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PloS One 2024Reproducible diagnoses of endometrial hyperplasia (EH) remains challenging and has potential implications for patient management. This systematic review aimed to...
OBJECTIVE
Reproducible diagnoses of endometrial hyperplasia (EH) remains challenging and has potential implications for patient management. This systematic review aimed to identify pathologist-specific factors associated with interobserver variation in the diagnosis and reporting of EH.
METHODS
Three electronic databases, namely MEDLINE, Embase and Web of Science, were searched from 1st January 2000 to 25th March 2023, using relevant key words and subject headings. Eligible studies reported on pathologist-specific factors or working practices influencing interobserver variation in the diagnosis of EH, using either the World Health Organisation (WHO) 2014 or 2020 classification or the endometrioid intraepithelial neoplasia (EIN) classification system. Quality assessment was undertaken using the QUADAS-2 tool, and findings were narratively synthesised.
RESULTS
Eight studies were identified. Interobserver variation was shown to be significant even amongst specialist gynaecological pathologists in most studies. Few studies investigated pathologist-specific characteristics, but pathologists were shown to have different diagnostic styles, with some more likely to under-diagnose and others likely to over-diagnose EH. Some novel working practices were identified, such as grading the "degree" of nuclear atypia and the incorporation of objective methods of diagnosis such as semi-automated quantitative image analysis/deep learning models.
CONCLUSIONS
This review highlighted the impact of pathologist-specific factors and working practices in the accurate diagnosis of EH, although few studies have been conducted. Further research is warranted in the development of more objective criteria that could improve reproducibility in EH diagnostic reporting, as well as determining the applicability of novel methods such as grading the degree of nuclear atypia in clinical settings.
Topics: Humans; Female; Endometrial Hyperplasia; Observer Variation; Pathologists; Endometrial Neoplasms
PubMed: 38683770
DOI: 10.1371/journal.pone.0302252 -
American Journal of Speech-language... Sep 2023Practice pattern studies suggest that liquid modification is currently a primary strategy used by speech-language pathologists to manage dysphagia; however, the breadth...
PURPOSE
Practice pattern studies suggest that liquid modification is currently a primary strategy used by speech-language pathologists to manage dysphagia; however, the breadth of negative consequences associated with their use is not well understood. The purpose of this review was to summarize the evidence on adverse events and effects of thickened liquid (TL) use in adults.
METHOD
Six databases were searched in February 2022: EMBASE, MEDLINE (PubMed), Speechbite, AMED, AgeLine, and CINAHL. Articles were included if they compared adults receiving different TL viscosities and discussed at least one adverse event or effect of consuming TLs. Articles were excluded if they were review articles, rehabilitation studies, rheological analyses, not in English, or not peer reviewed. Screening and data extraction were completed by two independent reviewers. Risk of bias was assessed using Cochrane tools.
RESULTS
Thirty-three studies ( = 4,990 participants across all studies) were eligible for inclusion (2,405 unique records screened). Reported adverse events included dehydration ( = 5), pneumonia ( = 4), death ( = 2), urinary tract infection ( = 1), and hospitalization ( = 1); adverse effects included reduced quality of life ( = 18), aspiration ( = 12), reduced intake ( = 8), increased residue ( = 4), and reduced medication bioavailability ( = 2). Results were mapped on to codes and domains of the International Classification of Functioning, Disability and Health.
CONCLUSIONS
A range of adverse outcomes associated with TL use were identified. Adverse outcomes should be monitored and reported in dysphagia research. Given current research evidence, it is vital for clinicians to weigh the risks and benefits of TL use to mitigate potential adverse outcomes.
Topics: Humans; Adult; Deglutition Disorders; Quality of Life; Hospitalization
PubMed: 37437527
DOI: 10.1044/2023_AJSLP-22-00380 -
Hepatology Communications Apr 2024The precision of clinical criteria and the utility of liver biopsy for diagnosis or prognosis remain unclear in patients with alcohol-associated hepatitis (AH). We... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The precision of clinical criteria and the utility of liver biopsy for diagnosis or prognosis remain unclear in patients with alcohol-associated hepatitis (AH). We systematically reviewed the literature to answer these questions.
METHODS
Four databases were searched for studies describing the precision of clinical criteria (National Institute on Alcohol Abuse and Alcoholism, European Association for Study of Liver, or classical) and the role of histology in AH. The precision(positive predictive value) of criteria was pooled through random-effects meta-analysis, and its variation was investigated through subgroups and meta-regression of study-level factors with their percent contribution to variation (R2). The risk of bias among studies was evaluated through the QUADAS2 tool (PROSPERO-ID-CRD4203457250).
RESULTS
Of 4320 studies, 18 in the systematic review and 15 (10/5: low/high risk of bias, N=1639) were included in the meta-analysis. The pooled precision of clinical criteria was 80.2% (95% CI: 69.7-89.7, I2:93%, p < 0.01), higher in studies with severe AH (mean-Model for End-Stage Liver Disease > 20) versus moderate AH (mean-Model for End-Stage Liver Disease < 20): 92% versus 67.1%, p < 0.01, and in studies with serum bilirubin cutoff 5 versus 3 mg/dL (88.5% vs.78.8%, p = 0.01). The factors contributing to variation in precision were Model for End-Stage Liver Disease (R2:72.7%), upper gastrointestinal bleed (R2:56.3%), aspartate aminotransferase:aspartate aminotransferase ratio (R2:100%), clinical criteria (R2:40.9%), bilirubin (R2:22.5%), and Mallory body on histology (R2:19.1%).The net inter-pathologist agreement for histologic findings of AH was variable (0.33-0.97), best among 2 studies describing AH through simple and uniform criteria, including steatosis, ballooning, and neutrophilic inflammation. Few studies reported the utility of histology in estimating steroid responsiveness (N = 1) and patient prognosis (N = 4); however, very broad septa, pericellular fibrosis, and cholestasis were associated with mortality. Bilirubinostasis was associated with infection in 1 study.
CONCLUSIONS
Clinical criteria are reasonably precise for diagnosing severe AH, while there is an unmet need for better criteria for diagnosing moderate AH. Histologic diagnosis of AH should be simple and uniform.
Topics: Humans; End Stage Liver Disease; Severity of Illness Index; Hepatitis, Alcoholic; Aspartate Aminotransferases; Bilirubin
PubMed: 38497934
DOI: 10.1097/HC9.0000000000000404 -
Computers in Biology and Medicine May 2024The incidence of colorectal cancer (CRC), one of the deadliest cancers around the world, is increasing. Tissue microenvironment (TME) features such as tumor-infiltrating... (Review)
Review
A systematic review of machine learning-based tumor-infiltrating lymphocytes analysis in colorectal cancer: Overview of techniques, performance metrics, and clinical outcomes.
The incidence of colorectal cancer (CRC), one of the deadliest cancers around the world, is increasing. Tissue microenvironment (TME) features such as tumor-infiltrating lymphocytes (TILs) can have a crucial impact on diagnosis or decision-making for treating patients with CRC. While clinical studies showed that TILs improve the host immune response, leading to a better prognosis, inter-observer agreement for quantifying TILs is not perfect. Incorporating machine learning (ML) based applications in clinical routine may promote diagnosis reliability. Recently, ML has shown potential for making progress in routine clinical procedures. We aim to systematically review the TILs analysis based on ML in CRC histological images. Deep learning (DL) and non-DL techniques can aid pathologists in identifying TILs, and automated TILs are associated with patient outcomes. However, a large multi-institutional CRC dataset with a diverse and multi-ethnic population is necessary to generalize ML methods.
Topics: Humans; Lymphocytes, Tumor-Infiltrating; Reproducibility of Results; Colorectal Neoplasms; Tumor Microenvironment
PubMed: 38554659
DOI: 10.1016/j.compbiomed.2024.108306 -
Diagnostics (Basel, Switzerland) May 2024Neck infections are often prone to being underestimated and can manifest insidiously. The spread of infection can lead to translocation into thoracic areas, causing... (Review)
Review
Neck infections are often prone to being underestimated and can manifest insidiously. The spread of infection can lead to translocation into thoracic areas, causing descending necrotizing mediastinitis (DNM). However, the application of the post-mortem approach in such cases is not well-described in the literature. A literature review was carried out according to the PRISMA methods. Nine papers were included in the final review, revealing different levels of involvement of neck layers that can be linked to different causes. Expertise with respect to the anatomy of the fasciae and spaces of the neck enables an understanding of the pathogenesis of DNM. However, a clear autoptic description was not provided in any of the articles. Therefore, we also employed a practical post-mortem approach to cases of death due to DNM. It is fundamental for pathologists to identify the exact head and neck structures involved. Providing dissectors with support from an otolaryngologist could be useful. This paper could help address such difficult cases.
PubMed: 38893677
DOI: 10.3390/diagnostics14111150 -
Digestive Diseases and Sciences Sep 2023Endoscopic eradication therapy for Barrett's esophagus (BE)-related neoplasia is increasingly being performed at tertiary and community centers. While it has been... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Endoscopic eradication therapy for Barrett's esophagus (BE)-related neoplasia is increasingly being performed at tertiary and community centers. While it has been suggested that these patients should be evaluated at expert centers, the impact of this practice has not been evaluated. We aimed to assess the impact of referral of BE-related neoplasia patients to expert centers by assessing the proportion of patients with change in pathological diagnosis and visible lesions detected.
METHODS
Multiple databases were searched until December 2021 for studies of patients with BE referred from the community to expert center. The proportions of pathology grade change and newly detected visible lesions at expert centers were pooled using a random-effects model. Subgroup analyses were performed based on baseline histology and other relevant factors.
RESULTS
Twelve studies were included (1630 patients). The pooled proportion of pathology grade change after expert pathologist review was 47% (95% CI 34-59%) overall and 46% (95% CI 31-62%) among patients with baseline low-grade dysplasia. When upper endoscopy was repeated at an expert center, the pooled proportion of pathology grade change was still high 47% (95% 26-69%) overall and 40% (95% CI 34-45%) among patients with baseline LGD. The pooled proportion of newly detected visible lesions was 45% (95% CI 28-63%) and among patients referred with LGD was 27% (95% CI 22-32%).
CONCLUSION
An alarmingly high proportion of newly detected visible lesions and pathology grade change were found when patients were referred to expert centers supporting the need for centralized care for BE-related neoplasia patients.
Topics: Humans; Barrett Esophagus; Endoscopy, Gastrointestinal; Esophageal Neoplasms; Precancerous Conditions
PubMed: 37402985
DOI: 10.1007/s10620-023-07968-4 -
Evidence-based Dentistry Mar 2024Electronic search was conducted up to September 2021 in three electronic databases including Scopus, Web of Science, and EMBASE. Only studies in English language were...
DATA SOURCES
Electronic search was conducted up to September 2021 in three electronic databases including Scopus, Web of Science, and EMBASE. Only studies in English language were selected.
STUDY SELECTION
Prospective and retrospective studies including cohort, cross-sectional, randomized control trials, and qualitative studies were included. Both the inclusion and exclusion criteria were reported. The search in the databases and the selection of the studies were performed independently by two reviewers. The included studies assessed the effects of clear aligner therapy on the speech difficulty.
DATA EXTRACTION AND SYNTHESIS
Data extraction was performed independently by two reviewers. The data from the relevant studies were extracted into a customized Template. The systematic review was carried out and reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Details regarding the authors, year of publication, sample size, included participants, age, groups, outcome assessment, results, and inferences were extracted from the selected studies. The quality of the selected studies was assessed based on the relevant guidelines from Cochrane Handbook for Systematic Reviews. The criteria examined sequence generation, allocation concealment, blinding, outcome data, selective reporting, and other sources of bias. Non-randomized studies were assessed using the ROBINS-I tool (Risk of Bias in Non-randomized studies). The strength of evidence was assessed by the evidence grading system developed by the GRADE collaboration as described in the Cochrane Handbook for Systematic Reviews of Interventions.
RESULTS
The search identified 283 results. 269 articles were excluded based on their title and abstract after evaluation against the inclusion criteria. 14 articles were assessed in full text. Finally, 7 papers were included in the qualitative analysis. The included studies were 5 cohort studies and 2 randomized clinical studies. 332 patients were examined in the included studies. There were 195 females and 137 males. 191 patients were treated using clear aligner therapy (CAT) while 122 patients were treated using labial fixed appliances and 19 patients were treated using lingual orthodontic treatment. Out of the 191 patients who were treated using CAT, 179 patients were treated using Invisalign (Santa Clara, CA, USA) while 12 patients were treated using Smile Align (Mumbai, India). All seven selected studies examined speech dysfunction. The speech difficulty was assessed through two tools - semiobjective assessment by speech pathologists and professionals and subjective evaluations by the patients themselves through a patient questionnaire that assess the effects of aligners on speech. The risk of bias assessment revealed that two studies had moderate risk of bias while five articles had serious risk of bias. Meta-analysis was not performed due to the high heterogeneity of the included studies. The level of evidence was assessed as low due to the methodological insufficiencies and risk of bias in the included studies. The results showed that both CAT and fixed appliances (FA) resulted in speech difficulties in terms of clarity and delivery of speech that include speech alteration, slurring of words, lisping, and nasality. Some patients who were treated using CAT reported impairment in the lingual space that affected their speech. Lingual FA resulted in more speech difficulty when compared to labial FA and CAT. Aligners caused errors in the articulation of /s/,/z/,/zh/,/sh/,/th/,/ch/. Acoustic analysis revealed /s/ sound appeared most affected. Aligners had an effect on speech while reading, with patients slowing down to their speed to better articulate. The above-mentioned speech difficulties were transient. The included patients normalized their speech within 7-14 days from start of treatment while few patients took 30-60 days to recover.
CONCLUSIONS
Although the likelihood of speech difficulties would be high with CAT, the current evidence states that speech difficulties shown with CAT are similar to those found with FA. However, the patients who were treated using CAT adapt quickly and speech recovers within a few weeks. Time to recovery varied greatly, ranging from a week to two months in certain cases.
Topics: Male; Female; Humans; Retrospective Studies; Speech; Prospective Studies; Cross-Sectional Studies; Speech Disorders; Orthodontic Appliances, Removable
PubMed: 38225369
DOI: 10.1038/s41432-024-00969-w -
Frontiers in Oncology 2024The risk that a large polyp (≥10 mm) evolves into high-grade dysplasia (HGD) is relatively high compared with that of a small/diminutive polyp (<10 mm). Recently, the...
INTRODUCTION
The risk that a large polyp (≥10 mm) evolves into high-grade dysplasia (HGD) is relatively high compared with that of a small/diminutive polyp (<10 mm). Recently, the detection of small and diminutive polyps has been substantially improved with the advancement of endoscopy. However, further research is needed on the role of the incidence of HGD caused by the co-occurrence of small and diminutive polyps in the progression of HGD. In this study, we aim to investigate whether and how the small and diminutive polyps correlate with the incidence of HGD in the population.
METHODS
The pooled data were deeply analyzed from four published randomized controlled trials (RCTs) regarding colon polyp detection. All polyps detected were examined and confirmed by pathologists. The primary outcome was the composition ratio of the HGD polyps in each polyp size category.
RESULTS
Among a total of 3,179 patients with 2,730 polyps identified, there were 83 HGD polyps confirmed, and 68 patients had at least one polyp with HGD. The risk of development of HGD was lower for a single small and diminutive polyp than for one large polyp (2.18% vs. 22.22%, < 0.0001). On the contrary, the composition ratio for HGD from small and diminutive polyps was significantly higher than that from the large ones (68.67% vs. 31.33%, < 0.0001). The combined number of HGD presented a trend negatively correlated to size.
CONCLUSIONS
Our data demonstrated that the absolute number of HGD significantly derives more from small and diminutive polyps than from the large ones, and the collective number of small and diminutive polyps per patient is indicative of his/her HGD exposure. These findings positively provide novel perspectives on the management of polyps and may further optimize the prevention of colorectal cancer.
SYSTEMATIC REVIEW REGISTRATION
http://www.chictr.org.cn, identifier ChiCTR1900025235, ChiCTR1800017675, ChiCTR1800018058, and ChiCTR1900023086.
PubMed: 38410098
DOI: 10.3389/fonc.2024.1294745 -
Journal of Voice : Official Journal of... Mar 2024To examine the effect of traditional voice therapy and cognitive therapy on the voice and client-wellbeing outcomes in adults with functional voice disorders (FVD).
OBJECTIVE
To examine the effect of traditional voice therapy and cognitive therapy on the voice and client-wellbeing outcomes in adults with functional voice disorders (FVD).
METHODS
A systematic review of English articles was conducted using Medline (Ovid), Embase (Elsevier), CINAHL (Ebsco), The Cochrane Central Register of Controlled Trials (CENTRAL), PsychInfo (Ebsco) and Speechbite from inception to current date. Additional studies were identified through bibliographies and authors were contacted when further information was required from an article. All study designs were included with pretest/posttest outcome measures related to voice. Independent extraction of studies was completed by three authors using predefined data fields and quality assessment tools.
RESULTS
Outcomes of 23 studies (2 RCTs and 21 cohort or case studies) are summarised using a narrative style due to heterogeneity of interventions and outcome scales used. Overall research quality of included studies was low, with many cohort and case studies lacking controls, blinding and robust outcome measures.
CONCLUSIONS
There are some benefits to pairing cognitive behavioural therapy (CBT) with traditional voice therapy for FVD including improved voice quality, psychosocial wellbeing and prevention of relapse. It is feasible to train speech-language pathologists (SLPs) in CBT-enhanced voice therapy. Further high-quality research is needed, however, to guide the clinical implementation of CBT for the management of FVD.
Topics: Adult; Humans; Cognitive Behavioral Therapy; Voice Quality; Voice Disorders
PubMed: 34772593
DOI: 10.1016/j.jvoice.2021.09.018 -
Archives of Pathology & Laboratory... May 2024Automated prostate cancer detection using machine learning technology has led to speculation that pathologists will soon be replaced by algorithms. This review covers...
CONTEXT
Automated prostate cancer detection using machine learning technology has led to speculation that pathologists will soon be replaced by algorithms. This review covers the development of machine learning algorithms and their reported effectiveness specific to prostate cancer detection and Gleason grading.
OBJECTIVE
To examine current algorithms regarding their accuracy and classification abilities. We provide a general explanation of the technology and how it is being used in clinical practice. The challenges to the application of machine learning algorithms in clinical practice are also discussed.
DATA SOURCES
The literature for this review was identified and collected using a systematic search. Criteria were established prior to the sorting process to effectively direct the selection of studies. A 4-point system was implemented to rank the papers according to their relevancy. For papers accepted as relevant to our metrics, all cited and citing studies were also reviewed. Studies were then categorized based on whether they implemented binary or multi-class classification methods. Data were extracted from papers that contained accuracy, area under the curve (AUC), or κ values in the context of prostate cancer detection. The results were visually summarized to present accuracy trends between classification abilities.
CONCLUSIONS
It is more difficult to achieve high accuracy metrics for multiclassification tasks than for binary tasks. The clinical implementation of an algorithm that can assign a Gleason grade to clinical whole slide images (WSIs) remains elusive. Machine learning technology is currently not able to replace pathologists but can serve as an important safeguard against misdiagnosis.
Topics: Humans; Prostatic Neoplasms; Male; Machine Learning; Artificial Intelligence; Neoplasm Grading; Algorithms
PubMed: 37594900
DOI: 10.5858/arpa.2022-0460-RA