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Journal of Smooth Muscle Research =... 2023Esophageal achalasia is classified into three subtypes according to manometric findings. Since several factors, including clinical characteristics and treatment...
Esophageal achalasia is classified into three subtypes according to manometric findings. Since several factors, including clinical characteristics and treatment response, have been reported to differ among the subtypes, the underlying pathogenesis may also differ. However, a comprehensive understanding regarding the differences is still lacking. We therefore performed a systematic review of the differences among the three subtypes of achalasia to clarify the current level of comprehension. In terms of clinical features, type III, which is the least frequently diagnosed of the three subtypes, showed the oldest age and most severe symptoms, such as chest pain. In contrast, type I showed a higher prevalence of lung complications, and type II showed weight loss more frequently than the other types. Histopathologically, type I showed a high loss of ganglion cells in esophagus, and on a molecular basis, type III had elevated serum pro-inflammatory cytokine levels. In addition to peristalsis and the lower esophageal sphincter (LES) function, the upper esophageal sphincter (UES) function of achalasia has attracted attention, as an impaired UES function is associated with severe aspiration pneumonia, a fatal complication of achalasia. Previous studies have indicated that type II shows a higher UES pressure than the other subtypes, while an earlier decline in the UES function has been confirmed in type I. Differences in the treatment response are also crucial for managing achalasia patients. A number of studies have reported better responses in type II cases and less favorable responses in type III cases to pneumatic dilatation. These differences help shed light on the pathogenesis of achalasia and support its clinical management according to the subtype.
Topics: Humans; Esophageal Achalasia; Manometry; Esophageal Sphincter, Lower; Esophageal Sphincter, Upper; Chest Pain
PubMed: 36948611
DOI: 10.1540/jsmr.59.14 -
Journal of Clinical Sleep Medicine :... May 2020The purpose of this study is to conduct a systematic review and meta-analysis evaluating the effects of respiratory muscle therapy (ie, oropharyngeal exercises, speech... (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVES
The purpose of this study is to conduct a systematic review and meta-analysis evaluating the effects of respiratory muscle therapy (ie, oropharyngeal exercises, speech therapy, breathing exercises, wind musical instruments) compared with control therapy or no treatment in improving apnea-hypopnea index ([AHI] primary outcome), sleepiness, and other polysomnographic outcomes for patients diagnosed with obstructive sleep apnea (OSA).
METHODS
Only randomized controlled trials with a placebo therapy or no treatment searched using PubMed, EMBASE, Cochrane, and Web of Science up to November 2018 were included, and assessment of risk of bias was completed using the Cochrane Handbook.
RESULTS
Nine studies with 394 adults and children diagnosed with mild to severe OSA were included, all assessed at high risk of bias. Eight of the 9 studies measured AHI and showed a weighted average overall AHI improvement of 39.5% versus baselines after respiratory muscle therapy. Based on our meta-analyses in adult studies, respiratory muscle therapy yielded an improvement in AHI of -7.6 events/h (95% confidence interval [CI] = -11.7 to -3.5; P ≤ .001), apnea index of -4.2 events/h (95% CI = -7.7 to -0.8; P ≤ .016), Epworth Sleepiness Scale of -2.5 of 24 (95% CI= -5.1 to -0.1; P ≤ .066), Pittsburgh Sleep Quality Index of -1.3 of 21 (95% CI= -2.4 to -0.2; P ≤ .026), snoring frequency (P = .044) in intervention groups compared with controls.
CONCLUSIONS
This systematic review highlights respiratory muscle therapy as an adjunct management for OSA but further studies are needed due to limitations including the nature and small number of studies, heterogeneity of the interventions, and high risk of bias with low quality of evidence.
Topics: Adult; Child; Continuous Positive Airway Pressure; Humans; Oropharynx; Respiratory Muscles; Sleep Apnea, Obstructive; Snoring
PubMed: 32026802
DOI: 10.5664/jcsm.8318 -
BMJ Open Respiratory Research 2019A systematic review was carried out on the effect of surgical maxillomandibular advancement (MMA) on pharyngeal airway (PA) dimensions and the apnoea-hypopnoea index... (Meta-Analysis)
Meta-Analysis
Impact of surgical maxillomandibular advancement upon pharyngeal airway volume and the apnoea-hypopnoea index in the treatment of obstructive sleep apnoea: systematic review and meta-analysis.
BACKGROUND
A systematic review was carried out on the effect of surgical maxillomandibular advancement (MMA) on pharyngeal airway (PA) dimensions and the apnoea-hypopnoea index (AHI) in the treatment of obstructive sleep apnoea (OSA), with the aim of determining whether increased PA in the context of MMA is the main factor conditioning the subsequent decrease in AHI.
METHODS
A search was made of the PubMed, Embase, Google Scholar and Cochrane databases. A total of 496 studies were identified. The inclusion criteria were a diagnosis of moderate to severe OSA, MMA success evaluated by polysomnography, reporting of the magnitude of MMA achieved, PA increase and a minimum follow-up of 6 months.
RESULTS
Following application of the eligibility criteria, eight articles were included. Metaregression analysis showed MMA to significantly increase both pharyngeal airway volume (PAV) (mean 7.35 cm (range 5.35-9.34)) and pharyngeal airway space (mean 4.75 mm (range 3.15-6.35)) and ensure a final AHI score below the threshold of 20 (mean 12.9 events/hour).
CONCLUSIONS
Although subgroup analysis showed MMA to be effective in treating OSA, more randomised trials are needed to individualise the required magnitude and direction of surgical movements in each patient, and to standardise the measurements of linear and nonlinear PAV parameters.
Topics: Humans; Mandibular Advancement; Organ Size; Pharynx; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 31673361
DOI: 10.1136/bmjresp-2019-000402 -
Scientific Reports Jul 2021Numerous supraglottic airway device (SADs) have been designed for adults; however, their relative efficacy, indicated by parameters such as adequacy of sealing, ease of... (Meta-Analysis)
Meta-Analysis
Numerous supraglottic airway device (SADs) have been designed for adults; however, their relative efficacy, indicated by parameters such as adequacy of sealing, ease of application, and postinsertion complications, remains unclear. We conducted a systematic review and network meta-analysis to evaluate the efficacy of various SADs. We searched electronic databases for randomized controlled trials comparing at least two types of SADs published before December 2019. The primary outcomes were oropharyngeal leak pressure (OLP), risk of first-attempt insertion failure, and postoperative sore throat rate (POST). We included 108 studies (n = 10,645) comparing 17 types of SAD. The Proseal laryngeal mask airway (LMA), the I-gel supraglottic airway, the Supreme LMA, the Streamlined Liner of the Pharynx Airway, the SoftSeal, the Cobra Perilaryngeal Airway, the Air-Q, the Laryngeal Tube, the Laryngeal Tube Suction II, the Laryngeal Tube Suction Disposable, AuraGain, and Protector had significantly higher OLP (mean difference ranging from 3.98 to 9.18 cmHO) compared with that of a classic LMA (C-LMA). The Protector exhibited the highest OLP and was ranked first. All SADs had a similar likelihood of first-attempt insertion failure and POST compared with the C-LMA. Our findings indicate that the Protector may be the best SAD because it has the highest OLP.Systematic review registration PROSPERO: CRD42017065273.
Topics: Anesthesia, General; Humans; Laryngeal Masks; Network Meta-Analysis; Oropharynx; Pharyngitis; Pressure; Randomized Controlled Trials as Topic
PubMed: 34301986
DOI: 10.1038/s41598-021-94114-7 -
Acta Bio-medica : Atenei Parmensis Sep 2020The ongoing pandemic has elicited an increasing interest regarding the SARS-CoV-2 viral RNA detection in saliva specimens rather than through nasopharyngeal swabs. Our... (Meta-Analysis)
Meta-Analysis
RT-qPCR assays based on saliva rather than on nasopharyngeal swabs are possible but should be interpreted with caution: results from a systematic review and meta-analysis.
BACKGROUND AND AIM OF THE WORK
The ongoing pandemic has elicited an increasing interest regarding the SARS-CoV-2 viral RNA detection in saliva specimens rather than through nasopharyngeal swabs. Our aim was to conduct a meta-analysis on the sensitivity and specificity of SARS-CoV-2 viral RNA detection through RT-qPCR based on salivary specimens compared to conventional nasopharyngeal swabs.
METHODS
We reported our meta-analysis according to the PRISMA statement. We searched Pubmed, Embase, and pre-print archive medRxiv.og for eligible studies published up to June 1st, 2020. Raw data included true/false positive and negative tests, and the total number of tests. Sensitivity and specificity data were calculated for every study, and then pooled in a random-effects model. Heterogeneity was assessed using the I2 measure. Reporting bias was assessed by means of funnel plots and regression analysis.
RESULTS
The systematic review eventually retrieved 14 studies including a total of 15 estimates, the were included in quantitative synthesis. We found a pooled specificity of 97.7% (95%CI 93.8-99.2) and a pooled sensitivity of 83.4% (95%CI 73.1-90.4), with an overall agreement assessed by means of Cohen's kappa equals to 0.750, 95%CI 0.62-0.88 (i.e. moderate agreement), with high heterogeneity and risk of reporting bias.
CONCLUSIONS
In conclusion, diagnostic tests based on salivary specimens are somewhat reliable, but relatively few studies have been carried out. Moreover, such studies are characterized by low numbers and low sample power. Therefore, the of salivary samples is currently questionable for clinical purposes and cannot substitute other more conventional RT-qPCR based on nasopharyngeal swabs.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Nasopharynx; Pandemics; Pneumonia, Viral; RNA, Viral; Real-Time Polymerase Chain Reaction; SARS-CoV-2; Saliva
PubMed: 32921721
DOI: 10.23750/abm.v91i3.10020 -
Frontiers in Bioscience (Landmark... Jul 2021: Several studies suggest that there is an association between the metastatic nodal tumor volume and the clinical outcome in patients with solid cancers. However,...
: Several studies suggest that there is an association between the metastatic nodal tumor volume and the clinical outcome in patients with solid cancers. However, despite the prognostic potential of nodal volume, a standardized method for estimating the nodal volumetric parameters is lacking. Herein, we conducted a systematic review of the published scientific literature towards investigating the prognostic value of nodal volume in the carcinomas of head and neck, taking into consideration the primary tumor site and the human papillomavirus (HPV) status. : For this purpose, the biomedical literature database PubMed/MEDLINE was searched for studies relevant to the relationship of nodal volume to the treatment outcome and survival in head and neck squamous cell carcinoma (HNSCC) patients. Collectively, based on stringent inclusion/exclusion criteria, 23 eligible studies were included in the present systematic review. : On the basis of our findings, nodal volume is suggested to be strongly associated with clinical outcomes in HNSCC patients. Of particular note, there is an indication that nodal volume is an independent factor for further risk stratification for recurrence-free survival in patients with squamous cell carcinoma of the pharynx (oropharynx and hypopharynx). Extranodal extension (ENE) and HPV status should be also taken into consideration in further studies.
Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Prognosis; Squamous Cell Carcinoma of Head and Neck; Tumor Burden
PubMed: 34340270
DOI: 10.52586/4937 -
Disease Markers 2021The anterior cervical approach is commonly used clinically for cervical spondylosis, but it also results in frequent postoperative dysphagia, which can increase the risk... (Meta-Analysis)
Meta-Analysis
PURPOSE
The anterior cervical approach is commonly used clinically for cervical spondylosis, but it also results in frequent postoperative dysphagia, which can increase the risk of complications and poor treatment satisfaction in severe cases. Intraoperative local application of retropharyngeal steroids has an impact on reducing the occurrence and severity of dysphagia; however, the results of current studies vary. The meta-analysis of this randomized trial was to evaluate the effectiveness and safety of intraoperative topical retropharyngeal steroids for the control of dysphagia after anterior cervical spine surgery.
METHODS
Two authors searched electronic databases such as PubMed, MEDLINE, EMBASE, Cochrane Library, and Google Scholar, respectively. The search terms were "Dysphagia," "Steroids," "Anterior Cervical Discectomy and Fusion," etc. A random effects model was used to conduct a meta-analysis based on deviance information criteria.
RESULTS
A total of 8 studies were included in this meta-analysis after screening of 792 studies. Bazaz scores were not significantly different in the steroid group at one day postoperatively ( = 0.38), and dysphagia was significantly improved at 14 days postoperatively (95% CI: 0.15 to 0.64; = 0.002). PSTSI was significantly improved one day ( = 0.03) and 14 days after surgery ( < 0.0001). VAS scores were all lower versus controls ( < 0.001).
CONCLUSION
Perioperative local retropharyngeal steroid administration as an adjunct to anterior cervical spine surgery reduces the incidence and severity of dysphagia compared with placebo control. However, future high-quality randomized controlled studies could incorporate nonsubjective dysphagia measures and long-term follow-up on the occurrence of associated complications or other side effects.
Topics: Administration, Topical; Cervical Vertebrae; Deglutition Disorders; Glucocorticoids; Humans; Intraoperative Care; Pharynx; Postoperative Complications; Spinal Fusion
PubMed: 35003393
DOI: 10.1155/2021/7115254 -
Saudi Medical Journal Jan 2022To evaluate the diagnostic utility of self-collected saliva in coronavirus desease-19 (COVID-19) screening procedures. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate the diagnostic utility of self-collected saliva in coronavirus desease-19 (COVID-19) screening procedures.
METHODS
A total of 6 databases were reviewed from their inception until August 2021. Sensitivity and specificity were measured by extracting items (true-positive, true-negative, false-positive and false-negative) from each paper. We evaluated the diagnostic accuracy based on Quality Assessment of Diagnostic Accuracy Studies, version 2.
RESULTS
A total of 41 studies were included in the final analysis. The diagnostic odds ratio (OR) of self-collected saliva was 196.2022 (95% confidence interval [CI]: 117.8833-326.5546). The area under the summary receiver operating characteristic curve was 0.955. For detecting COVID-19, self-collected saliva had a moderate sensitivity of 0.8476 [0.8045-0.8826] and positive predictive value of 0.9404 [0.9122-0.9599] but high specificity of 0.9817 [0.9707-0.9887] and negative predictive value of 0.9467 [0.9130-0.9678]. In a subgroup analysis, the diagnostic accuracy of self-collected saliva tended to be higher for symptomatic (vs. asymptomatic) examinees.
CONCLUSION
Although naso/oropharyngeal swab tests are the most accurate and important diagnostic tools, the saliva-based testing method can be used as a suitable alternative test, with the advantages of increased patient convenience, efficient testing, and the need for fewer medical staff and resources. In particular, simple collecting method such as drooling or spitting without coughing would be effective in evaluating the symptomatic patients.PROSPERO no.: CRD42021279287.
Topics: COVID-19; Humans; Nasopharynx; Reverse Transcriptase Polymerase Chain Reaction; SARS-CoV-2; Saliva; Sensitivity and Specificity; Specimen Handling
PubMed: 35022280
DOI: 10.15537/smj.2022.43.1.20210743 -
The Effect of Prophylactic HPV Vaccines on Oral and Oropharyngeal HPV Infection-A Systematic Review.Viruses Jul 2021Human papillomavirus (HPV) imposes an increased risk of developing cervical, anal and oropharyngeal cancer. In the Western world, HPV infection is currently the major...
Human papillomavirus (HPV) imposes an increased risk of developing cervical, anal and oropharyngeal cancer. In the Western world, HPV infection is currently the major cause of oropharyngeal cancer. The effectiveness of HPV vaccines for oral or oropharyngeal HPV infection is yet to be determined. This study conducted a systematic literature search in and . Studies investigating the impact of HPV vaccines on oral or oropharyngeal HPV infection were enrolled. This review reports the relative prevention percentage (RPP), including a risk of bias assessment as well as a quality assessment study. Nine studies were included (48,777 participants): five cross-sectional studies; one randomized community trial study (RCT); one longitudinal cohort study; and two case-control studies. A significant mean RPP of 83.9% (66.6-97.8%) was calculated from the cross-sectional studies, 82.4% in the included RCT and 83% in the longitudinal cohort study. Further, two case-control studies that measured antibody response in participants immunized with HPV vaccines were included. Respectively, 100% and 93.2% of participants developed HPV-16 Immunoglobulin G (IgG) antibodies in oral fluids post-vaccination. Analysis of the studies identified a significant decrease in vaccine-type oral or oropharyngeal HPV infections in study participants immunized with HPV vaccines across study designs and heterogenous populations. Further, a significant percentage of participants developed IgG antibodies in oral fluid post-vaccination.
Topics: Alphapapillomavirus; Case-Control Studies; Cross-Sectional Studies; Female; Humans; Longitudinal Studies; Male; Mouth; Mouth Neoplasms; Oropharyngeal Neoplasms; Oropharynx; Papillomaviridae; Papillomavirus Infections; Papillomavirus Vaccines; Pre-Exposure Prophylaxis; Vaccination
PubMed: 34372545
DOI: 10.3390/v13071339 -
Journal of Medical Virology Feb 2021Testing is one of the commendable measures for curbing the spread of coronavirus disease (COVID-19). But, it should be done using the most appropriate specimen and an... (Meta-Analysis)
Meta-Analysis
Testing is one of the commendable measures for curbing the spread of coronavirus disease (COVID-19). But, it should be done using the most appropriate specimen and an accurate diagnostic test such as real-time reverse transcription-polymerase chain reaction (qRT-PCR). Therefore, a systematic review was conducted to determine the positive detection rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in different clinical specimens using qRT-PCR. A total of 8136 pooled clinical specimens were analyzed to detect SARS-CoV-2, the majority were nasopharyngeal swabs (69.6%). A lower respiratory tract (LRT) specimens had a positive rate (PR) of 71.3% (95% confidence interval [CI]: 60.3%-82.3%) while no virus was detected in the urinogenital specimens. Bronchoalveolar lavage fluid (BLF) specimen had the PR of 91.8% (95% CI: 79.9%-103.7%), followed by rectal swabs; 87.8% (95% CI: 78.6%-96.9%) then sputum; 68.1% (95% CI: 56.9%-79.4%). A low PR was observed in oropharyngeal swabs; 7.6% (95% CI: 5.7%-9.6%) and blood samples; 1.0% (95% CI: -0.1%-2.1%) whereas no SARS-CoV-2 was detected in urine samples. Feces had a PR of 32.8% (95% CI:1 5.8%-49.8%). Nasopharyngeal swab, a widely used specimen had a PR of 45.5% (95% CI: 31.2%-59.7%). In this study, SARS-CoV-2 was highly detected in LRT specimens while no virus was detected in urinogenital specimens. BLF had the highest PR followed by rectal swab then sputum. Nasopharyngeal swab which is widely used had moderate PR. Low PR was recorded in oropharyngeal swab and blood samples while no virus was found in urine samples. Last, the virus was detected in feces, suggesting SARS-CoV-2 transmission by the fecal route.
Topics: Bronchoalveolar Lavage Fluid; COVID-19; COVID-19 Testing; Feces; Humans; Nasopharynx; Oropharynx; RNA, Viral; Real-Time Polymerase Chain Reaction; SARS-CoV-2; Specimen Handling; Sputum
PubMed: 32706393
DOI: 10.1002/jmv.26349