Pregnancy status at the time of COVID-19 vaccination and incidence of SARS-CoV-2 infection

alexandrossfakianakis shared this article with you from Inoreader Pregnancy status at the time of COVID-19 vaccination and incidence of SARS-CoV-2 infection via Clinical Infectious Diseases Advance Access Abstract Background Pregnant women are recommended to receive COVID-19 vaccines; however, relative effectiveness of vaccination by pregnancy status is unclear. Methods We compared the relative effectiveness of mRNA COVID-19 vaccines according to whether women received both while pregnant (n= 7,412), one dose while pregnant (n = 3,538), both while postpartum (n = 1,856), or both doses while neither pregnant nor postpartum (n = 6,687). We estimated risk of SARS-CoV-2 infection starting 14 days after the second dose using Cox regression, reporting hazard ratios (HR) and 95% confidence intervals (CI). Secondly, we examined relative effectiveness of a third (booster) dose while pregnant compared to outside pregnancy. The major circulating variant during the study period was the Delta variant. Results 54% of women received two doses of the BNT162b2 vaccine, 16% received two doses of the mRNA-1273 vaccine, while 30% receiv ed one dose of both vaccines. Compared to women who received both doses while neither pregnant nor postpartum, the adjusted HR for a positive SARS-CoV-2 PCR test was similar if the woman received both doses while pregnant (1.04; 95% CI: 0.94, 1.17), one dose while pregnant and one dose before or after pregnancy (1.03; 95% CI: 0.93, 1.14), or both doses while postpartum (0.99; 95% CI: 0.92, 1.07). The findings were similar for BNT162b2 (Pfizer-BioNTech Comirnaty) and mRNA-1273 (Moderna Spikevax), and during Delta- and Omicron-dominant periods. We observed no differences in the relative effectiveness of the booster dose according to pregnancy status. Conclusions We observed similar effectiveness of mRNA vaccines against SARS-CoV-2 infection among women regardless of pregnancy status at the time of vaccination. View on Web

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Risk factors for tooth loss and progression of periodontitis in patients undergoing periodontal maintenance therapy

alexandrossfakianakis shared this article with you from Inoreader Risk factors for tooth loss and progression of periodontitis in patients undergoing periodontal maintenance therapy via Journal of Clinical Periodontology ABSTRACT Aim The aim of this study was to investigate patient and tooth-level factors that may predict tooth loss and periodontitis progression in patients who have undergone at least 5 years of periodontal maintenance. Methods In this retrospective cohort study, 135 patients were examined after active periodontal therapy (APT) and periodontal maintenance for 5.09-8.65 years (mean 6.16±0.74 years). Regression models were applied to identify risk factors associated with tooth loss and disease progression. Results Stage IV periodontitis (Incidence Rate Ratio (IRR)=4.61; 95%CI [2.97,7.18], p<0.001), the presence of ≥5 sites with probing pocket depth (PPD)≥5mm at the end of APT (IRR=2.04; 95%CI [1.32,3.20], p<0.01), and residual PPD≥7mm at the end of APT (OR=3.01; 95%CI [1.14, 7.94], p<0.05) were risk factors for tooth loss. Residual PPD of 5mm (OR=2.02; 95%CI [1.20, 3.40], p<0.01) and 6mm (OR=2.41; 95%CI [1.22, 4.76], p<0.05) at the end of APT were risk factors for disease progression. Above 3mm, each 1mm increase in maximum PPD/clinical attachment loss was associated with an increased risk of tooth loss and disease progression. Conclusions Stage IV periodontitis is associated with an increased risk of tooth loss. Teeth with PPD≥5mm at the end of APT are at risk of periodontitis progression or tooth loss. This article is protected by copyright. All rights reserved. View on Web

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American Radium Society (ARS) Appropriate Use Criteria (AUC) for Locoregional Gastric Adenocarcinoma: Systematic Review and Guidelines

alexandrossfakianakis shared this article with you from Inoreader American Radium Society (ARS) Appropriate Use Criteria (AUC) for Locoregional Gastric Adenocarcinoma: Systematic Review and Guidelines via American Journal of Clinical Oncology - Current Issue Objective: The objective of this study was to systematically evaluate the data regarding the use of neoadjuvant, perioperative, surgical, and adjuvant treatment options in localized gastric cancer patients and to develop Appropriate Use Criteria recommended by a panel of experts convened by the American Radium Society. Methods: Preferred reporting items for systematic reviews and meta-analyses methodology was used to develop an extensive analysis of peer-reviewed phase 2/2R/3 trials, as well as meta-analyses found within the Ovid Medline database between 2010 and 2020. The expert panel then rated the appropriateness of various treatments in 5 representative clinical scenarios through a well-established consensus methodology (modified Delphi). Results: For patients with medically operable locally advanced gastric cancer, the strongest recommendation was for perioperative chemotherapy based on high-quality data. Acceptable alternatives included surgery followed by either chemotherapy or concurrent chemoradiotherapy (CRT). For patients with upfront resection of stages I to III gastric cancer (no neoadjuvant therapy), the group strongly recommended adjuvant therapy with either chemotherapy alone or CRT, based on high-quality data. For patients with locally advanced disease who received preoperative chemotherapy without tumor regression, the group strongly recommended postoperative chemotherapy or postoperative CRT. Finally, for medically inoperable gastric cancer patients, there was moderate consensus recommending definitive concurrent CRT. Conclusions: The addition of chemotherapy and/or radiation, either in the neoadjuvant, adjuvant, or perioperative setting, results in improved survival rates for patients compared with surgery alone. For inoperable patients, definitive CRT is a reasonable treatment option, though largely palliative. View on Web

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Voluntary Cough Testing as a Clinical Indicator of Airway Protection in Cervical Spinal Cord Injury

alexandrossfakianakis shared this article with you from Inoreader Voluntary Cough Testing as a Clinical Indicator of Airway Protection in Cervical Spinal Cord Injury via The Laryngoscope Voluntary cough testing (VCT) is an established predictor of aspiration in neurogenic dysphagia. However, the relation between VCT and protective laryngeal kinematics during swallowing post-traumatic cervical spinal cord injury (tCSCI) remains unknown. Our study shows that blunted volitional cough post-tCSCI reflects airway invasion and impaired laryngeal kinematics during swallowing. Objective Voluntary cough testing (VCT) may be useful for determining aspiration risk in neurogenic dysphagia; however, has yet to be investigated in traumatic cervical spinal cord injury (tCSCI). The study explored if VCT may elucidate swallowing safety and kinematics related to airway protection in tCSCI survivors. Methods Ten inpatients, 13–73 days post-tCSCI (7 incomplete injuries), completed VCT and a modified barium swallowing study that was analyzed via the Penetration Aspiration Scale (PAS) and norm-referenced measures of swallowing events related to airway protection. Spearman rho correlations explored relations among cough airflow, median PAS, and airway protection. Mann–Whitney U tests explored group differences based on clinical airway invasion (PAS > 2) and receiver operating characteristic statistics probed the sensitivity/specificity of VCT measures. Results Safe (PAS > 2) and unsafe swallowers differed by cough volume acceleration (CVA) for the total sample and by inspiratory duration for incomplete injuries (p = 0.03, r > 0.7). A cut-off value of 24.8 L/s for CVA predicted airway invasion (AUC = 0.917, p = 0.03) with sensitivity = 100%/specificity = 75%. CVA correlated with delayed laryngeal vestibule closure during swallowing for both the total sample and for incomplete injuries (r s > 0.6, p < 0.05). Blunted peak flow and prolonged cough phases were associated with disordered laryngeal kinematics and prolonged bolus transit during swallowing (p < 0.05). Conclusions Reduced CVA, blunted peak flow, and prolonged cough phases reflected PAS and disrupted mechanisms of airway protection in tCSCI survivors, demonstrating promise for VCT as a clinical assessment for post-tCSCI dysphagia. Level of Evidence 3 Laryngoscope, 2022 View on Web

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Oral lichenoid lesion in association with chemotherapy treatment for non-Hodgkin lymphoma or lichen planus? Review of the literature and report of two challenging cases

alexandrossfakianakis shared this article with you from Inoreader Oral lichenoid lesion in association with chemotherapy treatment for non-Hodgkin lymphoma or lichen planus? Review of the literature and report of two challenging cases via Head & Face Medicine - Latest Articles The diagnosis of oral lichenoid lesions (OLL) remains a challenge for clinicians and pathologists. Although, in many cases, OLL cannot be clinically and histopathologically distinguishable from oral lichen pla... View on Web

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P18.11.A Active beam scanning proton therapy for large skull base benign meningiomas: long-term results

alexandrossfakianakis shared this article with you from Inoreader P18.11.A Active beam scanning proton therapy for large skull base benign meningiomas: long-term results via # Neuro-Oncology Current Issue Abstract Purpose To report long-term results of active beam scanning proton therapy (PT) for large skull base benign meningiomas Material and Methods Eighty-two patients (pts) with large skull base meningiomas were treated with PT between April 2015 and December 2021. Median age was 62 years (range, 48-82) while KPS ranged between 60 and 100 (median 90); 60 were female (73%), and 22 were male (27%). Thirty-two pts (39%) had histologically proven World Health Organization (WHO) Grade I tumors. In remaining pts diagnosis was based on the typical imaging appearance of benign meningioma. All patients received PT for residual, progressive or non-operable lesions. Newly diagnosed tumors received total dose of 50 GyRBE (RBE: relative biologic effectiveness) while progressing meningiomas 54 GyRBE. All the treatments were delivered at 2 GyRBE per fraction. All pts were treated with active beam scanning PT using 3 fields with single field optimiz ation technique. Treatment planning was based on morphological magnetic resonance imaging (MRI) with contrast enhancement medium administration. All pts received also 68-Ga-DOTATOC-PET. Gross tumor volume ranged from 21 to 64 cc. Toxicity was assessed according to Common Terminology Criteria for Adverse Events version 4.0. Median follow-up time was 40 months (range, 3-83). Results All pts completed the treatment without breaks. Registered acute side effects include grade 1 (19%) and grade 2 (8%) skin erythema, grade 1 (5%) and grade 2 (5%) alopecia, grade 1 (40%) fatigue, grade 1 (5%) and grade 2 (10%) conjunctivitis, grade 1 (10%) pain, grade 1 (5%) blurred vision, grade 1 (10%) headache, and grade 2 (5%) skin hyperpigmentation. One pts (1%) experienced grade 3 pain. There were no further grade 3 or higher acute toxicities. Registered late side effects include grade 1 (2%) and grade 2 (5%) alopecia, grade 1 (21%) fatigue, grade 1 (5%) and grade 2 (5%) headache, grade 1 (6% ) dizziness, grade 1 (3%) blurred vision, grade 1 (3%) and grade 2 (6%) pain, grade 1 (2%) dry eye, and grade 1 (5%) skin hyperpigmentation. Two pts (2%) experienced grade 3 pain. Two further pts (2%) experienced grade 3 optic neuropathy. There were no further grade 3 or higher late toxicities. During follow-up one pts (1%) with cavernous sinus meningioma experienced complete obstruction of intracavernous carotid artery with mild transient symptoms that resolved in few days and brain tissue ischemia detected at MRI (grade 2). Before irradiation this pts already had a meningioma-related near-complete obstruction of the intracavernous carotid artery and received a vascular surgery evaluation. Currently, absolute tumor control is 99%. Moreover, relief of symptoms recorded before irradiation occurred in 40% of pts. Conclusion PT is safe and effective treatment for pts with large skull base benign meningiomas. View on Web

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P12.13.B Investigating the tumor - immune cell crosstalk inex vivo glioblastoma models

alexandrossfakianakis shared this article with you from Inoreader P12.13.B Investigating the tumor - immune cell crosstalk inex vivo glioblastoma models via # Neuro-Oncology Current Issue Abstract Background Immunotherapy is a promising therapeutic approach to fight cancer by activating the immune system. Multiple immune-based strategies are under development that aim at recruiting or re-activating cellular components of the immune system. While immunotherapies have recently revolutionized cancer therapy, they have shown so far little therapeutic success in glioblastoma patients. To enhance the efficacy of novel strategies, we need to better understand the immunogenic status of glioblastoma cells and their cross-talk with immune cells in different microenvironmental niches. Material and Methods We assessed expression of molecules related to antigen processing and presentation as well as immune checkpoints in patient tumor databases as well as in a series of glioblastoma patient-derived organoids, 3D stem-like cultures and adherent cell lines under varying microenvironmental conditions (varying oxygen levels, inflammation ). We further established an allogenic co-culture protocol for glioblastoma organoids with immune cells isolated from HLA matched donor blood, allowing for the functional assessment of the crosstalk between tumor and immune cells. Results Analysis of a large cohort of patient tumors and patient-derived glioblastoma preclinical models shows inter-patient heterogeneity at the level of components of major histocompatibility complex (MHC)-MHC-II, immune checkpoints. Glioblastoma cells in general express MHC-I machinery, albeit at different levels. MHC-II and immune checkpoints are variably expressed across glioblastoma cells. Different tumor microenvironment conditions, including hypoxia and interferon-γ, impact the expression of immune-related molecules. Upon co-culture, HLA-matched donor-derived T cells integrate well into the core of glioblastoma tumor organoids and display reciprocal crosstalk with tumor cells. Conclusion Assessing antigen presentation and immune cell responses at the functional level are key to improve patient-specific responses to immunotherapies. Advanced glioblastoma organoids incorporating the immune compartment appear as clinically-relevant models for ex vivo efficacy studies. View on Web

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