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International Journal of Surgical... Aug 2022This systematic review and meta-analysis aims to provide a robust qualitative and quantitative analysis of the different systems used to assess the grade of oral... (Meta-Analysis)
Meta-Analysis
This systematic review and meta-analysis aims to provide a robust qualitative and quantitative analysis of the different systems used to assess the grade of oral epithelial dysplasia (OED). This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyzes (PRISMA) statement. Six electronic databases were searched for primary research published over the past four decades. Overall quality and level of evidence were based on the Johns Hopkins Research Evidence Appraisal Tool, while evidence of heterogeneity was determined by the Q-statistic and I statistic. Evidence of publication bias was determined using Egger's regression and the Rank correlation tests. A total of 170 records were identified. Only 9 primary research articles were included in the qualitative systematic review. Four studies (4/9) were included in the final quantitative meta-analysis. The grading systems analyzed included the WHO, binary, Ljubljana, Smith and Pindborg, Brothwell, and the oral intraepithelial neoplasia. The results demonstrate the binary system to be superior to the WHO system in grading OED, by providing better inter-observer agreement, however, the substantial error among the inter-observer κ values analyzed indicates the significance of this finding to be of minimal impact. Lack of reliable reproducibility of the grading systems and lack of common effect size (heterogeneity analysis) were noted.
Topics: Carcinoma in Situ; Humans; Hyperplasia; Mouth Neoplasms; Reproducibility of Results
PubMed: 34994584
DOI: 10.1177/10668969211070171 -
Acta Reumatologica Portuguesa 2016An association between immune-mediated diseases and cervical pre-malignant and malignant lesions is described, having the human papillomavirus (HPV) infection a causal... (Review)
Review
An association between immune-mediated diseases and cervical pre-malignant and malignant lesions is described, having the human papillomavirus (HPV) infection a causal role. Related studies have been generally focused on systemic lupus erythematosus (SLE) patients, but relatively to other diseases, such as rheumatoid arthritis (RA), Sjögren's syndrome (SS) and systemic sclerosis (SSc), data has not been systematically evaluated. We conducted a systematic review analysis of the literature in PubMed, including articles published until March of 2015, in patients with RA, SS, SLE and SSc, to evaluate the frequency of HPV infection, cervical dysplasia and cervical cancer, and associated factors, with particular interest on the role of glucocorticoids and immunosuppressive treatment. Moreover, safety and efficacy of HPV vaccines in these patients was investigated. Of 476 articles identified, 27 were finally included. The studies showed an increased prevalence of cervical dysplasia and cancer, with the HPV infection being an important associated factor, in particular in SLE patients. The data relatively to other rheumatic diseases was very scarse, but an increased prevalence of smear abnormalities was also found in RA. Patients exposed to glucocorticoids and to long-term immunosuppression, particularly cyclophosphamide, have increased risk of presenting more pre-malignant lesions than the general population. The available vaccines seem to be generally safe and immunogenic in the short- period evaluation, but long-term follow-up is required to evaluate the impact of the vaccine in the protection against HPV infection and occurrence of high-grade cervical lesions.
Topics: Female; Humans; Papillomavirus Infections; Rheumatic Diseases; Uterine Cervical Neoplasms
PubMed: 27682966
DOI: No ID Found -
Endoscopy International Open Apr 2022Wide-area transepithelial sampling (WATS) is an emerging technique that may increase dysplasia detection in Barrett's esophagus (BE). We conducted a systematic... (Review)
Review
Wide-area transepithelial sampling (WATS) is an emerging technique that may increase dysplasia detection in Barrett's esophagus (BE). We conducted a systematic review and meta-analysis of patients who underwent surveillance for BE assessing the additional yield of WATS to forceps biopsy (FB). We searched Pubmed, Embase, Web of science, and the Cochrane library, ending in January 2021. The primary outcomes of interest were the relative and absolute increase in dysplasia detection when adding WATS to FB. Heterogeneity was assessed using and statistic. Publication bias was assessed using funnel plots and classic fail-safe test. A total of seven studies were included totaling 2,816 patients. FB identified 158 dysplasia cases, whereas WATS resulted in an additional 114 cases. The pooled risk ratio (RR) of all dysplasia detection was 1.7 (1.43-2.03), < 0.001, = 0. For high-grade dysplasia (HGD), the pooled RR was 1.88 (1.28-2.77), = 0.001, = 33 %. The yield of WATS was dependent on the prevalence of dysplasia in the study population. Among studies with high rates of dysplasia, the absolute increase in dysplasia detection (risk difference, RD) was 13 % (8 %-18 %, < 0.0001, number needed to treat [NNT] = 8). The pooled RD in HGD was 9 % (2 %-16 %), < 0.001, NNT = 11. For studies with a low prevalence of dysplasia, RD for all dysplasia was 2 % (1 %-3 %), = 0.001, NNT = 50. For HGD, the RD was 0.6 % (0.2 %-1.3 %), = 0.019, NNT = 166. In populations with a high prevalence of dysplasia, adding WATS to FB results in a significant increase in dysplasia detection.
PubMed: 35433217
DOI: 10.1055/a-1783-9015 -
Surgical Endoscopy Apr 2021This systematic review and meta-analysis aims to evaluate efficacy and safety of endoscopic treatment for the non-polypoid dysplasia in patients with long-standing IBD. (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systematic review and meta-analysis aims to evaluate efficacy and safety of endoscopic treatment for the non-polypoid dysplasia in patients with long-standing IBD.
METHODS
Medline, Embase, Cochrane, and clinicaltrials.gov registry were comprehensively searched. Pooled estimates of curative, R0, en-bloc resection rates, CRC, metachronous dysplasia, and local recurrence rates were calculated. Subgroup analysis according to areas, lesion size, endoscopic resection techniques, and grades of dysplasia were conducted. Data synthesis was completed in R using the package "meta".
RESULTS
Of the 973 studies initially identified, 7 met the inclusion/exclusion criteria. These were all single-arm cohorts and included a total of 202 patients with IBD and non-polypoid dysplasia. The combined R0 and en-bloc resection rate were 0.70 (95% CI 0.55-0.81) and 0.86 (95% CI 0.65-0.95), respectively, with a recurrence rate of 0.08 (95% CI 0.05-0.13). CRC and metachronous dysplasia incidences were pooled as 32.53 (95% CI 12.21-86.67) and 90.24 (95% CI 44.91-181.33) per 1000 patient years.
CONCLUSIONS
Non-polypoid dysplasia associated with IBD can be resected endoscopically, especially by ESD. However, these patients have higher CRC and metachronous dysplasia incidence rates than patients with polypoid dysplasia, indicating a closer endoscopic surveillance.
Topics: Aged; Endoscopic Mucosal Resection; Humans; Inflammatory Bowel Diseases; Middle Aged
PubMed: 33523273
DOI: 10.1007/s00464-020-08225-9 -
Alimentary Pharmacology & Therapeutics Oct 2016The proportion of oesophageal adenocarcinoma that is detected concurrently with initial Barrett's oesophagus diagnosis is not well studied. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The proportion of oesophageal adenocarcinoma that is detected concurrently with initial Barrett's oesophagus diagnosis is not well studied.
AIM
To compare the proportion of prevalent adenocarcinoma vs. incident adenocarcinoma found during surveillance of Barrett's.
METHODS
We performed a systematic search of MEDLINE, EMBASE and Web of Science (from their inception to 31 May 2015) for cohort studies in adults with Barrett's (nondysplastic Barrett's ± Barrett's with low-grade dysplasia) with minimum average follow-up of 3 years, and providing numbers of prevalent adenocarcinoma detected (concurrently with Barrett's diagnosis and up to 1 year afterwards) vs. incident adenocarcinoma detected (greater than 1 year after Barrett's diagnosis). Pooled weighted proportions of prevalent and incident adenocarcinoma were calculated, using a random effects model.
RESULTS
On meta-analysis of 13 studies reporting on 603 adenocarcinomas in 9657 Barrett's patients, 85.1% of adenocarcinomas were classified as prevalent [95% confidence interval (CI), 78.1-90.2%) and 14.9% as incident (95% CI, 9.8-21.9%), with substantial heterogeneity (I(2) = 66%). Among nine studies reporting on 787 high-grade dysplasia and oesophageal adenocarcinomas in 8098 Barrett's patients, the proportion of prevalent high-grade dysplasia-oesophageal adenocarcinoma was similar at 80.5% (95% CI, 68.1-88.8%, I(2) = 87%). These results remained stable across multiple subgroup analyses including study quality, setting, duration of follow-up and presence of baseline dysplasia.
CONCLUSIONS
In our meta-analysis, four of five patients diagnosed with adenocarcinoma or high-grade dysplasia at index endoscopy or within 1 year of Barrett's follow-up were considered to be prevalent cases. Continued efforts are needed to identify patients with Barrett's before the development of adenocarcinoma.
Topics: Adenocarcinoma; Adult; Aged; Barrett Esophagus; Endoscopy; Esophageal Neoplasms; Female; Humans; Male; Middle Aged; Prevalence
PubMed: 27562355
DOI: 10.1111/apt.13783 -
Digestive Diseases and Sciences Jan 2016Barrett's esophagus (BE) is a common and important precursor lesion of esophageal adenocarcinoma (EAC). A third of patients with BE are asymptomatic, and our ability to... (Meta-Analysis)
Meta-Analysis Review
Barrett's esophagus (BE) is a common and important precursor lesion of esophageal adenocarcinoma (EAC). A third of patients with BE are asymptomatic, and our ability to predict the risk of progression of metaplasia to dysplasia and EAC (and therefore guide management) is limited. There is an urgent need for clinically useful biomarkers of susceptibility to both BE and risk of subsequent progression. This study aims to systematically identify, review, and meta-analyze genetic biomarkers reported to predict both. A systematic review of the PubMed and EMBASE databases was performed in May 2014. Study and evidence quality were appraised using the revised American Society of Clinical Oncology guidelines, and modified Recommendations for Tumor Marker Scores. Meta-analysis was performed for all markers assessed by more than one study. A total of 251 full-text articles were reviewed; 52 were included. A total of 33 germline markers of susceptibility were identified (level of evidence II-III); 17 were included. Five somatic markers of progression were identified; meta-analysis demonstrated significant associations for chromosomal instability (level of evidence II). One somatic marker of progression/relapse following photodynamic therapy was identified. However, a number of failings of methodology and reporting were identified. This is the first systematic review and meta-analysis to evaluate genetic biomarkers of BE susceptibility and risk of progression. While a number of limitations of study quality temper the utility of those markers identified, some-in particular, those identified by genome-wide association studies, and chromosomal instability for progression-appear plausible, although robust validation is required.
Topics: Adenocarcinoma; Barrett Esophagus; Disease Progression; Esophageal Neoplasms; Esophagus; Genetic Markers; Genetic Predisposition to Disease; Genetic Variation; Genome-Wide Association Study; Humans; Phenotype; Precancerous Conditions; Prognosis; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 26445852
DOI: 10.1007/s10620-015-3884-5 -
Genetics in Medicine : Official Journal... Oct 2023Skeletal dysplasia are heterogeneous conditions affecting the skeleton. Common nutrition issues include feeding difficulties, obesity, and metabolic complications. This...
PURPOSE
Skeletal dysplasia are heterogeneous conditions affecting the skeleton. Common nutrition issues include feeding difficulties, obesity, and metabolic complications. This systematic scoping review aimed to identify key nutrition issues, management strategies, and gaps in knowledge regarding nutrition in skeletal dysplasia.
METHODS
The databases Ovid MEDLINE, Ovid EMBASE, Ebsco CINAHL, Scopus, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews were searched. Reference lists and citing literature for included studies were searched. Eligible studies included participants with skeletal dysplasia and described: anthropometry, body composition, nutrition-related biochemistry, clinical issues, dietary intake, measured energy or nutrition requirements, or nutrition interventions.
RESULTS
The literature search identified 8509 references from which 138 studies were included (130 observational, 3 intervention, 2 systematic reviews, and 3 clinical guidelines). Across 17 diagnoses identified, most studies described osteogenesis imperfecta (n = 50) and achondroplasia or hypochondroplasia (n = 47). Nutrition-related clinical issues, biochemistry, obesity, and metabolic complications were most commonly reported, and few studies measured energy requirements (n = 5).
CONCLUSION
Nutrition-related comorbidities are documented in skeletal dysplasia; yet, evidence to guide management is scarce. Evidence describing nutrition in rarer skeletal dysplasia conditions is lacking. Advances in skeletal dysplasia nutrition knowledge is needed to optimize broader health outcomes.
Topics: Humans; Comorbidity; Dwarfism; Obesity; Osteochondrodysplasias; Systematic Reviews as Topic
PubMed: 37330695
DOI: 10.1016/j.gim.2023.100920 -
Gastrointestinal Endoscopy Apr 2016Endoscopic real-time imaging of Barrett's esophagus (BE) with advanced imaging technologies enables targeted biopsies and may eliminate the need for random biopsies to... (Meta-Analysis)
Meta-Analysis Review
ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett's esophagus.
BACKGROUND AND AIMS
Endoscopic real-time imaging of Barrett's esophagus (BE) with advanced imaging technologies enables targeted biopsies and may eliminate the need for random biopsies to detect dysplasia during endoscopic surveillance of BE. This systematic review and meta-analysis was performed by the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee to specifically assess whether acceptable performance thresholds outlined by the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) document for clinical adoption of these technologies have been met.
METHODS
We conducted meta-analyses calculating the pooled sensitivity, negative predictive value (NPV), and specificity for chromoendoscopy by using acetic acid and methylene blue, electronic chromoendoscopy by using narrow-band imaging, and confocal laser endomicroscopy (CLE) for the detection of dysplasia. Random effects meta-analysis models were used. Statistical heterogeneity was evaluated by means of I(2) statistics.
RESULTS
The pooled sensitivity, NPV, and specificity for acetic acid chromoendoscopy were 96.6% (95% confidence interval [CI], 95-98), 98.3% (95% CI, 94.8-99.4), and 84.6% (95% CI, 68.5-93.2), respectively. The pooled sensitivity, NPV, and specificity for electronic chromoendoscopy by using narrow-band imaging were 94.2% (95% CI, 82.6-98.2), 97.5% (95% CI, 95.1-98.7), and 94.4% (95% CI, 80.5-98.6), respectively. The pooled sensitivity, NPV, and specificity for endoscope-based CLE were 90.4% (95% CI, 71.9-97.2), 98.3% (95% CI, 94.2-99.5), and 92.7% (95% CI, 87-96), respectively.
CONCLUSIONS
Our meta-analysis indicates that targeted biopsies with acetic acid chromoendoscopy, electronic chromoendoscopy by using narrow-band imaging, and endoscope-based CLE meet the thresholds set by the ASGE PIVI, at least when performed by endoscopists with expertise in advanced imaging techniques. The ASGE Technology Committee therefore endorses using these advanced imaging modalities to guide targeted biopsies for the detection of dysplasia during surveillance of patients with previously nondysplastic BE, thereby replacing the currently used random biopsy protocols.
Topics: Acetic Acid; Barrett Esophagus; Biopsy; Coloring Agents; Esophagoscopy; Esophagus; Humans; Intravital Microscopy; Methylene Blue; Microscopy, Confocal; Narrow Band Imaging; Predictive Value of Tests; Watchful Waiting
PubMed: 26874597
DOI: 10.1016/j.gie.2016.01.007 -
Orthopaedics & Traumatology, Surgery &... Jun 2022The Bernese periacetabular osteotomy (PAO) is a popular joint-preservation technique aimed at addressing the structural and biomechanical abnormalities associated with... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The Bernese periacetabular osteotomy (PAO) is a popular joint-preservation technique aimed at addressing the structural and biomechanical abnormalities associated with acetabular dysplasia. However, the prognostic factors and long-term survivorship of the native hip, with failure defined as conversion to total hip arthroplasty (THA), is poorly understood. Our study aims to address the following: (1) What is the estimated duration of survival of the native hip post-PAO, (2) What are some prognostic factors of functional outcome and (3) What is the complication rate and complications associated with PAO.
HYPOTHESIS
The Bernese PAO is able to result in favourable mid- to long-term outcomes conditional on a stringent patient selection criteria.
MATERIALS AND METHODS
A systematic review was performed using the PRISMA guidelines. All studies that reported on the outcomes of isolated Bernese PAO for the treatment of acetabular dysplasia were included.
RESULTS
A total of 24 studies (3471 patients, 3655 hips) were included at a mean follow-up duration of 54.2months (range: 1-336months). In total, 208 hips (6.03%; 95% CI: 5.25-6.94%) converted to THA at a mean duration of 4.71years (range: 1-240months). Univariate analysis identified advanced age beyond a follow-up duration of 6years (p=0.001) and preoperative Tönnis grade 2 and above (p<0.001) to be the most significant negative prognostic factors. Beyond a follow-up duration of 2years, intraoperative fluoroscopy proved to be a significant positive prognostic factor (p<0.001). Indications for PAO, obesity and gender were not found to be significant predictors of failure. Our study found the complication rate to be 23.5% (95% CI: 21.6-25.6%). The most common complications detailed are transient lateral femoral cutaneous nerve dysesthesia (8.24%; 95% CI: 7.02-9.65%), stress fracture (5.28%; 95% CI: 4.31-6.89%) and the delayed union, non-union or pseudoarthrosis of the ramus not necessitating surgical correction (3.73%, 95% CI: 2.93-4.75%).
DISCUSSION
PAO alters the natural history of the dysplastic hip with a 10- and 20-year survivorship of approximately 75.9% and 36.5% of patients respectively. The ideal patient should be below 40years old, with a preoperative Tönnis grade of 0 or 1. Intraoperative fluoroscopy is able to guide a better precision when re-orientating the acetabulum.
LEVEL OF EVIDENCE
IV; systematic review and meta-analysis.
Topics: Acetabulum; Hip Dislocation; Hip Dislocation, Congenital; Hip Joint; Humans; Osteotomy; Retrospective Studies; Survivorship; Time Factors; Treatment Outcome
PubMed: 35470119
DOI: 10.1016/j.otsr.2022.103283 -
EFORT Open Reviews Oct 2019Developmental dysplasia of the hip (DDH) is one of the most prevalent congenital malformations. It has a wide spectrum of anatomical abnormalities of the hip joint and... (Review)
Review
Developmental dysplasia of the hip (DDH) is one of the most prevalent congenital malformations. It has a wide spectrum of anatomical abnormalities of the hip joint and is characterized by mild or incomplete formation of the acetabulum leading to laxity of the joint capsule, secondary deformity of the proximal femur and irreducible hip dislocation. It is the leading cause of early hip osteoarthritis in young individuals.Both genetic and environmental factors have been proposed to play an important role in the pathogenesis of DDH. A high prevalence is present in Asian, Caucasian, Mediterranean and American populations, with females being more frequently affected. We evaluated a variety of genetic studies indexed in the PubMed database.Several susceptive genes, including WISP3, PAPPA2, HOXB9, HOXD9, GDF5, TGF Beta 1, CX3CR1, UQCC, COL1A1, TbX4 and ASPN have been identified as being associated with the development of DDH. Moreover, genetic association has also been reported between hip dysplasia and other comorbidities. Even though genetic components are a crucial part in the aetiology of DDH, several DDH susceptibility genes need further investigation.The purpose of this review is to present current literature evidence regarding genes responsible for DDH development. Cite this article: 2019;4:595-601. DOI: 10.1302/2058-5241.4.190006.
PubMed: 31754465
DOI: 10.1302/2058-5241.4.190006