Adjuvant Radiation and Survival Following Surgical Resection of Sinonasal Adenocarcinoma

alexandrossfakianakis shared this article with you from Inoreader Adjuvant Radiation and Survival Following Surgical Resection of Sinonasal Adenocarcinoma via The Laryngoscope Sinonasal adenocarcinoma is a rare primary malignancy treated with surgical resection with or without adjuvant radiotherapy. In this study, we saw that radiation therapy may not have an attributable survival benefit. Objectives This study aims to investigate the utility of adjuvant radiation in patients who undergo surgical resection for the management of node-negative sinonasal adenocarcinoma (SNAC). Study Design Retrospective database review. Methods The 2004–2016 National Cancer Data Base (NCDB) was used to extract patients with surgically resected node-negative SNAC. Kaplan–Meier survival analysis and Cox-Proportional Hazards Modelling were used to analyze the impact of adjuvant radiation on overall survival (OS) following surgery. Results 349 patients with SNAC underwent surgical resection. Of these patients, 154 (44.1%) received adjuvant radiotherapy (RT). Although there was no significant difference in race, age, or sex of those receiving RT, those receiving RT have more advanced diseases and are more likely to have positive margins. Kaplan Meier analysis showed no significant difference in 5-year OS in patient who received adjuvant RT in comparison to those who underwent surgical resection alone (65.7% vs. 72.6%, respectively; p = 0.378). In addition, when looking at only patients with positive margins, 5-year OS still did not have a significant difference (73.8% vs. 61.6%, respectively; p = 0.101). Only patients with clinical AJCC T4 showed a statistically significant survival benefit with adjuvant RT (56.9% vs. 29.9%, respectively; p = 0.009). Conclusions Adjuvant RT does not appear to provide a significant survival benefit in patients with resected SNAC, with the exception of those with clinically AJCC T4 disease. Level of Evidence 4 Laryngoscope, 2023 View on Web

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The Effect of Metformin on Vestibular Schwannoma Growth: A Systematic Review and Meta‐analysis

alexandrossfakianakis shared this article with you from Inoreader The Effect of Metformin on Vestibular Schwannoma Growth: A Systematic Review and Meta‐analysis via The Laryngoscope A systematic review and meta-analysis were performed to evaluate metformin's potential impact on VS growth. Metformin use may reduce the odds of VS growth. Objectives To systematically review and evaluate metformin's potential impact on vestibular schwannoma (VS) growth. Data Sources PubMed, Cochrane Library, and Embase. Review Methods A retrospective cohort study was performed on sporadic VS patients undergoing initial observation who had at least two magnetic resonance imaging studies. Patients were stratified by metformin use during the observation period. Primary endpoint was VS growth, defined as at least a 2 mm increase in diameter. Survival free of tumor growth was evaluated between groups. Systematic review and meta-analysis were performed to produce a pooled odds ratio [OR]. Study heterogeneity was assessed and post-hoc power analysis was performed. Results A total of 123 patients were included, of which 17% were taking metformin. Median patient age was 56.6 years (range, 25.1–84.5). There were no statistically significant differences between the groups. Survival analysis did not demonstrate a statistically significant difference in time to VS growth between groups (hazard ratio = 0.61, 95% confidence interval [CI] = 0.29–1.29). Furthermore, logistic regression analysis did not demonstrate a statistically significant difference between groups in the odds of VS growth (OR = 0.46, 95% CI = 0.17–1.27). Systematic review identified 3 studies. Meta-analysis suggested that metformin reduces the odds of developing VS growth (pooled OR = 0.45, 95% CI = 0.29–0.71). Studies demonstrated low between-study heterogeneity. Power analysis demonstrated a sample size of 220 patients with equal randomization would be required to prospectively identify a true difference with 80% powe r. Conclusions Metformin use may reduce the odds of VS growth. A randomized trial would be ideal to identify an unbiased estimate of metformin's effect on VS growth. Laryngoscope, 2023 View on Web

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Prevalence of Apical Periodontitis in Patients with Autoimmune Diseases: A Case Control Study

alexandrossfakianakis shared this article with you from Inoreader Prevalence of Apical Periodontitis in Patients with Autoimmune Diseases: A Case Control Study via International Endodontic Journal Abstract Aim The purpose of this case-control study was to compare the prevalence of Apical Periodontitis (AP) in patients affected by Autoimmune Disorders (AD) [Inflammatory Bowel Disease (IBD), Rheumatoid Arthritis (RA), and Psoriasis (Ps)] with the prevalence of AP in subjects without AD. The prevalences of AP in patients taking biologic medications, conventional medications and no medication were also compared. Methodology 89 patients (2,145 teeth) with AD were investigated and the control group included 89 patients (2,329 teeth) with no systemic diseases. Full dental panoramic tomograms were used to determine the periapical status of the teeth. Additional variables investigated included patient's socio-demographic characteristics, medications taken by AD patients, the Decayed, Missing, and Filled Teeth (DMFT) index. The chi-square test and logistic regression analysis were used to evaluate the correlation between AD and AP. P-values lower than 0.05 were considered to be statistically significant. Results The prevalence of AP was 89.9% in AD patients and 74.2% in control subjects (odds ratio [OR]=3.75, p=0.015). The DMFT score was found to be significantly higher in the AD group (p=0.004). Patients with RA had the highest risk of being affected by AP, whereas those with IBD had the lowest risk. Multiple binary logistic regression analysis indicated that the teeth of AD patients who were not taking any medication or were being treated with biologic Disease Modifying Anti-Rheumatic Drugs (bDMARDs) had a higher risk of being affected by AP than did the teeth of the control subjects (OR=1.42 and OR=2.03 respectively; p=0.010). The teeth of patients taking conventional DMARDs (cDMARDs) were less affected by AP compared with those of patients taking bDMARDs. Conclusions Patients with AD, whether treated or not with biologic medications, showed a higher prevalence of AP than did those in the control group. The DMFT index score, which was higher in AD patients compared with controls was identified as a significant predictor of AP prevalence. View on Web

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Estimating the effect of physical activity on cognitive function within the UK Biobank cohort

alexandrossfakianakis shared this article with you from Inoreader Estimating the effect of physical activity on cognitive function within the UK Biobank cohort via International Journal of Epidemiology - Advance Access Abstract Background Physical activity (PA) has been associated with benefits for cognitive function (CF), but previous estimates of the strength of this relationship may have been biased due to limitations in statistical modelling practices that are common among observational studies. We aimed to address this by using a rigorously constructed conceptual causal model to guide an empirical analysis estimating the effect of PA on CF in the UK Biobank cohort of middle-aged and older adults. Methods This study analysed a subsample of 334 227 adults from the UK Biobank prospective cohort study. PA was measured subjectively by self-report and by device using accelerometry, and CF was measured using objective cognitive tests. Composite CF measures were derived to represent general and domain-specific performance. Effect coefficients were estimated using regression models, adjusting for a wide range of confounders specified by the assumed caus al model, including genetic risk factors, and relevant health, sociodemographic and behavioural variables from across the lifespan. Results Results indicated very small effect sizes (standardized mean difference estimates all <0.01) of inconsistent direction, for both cross-sectional and longitudinal analyses. Conclusions The expected protective effect of PA on CF was not observed. This may reflect selection bias within UK Biobank, or the relatively young age of the sample at follow-up. View on Web

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