Publications by authors named "J Weir"

675 Publications

Predictors of Pathologic Response After Total Neoadjuvant Therapy in Patients With Rectal Adenocarcinoma: A National Cancer Database Analysis.

Cureus 2021 Aug 16;13(8):e17233. Epub 2021 Aug 16.

Radiation Oncology, West Virginia University School of Medicine, Morgantown, USA.

Purpose/objectives Induction chemotherapy followed by chemoradiation and surgical resection in rectal cancer, known as total neoadjuvant therapy (TNT), is associated with improved pathologic complete response (pCR) rates. The National Cancer Database was utilized to identify factors associated with pCR and survival following treatment with TNT compared to standard neoadjuvant chemoradiation (nCRT). Materials/methods The National Cancer Database was queried from 2004 to 2015 for patients with locally advanced, non-metastatic rectal cancer. We identified 16,299 patients receiving neoadjuvant chemotherapy and radiation followed by definitive surgical resection. Patients were stratified by treatment received, either TNT (n=350) or nCRT (n=15,949). Multivariate binomial regression analysis and propensity matching were used to evaluate predictors of pCR. Kaplan-Meier and Cox multivariate analysis of survival were performed. Results Median follow-up was 38 months vs 53 months in the TNT vs nCRT groups, respectively. There were more patients with T4 or node-positive disease in the TNT group. There was a trend towards improved pCR in the TNT group (p=0.053). Patients achieving pCR had improved 5-year overall survival (OS) of 85.1%. The 5-year OS was not improved for TNT (76.2%) over nCRT (69.9%) (p=0.19). Pelvic nodal pCR was significantly higher in the TNT group (72%). When stratified by clinical stage, patients with cT3 (p=0.038) or cN1 (p=0.049) disease had improved OS with TNT. Conclusions Compared to nCRT, TNT is correlated with higher rates of complete pelvic nodal clearance in patients with locally advanced rectal adenocarcinoma. The use of TNT showed improved survival in patients with cT3 and cN1 disease, indicating a potential benefit for patients with less advanced disease.
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http://dx.doi.org/10.7759/cureus.17233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443326PMC
August 2021

Use of Mayer wave activity to demonstrate aberrant cardiovascular autonomic control following sports concussion injury.

Ann N Y Acad Sci 2021 Sep 3. Epub 2021 Sep 3.

Department of Health, Sport and Exercise Sciences, University of Kansas, Lawrence, Kansas.

Dysregulation of cardiovascular autonomic control is gaining recognition as a prevailing consequence of concussion injury. Characterizing the presence of autonomic dysfunction in concussed persons is inconsistent and conventional metrics of autonomic function cannot differentiate the presence/absence of injury. Mayer wave (MW) activity originates through baroreflex adjustments to blood pressure (BP) oscillations that appear in the low-frequency (LF: 0.04-0.15 Hz) band of the BP and heart rate (HR) power spectrum after a fast Fourier transform. We prospectively explored MW activity (∼0.1 Hz) in 19 concussed and 19 noninjured athletes for 5 min while seated at rest within 48 h and 1 week of injury. MW activity was derived from the LF band of continuous digital electrocardiogram and beat-to-beat BP signals (LFHR, LF-SBP, MWHR, and MW-SBP, respectively); a proportion between MWBP and MWHR was computed (cMW). At 48 h, the concussion group had a significantly lower MWBP and cMW than controls; these differences were gone by 1 week. MWHR, LFHR, and LF-SBP were not different between groups at either visit. Attenuated sympathetic vasomotor tone was present and the central autonomic mechanisms regulating MW activity to the heart and peripheral vasculature became transiently discordant early after concussion with apparent resolution by 1 week.
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http://dx.doi.org/10.1111/nyas.14683DOI Listing
September 2021

The use of a synthetic skin membrane (Biobrane) in a paediatric patient with toxic epidermal necrolysis (TEN): Looking beyond the burn.

Clin Exp Dermatol 2021 Aug 25. Epub 2021 Aug 25.

Department of Dermatology, St Mary's Hospital, London, UK.

A ten-year-old previously healthy girl became acutely unwell with fever and abdominal pain. She was initially treated with paracetamol and ibuprofen. The following day she developed a pruritic, maculopapular rash on her torso and limbs. A suspected diagnosis of Kawasaki's disease was made, and she was given a single dose of intravenous immunoglobulin. She was also started on aspirin, ceftriaxone and aciclovir. The next day she developed painful ulceration of the oral cavity and was transferred to our hospital for further care.
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http://dx.doi.org/10.1111/ced.14913DOI Listing
August 2021

Radiation Toxicity in Patients With Collagen Vascular Disease: A Meta-analysis of Case-Control Studies.

Int J Radiat Oncol Biol Phys 2021 Aug 19. Epub 2021 Aug 19.

Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Maywood, Illinois.

Purpose: Several retrospective series have reported that patients with collagen vascular disease (CVD) are at increased risk of radiation (RT) toxicity. However, the evidence is mixed, and many series lack control groups. We performed a meta-analysis including only case-cohort or randomized studies that examined the risk of RT toxicity for patients with CVD compared with controls.

Methods And Materials: Meta-analysis of Observational Studies in Epidemiology guidelines were used to perform a comprehensive search identifying case-control or randomized studies reporting RT toxicity outcomes for patients with CVD versus controls. Data were synthesized from studies reporting grade 2 to 3 or more (G2/3 +) acute and late RT toxicities. Results were analyzed with fixed effects meta-analysis on the random-effects model for between-study heterogeneity; otherwise, the fixed-effects model was used. Hazard ratio or odds ratio (OR) were the effect-size estimators, as appropriate.

Results: Ten studies were included, with 4028 patients (CVD: 406, control: 3622). Patients with CVD had higher rates of acute G2/3 + toxicity (26.2% vs 16.5%, OR [odds ratio] 2.01; P < .001) and late G2/3 + toxicity (18.4% vs 10.1%, OR 2.37; P < .001). Higher rates of late G2/3 + toxicity were observed for CVD patients with systemic lupus erythematous (21% vs 9.7%; OR 2.55, P = .03), systemic scleroderma (31.8% vs 9.7%, OR 3.85; P = .03), rheumatoid arthritis (11.7% vs 8.4%, OR = 2.56; P = .008), and those irradiated to the pelvis/abdomen (32.2% vs 11.9%, OR 3.29; P = .001), breast (14.7% vs 4.4%, OR 3.51; P = .003), thorax (12.5% vs 8.7%, OR 3.46; P < .001), and skin (14.6% vs 5.2%, OR 2.59; P = .02). Late grade 5 toxicities were significantly higher for patients with CVD, although absolute rates were low (3.9% vs 0.6%, OR = 7.81; P = .01).

Conclusions: Moderate and severe toxicities are more likely in patients with CVD, with variable risk depending on toxicity grade, CVD subtype, treatment site, and dose. Severe toxicities are uncommon. These factors should be considered when informing patients of treatment-related risks and monitoring for morbid treatment sequelae.
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http://dx.doi.org/10.1016/j.ijrobp.2021.08.006DOI Listing
August 2021

Survival Outcomes for p16-positive Oropharyngeal Squamous Cell Carcinoma Based on Human Papillomavirus Status.

Clin Oncol (R Coll Radiol) 2021 Aug 16. Epub 2021 Aug 16.

Clinical Oncology Department, Charing Cross Hospital, Imperial College Healthcare Trust, London, UK; Department of Surgery and Cancer, Imperial College, London, UK.

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http://dx.doi.org/10.1016/j.clon.2021.08.001DOI Listing
August 2021
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