Survival outcomes for patients with T3N0M0 squamous cell carcinoma of the glottis treated with definitive radiation alone versus chemoradiation

alexandrossfakianakis shared this article with you from Inoreader Survival outcomes for patients with T3N0M0 squamous cell carcinoma of the glottis treated with definitive radiation alone versus chemoradiation via Head & Neck Abstract Background Given the poor lymphatics of the glottis, we evaluated omission of chemotherapy in patients treated definitely for T3N0M0 squamous cell carcinoma (SCC) of the glottis. Methods We performed survival analysis of patients with T3N0M0 SCC of the glottis identified in the National Cancer Database treated with radiation alone versus chemoradiation. Results A total of 3785 patients were identified. Patients age ≥70 and those with comorbidities were less likely to receive chemotherapy (odds ratio [OR] 0.30, 95% CI [0.25–0.37] and 0.48 [0.31–0.76], respectively). Five-year OS was lower in patients treated with radiation versus chemoradiation (33.8% [30.3%–37.2%] vs. 58.0% [55.8%–60.0%]). In patients <70 with no comorbidities this difference persisted (51.0% [44.5%–57.0%] versus 66.7% [64.0%–69.3%]). Conclusion Overall survival was higher in patients treated with chemoradiation compared to radiation alone, even when controlling for age and comorbidities. Radiotherapy with chemotherapy omission is not appropriate in patients with T3N0M0 SCC of the glottis. View on Web

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Pre‐treatment or post‐treatment with hydroxychloroquine demonstrate neuroprotective effects in cerebral ischemia/reperfusion

alexandrossfakianakis shared this article with you from Inoreader Pre‐treatment or post‐treatment with hydroxychloroquine demonstrate neuroprotective effects in cerebral ischemia/reperfusion via Fundamental & Clinical Pharmacology Abstract Background and Objectives Stroke is a serious life-threatening medical condition and is one of the principal reasons for death and disabilities worldwide. The aim of the present study was to determine the neuroprotective effects of hydroxychloroquine (HCQ) and the timing of its administration in cerebral ischemia/reperfusion (I/R) in rats. Methods A global I/R model was used and HCQ was administered in either pre- or post-treatment doses of 25 and 50 mg/kg. Effects of HCQ on infarct size, histological changes, oxidative stress, as well as learning and memory were evaluated. Phospho-AMPK and SQSTM1/p62 protein levels were also measured to elucidate the possible mechanisms involved. Results HCQ in both pre-(at doses of 25 and 50 mg/kg) or post-treatment (at a dose of 50 mg/kg) protocols reduces brain infarct size and histopathological changes and improves learning and memory after cerebral I/R. Pre-treatment with HCQ reduced AMPK activity with no significant effect on SQSTM1/p62 increment. Post-treatment with HCQ increased AMPK activity and SQSTM1/p62 protein levels. Conclusion Our results show the neuroprotective effects of HCQ on cerebral I/R through the reduction in infarct size, histopathological changes, as well as improvement in memory and learning functions. Moreover, AMPK and autophagy may play a role in this protective effect. View on Web

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Clinical and laboratory features and factors predicting disease severity in pediatric patients with hemorrhagic fever with renal syndrome caused by Hantaan virus

alexandrossfakianakis shared this article with you from Inoreader Clinical and laboratory features and factors predicting disease severity in pediatric patients with hemorrhagic fever with renal syndrome caused by Hantaan virus via Journal of Medical Virology Abstract The clinical features and factors associated with disease severity in children with hemorrhagic fever with renal syndrome (HFRS) have not been well characterized. This study analyzed the clinical and laboratory factors associated with disease severity in children with HFRS caused by Hantaan virus. Data in pediatric patients with HFRS were retrospectively collected from Xi'an Children's Hospital over a 9-year period. Independent factors associated with disease severity were identified. Nomogram predicting disease severity was constructed based on variables filtered by feature selection. In total, 206 children with HFRS were studied. Fever, digestive tract symptoms, headache, backache, bleeding and renal injury signs were the common symptoms. Elevated white blood cell, reduced platelet, hematuria, proteinuria, coagulation abnormalities, increased blood urea nitrogen (BUN) and procalcitonin (PCT), decreased estimated glomerular filtration rate and low serum Na< sup>+, Cl- and Ca2+ were the common laboratory findings. In the 206 patients, 21 patients had critical type disease and 4 patients (1.9%) died. Hydrothorax, hypotension and cerebral edema/cerebral herniation at hospital admission were independent clinical characteristics, and neutrophil %, prothrombin activity, PCT, BUN and Ca2+ at hospital admission were independent laboratory factors associated with critical disease. Feature selection identified BUN, PCT and prothrombin time as independent factors related to critical disease. A nomogram integrating BUN and PCT at admission was constructed and calibration showed high accuracy for the probability prediction of critical disease. In conclusion, this study characterized the clinical and laboratory features and constructed a nomogram predicting disease severity in pediatric HFRS, providing references for disease severity evaluation in managing children HFRS. This article is protected by copyr ight. All rights reserved. View on Web

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Optimal exposure to docetaxel in adjuvant chemotherapy for early‐stage breast cancer

alexandrossfakianakis shared this article with you from Inoreader Optimal exposure to docetaxel in adjuvant chemotherapy for early‐stage breast cancer via Journal of Clinical Pharmacy and Therapeutics Among the 70 participants, 47 (67.1%) developed severe neutropenia. The PopPK analysis showed that the typical drug clearance (CL) rate was 37.4 L/h. Age was a significant covariate of CL rate, and aspartate aminotransferase and albumin levels were covariables of the volume of distribution. The AUC estimated using the maximum a posteriori Bayesian method can predict the toxicity of docetaxel in patients with breast cancer. Docetaxel AUC >3.0 mg h/L, platinum and baseline haemoglobin level are risk factors for docetaxel-induced grade 3/4 neutropenia. The AUC of first cycle may not predict the occurrence rates of grade 3/4 neutropenia in later cycles. Abstract What Is Known and Objective Drug-induced neutropenia is the main reason for the dose limitation of docetaxel in patients with breast cancer. The area under the drug concentration-time curve (AUC) of docetaxel is associated with neutropenia. However, the optimal exposure to docetaxel for receiving postoperative adjuvant chemotherapy remains unclear. Therefore, we aimed to evaluate the relationship between the docetaxel AUC and neutropenia, identify potential influencing factors, and explore the best monitoring target for docetaxel when treating patients with early-stage breast cancer using a population pharmacokinetic (PopPK) model. Methods Docetaxel plasma concentration, demographics, clinical data, and related laboratory data were collected. PopPK analyses were performed using a nonlinear mixed-effect modelling program. The docetaxel AUC was determined using the maximum a posteriori Bayesian (MAPB) method. The docetaxel exposure-toxicity threshold measured from the AUC for neutropenia was determined using the receiver operating characteristic (ROC) curve. The correlation between docetaxel exposure and neutropenia was analysed using multivariable logistic regression. Results Among the 70 participants, 47 (67.1%) developed severe neutropenia. The PopPK analysis showed that the typical drug clearance (CL) rate was 37.4 L/h. Age was a significant covariate of CL rate, and aspartate aminotransferase and albumin levels were covariables of the volume of distribution. The multivariable regression analysis showed that AUC >3.0 mg.h/L (odds ratio [OR], 5.940; 95% confidence interval [CI], 1.693–20.843; P = 0.005), platinum use (OR, 0.156; 95% CI, 0.043–0.562; P = 0.005) and baseline haemoglobin level (OR, 0.938; 95% CI, 0.887–0.993; P = 0.027) were significant factors influencing the occurrence of grade 3/4 neutropenia. The AUC of first cycle may not predict the occurrence rates of grade 3/4 neutropenia in later cycles. What Is New and Conclusion We developed a docetaxel PopPK model for patients with early-stage breast cancer. Age and AST and ALB levels were significant covariates. AUC estimated using the MAPB method can predict the toxicity of docetaxel in patients with breast cancer. Docetaxel AUC >3.0 mg.h/L, absence of platinum use and low baseline haemoglobin level were risk factors for docetaxel-induced grade 3/4 neutropenia. Study Registration Chinese Clinical Trial Center Registry (ChiCTR2200056460). View on Web

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Surgical interventions for the treatment of peri‐implantitis

alexandrossfakianakis shared this article with you from Inoreader Surgical interventions for the treatment of peri‐implantitis via Clinical Implant Dentistry and Related Research Abstract Background Peri-implantitis constitutes one of the most frequent late dental implant complications. The disease is initiated by bacterial infection; therefore, anti-infective peri-implantitis treatment strategies are required to arrest the progressive marginal bone loss and maintain the affected implant in function. Although nonsurgical treatment strategies appear to be of limited predictability, treatment outcomes have been frequently improved following surgical interventions. Purpose The present narrative review describes various surgical peri-implantitis treatment modalities, with respect to their indications, performance, and effectiveness. Materials and Methods The present narrative review considered the most relevant studies in the field published in the English language. Results Surgical peri-implantitis treatment approaches can be categorized as nonreconstrucive therapy, reconstructive therapy, and combined therapy (ie, reconstructive and resective therapy). In addition to disease resolution, reconstructive approaches also seek to regenerate the bone defect and achieve reosseointegration. Conclusions The severity of the disease, the regenerative potential of the defetc and esthetic demands of the patient are the factors determining the surgical peri-implantitis treatment modality. View on Web

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Impact of maximal extent of resection on postoperative deficits, patient functioning and survival within clinically important glioblastoma subgroups

alexandrossfakianakis shared this article with you from Inoreader Impact of maximal extent of resection on postoperative deficits, patient functioning and survival within clinically important glioblastoma subgroups via Neuro-Oncology Advance Access Abstract Background The impact of extent of resection (EOR), residual tumor volume (RTV), and gross-total resection (GTR) in glioblastoma subgroups is currently unknown. This study aimed to analyze their impact in patient subgroups in relation to neurological and functional outcomes. Methods Patients with tumor resection for eloquent glioblastoma between 2010 and 2020 at four tertiary centers were recruited from a cohort of 3919 patients. Results One thousand and forty-seven (1047) patients were included. Higher EOR and lower RTV were significantly associated with improved OS and PFS across all subgroups, but RTV was a stronger prognostic factor. GTR based on RTV improved median OS in the overall cohort (19.0 months, p<0.0001), and in the subgroups with IDH wildtype tumors (18.5 months, p=0.00055), MGMT methylated tumors (35.0 months, p<0.0001), aged <70 (20.0 months, p<0.0001 ), NIHSS 0-1 (19.0 months, p=0.0038), KPS 90-100 (19.5 months, p=0.0012), and KPS ≤ 80 (17.0 months, p=0.036). GTR was significantly associated with improved OS in the overall cohort (HR 0.58, p=0.0070) and improved PFS in the NIHSS 0-1 subgroup (HR 0.47, p=0.012). GTR combined with preservation of neurological function (OFO 1 grade) yielded the longest survival times (median OS 22.0 months, p <0.0001), which was significantly more frequently achieved in the awake mapping group (50.0%) than in the asleep group (21.8%) (p<0.0001). Conclusions Maximum resection was especially beneficial in the subgroups aged <70, NIHSS 0-1, and KPS 90-100 without increasing the risk of postoperative NIHSS or KPS worsening. These findings may assist surgical decision making in individual glioblastoma patients. View on Web

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Rate of atypical nodal metastases in surgically treated HPV‐associated oropharyngeal squamous cell carcinoma

alexandrossfakianakis shared this article with you from Inoreader Rate of atypical nodal metastases in surgically treated HPV‐associated oropharyngeal squamous cell carcinoma via Head & Neck Abstract Background Understanding of nodal metastasis in patients with HPV+ oropharyngeal squamous cell carcinoma (OPSCC) is warranted. Methods Patients with HPV+ OPSCC who underwent neck dissection (ND) between 2016 and 2021 were reviewed. Pathology reports were reviewed for lymph node (LN) metastases. Noncontiguous metastases were defined as pathologic evidence of level II disease with another involved LN in a noncontiguous neck level. Skip metastases were defined as pathologic lymph node(s) in the neck without disease in level II. Results One hundred and thirty-one patients underwent levels II–IV ND with a mean (SD) LN yield of 33.3 (±13.5). The rate of atypical metastases in both the therapeutic and elective ND cohort was 5%. The noncontiguous and skip metastases were in level IV (n = 2) and level III (n = 4), respectively. Conclusions Skip and noncontiguous metastases were rare in patients with HPV+ OPSCC undergoing surgical treatment. Surgeons may consider a selective ND omitting Level IV in select patients with HPV+ OPSCC undergoing surgery. View on Web

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Predictive effect of pretreatment nutritional risk and GLIM‐defined malnutrition on the nutrition impact symptom clusters in patients with head and neck cancer undergoing radiotherapy

alexandrossfakianakis shared this article with you from Inoreader Predictive effect of pretreatment nutritional risk and GLIM‐defined malnutrition on the nutrition impact symptom clusters in patients with head and neck cancer undergoing radiotherapy via Head & Neck Abstract Background Evidence supporting predictive effects of pretreatment nutritional risk and nutritional status on nutrition impact symptom (NIS) clusters during radiotherapy in patients with head and neck cancer (HNC) is insufficient. Methods At baseline (T1), we collected severity and interference of NIS (Head and Neck Patient Symptom Checklist), nutritional risk, and nutritional status. During (T2) and at the end of radiotherapy (T3), we re-evaluated NIS. Symptom clusters were identified by exploratory factor analysis using mean scores of NIS severity at T2 and T3. Predictive effects were explored by generalized estimating equations. Results Five hundred thirty-seven patients were recruited and 334 of them completed. Four clusters were identified; the oropharyngeal symptom cluster was the most severe and had the greatest interference with diet. Patients with pretreatment nutritional risk or malnutrition experienced more severe oropharyngeal symptom cluster. Conclusions Pretreatment nutritional risk or malnutrition could predict the oropharyngeal symptom cluster in patients with HNC undergoing radiotherapy. View on Web

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Periodontitis is associated with the development of fungal sinusitis: A nationwide 12‐year follow‐up study

alexandrossfakianakis shared this article with you from Inoreader Periodontitis is associated with the development of fungal sinusitis: A nationwide 12‐year follow‐up study via Journal of Clinical Periodontology Abstract Aims The incidence of fungal sinusitis is increasing; however, its pathophysiology has not been investigated previously. This study investigated the effect of periodontitis on the incidence of fungal sinusitis over a 12-year follow-up period using nationwide, population-based data. Materials and Methods The periodontitis group was randomly selected from the National-Health-Insurance-Service database. The non-periodontitis group was obtained by propensity score matching considering several variables. The primary end point was the diagnosis of sinonasal fungal balls and invasive fungal sinusitis. Results The periodontitis and non-periodontitis groups included 12442 and 12442 individuals, respectively. The overall adjusted hazard ratio (aHR) for sinonasal fungal balls in the periodontitis group was 1.46 (p=0.002). In subgroup analysis, the aHR for sinonasal fungal balls was 1.59 (p=0.008) for those with underlying chronic kidney disease (CKD), 1.58 (p=0.022) for those with underlying atopic dermatitis, 1.48 (p=0.019) for those with chronic obstructive pulmonary disease (COPD), and 1.36 (p=0.030) for those with diabetes mellitus (DM), but these values are only applicable when considering the relationship between periodontitis and SFB. The aHR for invasive fungal sinusitis (IFS) in the periodontitis group was higher than in the non-periodontitis group (2.80; p=0.004). Conclusions The risk of sinonasal fungal balls and IFS increased after diagnosis of periodontitis. This trend is often more severe in patients with DM, COPD, or CKD, but this association with underlying diseases is only applicable when considering the association between periodontitis and fungal sinusitis. View on Web

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Association between periodontitis and chronic kidney disease by functional atherosclerosis status among older Japanese individuals: a cross‐sectional study

alexandrossfakianakis shared this article with you from Inoreader Association between periodontitis and chronic kidney disease by functional atherosclerosis status among older Japanese individuals: a cross‐sectional study via Journal of Clinical Periodontology Abstract Aims This study aimed to clarify the influence of functional atherosclerosis on the association between periodontitis and chronic kidney disease (CKD). Methods A cross-sectional study of 998 older Japanese individuals aged 60–99 years who participated in an oral health check-up was conducted. Early and advanced periodontitis were defined as periodontal pocket depth 4.0–5.9 mm and ≥6.0 mm, respectively. Functional atherosclerosis was defined as cardio-ankle vascular index (CAVI) ≥9.0. Results Of the 998 study participants, 238 (23.8%) had CKD. No significant associations between periodontitis and CKD were observed in participants without functional atherosclerosis. After adjusting for known cardiovascular risk factors, the odds ratio (OR) (95% confidence interval [CI]) was 1.31 (0.81, 2.11) for early periodontitis and 0.74 (0.41, 1.34) for advanced periodontitis. Significant positive associations were observed for participants with functional atherosclerosis; the adjusted ORs (95%CIs) were 1.76 (1.04, 3.01) for early periodontitis and 1.95 (1.05, 3.63) for advanced periodontitis, respectively. Conclusions A significant positive association between periodontitis and CKD was established for older participants with functional atherosclerosis. No significant associations were observed for those without functional atherosclerosis. These results can help clarify the influence of periodontitis on systemic circulation. View on Web

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