Checkpoint blockade and BRAF/MEK therapy in the therapeutic setting improved the overall survival after sentinel node biopsy – a retrospective study comparing patients with primary care between 1998‐2009 and 2010‐2017

AlexandrosSfakianakis shared this article with you from Inoreader Checkpoint blockade and BRAF/MEK therapy in the therapeutic setting improved the overall survival after sentinel node biopsy – a retrospective study comparing patients with primary care between 1998‐2009 and 2010‐2017 via International Journal of Cancer Abstract Immunotherapies using checkpoint blockade and BRAF/MEK therapies have improved overall survival (OS) in patients with unresectable melanoma metastases. In this retrospective study, we aimed to demonstrate the resulting increase in melanoma-specific survival (MSS) and OS after the excision of primary melanomas (≥1 mm thick) and sentinel lymph node (SN) biopsy (SNB). Using Kaplan - Meier estimates and Cox models, we compared two consecutive cohorts. Patients in cohort 1 (N = 518) underwent SNB between 1998 and 2009, and patients in cohort 2 (N = 460) between 2010 and 2017, when checkpoint blockade and BRAF/ (MEK) inhibition became available for the treatment of unresectable relapses. The median follow-up times were 120 months and 73 months, respectively. While recurrence-free and distant metastasis-free survival rates remained very similar, MSS and OS increased in favor of cohort 2. The estimated 5-year OS rate of SN-positive patients increased by 14.3% (78.5% vs 64.2%, logrank test: P=0.005). The MSS benefit was significant even with low SN tumor burden (metastasis diameter <1 mm). On multivariate analyses, the risk-reduction in favor of cohort 2 was significant in the total population and in the SN-negative and SN-positive subgroups. In SN-positive patients, besides the availability of modern therapies, SN metastasis diameter, and ulceration were independent factors of MSS and OS. Treatment of unresectable melanoma recurrences with modern drug therapies results in significantly higher survival rates in a population with SNB. The survival benefit measured from primary melanoma affects both the SN-positive and SN-negative subpopulations. This article is protected by copyright. All rights reserved. View on Web

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Operation early‐bird: Investigating altered light exposure in military barracks on sleep and performance—a placebo‐controlled study

AlexandrosSfakianakis shared this article with you from Inoreader Operation early‐bird: Investigating altered light exposure in military barracks on sleep and performance—a placebo‐controlled study via Journal of Sleep Research Summary The manipulation of light exposure in the evening has been shown to modulate sleep, and may be beneficial in a military setting where sleep is reported to be problematic. This study investigated the efficacy of low-temperature lighting on objective sleep measures and physical performance in military trainees. Sixty-four officer-trainees (52 male/12 female, mean ± SD age: 25 ± 5 years) wore wrist-actigraphs for 6 weeks during military training to quantify sleep metrics. Trainee 2.4-km run time and upper-body muscular-endurance were assessed before and after the training course. Participants were randomly assigned to either: low-temperature lighting (LOW, n = 19), standard-temperature lighting with a placebo "sleep-enhancing" device (PLA, n = 17), or standard-temperature lighting (CON, n = 28) groups in their military barracks for the duration of the course. Repeated-measures ANOVAs were run to identify significant differences with post hoc ana lyses and effect size calculations performed where indicated. No significant interaction effect was observed for the sleep metrics; however, there was a significant effect of time for average sleep duration, and small benefits of LOW when compared with CON (d = 0.41–0.44). A significant interaction was observed for the 2.4-km run, with the improvement in LOW (Δ92.3 s) associated with a large improvement when compared with CON (Δ35.9 s; p = 0.003; d = 0.95 ± 0.60), but not PLA (Δ68.6 s). Similarly, curl-up improvement resulted in a moderate effect in favour of LOW (Δ14 repetitions) compared with CON (Δ6; p = 0.063; d = 0.68 ± 0.72). Chronic exposure to low-temperature lighting was associated with benefits to aerobic fitness across a 6-week training period, with minimal effects on sleep measures. View on Web

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Efficacy of adjunctive measures in peri‐implant mucositis. A systematic review and meta‐analysis

AlexandrosSfakianakis shared this article with you from Inoreader Efficacy of adjunctive measures in peri‐implant mucositis. A systematic review and meta‐analysis via Journal of Clinical Periodontology Abstract Aim To answer the following PICO question: In systemically healthy humans with peri-implant mucositis (PiM), what is the efficacy of patient-performed or administered (by prescription) measures used adjunctively to submarginal instrumentation, as compared to submarginal instrumentation alone or combined with a negative control, in terms of reducing bleeding on probing (BOP), in randomized controlled clinical trials (RCTs) with at least 3-month follow-up? Material and methods Three databases were searched until April 2022. Weighted mean differences (WMD) with 95% confidence intervals (CIs) and predictive intervals were calculated. Results 16 parallel RCTs corresponding to 14 studies with low/moderate risk of bias were included. Test groups showed greater reductions in BOP (%) than control groups (nstudies=16; npatients=650; WMD=14.25%; 95% CI [9.06; 19.45]; p<0.001; I2=98.7%). The greatest WMD in BOP reductions (%) were obtained by antiseptics (ns=5; np=229; WMD=22.72%; 95% CI [19.40; 26.04]; p<0.001; I2=94.8%), followed by probiotics (ns=6; np=260; WMD=12.11%; 95% CI [3.20; 21.03]; p=0.008; I2=93.3%), and systemic antibiotics (ns=3; np=101; WMD=5.97%; 95% CI [1.34; 10.59]; p=0.012; I2=58.1%). Disease resolution was scarcely reported (n=6). Conclusions Significant clinical improvements can be obtained when professional submarginal instrumentation is combined with patient-performed or administered (by prescription) adjunctive measures, although a complete disease resolution may not be achieved. View on Web

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The Efficacy of Implant Surface Decontamination Using Chemicals during Surgical Treatment of Peri‐implantitis: A Systematic Review and Meta‐Analysis

AlexandrosSfakianakis shared this article with you from Inoreader The Efficacy of Implant Surface Decontamination Using Chemicals during Surgical Treatment of Peri‐implantitis: A Systematic Review and Meta‐Analysis via Journal of Clinical Periodontology ABSTRACT Aim To answer the following PICOS question: in adult patients with peri-implantitis, what is the efficacy of surgical therapy with chemical surface decontamination of implant surfaces in comparison with surgical therapy alone or surgery with placebo decontamination, on probing pocket depth (PD) reduction and bleeding on probing (BoP)/suppuration on probing (SoP), in randomized controlled clinical trials (RCTs) and non-RCTs with at least 6 months of follow-up? Materials and Methods Six databases were searched from their inception up to May 20, 2022. Data on clinical outcome variables were pooled and analyzed using mean differences (MDs), Risk Ratios (RR) or Risk Differences (RD) as appropriate, 95% confidence intervals (CI), and prediction intervals (PIs) in the case of significant heterogeneity. Primary outcomes were determined as changes in PD and BoP/SoP. Secondary outcomes were detrmined as radiographic marginal bone loss (MBL), implant loss, and disease resolution. PROSPERO registration number: CRD42022325603. Results Six RCTs - two moderate, three high, and one low risk of bias (RoB) studies - were included. These studies test the adjunctive effect of photodynamic therapy (PDT), chlorhexidine (CHX), and administration of local antibiotics (LAbs) during surgery on the clinical outcome. In a single 12-month study, the adjunctive use of local antibiotics showed a clinically relevant reduction of PD )MD= 1.44; 95% CI [0.40; -2.48] and MBL (MD= 1.21; 95% CI [0.44; 1.98]; one trial, 32 participant). PDT showed a small but significant reduction in BoP (MD= 7.41%; 95% CI [0.81; 14.00]; P=0.028; two trials; 42 participants). Treatment with CHX resulted in no significant changes in PD, BoP, or MBL compared to placebo saline solution. None of the interventions affected disease resolution and implant loss. Certainty of the evidence was very low for all outcome measures assessed. Conclusions Within the limitations of this systematic review and the meta-analysis, adjunctive use of chemicals such as PDT, CHX, LAbs for surface decontamination during surgery of peri-implantitis cannot be recommended as superior to standard debridement procedures (mechanical debridement +/- saline). This article is protected by copyright. All rights reserved. View on Web

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Differential adoption of castration‐resistant prostate cancer treatment across facilities in a national healthcare system

AlexandrosSfakianakis shared this article with you from Inoreader Differential adoption of castration‐resistant prostate cancer treatment across facilities in a national healthcare system via Cancer Medicine There is variability in the timing of adoption of novel oral therapies for castration resistant prostate cancer across different facilities. Abstract Background Over the past decade, abiraterone and enzalutamide have largely replaced ketoconazole as oral treatments for castration-resistant prostate cancer (CRPC). We investigated the differential adoption of abiraterone and enzalutamide across facilities in a national healthcare system to understand the impact a facility has on the receipt of these novel therapies. Methods Using data from the VA Corporate Data Warehouse, we identified a cohort of men with CRPC who received the most common first-line therapies: abiraterone, enzalutamide, docetaxel, or ketoconazole between 2010 and 2017. We described variability in the adoption of abiraterone and enzalutamide across facilities by time period (2010–2013 or 2014–2017). We categorized facilities depending on the timing of adoption of abiraterone and enzalutamide relative to other facilities and described facility characteristics associated with early and late adoption. Results We identified 4998 men treated with ketoconazole, docetaxel, abiraterone, or enzalutamide as first-line CRPC therapy between 2010 and 2017 at 125 national facilities. When limiting the cohort to oral therapies, most patients treated earlier in the study period (2010–2013) received ketoconazole. A dramatic shift was seen by the second half of the study period (2014–2017) with most men treated with first-line abiraterone (61%). Despite this shift and a new standard of care, some facilities persisted in the widespread use of ketoconazole in the later period, so-called late adopting facilities. After multivariable adjustment, patients who received treatment at a late adopting facility were more likely receiving care at a lower complexity, rural facility, with less urology and hematology/oncology workforce (all p < 0.01). Conclusion Many facilities persisted in their use of ketoconazole as first-line CRPC therapy, even when other facilities had adopted the new standard of care abiraterone and enzalutamide. Further work is needed to identify the effect of this late adoption on outcomes important to patients. View on Web

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Embolization in Juvenile Nasopharyngeal Angiofibroma Surgery: A Systematic Review and Meta‐Analysis

AlexandrosSfakianakis shared this article with you from Inoreader Embolization in Juvenile Nasopharyngeal Angiofibroma Surgery: A Systematic Review and Meta‐Analysis via The Laryngoscope How are clinical outcomes of juvenile nasopharyngeal angiofibroma (JNA) resection affected by preoperative embolization and the type of embolization used? In this systematic review and meta-analysis, the use of preoperative embolization was shown to decrease blood loss during JNA resection and direct embolization provided improved recurrence and complication rates compared to transarterial embolization. Preoperative direct puncture embolization in JNA resection may reduce intraoperative and postoperative complications. Objective To compare outcomes of juvenile nasopharyngeal angiofibroma (JNA) resection between embolized and non-embolized cohorts, and between transarterial embolization (TAE) and direct puncture embolization (DPE). Data Sources Per PRISMA guidelines, PubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched for publications prior to or in 2021. Materials and Methods Original English manuscripts investigating the resection of JNA with and without preoperative embolization were included. Embolization type, recurrence rate, complication rates, blood loss, and transfusions were extracted. Risk of bias was assessed by the Risk of Bias in Non-randomized Studies—of Interventions method. Results There were 61 studies with 917 patients included. Preoperative embolization was performed in 79.3% of patients. Of those embolized, 75.8% (N = 551) underwent TAE and 15.8% (N = 115) underwent DPE. JNA recurrence in embolized patients was lower than in non-embolized patients (9.3% vs. 14.4%; odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.35, 1.06). DPE resulted in lower rates of disease recurrence (0% vs. 9.5%; OR: 0.066, 95% CI: 0.016, 0.272) and complications (1.8% vs. 21.9%; OR: 0.07, 95% CI: 0.02, 0.3) than TAE. A random effects Bayesian model was performed to analyze the difference in mean blood loss in 6 studies that included both embolized and non-embolized patients. This analysis showed a mean reduction in blood loss of 798 mL in the embolized group. Conclusions We found embolization decreases blood loss in JNA resection. DPE led to improved recurrence and complication rates when compared to TAE, but future prospective studies are needed to further evaluate which embolization technique can optimize outcomes in JNA. Level of Evidence NA Laryngoscope, 2023 View on Web

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Onychomycosis associated with diabetic foot syndrome: a systematic review

AlexandrosSfakianakis shared this article with you from Inoreader Onychomycosis associated with diabetic foot syndrome: a systematic review via Mycoses Abstract Background A systematic review was conducted to investigate the prevalence of onychomycosis in patients with diabetes. The association of onychomycosis with risk factors in patients with diabetic foot syndrome was also examined. Methods The recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist were applied, and the included studies were assessed using the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) method. Searches were conducted in October 2022 using PubMed (Medline) and Scopus for clinical studies, clinical trials, comparative studies, observational studies, and randomised clinical trials or controlled clinical trials addressing the prevalence and consequences of onychomycosis in patients with diabetes, diagnoses, or treatments. Two authors performed the study selection and data extraction, and any discrepancies between the two reviewers were resolved through discussion with a third reviewer. Results The systematic review included nine studies that met the inclusion criteria, and these studies enrolled 5426 patients with diabetes. Among these patients, 28.55% had onychomycosis that was mainly caused by Trichophyton rubrum. A significant association was found between the occurrence of onychomycosis and the presence of diabetic neuropathy (p=0.012) and elevated glycosylated haemoglobin values (p=0.039). There was no significant association between onychomycosis and ulceration (p=0.185). Eight studies had a grade 4 level of evidence and a grade C recommendation, and one study had a grade 1b level of evidence and a grade A recommendation. Conclusion The information described in the literature is insufficient and heterogeneous regarding the association of risk factors and ulceration in patients with diabetic foot compared with developing onychomycosis. There is also a need to implement onychomycosis diagnostic testing instead of relying only on a clinical diagnosis. Additional prospective, randomised, comparative studies are needed to increase the quality of studies in the literature. View on Web

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Risky business: Understanding the association between objective COVID‐19 occupational risk features and worker subjective risk perceptions

AlexandrosSfakianakis shared this article with you from Inoreader Risky business: Understanding the association between objective COVID‐19 occupational risk features and worker subjective risk perceptions via Journal of Occupational and Organizational Psychology Abstract Many workers are at risk of contracting COVID-19 through work, and subjective perceptions of COVID-19 risk are important predictors of worker attitudes and behaviours. However, little to no research provides comprehensive examination of objective COVID-19 occupational risk factors and how, or under what conditions, these factors relate to subjective risk perceptions. Using two wave survey data matched with archival data from the Occupational Information Network (O*Net) and county-level COVID-19 case data (N = 295), we examine how objective COVID-19 occupational risk relates to workers' subjective risk of contracting COVID-19 at work. We also examine the moderating roles of financial frailty, adherence to governmental workplace safety recommendations, and local COVID-19 threat. Results indicate that objective COVID-19 occupational risk significantly predicts subjective risk of contracting COVID-19 at work. Moreover, factors representing in-person work conducted in close proximity to others accounted for a large proportion of explained variance in subjective risk. There was no support for moderation; however, financial frailty and workplace safety had independent main effects on subjective risk perceptions. Our results have theoretical implications for the Economic Stress and COVID-19 Occupational Risk model (Sinclair et al., Appl. Psychol., 70, 2021, 85), individual models of subjective risk perceptions, and practical implications for mitigating occupational risk at work. View on Web

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PPAR-γ activation promotes xenogenic bioroot regeneration by attenuating the xenograft induced-oxidative stress

AlexandrosSfakianakis shared this article with you from Inoreader PPAR-γ activation promotes xenogenic bioroot regeneration by attenuating the xenograft induced-oxidative stress via International Journal of Oral Science - Issue International Journal of Oral Science, Published online: 16 February 2023; doi:10.1038/s41368-023-00217-4 PPAR-γ activation promotes xenogenic bioroot regeneration by attenuating the xenograft induced-oxidative stress View on Web

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RGS12 represses oral squamous cell carcinoma by driving M1 polarization of tumor-associated macrophages via controlling ciliary MYCBP2/KIF2A signaling

AlexandrosSfakianakis shared this article with you from Inoreader RGS12 represses oral squamous cell carcinoma by driving M1 polarization of tumor-associated macrophages via controlling ciliary MYCBP2/KIF2A signaling via International Journal of Oral Science - Issue International Journal of Oral Science, Published online: 16 February 2023; doi:10.1038/s41368-023-00216-5 RGS12 represses oral squamous cell carcinoma by driving M1 polarization of tumor-associated macrophages via controlling ciliary MYCBP2/KIF2A signaling View on Web

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