Long-term Locoregional Control With Unilateral Radiation for AJCC-7 T1-2N2b Tonsillar Cancer

alexandrossfakianakis shared this article with you from Inoreader Long-term Locoregional Control With Unilateral Radiation for AJCC-7 T1-2N2b Tonsillar Cancer via American Journal of Clinical Oncology - Current Issue Objectives: Unilateral radiation to cervical nodes has been used as a de-escalation strategy in well-lateralized tonsil cancers. The efficacy of this approach with multiple ipsilateral nodes is not established. The study hypothesis was that unilateral radiation for American Joint Committee on Cancer (AJCC)-7 T1-2N2b tonsillar cancer results in a low rate of contralateral nodal failure. Materials and Methods: This study was a retrospective chart review of patients with AJCC-7 T1-2N2b tonsillar cancer from 2 academic institutions who were treated with unilateral radiation. The primary endpoint was the contralateral nodal failure rate. Locoregional control, overall survival, and the need for gastrostomy tube placement were additional endpoints. Results: The study cohort included 66 patients treated between 2005 and 2016. The median follow-up time was 80.9 months; contralateral nodal failure occurred in 2/66 (3.0%) patients at 4.1 and 20.9 months, respectively. Both patients underwent salvage treatment with long-term subsequent survival. Overall locoregional control at both 2 and 5 years was 93.9% and the median duration of control was not reached. Overall survival at 5 years was 92.4%. Conclusions: The use of unilateral radiation for AJCC-7 T1-2N2b tonsillar cancer resulted in low rates of contralateral nodal failure. This outcome demonstrates the safety of considering unilateral radiation treatment in patients with a relatively high ipsilateral nodal burden. View on Web

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A Novel Nomogram for Predicting Breast Cancer–specific Survival in Male Patients

alexandrossfakianakis shared this article with you from Inoreader A Novel Nomogram for Predicting Breast Cancer–specific Survival in Male Patients via American Journal of Clinical Oncology - Current Issue Objectives: To compare breast cancer–specific survival (BCSS) of nonmetastatic invasive breast cancer between male (MBC) and female (FBC) patients, define clinicopathologic variables related to BCSS in nonmetastatic invasive MBC patients, and establish a nomogram for individual risk prediction. Materials and Methods: On the basis of Surveillance, Epidemiology, and End Results database, 2094 MBC and 48,104 FBC cases underwent propensity score matching (PSM). We compared the prognosis of patients before and after PSM and developed a nomogram for BCSS of nonmetastatic invasive MBC patients. Internal validation was performed using the consistency index, calibration curves, and receiver operating characteristic curves. Simultaneously, data from 49 nonmetastatic invasive MBC patients diagnosed between January 2012 and May 2016 were collected for external validation. Results: Before PSM, overall survival and BCSS were significantly shorter in MBC than those in FBC patients. After PSM, MBC patients continued to have a shorter overall survival, but not BCSS, than FBC patients. Marital status, age, histologic grade, estrogen/progesterone receptor status, Tumor Lymph Node stage, and surgery were included in the prediction model. Conclusions: The nomogram developed in this study seems to be more accurate than conventional Tumor-nodal-metastasis staging staging to predict BCSS and may serve as an effective tool for assessing the prognosis of nonmetastatic invasive MBC. View on Web

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Tumor Volume Predicts for Pathologic Complete Response in Rectal Cancer Patients Treated With Neoadjuvant Chemoradiation

alexandrossfakianakis shared this article with you from Inoreader Tumor Volume Predicts for Pathologic Complete Response in Rectal Cancer Patients Treated With Neoadjuvant Chemoradiation via American Journal of Clinical Oncology - Current Issue Objectives: Nonoperative management (NOM) of locally advanced rectal cancer is an emerging approach allowing patients to preserve their anal sphincter. Identifying clinical factors associated with pathologic complete response (pCR) is essential for physicians and patients considering NOM. Materials and Methods: In total, 412 locally advanced rectal cancer patients were included in this retrospective analysis. Tumor volumes were derived from pretreatment MRI. Clinical parameters such as tumor volume, stage, and location were analyzed by univariate and multivariate analysis, against pCR. A receiver operator characteristic curve was generated to identify a tumor volume cut-off with the highest clinically relevant Youden index for predicting pCR. Results: Seventy-five of 412 patients (18%) achieved pCR. A tumor volume threshold of 37.3 cm3 was identified as predictive for pCR. On regression analysis, a tumor volume >37.3 cm3 was associated with a greater than 78% probability of not achieving pCR. On multivariate analysis, a GTV 4.85 cm was associated with pCR on univariate (OR=3.03, P View on Web

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Point‐of‐care testing allows successful simultaneous screening of sickle cell disease, HIV, and tuberculosis for households in rural Guinea‐Bissau, West Africa

alexandrossfakianakis shared this article with you from Inoreader Point‐of‐care testing allows successful simultaneous screening of sickle cell disease, HIV, and tuberculosis for households in rural Guinea‐Bissau, West Africa via Pediatric Blood & Cancer Abstract Diagnosis of noncommunicable genetic diseases like sickle cell disease (SCD) and communicable diseases such as human immunodeficiency virus (HIV) or tuberculosis (TB) is often difficult in rural areas of Africa due to the lack of infrastructures, trained staff, or capacity to involve families living in remote areas. The availability of point-of-care (POC) tests for the above diseases offers the opportunity to build joint programs to tackle all conditions. We report successful simultaneous screening of SCD, HIV, and TB utilizing POC tests in 898 subjects in Fanhe, in rural Guinea-Bissau. Adherence was 100% and all diagnosed subjects were enrolled in care programs. View on Web

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Controlling Nutritional Status (CONUT) score is a prognostic marker for laryngeal cancer patients with curative resection

alexandrossfakianakis shared this article with you from Inoreader Controlling Nutritional Status (CONUT) score is a prognostic marker for laryngeal cancer patients with curative resection via Head & Neck Abstract Background To investigate the prognostic value of pre-treatment Controlling Nutritional Status (CONUT) score in laryngeal cancer. Methods Preoperative CONUT score was retrospectively calculated in 154 laryngeal cancer patients who underwent curative resection in our hospital from 2013 to 2016. The associations of CONUT with clinicopathological factors and survival were evaluated. The efficacy of CONUT score to predict prognosis was evaluated. Results The CONUT score was associated with body mass index (p = 0.033), neutrophil (p = 0.011), tumor size (p = 0.017), pTNM stage (p = 0.001), adjuvant radiotherapy (p < 0.001), negative pathologic factors (p < 0.001), and larynx preservation (p < 0.001). Patients with a higher CONUT score had worse overall survival (hazard ratio: 1.94, 95% confidence interval [CI]: 1.13–3.72, p = 0.039) and disease-free survival (hazard ratio: 2.16, 95% CI: 1.19–3.90, p = 0.011). The area under the curve of CONUT score (0.728) was higher than Preoperative Nutritional Index (0.72), platelet-to-lymphocyte ratio (0.675), and neutrophil-to-lymphocyte ratio (0.687). Conclusion The CONUT score can be useful for predicting survival in laryngeal cancer patients after curative resection. View on Web

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Risk of adverse neonatal outcomes among pregnant women with disabilities

alexandrossfakianakis shared this article with you from Inoreader Risk of adverse neonatal outcomes among pregnant women with disabilities via International Journal of Epidemiology - Advance Access Abstract Background To compare risk of neonatal morbidities between women with and without documented disability and to evaluate mediation of these associations by pre-term birth and caesarean delivery. Methods Using data from the Consortium on Safe Labor (2002–2008; n = 223 385), we evaluated risk of 22 neonatal outcomes among singleton deliveries using ICD-9 codes to define physical (n = 1733), sensory (n = 250) and intellectual disability (n = 91). Adjusted relative risk (aRR) was estimated for each outcome among each category of disability, and among women with any disability using Poisson regression models with robust variance. Causal mediation methods evaluated pre-term birth and caesarean delivery as mediators. Results Compared with no disabili ty, neonates of women with any disability had higher risk of nearly all neonatal outcomes, including pre-term birth (aRR = 1.77; 95% CI 1.62–1.94), small for gestational age (SGA) (aRR = 1.25; CI 1.11–1.41), neonatal intensive care unit (NICU) admission (aRR = 1.70; CI 1.54–1.87), seizures (aRR = 2.81; CI 1.54–5.14), cardiomyopathy (aRR = 4.92; CI 1.15–20.95), respiratory morbidities (aRR ranged from 1.33–2.08) and death (aRR = 2.31; CI 1.38–3.87). Women with disabilities were more likely to have a maternal indication for pre-term delivery, including pre-pregnancy diabetes (aRR = 3.80; CI 2.84–5.08), chronic hypertension (aRR = 1.46; CI 0.95–2.25) and severe pre-eclampsia/eclampsia (aRR = 1.47; CI 1.19–1.81). Increased risk varied but was generally consistent across all disability categories. Most outcomes were partially mediated by pre-term birth, except SGA, and heightened risk remained for NICU admissions, respiratory distre ss syndrome, anaemia and a composite of any adverse outcome (aRR = 1.21; CI 1.10–1.32). Conclusion Neonates of women with disabilities were at higher risk of a broad range of adverse neonatal outcomes, including death. Risks were not fully explained by pre-term birth. View on Web

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Surveillance for Survivors of Locoregionally Advanced Head and Neck Cancer

alexandrossfakianakis shared this article with you from Inoreader Surveillance for Survivors of Locoregionally Advanced Head and Neck Cancer via JAMA Otolaryngology–Head & Neck Surgery Online First The evaluation and management of head and neck cancers is an area of intense research and data-driven recommendations. However, once a patient completes definitive treatment for a head and neck cancer, there is surprisingly little evidence to guide the surveillance and long-term management of these patients. Most guidelines, such as those of the National Comprehensive Cancer Network, are based primarily on expert opinion and take a one-size-fits-all approach to head and neck cancers. However, the long-term prognoses of head and neck cancers vary widely, depending on numerous factors, such as subsite, staging, human papillomavirus (HPV) status for oropharyngeal cancers, and other tumor and patient characteristics. Furthermore, surveillance visits represent a substantial use of clinical resources, time, and patient expense for many years after cancer treatment. Clearly, this is an area in need of evidence-based approaches to ensure optimal patient care. View on Web

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Posttraumatic Lingual Artery Pseudoaneurysm and Synchronous Multiple Pneumatosis in a Child

alexandrossfakianakis shared this article with you from Inoreader Posttraumatic Lingual Artery Pseudoaneurysm and Synchronous Multiple Pneumatosis in a Child via JAMA Otolaryngology–Head & Neck Surgery Online First This case report describes a lingual artery pseudoaneurysm in a child after a low-energy, blunt, neck trauma accompanied by subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum and pneumorrhachis. View on Web

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Transmission of Carbapenem-resistant Klebsiella pneumoniae in US hospitals

alexandrossfakianakis shared this article with you from Inoreader Transmission of Carbapenem-resistant Klebsiella pneumoniae in US hospitals via Clinical Infectious Diseases Advance Access ABSTRACT Background Carbapenem-resistant Klebsiella pneumoniae (CRKp) is the most prevalent carbapenem-resistant Enterobacterales in the United States. We evaluated clustering of CRKp in hospitalized patients in US hospitals. Methods From April 2016 to August 2017, 350 patients with clonal group 258 were included as part of the Consortium on Re sistance Against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE-2), a prospective, multicenter, cohort study. A maximum-likelihood tree was constructed using RAxML. Static clusters shared ≤21 single nucleotide polymorphisms (SNP) and a most recent common ancestor. Dynamic clusters incorporated SNP distance, culture timing, and rates of SNP accumulation and transmission using the R program TransCluster. Results Most patients were admitted from home (n = 150, 43%) or a long-term care facility (n = 115, 33%). Urine (n = 149, 43%) was the most common site of isolation. In total, 55 static and 47 dynamics clusters were identified involving 210/350 (60%) and 194/350 (55%) patients, respectively. About half of static clusters were identical to dynamic clusters. Static clusters consisted of 33 (60%) intra-system and 22 (40%) inter-system clusters. Dynamic clusters consiste d of 32 (68%) intra-system and 15 (32%) inter-system clusters and had fewer SNP differences compared to static clusters (8 versus 9, P= 0.045, 95% CI: [-4, 0]). Dynamic inter-system clusters contained more patients than dynamic intra-system clusters (median [IQR]: 4 [2, 7] vs 2 [2, 2], P= 0.007, 95% CI: [-3, 0]). Conclusions Widespread intra-system and inter-system transmission of CRKp was identified in hospitalized US patients. Employing different methods for assessing genetic similarity resulted in only minor differences in interpretation. View on Web

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