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Medicine Jan 2022To evaluate the prognostic effect and clinical significance of epidermal growth factor receptor and its phosphorlated form (EGFR/p-EGFR) in nasopharyngeal carcinoma. (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the prognostic effect and clinical significance of epidermal growth factor receptor and its phosphorlated form (EGFR/p-EGFR) in nasopharyngeal carcinoma.
METHODS
A systematic review and meta-analysis was designed. We visited PubMed, Embase, China National Knowledge Infrastructure Database, Database of Chinese sci-tech periodicals, WanFang Database, and China Biology Medicine disc to search for Chinese and English publications of prospective studies and retrospective studies investigating the association of EGFR/p-EGFR and nasopharyngeal carcinoma prognosis from inception to April 2021. The inclusion criteria were that the samples should be pathologically confirmed as nasopharyngeal carcinoma and the expression of EGFR/p-EGFR should be detected via immunohistochemistry; the study should analyze the prognostic significance of EGFR/p-EGFR in nasopharyngeal carcinoma; hazard ratio (HR) and 95% confidence interval (CI) should be reported in the study or could be derived from survival curves; and the outcomes of the study should include overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS).
RESULTS
A total of 18 studies evaluating 1451 samples were included. For studies that reported OS as an outcome, EGFR overexpression indicated worse OS of nasopharyngeal carcinoma patients. The heterogeneity between studies was high (I2 = 91%, P < .01), and a random-effect model was used to combine the effect size (HR = 1.71, 95% CI [1.21, 2.41], P < .01). Further sensitivity analysis and prespecified subgroup analysis were performed to detect the source of heterogeneity, and the results showed that the heterogeneity could not be eliminated. Publication bias assessed by funnel plots and Begg test and Egger test was low (Begg test: P = .846 and Egger test: P = .074). p-EGFR was not correlated with the OS of nasopharyngeal carcinoma patients (HR = 1.01, 95% CI [0.88, 1.15], P = .92). For studies that reported DFS, EGFR overexpression was associated with worse DFS in patients with nasopharyngeal carcinoma (HR = 2.53, 95% CI [1.84, 3.47], P < .01). For studies that reported PFS, EGFR overexpression was not correlated with the PFS of nasopharyngeal carcinoma patients (HR = 1.86, 95% CI [0.90, 3.82], P = .09). For studies that reported DMFS, EGFR overexpression was not correlated with the DMFS of nasopharyngeal carcinoma patients, and high heterogeneity between studies was detected (I2 = 97%, P < .01). A random-effect model was used to combine the effect size (HR = 1.80, 95% CI [0.56, 5.76], P = .32). A sensitivity analysis was conducted. Publication bias was detected to be low (Begg test: P = .817 and Egger test: P = .954). There was no correlation between p-EGFR overexpression and DMFS in patients with nasopharyngeal carcinoma (HR = 1.20, 95% CI [0.95, 1.52], P = .12).
CONCLUSION
In nasopharyngeal carcinoma patients, EGFR overexpression could be used as a biomarker that predicts poor OS and DFS, but not a prognostic biomarker for PFS and DMFS. The overexpression of p-EGFR was not shown to be associated with the prognosis of nasopharyngeal carcinoma patients and could not be used as a prognostic biomarker.
ETHICS AND DISSEMINATION
This study was registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), and reported as stated by the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Neither ethical approval nor informed consent was required since this study was conducted based on previous publications.
INPLASY REGISTRATION NUMBER
INPLASY 202150010.
Topics: ErbB Receptors; Humans; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Prognosis
PubMed: 35060503
DOI: 10.1097/MD.0000000000028507 -
Health and Quality of Life Outcomes Jan 2024Nutrition care can positively affect multiple aspects of patient's health; outcomes are commonly evaluated on the basis of their impact on a patient's (i)... (Review)
Review
BACKGROUND
Nutrition care can positively affect multiple aspects of patient's health; outcomes are commonly evaluated on the basis of their impact on a patient's (i) illness-specific conditions and (ii) health-related quality of life (HRQoL). Our systematic review examined how HRQoL was measured in studies of nutritional interventions. To help future researchers select appropriate Quality of Life Questionnaires (QoLQ), we identified commonly-used instruments and their uses across populations in different regions, of different ages, and with different diseases.
METHODS
We searched EMCare, EMBASE, and Medline databases for studies that had HRQoL and nutrition intervention terms in the title, the abstract, or the MeSH term classifications "quality of life" and any of "nutrition therapy", "diet therapy", or "dietary supplements" and identified 1,113 studies for possible inclusion.We then reviewed titles, abstracts, and full texts to identify studies for final inclusion.
RESULTS
Our review of titles, abstracts, and full texts resulted in the inclusion of 116 relevant studies in our final analysis. Our review identified 14 general and 25 disease-specific QoLQ. The most-used general QoLQ were the Short-Form 36-Item Health Survey (SF-36) in 27 studies and EuroQol 5-Dimension, (EQ-5D) in 26 studies. The European Organization for Research and Treatment of Cancer Quality of life Questionnaire (EORTC-QLQ), a cancer-specific QoLQ, was the most frequently used disease-specific QoLQ (28 studies). Disease-specific QoLQ were also identified for nutrition-related diseases such as diabetes, obesity, and dysphagia. Sixteen studies used multiple QoLQ, of which eight studies included both general and disease-specific measures of HRQoL. The most studied diseases were cancer (36 studies) and malnutrition (24 studies). There were few studies focused on specific age-group populations, with only 38 studies (33%) focused on adults 65 years and older and only 4 studies focused on pediatric patients. Regional variation in QoLQ use was observed, with EQ-5D used more frequently in Europe and SF-36 more commonly used in North America.
CONCLUSIONS
Use of QoLQ to measure HRQoL is well established in the literature; both general and disease-specific instruments are now available for use. We advise further studies to examine potential benefits of using both general and disease-specific QoLQ to better understand the impact of nutritional interventions on HRQoL.
Topics: Humans; Deglutition Disorders; Europe; Malnutrition; Quality of Life
PubMed: 38267976
DOI: 10.1186/s12955-024-02229-y -
Nutrients Mar 2023Post-stroke oropharyngeal dysphagia (PS-OD) and its complications increase healthcare costs, suggesting that its appropriate management is cost-effective. We aimed to... (Review)
Review
BACKGROUND
Post-stroke oropharyngeal dysphagia (PS-OD) and its complications increase healthcare costs, suggesting that its appropriate management is cost-effective. We aimed to assess the efficiency of healthcare interventions in PS-OD management.
METHODS
A systematic review was conducted following PRISMA recommendations. Four databases were searched from inception through 30 June 2021. Outcome measures were cost-effectiveness and cost-savings of healthcare interventions. English and Spanish literature were included. Narrative and tables were used to present and synthesise evidence. Quality was evaluated using the CHEERS Statement.
RESULTS
A total of 244 studies were identified, and 10 were included. Screening and diagnosis of PS-OD studies found: (1) adjusted reduction in hospitalisation costs when assessed during the first admission day; (2) non-significant reduction in hospitalisation costs with OD management after thrombolysis; and (3) videofluoroscopy as the most cost-effective screening method (compared to bedside evaluation and a combination of both). Two studies showed cost-effective rehabilitation programmes, including OD management. Pelczarska et al. showed an incremental cost-utility ratio of texture-modified diets using a gum-based thickener of 20,977 PLN (4660€) following a dynamic model, and Kotecki et al. commercially prepared thickened fluids that were 44% to 59% less expensive than in situ prepared fluids. Elia et al. showed home enteral nutrition was cost-effective (£12,817/QALY), and Beavan et al. showed higher nutrient intake and low increase in hospitalisation costs using looped-nasogastric tubes (£5.20 for every 1% increase). Heterogeneity between studies precluded a quantitative synthesis.
CONCLUSIONS
Included studies suggest that healthcare interventions aiming to prevent OD complications are cost-effective. However, studies assessing novel strategies are needed.
Topics: Humans; Cost-Benefit Analysis; Deglutition Disorders; Stroke; Health Care Costs; Delivery of Health Care
PubMed: 37049553
DOI: 10.3390/nu15071714 -
EJIFCC Aug 2022Quantification of SARS-CoV-2 antigens by means of rapid, high-throughput and fully-automated techniques has been proposed as a feasible alternative to overcome the... (Review)
Review
BACKGROUND
Quantification of SARS-CoV-2 antigens by means of rapid, high-throughput and fully-automated techniques has been proposed as a feasible alternative to overcome the current shortage of resources for routine molecular diagnostics. To this end, we provide here a systematic review of diagnostic accuracy of DiaSorin Liaison SARS-CoV-2 antigen immunoassay.
METHODS
An electronic search was conduced in Medline and Scopus, with no language or date restrictions (up to January 20, 2022), for identifying all published studies articles in which the diagnostic performance of the DiaSorin Liaison SARS-CoV-2 antigen immunoassay was compared with molecular diagnostic techniques.
RESULTS
The electronic search identified a final number of 11 studies, totalling 4449 oro- and naso-pharyngeal specimens. The pooled diagnostic sensitivity, specificity and area under the curve (AUC) of the Liaison SARS-CoV-2 antigen immunoassay in all samples were 0.51 (95%CI, 0.49-0.54), 1.00 (95%CI, 1.00-1.00) and 0.994 (95%CI, 0.990-0.998), respectively, whilst the overall concordance with molecular diagnostics was 82.1%. The pooled diagnostic sensitivity, specificity and AUC of the Liaison SARS-CoV-2 antigen immunoassay in specimens with high viral load (i.e., cycle threshold values <25-30) were 0.79 (95%CI, 0.75-0.82), 1.00 (95%CI, 0.99-1.00) and 0.911 (95%CI, 0.879-0.943), respectively, whilst the overall concordance with molecular diagnostics in such samples increased to 94.2%.
CONCLUSION
The results of this systematic literature review suggest that there is sufficient accuracy of the DiaSorin Liaison SARS-CoV-2 antigen immunoassay in samples with high viral loads that would enable its reliable usage for identifying superspreaders, who are responsible for the vast majority of transmission events.
PubMed: 36313904
DOI: No ID Found -
International Journal of Environmental... May 2021Oropharyngeal dysphagia is a condition characterized by swallowing difficulty in the mouth and pharynx, which can be due to various factors. Animal models of... (Review)
Review
Oropharyngeal dysphagia is a condition characterized by swallowing difficulty in the mouth and pharynx, which can be due to various factors. Animal models of oropharyngeal dysphagia are essential to confirm the cause-specific symptoms, pathological findings, and the effect of treatment. Recently, various animal models of dysphagia have been reported. The purpose of this review is to organize the rodent models of oropharyngeal dysphagia reported to date. The articles were obtained from Medline, Embase, and the Cochrane library, and selected following the PRISMA guideline. The animal models in which oropharyngeal dysphagia was induced in rats or mice were selected and classified based on the diseases causing oropharyngeal dysphagia. The animal used, method of inducing dysphagia, and screening methods and results were collected from the selected 37 articles. Various rodent models of oropharyngeal dysphagia provide distinctive information on atypical swallowing. Applying and analyzing the treatment in rodent models of dysphagia induced from various causes is an essential process to develop symptom-specific treatments. Therefore, the results of this study provide fundamental and important data for selecting appropriate animal models to study dysphagia.
Topics: Animals; Deglutition; Deglutition Disorders; Mice; Mouth; Pharynx; Rats; Rodentia
PubMed: 34067192
DOI: 10.3390/ijerph18094987 -
Journal of B.U.ON. : Official Journal... 2021Hypopharyngeal cervical esophageal carcinoma (HPCEC) is a group of highly malignant entities usually presenting at an advanced stage. Our purpose was to systematically...
PURPOSE
Hypopharyngeal cervical esophageal carcinoma (HPCEC) is a group of highly malignant entities usually presenting at an advanced stage. Our purpose was to systematically review and synthesize all available data on the management and outcomes of patients with these upper gastrointestinal malignancies.
METHODS
A systematic literature search of the PubMed and Cochrane databases was performed with respect to the PRISMA statement (end-of-search date: May 1st, 2017). Data on the study design, interventions, participants, and outcomes were extracted by two independent reviewers. Quality assessment of included studies was performed using the tool developed by the National Heart, Lung, and Blood Institute.
RESULTS
Thirty-four observational studies were included in this review. Overall, 20,409 patients with HPCECs were included. Mean patient age was 61.3 years. The most widely implemented therapeutic modalities were chemoradiation (38%), radiation alone (16%), and surgery plus radiation (13%). Overall, mean relapse rates were 15±2.6% for local recurrence, 14.7±2.6% for regional recurrence. and 10±2.3% for distant metastases. Cumulative mean 5- and 3-year survival rates were 20±2.6% and 22±2.6%, respectively, while mean 5-year disease-free survival rates were 22±2.3%. The most common complications were fistulae and pulmonary complications. Mean 30-day mortality rate was 7±2.2% and the mean long-term mortality rate was 22±3.3%.
CONCLUSIONS
Multimodal approaches are typically needed for the management of HPCECs. Radiotherapy is the mainstay of treatment for local tumors. Locally advanced non-metastatic tumors are typically managed with chemoradiation or a combination of pharyngolaryngoesophagectomy and chemoradiation. For metastatic carcinomas, an arsenal of surgical and medical treatment options can help relieve tumor burden and improve quality of life.
Topics: Esophageal Neoplasms; Female; Humans; Hypopharyngeal Neoplasms; Male; Middle Aged
PubMed: 33721430
DOI: No ID Found -
The Cochrane Database of Systematic... May 2020Sore throat is a common condition associated with a high rate of antibiotic prescriptions, despite limited evidence for the effectiveness of antibiotics. Corticosteroids... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sore throat is a common condition associated with a high rate of antibiotic prescriptions, despite limited evidence for the effectiveness of antibiotics. Corticosteroids may improve symptoms of sore throat by reducing inflammation of the upper respiratory tract. This review is an update to our review published in 2012.
OBJECTIVES
To assess the clinical benefit and safety of corticosteroids in reducing the symptoms of sore throat in adults and children.
SEARCH METHODS
We searched CENTRAL (Issue 4, 2019), MEDLINE (1966 to 14 May 2019), Embase (1974 to 14 May 2019), the Database of Abstracts of Reviews of Effects (DARE, 2002 to 2015), and the NHS Economic Evaluation Database (inception to 2015). We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that compared steroids to either placebo or standard care in adults and children (aged over three years) with sore throat. We excluded studies of hospitalised participants, those with infectious mononucleosis (glandular fever), sore throat following tonsillectomy or intubation, or peritonsillar abscess.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane.
MAIN RESULTS
We included one new RCT in this update, for a total of nine trials involving 1319 participants (369 children and 950 adults). In eight trials, participants in both corticosteroid and placebo groups received antibiotics; one trial offered delayed prescription of antibiotics based on clinical assessment. Only two trials reported funding sources (government and a university foundation). In addition to any effect of antibiotics and analgesia, corticosteroids increased the likelihood of complete resolution of pain at 24 hours by 2.40 times (risk ratio (RR) 2.4, 95% confidence interval (CI) 1.29 to 4.47; P = 0.006; I² = 67%; high-certainty evidence) and at 48 hours by 1.5 times (RR 1.50, 95% CI 1.27 to 1.76; P < 0.001; I² = 0%; high-certainty evidence). Five people need to be treated to prevent one person continuing to experience pain at 24 hours. Corticosteroids also reduced the mean time to onset of pain relief and the mean time to complete resolution of pain by 6 and 11.6 hours, respectively, although significant heterogeneity was present (moderate-certainty evidence). At 24 hours, pain (assessed by visual analogue scales) was reduced by an additional 10.6% by corticosteroids (moderate-certainty evidence). No differences were reported in recurrence/relapse rates, days missed from work or school, or adverse events for participants taking corticosteroids compared to placebo. However, the reporting of adverse events was poor, and only two trials included children or reported days missed from work or school. The included studies were assessed as moderate quality evidence, but the small number of included studies has the potential to increase the uncertainty, particularly in terms of applying these results to children.
AUTHORS' CONCLUSIONS
Oral or intramuscular corticosteroids, in addition to antibiotics, moderately increased the likelihood of both resolution and improvement of pain in participants with sore throat. Given the limited benefit, further research into the harms and benefits of short courses of steroids is needed to permit informed decision-making.
Topics: Adolescent; Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Child; Child, Preschool; Drug Therapy, Combination; Humans; Middle Aged; Pharyngitis; Randomized Controlled Trials as Topic; Time Factors; Tonsillitis; Treatment Outcome; Young Adult
PubMed: 32356360
DOI: 10.1002/14651858.CD008268.pub3 -
The Cochrane Database of Systematic... Aug 2017Please see Appendix 4 for a glossary of terms.The outcome of patients with esophageal cancer is generally poor. Although multimodal therapy is standard, there is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Please see Appendix 4 for a glossary of terms.The outcome of patients with esophageal cancer is generally poor. Although multimodal therapy is standard, there is conflicting evidence regarding the addition of esophagectomy to chemoradiotherapy.
OBJECTIVES
To compare the effectiveness and safety of chemoradiotherapy plus surgery with that of chemoradiotherapy alone in people with nonmetastatic esophageal carcinoma.
SEARCH METHODS
We performed a computerized search for relevant studies, up to Feburary 2017, on the CENTRAL, MEDLINE, and Embase databases using MeSH headings and keywords. We searched five online databases of clinical trials, handsearched conference proceedings, and screened reference lists of retrieved papers.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) comparing chemoradiotherapy plus esophagectomy with chemoradiotherapy alone for localized esophageal carcinoma. We excluded RCTs comparing chemotherapy or radiotherapy alone with esophagectomy.
DATA COLLECTION AND ANALYSIS
Two authors independently selected studies, extracted data, and assessed risk of bias and the quality of the evidence, using standardized Cochrane methodological procedures. The primary outcome was overall survival (OS), estimated with Hazard Ratio (HR). Secondary outcomes, estimated with risk ratio (RR), were local and distant progression-free survival (PFS), quality of life (QoL), treatment-related mortality and morbidity, and use of salvage procedures for dysphagia. Data were analyzed using a random effects model in Review Manager 5.3 software.
MAIN RESULTS
From 2667 references, we identified two randomized studies, in six reports, that included 431 participants. All participants were clinically staged to have at least T3 and/or node positive thoracic esophageal carcinoma, 93% of which was squamous cell histology. The risk of methodological bias of the included studies was low to moderate.High-quality evidence found the addition of esophagectomy had little or no difference on overall survival (HR 0.99, 95% CI 0.79 to 1.24; P = 0.92; I² = 0%; two trials). Neither study reported PFS, therefore, freedom from loco-regional relapse was used as a proxy. Moderate-quality evidence suggested that the addition of esophagectomy probably improved freedom from locoregional relapse (HR 0.55, 95% CI 0.39 to 0.76; P = 0.0004; I² = 0%; two trials), but low-quality evidence suggested it may increase the risk of treatment-related mortality (RR 5.11, 95% CI 1.74 to 15.02; P = 0.003; I² = 2%; two trials).The other pre-specified outcomes (quality of life, treatment-related toxicity, and use of salvage procedures for dysphagia) were reported by only one study, which found very low-quality evidence that use of esophagectomy was associated with reduced short-term QoL (MD 0.93, 95% CI 0.24 to 1.62), and low-quality evidence that it reduced use of salvage procedures for dysphagia (HR 0.52, 95% CI 0.36 to 0.75). Neither study compared treatment-related morbidity between treatment groups.
AUTHORS' CONCLUSIONS
Based on the available evidence, the addition of esophagectomy to chemoradiotherapy in locally advanced esophageal squamous cell carcinoma, provides little or no difference on overall survival, and may be associated with higher treatment-related mortality. The addition of esophagectomy probably delays locoregional relapse, however, this end point was not well defined in the included studies. It is undetermined whether these results can be applied to the treatment of adenocarcinomas, tumors involving the distal esophagus and gastro-esophageal junction, and to people with poor response to chemoradiation.
Topics: Carcinoma; Carcinoma, Squamous Cell; Chemoradiotherapy; Cisplatin; Combined Modality Therapy; Deglutition Disorders; Esophageal Neoplasms; Esophagectomy; Fluorouracil; Humans; Neoplasm Recurrence, Local; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 28829911
DOI: 10.1002/14651858.CD010511.pub2 -
Anaesthesia Oct 2014We systematically reviewed 31 adult randomised clinical trials of the i-gel(®) vs laryngeal mask airway. The mean (95% CI) leak pressure difference and relative risk... (Comparative Study)
Comparative Study Meta-Analysis Review
We systematically reviewed 31 adult randomised clinical trials of the i-gel(®) vs laryngeal mask airway. The mean (95% CI) leak pressure difference and relative risk (95% CI) of insertion on the first attempt were similar: 0.40 (-1.23 to 2.02) cmH2 O and 0.98 (0.95-1.01), respectively. The mean (95% CI) insertion time and the relative risk (95% CI) of sore throat were less with the i-gel: by 1.46 (0.33-2.60) s, p = 0.01, and 0.59 (0.38-0.90), p = 0.02, respectively. The relative risk of poor fibreoptic view through the i-gel was 0.29 (0.16-0.54), p < 0.0001. All outcomes displayed substantial heterogeneity, I(2) ≥ 75%. Subgroup analyses did not decrease heterogeneity, but suggested that insertion of the i-gel was faster than for first-generation laryngeal mask airways and that the i-gel leak pressure was higher than first generation, but lower than second-generation, laryngeal mask airways. A less frequent sore throat was the main clinical advantage of the i-gel.
Topics: Adult; Humans; Laryngeal Masks; Pharyngitis; Randomized Controlled Trials as Topic
PubMed: 25040063
DOI: 10.1111/anae.12772 -
Journal of Personalized Medicine Sep 2022Obesity is a multifactorial chronic disease involving multiple organs, devices, and systems involving important changes in the stomatognathic system, such as in the... (Review)
Review
BACKGROUND
Obesity is a multifactorial chronic disease involving multiple organs, devices, and systems involving important changes in the stomatognathic system, such as in the orofacial muscles, temporomandibular joint, cheeks, nose, jaw, maxilla, oral cavity, lips, teeth, tongue, hard/soft palate, larynx, and pharynx. Patients with obesity indicated for bariatric surgery reportedly presented with abnormalities in the structures and function of the stomatognathic apparatus. This occurs through the accumulation of adipose tissue in the oral cavity and pharyngeal and laryngeal regions. Therefore, this systematic review aimed to elucidate the changes occurring in the stomatognathic system of patients with obesity after undergoing bariatric surgery.
METHOD
Information was searched based on the equations developed with the descriptors obtained in DECS and MESH using the PRISMA methodology. Studies published between 2010 and October 2021 in databases including PubMed, ProQuest, Scielo, Dialnet, EBSCO, and Springer Link were considered.
RESULTS
Eighty articles met the inclusion criteria after evaluating the articles, thereby allowing for the determination of the morphophysiological correlation of the stomatognathic system with the population studied. At the morphological or structural level, changes were observed in the face, nose, cheeks, maxilla, jaw, lips, oral cavity, teeth, tongue, palate, temporomandibular joint, neck, muscles, head, shoulders, larynx, and pharynx. At the morphological level, the main changes occurred in, and the most information was obtained from, the labial structures, teeth, muscles, pharynx, and larynx. Physiological changes were in breathing, phonation, chewing, and swallowing, thereby revealing the imbalance in basic and vital functions.
CONCLUSIONS
Analyzing the changes and structures of obese patients and candidates for bariatric surgery revealed that, in the preoperative period, the evidence is clear owing to the presence of a wide range of information. However, the information is more limited regarding the postoperative period; thus, further research focusing on characterization of the system postoperatively is warranted.
PubMed: 36294680
DOI: 10.3390/jpm12101541