide (FAC) every 3 weeks for six cycles. Randomisation was stratified according to institution and number of involved axillary lymph nodes per patient (one to three vs four or more). Disease-free survival was the primary endpoint and was defined as the interval between randomisation and breast cancer relapse, second primary cancer, or death, whichever occurred first. Efficacy analyses were based on the intention-to-treat principle. BCIRG 001 is registered with ClinicalTrials.gov , number NCT00688740. Findings Enrolement took place between June 11, 1997 and June 3, 1999; 745 patients were assigned to receive TAC and 746 patients were assigned to receive FAC. After a median follow-up of 124 months (IQR 90–126), disease-free survival was 62% (95% CI 58–65) for patients in the TAC group and 55% (51–59) for patients in the FAC group (hazard ratio HR 0·80, 95% CI 0·68–0·93; log-rank p=0·0043). 10-year overall survival was 76% (95% CI 72–79) for patients in the TAC group and 69% (65–72) for patients in the FAC group (HR 0·74, 0·61–0·90; log-rank p=0·0020). TAC improved disease-free survival relative to FAC irrespective of nodal, hormone receptor, and HER2 status, although not all differences were significant in these subgroup analyses. Grade 3–4 heart failure occurred in 26 (3%) patients in the TAC group and 17 (2%) patients in the FAC group, and caused death in two patients in the TAC group and four patients in the FAC group. A substantial decrease in left ventricular ejection fraction (defined as a relative decrease from baseline of 20% or more) was seen in 58 (17%) patients who received TAC and 41 (15%) patients who received FAC. Six patients who received TAC developed leukaemia or myelodysplasia, as did three patients who received FAC. Interpretation Our results provide evidence that the initial therapeutic outcomes seen at the 5-year follow-up with a docetaxel-containing adjuvant regimen are maintained at 10 years. However, a substantial percentage of patients had a decrease in left ventricular ejection fraction, probably caused by anthracycline therapy, which warrants further investigation. Funding Sanofi.
New Scope of the Document Although reports on cardiovascular screening efficacy have predominantly involved populations of adolescents and young adults participating in competitive athletics, the ...context of the present discussion is intentionally (and necessarily) much more expansive. ...it is underscored that the present report is not limited in scope to universal mass screening for athlete populations but importantly includes considerations for screening large, young, and truly general populations (school-aged, 12-25 years old, of both sexes) with respect to relevant logistical, ethical, legal, and societal issues (e.g., in the United States or other countries or communities of various sizes, in schools, or in regional or military populations).
Work Group report: Oral food challenge testing Nowak-Węgrzyn, Anna, MD; Assa'ad, Amal H., MD; Bahna, Sami L., MD, DrPH ...
Journal of allergy and clinical immunology,
06/2009, Letnik:
123, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Oral food challenges are procedures conducted by allergists/immunologists to make an accurate diagnosis of immediate, and occasionally delayed, adverse reactions to foods. The timing of the challenge ...is carefully chosen based on the individual patient history and the results of skin prick tests and food specific serum IgE values. The type of the challenge is determined by the history, the age of the patient, and the likelihood of encountering subjective reactions. The food challenge requires preparation of the patient for the procedure and preparation of the office for the organized conduct of the challenge, for a careful assessment of the symptoms and signs and the treatment of reactions. The starting dose, the escalation of the dosing, and the intervals between doses are determined based on experience and the patient's history. The interpretation of the results of the challenge and arragements for follow-up after a challenge are important. A negative oral food challenge result allows introduction of the food into the diet, whereas a positive oral food challenge result provides a sound basis for continued avoidance of the food.
•An integrated modelling framework for mode, departure time and route choices.•Mode and departure time choice is added to dynamic traffic and transit assignment.•The study addresses the interactions ...between traffic and transit networks.•A case study of the proposed modelling framework is presented in this paper.•Replacing a flat transit fare with a time-based transit fare structure is tested.
This paper presents a large-scale integrated modelling framework that can capture the relationships between travel mode choice, departure time choice and route choices simultaneously. Conventional transportation models have typically been applied to small scale networks to avoid the complexity of the large-scale simulation. While there are different approaches and strategies that researchers have presented to tackle the transportation congestion challenges, such strategies need to be accurately evaluated at the full system scale before implementation. The proposed framework integrates an econometric model for travel mode and departure time choice with a simulation-based dynamic traffic and transit assignment model. It addresses the interactions between the traffic and transit networks in addition to their interactions with the mode and departure time choice model. A case study of the proposed modelling framework is presented in this paper, where the effects of replacing the current flat transit fare used in the City of Toronto with a time-based transit fare structure are captured. It is found that an increase in the fare during the middle of the peak results in a reduction in transit vehicles crowdedness. The scenario analysis also shows that 1.85% of transit users will shift their departure time from the (congested) middle period of the peak to the (less costly) shoulders of the peak, whilst 2.6% of transit users opt-out of using transit in favour of either driving or accompanying another driver.
Ocular trauma terminology should be periodically updated to enable comprehensive capturing and monitoring of ocular trauma in clinical and research settings.
To update terminology for globe and ...adnexal trauma.
A 2-round modified Delphi survey was conducted from January 1 to July 31, 2021, using an expert panel, including 69 ophthalmologists identified through their membership in ophthalmology (globe and adnexal trauma) societies. Consensus was defined as at least 67% expert agreement. A steering committee developed questions after identifying gaps in the current terminology via a targeted literature review. Round 1 sought consensus on existing and newly proposed terminology, and round 2 focused on unresolved questions from round 1. Experts included ophthalmologists who had managed, on average, 52 globe or adnexal trauma cases throughout their careers and/or published a total of 5 or more globe or adnexal trauma-related peer-reviewed articles.
Expert consensus on ocular and adnexal terms.
A total of 69 experts participated in and completed round 1 of the survey. All 69 participants who completed round 1 were asked to complete round 2, and 58 responses were received. Consensus was reached for 18 of 25 questions (72%) in round 1 and 4 of 7 questions (57%) in round 2. Existing Birmingham Eye Trauma Terminology system terminology achieved consensus of 84% (58 of 69 experts) in round 1 and 97% (56 of 58 experts) in round 2. Experts agreed on the need for further refinement of the definition of zones of injury (55 of 69 80%), as the zone affected can have a substantial effect on visual and functional outcomes. There was consensus that the mechanism of injury (52 of 69 75%) and status of the lacrimal canaliculi (54 of 69 78%), nasolacrimal ducts (48 of 69 69%), lens (46 of 58 80%), retina (42 of 58 73%), and central and paracentral cornea (47 of 58 81%) be included in the revised terminology.
There was consensus (defined as at least 67% expert agreement) on continued use of the existing Birmingham Eye Trauma Terminology system definitions and that additional terms are required to update the current ocular trauma terminology.
The article proposes a two-staged modelling approach to identify the association between one vehicle's attributes, as well as roadway engineering, environmental and crash characteristics, and the ...injury severity of occupants in the partnering vehicle in two-vehicle crashes. The modelling approach uses a bivariate binary probit model, and crash data for Toronto, to first determine the probability of injury and no injury occurring, followed by the use of a bivariate ordered probit model to investigate the conditional probability of the specific severity level. Vehicles in two-vehicle crashes are categorized as "not-at-fault" (NAF) or "at-fault" (AF) and their occupants also categorized as such. The findings demonstrate that the modelling approach used in this study can reveal meaningful insights by improving understanding of how the same attribute could behave differently for NAF and AF vehicles. For example, factors found to be associated with increased probability of more severe injuries of NAF vehicle occupants are inattentive driving, left-turn movement, heavy vehicle type of the AF vehicle, and angle and rear-end impact type; conversely, for AF vehicles, their probability of more severe injury is positively associated with inattentive driving and heavy vehicle type of the NAF vehicle, and angle and approaching impact type.
Food allergy (FA) practice varies widely.
To report differences between allergists and nonallergists regarding diagnosis, treatment, and prevention of FA.
A 2-page questionnaire was mailed to 3,000 ...allergists and 4,000 nonallergists. We previously published the findings on prevalence and manifestations. Herein, we report the findings on food allergens, diagnosis, treatment, and prevention.
Responses were received from 584 (19.5%) of the allergists and 77 (1.9%) of the nonallergists. Because of the nonallergists' low response rate, descriptive comparisons were made without emphasis on statistical significance. Allergists and nonallergists differed in their rankings of the 5 most common food allergens. Nonallergists differed markedly from allergists in the diagnostic methods, using more leukocytotoxic tests (10.9% vs 0.3%), specific IgG4 tests (33.8% vs 6.0%), and intradermal tests (40.0% vs 9.5%), but fewer percutaneous skin tests (44.7% vs 98.9%), specific IgE tests (73.4% vs 97.8%), and challenges (61.1% vs 87.6%). They also differed in their use of open, single-blind, and double-blind challenge tests. Allergists were more likely to rely on elimination of proven food allergens and less likely to use conventional elimination diets, rotation diets, and sublingual or subcutaneous hyposensitization. Allergists were more likely to recommend a diet regimen during pregnancy (76.7% vs 35.3%) and lactation (91.1% vs 72.9%), breastfeeding (93.6% vs 84.3%), hydrolysate formulas (83.5% vs 64.3%), and withholding solids until the age of 6 months (89.4% vs 70.0%).
Differences were noted between nonallergists and allergists regarding causes, diagnostic methods, treatment, and prevention of FA, indicating the need for more education in this area.
Food allergy (FA) prevalence is increasing and is being popularly claimed by the general population.
To evaluate attitudinal differences between allergists and nonallergists with regard to ...prevalence, manifestations, offending food component, and time of onset of FA reactions.
A 2-page questionnaire was mailed to 3,000 members of the American College of Allergy, Asthma and Immunology and 4,000 nonallergists (1,000 each of internists, pediatricians, family practitioners, and otolaryngologists).
Responses were received from 584 allergists and 77 nonallergists. The overall estimated prevalence of FA was significantly higher for nonallergists than allergists (12.1% vs 4.6%) and in each age group. The most common gastrointestinal manifestation of FA was oropharyngeal itching according to allergists (67.2%) vs diarrhea according to nonallergists (42.5%). More nonallergists than allergists reported neurobehavioral manifestations, musculoskeletal symptoms, and upper airway symptoms as common in FA. On the other hand, more allergists than nonallergists considered atopic dermatitis, acute urticaria or angioedema, and anaphylaxis to be common. Nonallergists considered carbohydrates, fat, and additives as causing allergy much more than allergists did (34.4% vs 6.9%; P < .001). With regard to time of onset of FA, nonallergists had higher estimates than allergists for both late (25.5.% vs 13.0%; P < .001) and delayed (22.1% vs 4.5%; P < .001) reactions.
Significant differences in attitudes toward FA were revealed between allergists and nonallergists, which highlights the need to enhance education in this area.
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