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Lenvatinib plus Pembrolizumab or Everolimus for Advanced Renal Cell Carcinoma
Lenvatinib plus either pembrolizumab or everolimus was compared with sunitinib as first-line therapy for advanced renal cell cancer. Progression-free survival was significantly longer with lenvatinib plus pembrolizumab than with sunitinib. Lenvatinib plus everolimus was also more effective than sunitinib, but the difference was smaller.
Journal Article
Perioperative Chemotherapy or Preoperative Chemoradiotherapy in Esophageal Cancer
The best multimodal approach for resectable locally advanced esophageal adenocarcinoma is unclear. An important question is whether perioperative chemotherapy is preferable to preoperative chemoradiotherapy.
In this phase 3, multicenter, randomized trial, we assigned in a 1:1 ratio patients with resectable esophageal adenocarcinoma to receive perioperative chemotherapy with FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) plus surgery or preoperative chemoradiotherapy (radiotherapy at a dose of 41.4 Gy and carboplatin and paclitaxel) plus surgery. Eligibility criteria included a primary tumor with a clinical stage of cT1 cN+, cT2-4a cN+, or cT2-4a cN0 disease, in which T indicates the size and extent of the tumor (higher numbers indicate a more advanced tumor), and N indicates the presence (N+) or absence (N0) of cancer spread to the lymph nodes, without evidence of metastatic spread. The primary end point was overall survival.
From February 2016 through April 2020, we assigned 221 patients to the FLOT group and 217 patients to the preoperative-chemoradiotherapy group. With a median follow-up of 55 months, overall survival at 3 years was 57.4% (95% confidence interval [CI], 50.1 to 64.0) in the FLOT group and 50.7% (95% CI, 43.5 to 57.5) in the preoperative-chemoradiotherapy group (hazard ratio for death, 0.70; 95% CI, 0.53 to 0.92; P = 0.01). Progression-free survival at 3 years was 51.6% (95% CI, 44.3 to 58.4) in the FLOT group and 35.0% (95% CI, 28.4 to 41.7) in the preoperative-chemoradiotherapy group (hazard ratio for disease progression or death, 0.66; 95% CI, 0.51 to 0.85). Among the patients who started the assigned treatment, grade 3 or higher adverse events were observed in 120 of 207 patients (58.0%) in the FLOT group and in 98 of 196 patients (50.0%) in the preoperative-chemoradiotherapy group. Serious adverse events were observed in 98 of 207 patients (47.3%) in the FLOT group and in 82 of 196 patients (41.8%) in the preoperative-chemoradiotherapy group. Mortality at 90 days after surgery was 3.1% in the FLOT group and 5.6% in the preoperative-chemoradiotherapy group.
Perioperative chemotherapy with FLOT led to improved survival among patients with resectable esophageal adenocarcinoma as compared with preoperative chemoradiotherapy. (Funded by the German Research Foundation; ESOPEC ClinicalTrials.gov number, NCT02509286.).
Journal Article
The science of drinking : how alcohol affects your body and mind /
Discusses healthy versus unhealthy alcohol consumption, describes the health benefits of consuming alcohol in moderation, and explains how alcohol influences the brain and body.
Book
Bone Mineral Density and Fractures in Antiretroviral-Naive Persons Randomized to Receive Abacavir-Lamivudine or Tenofovir Disoproxil Fumarate-Emtricitabine Along With Efavirenz or Atazanavir-Ritonavir: AIDS Clinical Trials Group A5224s, a Substudy of ACTG A5202
Background. Long-term effects of abacavir (ABC)-lamivudine (3TC), compared with tenofovir (TDF)-emtricitabine (FTC) with efavirenz (EFV) or atazanavir plus ritonavir (ATV/r), on bone mineral density (BMD) have not been analyzed. Methods. A5224s was a substudy of A5202, in which HIV-infected treatment-naive participants were randomized and blinded to receive ABC-3TC or TDF-FTC with open-label EFV or ATV/r. Primary bone end points included Dual-emission X-ray absorbtiometry (DXA)-measured percent changes in spine and hip BMD at week 96. Primary analyses were intent-to-treat. Statistical tests used the factorial design and included linear regression, 2-sample t, log-rank, and Fisher's exact tests. Results. Two hundred sixty-nine persons randomized to 4 arms of ABC-3TC or TDF-FTC with EFV or ATV/r. At baseline, 85% were male, and 47% were white non- Hispanic; the median HIV-1 RNA load was 4.6 log₁₀ copies/ML, the median age was 38 years, the median weight was 76 kg, and the median CD4 cell count was 233 cells/μL. At week 96, the mean percentage changes from baseline in spine and hip BMD for ABC-3TC versus TDF-FTC were -1.3% and -3.3% (P = .004) and -2.6% and -4.0% (P = .024), respectively; and for EFV versus ATV/r were -1.7% and -3.1% (P = .035) and -3.1% and -3.4% (P = .61), respectively. Bone fracture was observed in 5.6% of participants. The probability of bone fractures and time to first fracture were not different across components. Conclusions. Compared with ABC-3TC, TDF-FTC-treated participants had significantly greater decreases in spine and hip BMD, whereas ATV/r led to more significant losses in spine, but not hip, BMD than EFV. Clinical Trials Registration. NCT00118898.
Journal Article
The darkness manifesto : on light pollution, night ecology, and the ancient rhythms that sustain life
\"In the tradition of Why We Sleep and The Sixth Extinction, an urgent and insightful look at the hidden impact of light pollution, and a passionate appeal to cherish natural darkness for the sake of the environment, our own wellbeing, and all life on earth. How much light is too much light? Satellite pictures show our planet as a brightly glowing orb, and in our era of constant illumination, light pollution has become a major issue. The world's flora and fauna have evolved to operate in the natural cycle of day and night. But in the last 150 years, we have extended our day-and in doing so have forced out the inhabitants of the night and disrupted the circadian rhythms necessary to sustain all living things, including ourselves. In this persuasive, well-researched book, Swedish conservationist Johan Eklöf urges us to appreciate natural darkness, its creatures, and its unique benefits. He ponders the beauties of the night sky, traces the swift dives of keen-eyed owls, and shows us the bioluminescent creatures of the deepest oceans. As a devoted friend of the night, Eklöf reveals the startling domino effect of diminishing darkness: insects, dumbfounded by streetlamps, failing to reproduce; birds blinded and bewildered by artificial lights; and bats starving as they wait in vain for insects that only come out in the dark. For humans, light-induced sleep disturbances impact our hormones and weight, and can exacerbate chronic stress and depression. Streetlamps, floodlights, and the ever more pervasive and searingly bright LED lights are altering entire ecosystems, and scientists are only just beginning to understand the long-term effects. Educational, eye-opening, and ultimately encouraging, The Darkness Manifesto outlines simple steps that we can take to benefit ourselves and the planet. In order to ensure a bright future, we must embrace the darkness\"-- Provided by publisher.
Book
Adjunctive Intravenous Argatroban or Eptifibatide for Ischemic Stroke
In this trial involving patients with acute ischemic stroke treated with thrombolysis within 3 hours after symptom onset, the use of adjunctive intravenous argatroban or eptifibatide did not improve 90-day poststroke outcomes.
Journal Article
Toxic cocktail : how chemical pollution is poisoning our brains
Children born to women exposed to thyroid-disrupting chemicals have lower IQs and more neurodevelopmental disorders in autism and ADHD, among others. Numerous chemicals that contaminate our bodies and interfere with our thyroids are in fact lowering our IQ and increasing disorders for future generations. A \"self-help\" guide to reducing exposure to chemicals is included. -- Provided by publisher.
Book
Perioperative Durvalumab in Gastric and Gastroesophageal Junction Cancer
In resectable gastric and gastroesophageal junction cancer, adding durvalumab to perioperative chemotherapy improved event-free survival and pathological complete response, with no major increase in high-grade adverse events.
Journal Article