The University of Vermont Medical Center (UVM) is a five-campus academic medical facility under the corporate umbrella of The University of Vermont Health Network corporate that is anchored by a 562-bed hospital. UVM is located in Burlington, Vermont, and serves as both a regional referral center (providing advanced care to approximately one million people in Vermont and northern New York) and a community hospital (for approximately 160,000 residents in the Chittenden and Grand Isle Vermont counties). They were formerly known as both the Medical Center Hospital of Vermont as well as Fletcher Allen Health Care." and are affiliated with the University of Vermont College of Medicine and the University of Vermont College of Nursing and Health Sciences.
BACKGROUND:Various factors such as race/ethnicity, practice settings, socioeconomic status (SES), and geographic region influence cancer outcomes. We describe treatment patterns and outcomes among women with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer treated in the United States based on these factors. METHODS:A retrospective, observational cohort study was conducted using the Flatiron Health Research Database of deidentified electronic health records in women ≥18 years in the United States who received first-line treatment for HR+/HER2- metastatic breast cancer from January 1, 2015, to February 28, 2023. Real-world overall survival (rwOS) and time to next treatment or death (rwTTNTD) were assessed using Kaplan-Meier methods. RESULTS:The analysis included 6,974 women, who were most commonly non-Hispanic White (64%), lived in the South (37%), and received treatment in community settings (83%). From 2015 to 2019, the early uptake period of cyclin-dependent kinase 4/6 inhibitors (CDK4/6i), non-Hispanic White women were more likely to receive endocrine therapy (ET) + CDK4/6i compared with non-Hispanic Black and Hispanic/Latino women; ET + CDK4/6i was less common in lower (Q1-Q3) versus higher (Q4-Q5) SES quintiles and in community versus academic settings. These differences were less pronounced from 2020 to 2023. Non-Hispanic White women had significantly longer rwOS compared with non-Hispanic Black women but shorter rwOS compared with Hispanic/Latino women. rwOS was longer in academic versus community settings. No substantial differences in rwTTNTD were observed. CONCLUSIONS:We observed disparities in first-line treatment and outcomes among women with HR+/HER2- metastatic breast cancer during a time of changes to the standard of care across racial/ethnic groups and practice settings. IMPACT:These findings emphasize the need for improved access to evidence-based therapies, particularly in underrepresented populations.
OBJECTIVE:Up to 1.6% of patients with endometriosis develop epithelial ovarian carcinoma. The genetic overlap between endometriosis and ovarian cancer has not been fully characterized. This review aims to describe the current literature on mutations correlated with endometriosis-associated epithelial ovarian carcinoma. METHODS:In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO ID: CRD42023400697), Cochrane Library, Embase, PubMed, Scopus, and Web of Science Core Collection databases were queried from January 1st, 1995, to April 1st, 2022 for English language studies on the genetic basis of endometriosis-associated epithelial ovarian carcinoma. The quality of included studies was assessed using the Newcastle-Ottawa Scale. RESULTS:Search criteria yielded 18,639 articles, of which 30 met inclusion criteria. 70 genes were assessed in the 30 included studies, and 9 of these appeared in two or more studies. The most frequently mutated genes were PIK3CA, PTEN, ARID1A and CTNNB1. None of these genes had a mutation frequency greater than 0.5 when data from all 30 studies were aggregated. Stratification by epithelial ovarian cancer subtype revealed an association between CTNNB1 mutation and endometrioid carcinoma (47/97; 48.4%) compared to clear cell carcinoma (4/38; 10.5%) (p = 0.00004). CONCLUSIONS:Due to the low mutation frequency of commonly studied genes, cumulative mutational burden may better explain the progression and pathogenesis of endometriosis-associated epithelial ovarian carcinoma than any single mutation. CTNNB1 may be associated with the development of endometrioid ovarian carcinoma. Future studies may consider the use of polygenic scores for risk assessment of endometriosis-associated ovarian cancer.
BACKGROUND:Reoperation rates following penile prosthesis implantation are influenced by patient- and device-related factors. While previous studies from high-volume centers have reported 5 to 10-year reoperation rates of 11%-16%, these findings may not fully capture outcomes in broader, real-world populations. AIM:This study aimed to assess long-term complication and reoperation rates for penile prostheses using a global electronic health records database. METHODS:We conducted a retrospective observational analysis using electronic health records and insurance claims from the TriNetX Global Health Research Network, covering May 2005 to May 2025. Men aged 18-90 who underwent initial implantation of either an inflatable or semi-rigid penile prosthesis (SRPP) were included. Statistical comparisons between cohorts used two-sample Z-tests, with significance set at P < .05. OUTCOMES:Outcomes included device revision or reimplantation, explantation, infection, mechanical failure, and displacement. RESULTS:Among 29 385 men, 18 749 received inflatable prostheses and 10 636 received semi-rigid devices. At 5 years, the revision/removal rate was not significantly lower for inflatable devices (13.9%) compared to semi-rigid implants (13.7%; P < .77). Total explantation rates were lower for inflatable prostheses at 5 years (6.5% vs. 8.4%, P < .00001). Mechanical breakdown was more common in the inflatable cohort at 5 years (9.1% vs. 6.7%; P ≤ .0001). There was also a significantly higher rate of device displacement for inflatable prostheses at 5 years (2.3% vs. 1.6%; P = .002). There were no differences in infection rates between devices over time. CLINICAL IMPLICATIONS:This analysis found that inflatable penile prostheses (IPPs) are associated with similar long-term revision and lower explantation rates compared to semi-rigid devices, but more prone to mechanical breakdown and displacement. These findings support the use of inflatable prostheses in appropriate patients seeking lower rates of device removal and underscore the importance of real-world data in surgical decision-making. STRENGTHS & LIMITATIONS:The strengths of this study include its large sample size, applicability, and the use of a global clinical dataset integrating claims and electronic health record data to reduce missing information. However, several limitations should be acknowledged. TriNetX does not account for variation in surgical technique, device manufacturer, or surgeon experience. In addition, reliance on administrative codes may underreport complications or omit clinical nuances. Retrospective and observational studies are also limited by inherent biases, incomplete data, and inability to establish causality, which constrain the interpretation. CONCLUSION:In this large-scale, real-world analysis, IPPs were associated with similar long-term revision and significantly lower removal rates compared to SRPPs.
BACKGROUND:Cardiac rehabilitation (CR) is a secondary prevention program that is associated with a decrease all-cause mortality. Physical inactivity is a major risk factor for disease, and long-term physical activity (PA) adherence is an essential component of CR. The purpose of this study is to assess self-reported PA adherence 1 year after CR completion. We hypothesize that individuals would not meet nationally recommended Physical Activity Guidelines (PAG) 1-year post-CR, but males would meet PAG at higher rates than females. METHODS:Using a prospective, cross-sectional design, 172 CR graduates completed the International Physical Activity Questionnaire-Short Form telephone survey on self-reported PA and sitting time. Meeting PAG was defined as ≥150 minutes of moderate PA, ≥75 minutes of vigorous PA, or any combination of ≥150 minutes of moderate to vigorous PA. RESULTS:The cohort (n = 172; 38 [19%] female; mean age 67 ± 11 y, range 35-90) attended 31 ± 8 (of 36) CR sessions and were surveyed 13.6 (2.7) months post-CR (76.1% response rate). Participants reported an average of 97 ± 125 min/week of moderate to vigorous PA, with 32% (n = 55, 80% male) meeting PAG and 5.3 ± 3.3 hr/day of sitting. There were no sex differences in how PAG was met or in minutes per day, days per week, or sitting time. CONCLUSION:Only 32% of CR graduates met PAG 1-year post-CR, with both sexes failing to achieve national guidelines. Significance/Implications: Providers should recognize that patients often fail to meet PAG after CR, undermining CR's long-term goals. Continued interventions targeting both sexes are needed to promote sustained long-term PA to support disease prevention.
Background/Objectives: Choline plays an important role in maintaining normal cellular function and overall physiology. Endogenous choline availability depends on the synthesis of phosphatidylcholine via the phosphatidylethanolamine N-methyltransferase (PEMT) pathway. Expression of PEMT is influenced by estrogen, as its promoter contains multiple estrogen-responsive elements that enhance enzyme activity. How a low estrogenic condition like menopause influences choline's effect on the brain is not yet fully understood. Methods: In this pilot study, 20 women participated in two study days, with 1650 mg of oral choline bitartrate or a matching placebo administered three hours before a functional and structural magnetic resonance imaging (MRI) scan. Blood oxygen level dependent (BOLD) functional MRI scans were collected on each study day while subjects performed an N-back working memory task. Results: In this pilot study, no differences in working memory performance were observed, but decreased activation was found for the choline compared to the placebo during the 2-back compared to 0-back conditions in regions of the right temporal lobe (p < 0.001 voxel-level threshold, and p-FDR < 0.05 cluster-size threshold). When we seeded the right planum temporale to examine its functional connectivity with the rest of the brain, we found that choline modulated a large portion of the working memory network during the difficult memory load condition. Conclusions: These results in this pilot study illustrate the effect of choline on working memory-related brain activation and functional connectivity in postmenopausal women. We propose that choline may increase brain functional efficiency in low estrogenic conditions like menopause, but further studies are needed.
