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REPLYWe appreciate the comments by Almasi-Hashiani et al about our recent work. 1 In our study, the incidence of metachronous ovarian cancer after ovarian conservation for young women with early-stage cervical cancer was examined by the use of a population-based tumor registry in the United States. We found that there were only 13 of 4365 women (0.3%) who experienced the development of metachronous ovarian cancer during the follow-up period. We agree with their concern that the number for metachronous ovarian cancer cases is relatively small to perform detailed analysis of risk factors. Because the primary objective of our study was to examine the incidence of metachronous ovarian cancer after ovarian conservation, we believe that the low incidence of metachronous ovarian cancer that was found in our study is indeed reassuring for care providers and patients when ovarian conservation is discussed in the treatment plan of early-stage cervical cancer.We agree that confidence intervals of the point estimates for the associations of various factors with metachronous ovarian cancer are wide, given the small number of events. Confidence intervals are provided so that readers can understand the degree of uncertainty for the point estimates. We thank Almasi-Hashiani et al for their suggestions for alternative statistical approaches to enrich the methods for the analysis of risk factors that are associated with metachronous ovarian cancer after ovarian conservation. Again, because this was not the primary objective of the study but rather a secondary objective, we respectfully would defer further exploration for additional studies. Proportional hazard assumption in our model was satisfied.Given the frequency of cervical cancer in young women, the possibility of ovarian conservation is of great interest. Clearly, further work to define the risk of metachronous ovarian cancer and risk factors for the development of ovarian lesions is needed. 2 -

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I read with great interest the discussion by Ramchand et al. of the Deepwater Horizon oil spill's impact on US Gulf Coast residents. 1 The authors should be commended for an interesting study that highlights the importance of considering behavioral health in disaster mitigation, preparedness, response, and recovery. I offer the following comments and observations.